Improving Healthcare Quality at Jacobi

Strategic Leadership

Impact on Quality

The key recommendations are oriented towards quality improvement. First, evidence-based practice has established links between the practice and desirable outcomes. Using evidence to guide treatments and decision-making will deliver better medical decisions, and this should result in better patient outcomes. Furthermore, there is literature on service metrics as well. This will form the foundation of evidence that can be used to improve specific service metrics. For example, it was identified that 47% of patients felt help came when they needed it, meaning that 53% did not. This score can be improved. There are studies that show that nurse-to patient staffing ratios improve performance on a number of measures ranging from service to safety (Rothberg et al., 2005). Using the body of academic evidence to solve problems will improve quality because it reflects the use of techniques that have proven effective in the past for other healthcare institutions.

Improved communication with patients also serves to improve quality. First, when patients receive better communication about what to do, they are likely to have better outcomes. Additionally, patients appreciate a high level of communication. Studies show that patient perceptions of quality are higher when there is a higher level of communication between the patient and the perception is what is recorded in the HCAHPA survey.

Improving Organizational Quality

Shared governance is a key component of improving organizational quality. While evidence-based practice can be used to improve any one procedure or task, improving overall quality is usually a matter of building an organization that is more capable of improving quality. There are a few implications for this. One is that the organization's structure and culture need to be more oriented towards quality improvement. This is where shared governance comes into play. Under the shared governance model, responsibility is shared, but ultimately everybody in the organization is responsible for quality. Departments that work together hold each other accountable, especially when quality objectives are missed. A shared governance model creates the mechanisms for communication between units that not only allows them to work together to provide better service levels, but also allows them to be more accountable, something that is also associated with higher quality levels.

Training

The plan contains three elements -- communication, evidence-based practice and shared governance. To some extent, all three of these will require some amount of staff training to implement. Shared governance is more of an organizational structure issue, but there will need to be some training to help people understand what the new structure is, how it works and what it is intended to achieve.

Evidence-based practice requires training of staff at multiple levels. They will need to know how to find evidence that can inform procedures and policies. This is not as easy as it sounds -- there are academic sources, and input from collaborative partners, and there are electronic decision-making tools, so there is a wealth of information available. But decisions need to be made quickly, which places emphasis on having evidence available quickly and easily -- that is where the training will be required, to help staff identify the right source for different types of information and then have them trained to find that information quickly.