¶ … communication and best practices or standards are very simple yet when not addressed may cause complex problems that require serious modification. Quality improvement within certain aspects of the medical professional landscape may be extremely beneficial to the solving of these problems. This Quality Improvement Plan is based upon the problems experienced at Samaritan Hospital, located in Watertown, NY. This environment has been targeted because a lack of effective patient transfer from one department to another. The documentation process has been identified as problematic and in order to adjust to this problem a quality improvement effort is applied to this situation.

This plan describes in detail the many facets of this process into a real world situation. The goals and objectives of this plan are to significantly increase patient quality through better communication at the transfer patient level within this hospital. This plan details how the gathering of information and data in regards to the perceived failures may be repackaged and reorganized into a better and more complete system that specifically improves communication, patient quality and conserves valuable resources that may make the entire organization a stronger entity and provide the healing and care that is so desperately needed in today's chaotic world.

Introduction

The purpose of this performance improvement (PI) plan is to discuss the effects of quality improvement (QI) methods in a practical situation. The basis for this discussion revolves around the issue of patient transfers. The problem that has been targeted for quality improvement is the documentation processes when patients are being moved from one unit of care to another (lower level of care to a higher level of care). The specific issues deal with information tracking and effective patient handoffs.

Three methods of QI will be introduced that may be helpful in resolving these problems. Next the discussion will focus on the information technology (IT) applications that may be effective in approaching these issues. Finally, the importance of benchmarks and milestones in QI management will be illuminated to highlight how these ideas may best be incorporated into the issue at hand.

Goals and Objectives

The main issue that should be addressed in this organization deals with effective documentation. It has been identified that the current method of documentation leaves out some critical information. An example of a critical piece of information that is not included on the patients documents is the circumstances or criteria that has justified a patient being moved from one unit of care to another. For example, when a patient is moved from a department such as the Medical/Surgical unit to the intensive care unit (ICU), then the documentation should indicate the reasons for this decision so that the nursing staff is able to quickly understand the basis for this decision and can give the right kinds of care easily and quickly. Especially with regard to ICU transfers, the reason for the transfer could easily represent critical data about the patients situation in a life or death emergency.

Scope / QI Activities

The QI activities associated with this plan revolve around the issue of communication and transferring of patients. To best understand this problem the scope of this plan must be comprehensive and reach out to all key players within the environment. The plan is focused on the transferring of other patients and the communication of the appropriate data associated with each patient being transferred. The activities all are based on this premise and should be directed in this area.

To fully understand this problems more information is needed to improve the quality of patient care. Technology and human involvement are both needed in order to best make the desired improvements within the ER at this hospital. The alignment of these ideals is central to the research process and the selection of the most beneficial QI strategy.

Data Collection

There are many sources of data that can be used to help guide organizational council meetings. Meetings can be expensive in terms of their costs to an organization. Not only do the people spend the time in the actual meeting which represents a direct cost in terms of wages, but they also are using this time to be in a meeting as opposed to working on their other job requirements which can represent an indirect cost to the organization as well. Therefore, formal meetings should only be conducted when the situation merits the team hosting a meeting. There are many instances of organizational issues that do not necessarily need a meeting to address.

There are many best practices that are associated with meetings. One of the best practices I have personally experienced is having a formal agenda...

If the agenda is prepared and distributed before the meeting, then this gives group members an opportunity to think about what is to be discussed well before hand which allows them to make more effective use of the allotted time. As a result, the group in general is able to offer insightful opinions rather than having to determine their responses to random topics. Furthermore, a well-trained facilitator can help keep the meeting on track so that the group covers all the topics that it intends to.
There are also time management models that can increase individual and meeting productivities. For example, the POSEC method, which stands for Prioritizing by Organizing, Streamlining, Economizing and Contributing and works better for individuals (Finkelstein, 2010). Finkelstein stated that this method enables a person to break the goals and tasks into small projects. If they do the individual tasks well, this will make the rest of the goals easier to accomplish. Employing such an approach to group meetings would undoubtedly provide a good foundation to improve their effectiveness.

QI Processes Methodology

According to the U.S. Department of Health and Human Services (2011), quality improvement "consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups & #8230; to make improvements, an organization needs to understand its own delivery system and key processes" (p. 1). Methodologies and systematic practices establish strong habits that result in the desired qualities that resonate and align with the greater organizational strategy.

Continuous QI (CQI) is another methodology that can be used in this instance. Varkey, Reller, & Resar (2007) wrote "CQI subscribes to the principle that opportunity exists in every process on every occasion. Within an organization, it requires a commitment to constantly improve operations, processes and activities to meet patient needs in an efficient, consistent and cost effective manner. The CQI model emphasizes the view of health care as a process and focuses on the system rather than the individual when considering improvement opportunities" (p. 736).

The preferred methodology for this problem is CQI as it addresses the healthcare situation most effectively. By approaching this problem as a system and not an acute problem, a different understanding of how communication can be achieved. CQI allows other aspects of the other methodologies to be introduced making the approach more holistic and comprehensive in the long run.

Benchmarks and Standards

Growth and evolution must be recorded and noted in order to actually notice the myriad of changes that occur with a quality improvement cycle. These short-term objectives should be incorporated with the larger organizational strategy and serve as guide posts to the right path of decision. For this case both quality and clinical expertise need to be measured. Benchmarks need to represent these ideas. Patient surveys taken at periods throughout the QI cycle such as Week 1 Week 8 and Week 16 all seem necessary. Healing rates and successful transfer rates need also to be recorded at these benchmark intervals.

Organization

The authority structure of this plan's implantation is hierarchical in nature. The board of directors has no direct impact on the plan although the general hospital strategy is directed from this source of power. The executive leadership of the hospital provides the translated guidance from the board of directors to those who are going to be the actual performers of the new tasks assigned.

To help the executive leadership, a quality improvement committee may be tactically created and implemented to assist in the change. This committee will be directly responsible for the success or failures of the plan. In turn, the ideas formulated in the strategy will begin to take shape when members of middle management actually direct the medical staff to the new proceedings.

Since the QI initiative is based around an information technology idea, the IT department at the hospital will play a major supplemental role in the effort. This department may be allocated to anyone within the organizational structure and the flexibility during this change over is very important.

Communication

Communication is just as important as the plan itself, and without a means to convey meaning and guidance to this QI effort the plan will most likely fall short of its intended goals and objectives. Leonard, Graham, and Bonacum (2004) agreed with this idea when they suggested that

"effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The…