Making Sense of the Quality Framework for Nursing Students · Making Sense of the Quality Framework...
Transcript of Making Sense of the Quality Framework for Nursing Students · Making Sense of the Quality Framework...
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Making Sense of the Quality
Framework for Nursing Students June 2, 2011
QSEN National Forum
Anthony D’Eramo, MSN, RN
VA Nursing Academy, Providence VAMC &
Rhode Island College, School of Nursing
Anthony.d’[email protected]
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Describe a framework developed for a pilot to
introduce baccalaureate nursing students to quality
improvement concepts.
Objective
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The Pilot
Goals
1. Informal Post-Conference (90 minutes)
2. Big-Picture View
3. Create Visual Teaching Tool
4. Include Key QI Concepts:
a. Regulatory Oversight
b. The Organization
c. QM Department
d. Quality Improvement
Purpose is to connect all 4 Parts
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___________________________________________________________________________________________________________________________________ Figure. The Quality Framework within a Healthcare Organization
___________________________________________________________________________________________________________________________________
Part II: The Organization
BSN Essentials & QSEN
PDSA
The Joint Commission
“Voluntary?
WHAT” vs. “HOW”
Focus on Safety
Who/When/Notice
Chapters/Standards/EPs/Scoring
Method: TRACERS
Part I: Regulatory Oversight
Patient Flow?
Staff & Patient
Satisfaction?
Utilization MGMT
Severity Intensity
of Illness of Service
3rd Party Reimbursement
Chief
Quality
Officer
Readiness
Coordinator
Pt
Safety
Risk
Manager
Systems
Redesign
Support
Staff
Infection
Control &
Prevention
Utilization
Review
Part III: Quality Management
Improvement Processes Internal/External
Measures
System Redesign
Microsystems Redesign
Lean Six Sigma
Quality Work/Councils
Performance Measures
Patient/Staff Satisfaction
NDNQI
Project Outcomes
Dashboards/Control Charts/Data Analysis
Part IV: Quality Improvement
Met the Aim or
Benchmark?
Yes or No
MACROSYSTEM
MESOSYSTEM
MICROSYSTEM
D’Eramo 3-24-11
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(Part I) Regulatory Oversight
Many Oversight agencies... Purpose?
Outcomes?
The Joint Commission
(JC)
*Logistics
*Scoring
*Tracer Methodology
*Multiple IOM Reports (2000, 2001, 2004)
*Interprofessional training is needed on QI/Safety:
1. Safety
2. Effectiveness
3. Patient-Centeredness
4. Timeliness
5. Efficiency
6. Equity
JC: Sentinel Event Stats- First 3Qts-2010 (about 270 days)
-Unintended retention of foreign body (91) EVERY 3 Days
-Wrong-site surgery (66) EVERY 4 Days
-Operative/Post-op complications (54)
-Delay in Tx (54)
-Suicide (47)
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(Part II) The Organization
Regulations Impact the Entire
Organization
Mesosystem
MICROSYSTEM
Macrosystem
QSEN & BSN Essentials
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(Part III) The QM Department
Credentials & Certification
Roles
UR/UM and Case Management
InterQual Criteria (handout)
– Admission & Continued Stay Review
– Severity of Illness
– Intensity of Service
Link between regulations, the organization, QI and QM using
UM/UR
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(Part IV) Quality Improvement
Systems Redesign
Microsystems Redesign
Lean Six Sigma
Lean (Toyota-1990’s) GOAL: Eliminate waste, efficiency, customer value
Six Sigma (Motorola-1980’s) GOAL: Remove defects, minimize variability
Quality Improvement (Unit Based Councils)
Data/Dashboards/Benchmarks
Organization Performance Measures/NDNQI
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PDSA
Sound like a familiar process?
Link between QI, regulations, the organization, & QM
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Undergraduate Pilot Findings
4 Groups: (n=30)
Anecdotal Outcomes:
No Formal Evaluation
Minimal time to discuss data
Student Feedback – level dependent
1 Group (n=8)
Modifications:
Mainly Time
Framework edited, no formal evaluation
Student Feedback-all positive/use slides
2 Groups (n=15)
Modifications:
Informal with slides
Framework edited to current version
Evaluation process
Spring-2010
(90-minutes)
Fall-2010
(120-minutes)
Spring-2011
(120-minutes)
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Student Evaluation (Spr-11)
Pre-Post Pilot Participant Self Reported Change in QI Knowledge, Skills & Attitudes
Lickert Scale where 0 is lowest and 10 is highest
Undergraduate1 Group 1 (n=7) Group 2 (n=8) Groups 1&2
(n=15)
Pre-Pilot Range 0-2 0-4 0-4
Post-Pilot Range 3-7 6-8 3-8
Pre-Pilot Mean 1.3 2.1 1.7
Post-Pilot Mean 5.3 7.5 6.4 1N375-Transitions (Last Semester Undergraduate Seniors)
Summary Evaluations
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Faculty Presentation
Clinical QI Adjuncts
Consider observational experiences differently
Consider formal papers differently
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Curricular Considerations
Using the QI Framework Sophomore Sequence Junior Sequence Senior Sequence
Curriculum Curriculum Curriculum
N222 Regulatory &
Organizational
Content
No Curricular Content N374 QM Department
& QI/Data
Content
Clinical Clinical Clinical
N223 Agency
regulations and
how that
organization
functions.
N340,
N342,
N344,
&
N346
All courses with
emphasis on
observational
experiences on
QI/Microsystem
teams.
(Interprofessional)
N372
&
N375
Participate in
QI/Microsystem
teams. Formal
presentations?
Papers? Group
project?
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Summary
Significant Gaps Exist
Student Observations
Organizational Expectations
Faculty Expertise
Operationalizing QSEN
Next Steps
Curricular Revisions
Clinical Partnerships
(e.g. DEU Model)
Do We Need a QI Train the
Trainer Program?
(e.g. ELNEC) Co-QIM (Curriculum on Quality Improvement Methods)
Interprofessional in scope/Faculty centered
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THANK YOU!
Comments?
Questions?