NURS FPX 8010 Assessment 4 Quality Improvement Proposal

Student Name

Capella University

NURS-FPX 8010 Executive Leadership in Contemporary Nursing

Prof. Name

Date

Quality Improvement Proposal

“A successful nursing strategic plan establishes a roadmap for the future. It gives nurses a direction to follow and can refresh and reenergize an organization. A robust strategic plan is a critical component to ensure excellent patient care and the best possible outcomes” (Lal, 2020). To provide high-quality, cost-effective care, the creation of a department-specific strategic plan and balanced scorecard has been developed (see Figure A1).

Inbox Management Challenges and Provider Attrition

A growing source of frustration for patients and providers alike is inbox management. The ability to communicate with healthcare providers through email-like systems has become more prominent in the last decade. The NextGen Electronic Health Record (EHR), used at Adelante, like its many competitors, is not a perfect system, and yet more and more patients prefer and even expect timely messaging and results to and from their health practitioner. But when that system is flawed, it can create larger issues. At Adelante, the organization saw a 12% increase in provider attrition which mostly resulted from poor inbox management and/or a lack of a plan to support the large workload.

Impact on Patient Experience

Looking beyond the providers, patients are experiencing delayed care, diagnoses, referrals, and communication, which is ultimately damaging Adelante’s brand and reputation because of its direct impact on the patient experience. With the organizational demands to increase patient visits, enhance the quality of the visits, support digital infrastructure, and the decrease in available provider administrative time, the inbox management problem continues to grow. Patient messages are getting lost in the shuffle, and clinical staff don’t have the time to sort through the large volume of daily tasks. To put it simply, staff are overwhelmed, and patients are suffering.

Quality Improvement Measures: Patient Satisfaction as a KPI

A key performance indicator (KPI) measure within the patient domain on Adelante’s balanced scorecard is patient satisfaction. Aligning with this indicator, the nursing department has chosen to elevate nursing practices aimed at patient-centric models of care and focus on the patient experience as it has direct ties at Adelante. For the purpose of this quality improvement project, the provider inbox issue will be addressed, and the patient experience will be improved. Success will be measured through patient satisfaction surveys yielding an 84% or greater likelihood to recommend rating. To achieve this, new policies will be developed and instituted along with daily clinical huddles to facilitate enhanced team communications (see Figure A2).

Key Stakeholders and Policy Recommendations

To solve this issue, in-depth analysis, collaboration, and provider buy-in will be required. Globally, many stakeholders exist, including patients, providers, and informatics teams. Arguably, “Patients are the single most important stakeholder group with regard to the learning healthcare system. They are both the donors of personal clinical data and the ultimate beneficiaries from the knowledge gained” (Eichler, Bloechl-Daum, Broich et al., 2018). More specifically, however, three departmental sponsors are called out in support of this proposal.

Executive Sponsorship and Policy Development

The two executive sponsors include the chief executive officer (CEO), P.C. and chief medical officer (CMO), R.B. at Adelante Healthcare. The CMO is responsible for providing organizational direction to licensed medical providers and their leaders to drive safe and effective medical services. As a licensed provider, the CMO also works with business administration functions and supports clinical implementation and innovation for the organization (Norris et al., 2017). Lastly, the CMO sponsorship is crucial in helping garner physician buy-in. The CEO is the key person responsible for the overall productivity and operation of the company. The CEO is instrumental in providing fiscal, political, and networking support.

Policy Recommendations and Implementation

In assessing policy recommendations, it is noted that no current policies exist detailing inbox management or expected response times for patients. The largest recommendation would be to develop and institute a policy which clearly delineates when messages or tasks are received who manages them and in what time frame are patients having their needs addressed. For example, within 30 days of implementation, all patient messages will be addressed and receive a response within 48 business hours for routine, non-urgent needs. Development and implementation of this type of policy level sets expectations across the organization and extends to the patients so they know what to expect as well. Additionally, if implemented, this policy would allow clinical leaders to hold their teams accountable for their respective productivity and responsiveness that directly contribute to the patient experience.

Importance of Communication in Nursing Care and Project Success

“Good communication skills are indispensable to basic concepts of nursing care as communicating effectively can help reduce the risk of medical errors, ensure better patient outcomes, and nurture patient satisfaction. A good patient experience– while considered merely desirable in the past – is moving center-stage” (Lang, 2012). The success of this project, if implemented would be determined by patient satisfaction numbers, which would demonstrate timelier patient-provider communications, and improved patient experiences. Continued success will also promote Adelante’s reputation in the community which may also drive more revenue through increased patient referrals.

SWOT Analysis and Contemporary Change Theory

In assessing the political landscape at Adelante Healthcare, traditional power dynamics exist as seen in the traditional organizational chart with the Chief Executive Officer at the head of the company. Along with this, however, is a strong display of informal power lines. Many of the executive leaders have built strong relationships with their peers, direct reports, and community contacts which, in turn, has built deep bonds of trust and respect. Understanding these power dynamics is crucial when considering change theories, policy recommendations, and/or quality improvement projects as these key stakeholders can help garner support and leverage resources that project leads may not otherwise have the access or capability to do.

Application of Lewin’s Change Theory and SWOT Analysis

Alongside the leveraging of key stakeholder support, the application of Lewin’s Change Theory could be a practical advantage. Lewin’s Change Theory “theorized a three-stage model of change known as the unfreezing-change-refreeze model that requires prior learning to be rejected and replaced” (Petiprin, 2020). Drawing from the unfreezing stage, Lewin suggests that teams and people let go of old, counterproductive habits that no longer serve a purpose; in this case, a lack of policy or procedure around patient-provider communications.

The change stage theorizes that those same people or teams need to process and work through the newly implemented changes, which may require leaders to take a more vested interest in their teams and their adjustment to a new version of productivity. Lastly, the refreezing stage is a method of solidifying the new change to make it habitual. For this project, the standard operating procedure and supporting policies would be finalized and disseminated across the organization and leaders would be expected to hold their teams accountable and prevent them from returning to old habits which diminish the patient experience.

Adelante’s Strategic Priorities and SWOT Analysis

Adelante’s strategic priorities are spread across 4 domains: finance, people, patients, and wellness. The selected nursing department priority for this quality improvement proposal is patient experience which aligns directly with Adelante’s patient satisfaction objective in the patient domain. In conducting a SWOT analysis (Avila, 2022), strengths, weaknesses, opportunities, and threats were reviewed and can be seen below.

SWOT Analysis

Strengths

• The project team is comprised of individuals with extensive medical knowledge, background, and experience such as leadership, operations, quality, nursing, and clinical informatics.
• The project will focus on the quality measures relevant to the organization through an improvement in key performance indicators (KPIs) such as patient satisfaction scores.
• Using an optimized provider inbox within the EMR will improve the quality of care provided to patients and enhance clinical staff satisfaction.
• Increased patient satisfaction can promote increased patient referrals and visits to the clinics, which improves revenue generation for the organization.

Weaknesses

• There is no guarantee that clinical staff and providers will continue to adhere to modified guidelines and processes following project implementation.
• The timing of project planning and implementation competes with daily tasks and priorities of team members for this project. Setting aside dedicated project time may be a challenge.
• A lack of understanding of the root issue of the problem may require more resources initially than initially anticipated.

Opportunities

• Talent retention: improved patient-provider communications and have a beneficial impact on provider retention and satisfaction scores.
• Provides more timely labs and diagnostic services and results to Adelante’s patients.
• Improving patient retention through advocacy and resource provisioning via the inbox optimization.

Threats

• Staff turnover may increase and make implementation and training more challenging.
• Clinical staff do not currently have a good understanding of the process or problem; gaining buy-in may be a challenge.

Risk Level (Low, Medium, High)

• Risk: Medium (Staff attrition)
• Risk: Low (Lack of buy-in to the project)

Conclusion

Patients are experiencing delayed care, diagnoses, referrals, and communication, which is ultimately damaging Adelante’s brand and reputation because of its direct impact on the patient experience. To solve this issue, in-depth analysis, collaboration, and provider buy-in will be required. Key stakeholders include members of the c-suite like the CEO and CMO as well as the Director of Quality, Regional Medical Director, and Clinical Informatics manager. Leveraging stakeholder power lines, resources, and Lewin’s Change Theory of unfreeze-change-refreeze, optimizing patient-provider communications can be significantly improved and enhance the value of care Adelante patients receive, which, in turn, will improve the patient experience.

A SWOT analysis was conducted and concluded that while some threats exist, the number of strengths, including the assets of the project team really minimizes the probability of threats being realized. “…A good patient experience– while considered merely desirable in the past – is moving center-stage” (Lang, 2012). Aligning with Adelante’s strategic objective of patient satisfaction, the nursing department has chosen to elevate nursing practices through patient-centric models of care and focus on the patient experience. The provider inbox issue will be addressed, and the patient experience will be improved. Success will be measured through patient satisfaction surveys yielding an 84% or greater likelihood to recommend rating. To achieve this, new policies will be developed and instituted along with daily clinical huddles to facilitate enhanced team communications.

References

Avila, C. (2022). Project Charter – Part 3. [Unpublished manuscript]. Capella University.

Eichler HG, Bloechl-Daum B, Broich K, et al. Data rich, information poor: can we use electronic health records to create a learning healthcare system for pharmaceuticals? Clin Pharmacol Ther 2018;September 4. doi: 10.1002/cpt.1226. [Epub ahead of print].

NURS FPX 8010 Assessment 4 Quality Improvement Proposal

Lal, M. Maureen DNP, MSN, RN. Why You Need a Nursing Strategic Plan. JONA: The Journal of Nursing Administration: April 2020 – Volume 50 – Issue 4 – p 183-184 doi: 10.1097/NNA.0000000000000863

Lang EV. A Better Patient Experience Through Better Communication. J Radiol Nurs. 2012 Dec 1;31(4):114-119. doi: 10.1016/j.jradnu.2012.08.001. PMID: 23471099; PMCID: PMC3587056.

Norris, J. M., White, D. E., Nowell, L., Mrklas, K., & Stelfox, H. T. (2017). How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study [PDF]. Implementation Science, 12.

Petiprin, A. (2020, July 19). Lewin’s change theory. Nursing Theory. Retrieved October 12, 2022, from https://nursing-theory.org/theories-and-models/lewin-change-theory.php