As a nurse working in an ambulatory or outpatient care setting, I have been given opportunities to experience quality improvement process occurring at my healthcare facility.  Working for a very large organization, improving health care quality is something we have always strived daily.  One quality improvement process that I was exposed to is the Total Quality Management.  In their book Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, Gwen Sherwood and Jane Barnsteiner write, “Total quality management (TQM) is a management approach that focuses on customer satisfaction with products or services by improving internal processes” (2021, pg. 163).  According to Sherwood and Barnsteiner, TQM involves all aspects of the organization with all involvement of all employees, (2021, pg. 163).  TQM improvement process was used to improve quality of healthcare delivery by surveying patients after each outpatient visit of their experience starting with the time checking in with reception to their experience with the provider and any other services they experience after the visit such as radiology, lab or pharmacy.   With the results obtained from their survey, my managers would review them at our staff meetings and discuss with everyone involved on how we can improve.  This quality improvement process focuses on patients’ satisfaction of service. 

Another quality improvement process that I have experienced with at my healthcare facility is the use of Lean quality improvement. According to Sherwood and Barnsteiner, Lean evolved from Toyota Production System and implements value stream mapping (2021). Ramori et al. (2021), also states that the implementation of Lean quality improvement model in healthcare industry gives healthcare facilities the opportunity to improve patient care.  The outcome of the process includes improving patient satisfaction in knowing their expected wait time.

Both quality improvement processes focus on quality with goals to improve patient satisfaction. They are both models with a process of continuous improvement and involves everyone in the department. Their methods are different in that TQM uses the plan, do study and act method whereas Lean uses a value streaming and flowing method.

Ramoria, K., Cudney, E., Elrod, C., & Anthony, J. (2021) Lean business models in healthcare:

a systematic review. Total Quality Management 32(6), 558-573.

Sherwood, G., & Barnsteiner, J. (2021). Quality and Safety in Nursing (3rd Edition). Wiley

Global Research (STMS). https://coloradotech.vitalsource.com/books/9781119684459

Working as an ambulatory nurse in the department of family medicine, needle sticks are a huge problem. Implementing different quality improvement processes in the clinic has been a struggle, mainly because of the lack of cooperation from staff and the absence of teamwork between management and staff. Management tries to implement a change on the floor without asking for the nurse’s input. For example, the area assigned to vitalize the patients is also where the nurses administer injections; the sharp container is located around the corner where the nurse is administering the injection. So, it is not rare to see syringes with used needles at the nurses’ desk. This practice puts both nurse and patient at risk of being accidentally stabbed by a used needle.

Because of this scenario, a group of nurses got together with management to devise a plan to prevent needle sticks. As stated by Sherwood and Barnsteiner (2021), transparency is a must in nursing practice; being able to talk to management about what is needed to practice safe nursing will help prevent needle sticks. A designated area is now being used exclusively for injection administration. More sharp containers have been installed closer to where the medications are administered. The number of needle sticks has decreased, but there is still some work to do.

In the clinic where I work, the implementation of medication scanning devices is a clear example of the quality improvement process. The pros are that it helps detect medication errors before administration. The cons are that not all the rooms have a medication scanner because of the cost. According to Tolley et al. (2022), administering medication is not a simple task. It could be affected by a certain number of disruptions. Not having medication scanning devices in all the rooms could adversely affect the process and cause a medication error.

Another quality improvement in the clinic where I worked is using disposable speculums to perform pap smears. The pros are that they are easy to use, and there is no need to clean them after use providing a safer delivery of care for the patient. The cons are that they are expensive and break easily because they are made of plastic.

NRSG 314 Unit 1 – Discussion Board 2 CTU References:

Sherwood, G., & Barnsteiner, J. (2021). Quality and Safety in Nursing (3^rd ed., pp.226). Wiley Global Research (STMS).

Tolley, C.L., Watson, N. W., Heed, A., Einbeck, J., Medows, S., Wood, L., Campbell, L., & Slight, S. P. (2022). The impact of a novel medication scanner on administration errors in the hospital setting: a before and after feasibility study. BMC Medical Informatics & Decision making, 22(1), 1-9. https://doi.org/10.1186/s12911-022-01828-3

I once worked in an institution that had a quality improvement plan directed toward reducing the readmission rates of patients. The main target was cancer and heart failure patients because they were increasing in number, and their readmission rate was high. The hospital did an investigation behind the reasons for readmission and learned that most patients were readmitted because they could not control the symptoms they observed during their recovery process. The hospital introduced the use of a mobile medical app where patients would record their symptoms and feelings and share them with their respective nurses and doctors. The doctor would then offer recommendations on what needed to be done. For example, patients who underwent chemotherapy after cancer treatment reported cases of appetite loss, bleeding, and vomiting. Most of them would wait until they got weak and lost much weight to a level where they were dehydrated and readmitted back to the hospital. In such a scenario, it would be advisable to reach out to the medical team and get treatment and diet recommendations to reduce readmission rates.

The other two quality improvement processes in my healthcare include the use of technology in data entry to reduce patient waiting time and improving communication channels to reduce mortality cases due to emergencies. The two are beneficial in that they help the organization identify areas of change and motivate change to achieve better care. The processes also help us meet patient needs, such as saving on time and getting instant support during emergencies. However, a leading problem of using technology in data entry is resistance from nurses to transition and lack of staff cooperation (Iqbal, Humayun, & Li, 2019). On the other hand, the communication devices are costly to purchase and train staff members on their usage. These challenges might delay the quality improvement processes. A report by Fulop & Ramsay(2019) shows that leadership, staff training, and engagement can help solve these problems.

NRSG 314 Unit 1 – Discussion Board 2 CTU References

Fulop, N. J., & Ramsay, A. I. (2019). How organisations contribute to improving the quality of healthcare. British Medical Journal , 365.

Iqbal, U., Humayun, A., & Li, Y. C. J. (2019). Healthcare quality-improvement and measurement strategies and its challenges ahead. International Journal for Quality in Health Care.