Author: Sarah Coiner, MSN, RN-BC, CNL, CNE
Institution: University of Alabama at Birmingham School of Nursing
Coauthors: Kathy Langley, MSN, CRNP, AGACNP-BC
Quality Improvement, Safety, Teamwork and Collaboration
Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN
Learners will recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families
Learners will be able to describe approaches for changing processes of care
Learners will practice aligning the aims, measures, and changes involved in improving care
Learners will use cause-effect diagrams to make processes of care explicit and identify areas for improvement
Learners will be able to identify gaps between local, current and best practice
Learners will design a small test of change in daily work using the Plan-Do-Study-Act method
Learners will value their own and others’ contributions to outcomes of care in local care settings and appreciate the value of what individuals and teams can do to improve care
Learners will value measurement and its role in safe patient care.
Teamwork and Collaboration
Learners will be able to describe examples of the impact of team functioning on safety and quality of care.
Learners will initiate requests for help from their team when needed.
Learners will clarify roles and responsibilities of team members as it relates to the quality improvement project team.
Learners will respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities.
This strategy is used as four separate assignments that build upon each other over the course of several weeks and can span the length of a semester. This is an unfolding design project where the students work individually or in groups to address a clinical quality or safety problem of their choosing. This strategy was designed for use with registered Nurse (RN) mobility students who are typically working in a professional nursing role while obtaining their Bachelor of Science in Nursing (BSN) degree. This has also been performed with BSN students who have completed some portion of student clinicals and have some clinical experience to draw from and apply the strategies to. It helps if the students have clinical experience so they can relate to an actual quality problem, its many causes, and data or measurements related to the issues. This teaching strategy uses a combination of the student’s personal clinical experiences, online content, and instruction, and simulates a real-world quality improvement (QI) project application through virtual assignments.
The learners begin by choosing a clinical quality or safety problem they would like to focus on for their project. They are encouraged to choose a problem that exists in their clinical area or that they have a personal interest in. They are then introduced to the Model of Improvement (MFI): Three Questions and a Plan, Do, Study, Act (PDSA) Cycle. The MFI was designed by the Associates in Process Improvement (2021). This model is used as a framework for the QI project design and is divided into these four assignments that each answer a question and end with designing a PDSA cycle.
The instructions and details of these assignments are available in the provided attachment. After a quality or safety problem has been chosen, the students begin to support their need for change in Assignment #1 and answering the first MFI question “What are we trying to accomplish?” They must provide background information from the literature including statistics and data and then connect the problem to a national quality and safety initiative from an organization. They then form a SMART aim statement that will be restated in each assignment. Assignments #2 answers the next MFI question “How will we know a change is an improvement?” In this assignment, students will complete a fishbone, or cause and effect, diagram to identify causes for the problem. They will then decide how they will measure progress in their project by identifying an outcome, process, and balancing measure. This is entered into a “measures table” for organization and clarity. During this step, they will also choose their team members for the project team and explain their choices. The last MFI question is “What change can we make that will result in an improvement?” This is answered in Assignment #3 when students choose the change they want to implement, with inspiration taken from their fishbone diagram. They will then create the first PDSA cycle and describe each step in as much detail as possible. The project finally comes together in Assignment #4 when students display all of their project details in a scholarly poster format. These posters are submitted to a course discussion board for all to view. Each individual student will complete an evaluation form on two other posters to simulate an actual poster presentation evaluation process.
Associates in Process Improvement. (2021). Model for Improvement. http://www.apiweb.org/index.php
Attached is a document with the description of assignments 1-4 and peer evaluation for the poster.
The objective of this assignment is for students to learn the process of implementing a QI project by engaging with a topic of interest and walking through the steps of the MFI in a safe simulation. This set of assignments is intended for formative evaluation. Each individual assignment is graded based on a rubric for the inclusion and quality of the material. Faculty feedback is given and must be incorporated into the next assignment to ensure that the projects are appropriate and follow a QI model. Points are deducted for not incorporating feedback. Students have found this coursework to be relevant to their current practice as evidenced by their response to a survey (IDEA). Some of the projects have been proposed and implemented in the student’s clinical workplaces.