Unit: Quality Improvement Approaches and Planning

Most healthcare organizations in the country are implementing quality improvement programs to save lives, enhance customer satisfaction, and reduce the cost of healthcare services. Limited human and material resources often undermine such efforts. Zenith Hospital in a rural community has 200 beds. Postsurgical patients tend to contract infections at the surgical site, requiring extended hospitalization. Mr. Jones—75 years old—was admitted to Zenith Hospital for inguinal hernia repairs. He was also hypertensive, with a compromised immune system. Two days after surgery, he acquired an infection at the surgical site, with elevated temperature, and then he developed septicemia. His condition worsened, and he was moved to isolation in the intensive care unit (ICU). A day after transfer to the ICU, he went into ventricular arrhythmia and was placed on a respirator and cardiac monitoring machine. Intravenous fluids, antibiotics, and antipyretics could not bring the fever down, and blood analysis continued to deteriorate.

The hospital infection control unit got involved. The team confirmed that postsurgical infections were on the increase, but the hospital was unable to identify the sources of infection. The surgery unit and surgical team held meetings to understand possible sources of infection. The team leader had earlier reported to management that they needed to hire more surgical nurses, arguing that nurses in the unit were overworked, had to go on leave, and often worked long hours without break.

Mr. Jones’ family members were angry and wanted to know the source of his infection, why he was on the respirator in isolation, and why his temperature was not coming down. Unfortunately, his condition continued to deteriorate. His daughter invited the family’s legal representative to find out what was happening to her father and to commence legal proceedings.

Then, the healthcare manager received information that two other patients were showing signs of postsurgical infection. The healthcare manager and care providers acknowledged the serious quality issues at Zenith Hospital, particularly in the surgical unit. The healthcare manager wrote to the Chairman of the Hospital Board, seeking approval to implement a quality improvement program. The Board held an emergency meeting and approved the manager’s request. The healthcare manager has invited you to support the organization in this process.

Please address the following questions in your response:

1. What are successful approaches for gaining a shared understanding of the problem?
2. How can effective communication be implemented?
3. What is a qualitative approach that helps in identifying the quality problem?
4. What tools can provide insight into understanding the problem?
5. In quality improvement, what does appreciative inquiry help do?
6. What is a benefit of testing solutions before implementation?
7. What is a challenge that is inherent in the application of the plan, do, study, act (PDSA) method?
8. What are the attributes of the outcome measure?
9. What are the attributes of the measurement for improvement?
10. Why is collecting the right data important?
11. What is a component of establishing a culture of quality improvement in healthcare organizations?
12. What knowledge do healthcare managers require to sustain a quality culture?