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Quality Improvement Principles and ApplicationMelissa L. KaneParis Junior College Quality Improvement Principles and ApplicationQuality improvement principles and application are important in health care and pertinent to the nursing profession. There are many benefits to quality health care, as well as many processes and methods to determine quality. That data is gathered and analyzed to make decisions to provide the safest, efficient, cost-effective care to the patient. Nurses play a key role in this process. Principles of Quality ImprovementTo understand quality improvement, a definition is needed to understand what it encompasses. It is commonly defined as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” CITATION Und19 l 1033 (Understanding Quality Measurement, n.d.) This includes areas such as effectiveness, efficiency, equity, patient-centeredness, safety, and timelines. These items are key to providing safe, quality care to patients. All areas are measured to determine if a positive outcome has been reached in patient care. CITATION Var07 l 1033 (Varkey, Reller, & Resar, 2007) . Providing quality care limits the waste of resources included but not limited to, funds, supplies, energy and time; providing equality of care to patients no matter their sexual orientation, socioeconomic status, race, gender, sex, or financial resources. Quality care also takes into consideration the patients individual situation customizing the plan of care and treatment to that patient. Eliminating delays in care and limiting treatment that causes other harm while treating the ailment it was meant to treat, using scientific knowledge to provide services to those who will benefit and avoid using those services on those that would not. This ensures that the best care is provided and gets away from the cookie cutter style of treatment to achieve the best possible outcome. CITATION May06 l 1033 (Mayberry, Nicewander, Qin, & Ballard, 2006). This reduces cost, improves individual outcomes, improves patient compliance, and leads to overall healthier patients with less health care related injury.Fundamental Principles of Quality Assurance and Quality Improvement.Quality improvement involves evaluations of a specific process. These evaluations look to see how a small change in a process affect the outcome, impacts on other unpredicted systems and are reevaluated as needed and changes are made until the desired result is met. Quality assurance evaluates primarily, the delivery of service CITATION Var07 l 1033 (Varkey, Reller, & Resar, 2007). The four principles of Quality improvement include system and process, focus on patients, focus on the team and the use of data. QI (Quality improvement) needs to be individualized to meet the needs of the entity for best results. CITATION HRS11 l 1033 (HRSA.gov, 2011)Quality assurance is the process that monitors the quality of the service provided. It evaluates the quality of service provided and identifies problems and designates an activity to correct an identified issue. Follow up is needed to ensure that the issue is resolved or improved. CITATION Shi16 l 1033 (Jevaji, 2016) While quality improvement is the system to correct the issue quality assurance makes sure that the process is followed, and that quality remains at a designated level or higher.Quality Improvement Processes and MethodsThere are several different processes and methods of QI. These include but are not limited to Plan, Do, Study act, COPE model, and SBM-R. With the Plan, Do, Study, Act system plans are made as to what needs to be corrected and how it is to be accomplished. (Coury,2017) The plan is then done and studied for the effectiveness of the plan. An action is then taken to fully implement or change the plan until the desired effects are accomplished. This is a continuous process constantly evaluating and adapting the process to make it dependable and successful in improving the standard of quality of the action. An example of this was done with a recent clinical research study called the Strategies and Opportunities to STOP Colon Cancer in Priority Populations. This test was to see the effectiveness of direct-mail fecal immunochemical testing and locating patients who were due for there their colorectal screening. (Coury,2017)Using Data to Make Decisions There is a large amount of value placed on the data and measurement in healthcare quality. Quality measurements in health care are the process of using data to evaluate the performance of health plans and health care providers against recognized quality standards. (Families USA, 2014) It can improve our nations health care by preventing overuse, underuse, and misuse of health care services and ensuring patient safety. It can help identify what works and what does not work to drive improvement. (Families USA, 2014) It also holds health insurance plans and health care providers accountable to provide quality care and address disparities in how care is delivered. (Families USA, 2014) This will allow the consumer to make informed choices about their personal health care. Measuring the quality of healthcare patients receive is very important and cantake many forms. (Families USA, 2014) It usually falls under four broad categories:structure, process, outcome and patient experience. None of these can stand alone, they must all be initiated together. (Families USA, 2014) One method that can be used when evaluating the quality of health care is root cause analysis. This allows healthcare providers to be able to identify the main problems going on in the healthcare system and guide them on a way to solve it. (Quality-one,2019) To do the root cause analysis correctly four easy steps must be followed. (Quality-one,2019) First, the problem must be identified, followed by establishing a timeline from before the problem occurred up until the problem started. (Quality-one,2019) Next, decide what is the actual root cause and what are just causal factors that could be involved. Last you need to establish a causal graph between the root cause and the problem. Once these steps are taken you should be able to keep the problem from reoccurring again. (Quality-one,2019) There are many quality improvement tools that you can use to help you with these procedures. The first of these being the cause and effect diagram. Also known as the fishbone diagram. This tool can help analyze the root cause contributing to an outcome. If the team is wanting to see what could potentially happen with a change, this diagram could come in handy with predicting that. (Quality-One, 2019)Another tool is the Failure Modes and Effects Analysis. This tool is a proactive method for identifying potential risk and impact. With this tool, all potential failures are looked at, especially ones that could gravely harm a patient, and they make plans on how to avoid these failures. (Quality-One, 2019)Run Charts and Control Charts are another quality improvement tool. This gives a visual reference to a team can monitor performance as it happens. Over a period of time, it can show if the actions being taking are causing a negative or positive impact. (Quality-One, 2019)Driver Diagram is a quality improvement tool that is a visual display of what contributes to the achievement of a project’s aim. This can help get a clear message across to many people on exactly the direction the organization wants to take a project. (Quality-One, 2019)A Flowchart is a quality improvement tool that can show a sequence of steps for a process. These are most useful in the beginning stages of improvement to see what directions your developing ideas should go. (Quality-One, 2019)A Histogram is a special type of quality improvement tool. It is a bar chart that shows the variation in continuous data such as time, weight, size, or temperature. Histograms help to determine patterns that you cannot simply get from a table of data. It can also be used to find the average and median of the information you are using. (Quality-One, 2019)A Pareto chart is a bar chart that arranges various factors that contribute to an overall effect from largest to smallest. This will help to see what factors need the most attention to fix the issues at hand. This chart involves the Pareto principle, also called the 80/20 rule, which says only 80% of the effect comes from 20% of the cause. (Quality-One, 2019)The PDSA Worksheet involves the Plan-Do-Study-Act cycle. This is a worksheet where a plan is written out and see what could happen when testing the plan. (Quality-One, 2019)Project Planning Form help teams think systematically about their improvements. This will allow the whole team to see each and every part of the project and to see how each part is advancing. (Quality-One, 2019)A Scatter Diagram shows the relationship between two variables. After using the Cause and Effect Method you may use this to see if the cause and effect are related. (Quality-One, 2019) One variable will be placed on the X-axis and the other on the Y-axis and if the data points fall close to each other that could signify a relationship. (Quality-One, 2019)ApplicationNursing has many roles in dealing with healthcare quality and improvement. From being involved with direct patient care, improving quality standards by continuing education and research, following evidence-based practices and educating patients and their families on community resources, post-hospital care, medication administration, and so much more. Nurses are researching and testing strategies to improve patient health and safety constantly. Florence Nightingale was a leader in evidence-based practice before there was a word for it, and nurses are constantly coming up with new innovative ways to keep patients safe, healthy, and happy while reducing costs, saving time, and accommodating the patient needs. Nurses are the first and last person that patients see at the hospital and have a great amount of influence on how the patient views the level of care provided and overall satisfaction. ReferencesCoury, J., Schneider, J. L., Rivelli, J. S., Petrik, A. F., Seibel, E., D’Agostini, B., . . . Coronado, G. D. (2017, June 19). Applying the Plan-Do-Study-Act (PDSA) approach to a large pragmatic study involving safety net clinics. Retrieved March 22, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477281/#!po=0.746269HRSA.gov. (2011). Retrieved from HRSA.gov: Jovani, S. J., Senior Public Policy andCommunications Specialist, Ncqa, Ncqa, Public Health Communication, and Marketing, & George Washington University. (2016, January 14). The Q Series: What is Health Care Quality Assurance? Retrieved March 22, 2019, from https://blog.ncqa.org/the-q-series-what-is-health-care-quality-assurance/Families USA. (2014). Measuring Health Care Quality: An Overview of Quality Measures.Morris, C. (2014, May). Measuring Healthcare Quality: An Overview of Health Care Measures. Retrieved March 22, 2019, from https://familiesusa.org/sites/default/files/product_documents/HSI Quality Measurement_Brief_final_web.pdfHealth, B. O. (2015, November 19). Six Widely Used Methods to Improve Quality. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK333244/Institute of Medicine (US) Committee on the Quality of Long-Term Care Services in Home and Community-Based Settings. (1996, January 01). Current Quality Assurance and Improvement Strategies. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK231104Jevaji, S. J., Senior Public Policy and Communications Specialist, Ncqa, Ncqa, Public Health Communication, and Marketing, & George Washington University. (2016, January 14). The Q Series: What is Health Care Quality Assurance? Retrieved March 22, 2019, from https://blog.ncqa.org/the-q-series-what-is-health-care-quality-assurance/Mayberry, R., Nicewander, D., Qin, H., & Ballard, D. J. (2006). Improving quality and reducing inequities: a challenge in achieving the best care. Retrieved 3 22, 2019, from https://ncbi.nlm.nih.gov/pmc/articles/pmc1426185Plsek, P. (1999). Quality Improvement Methods in Clinical Medicine. Pediatrics, 103, 203-214. Retrieved 3 22, 2019, from https://ncbi.nlm.nih.gov/pubmed/9917464Root Cause Analysis (RCA). (n.d.). Retrieved from https://quality-one.com/rca/The Role of Nurses in Hospital Quality Improvement. (2017, June 05). Retrieved fromhttp://tinehealth.com/2017/06/05/the-role-of-nurses-in-hospital-quality-improvement/Understanding Quality Measurement. (n.d.). Retrieved 3 21, 2019, from http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/understand/index.htmlVarkey, P., Reller, M. K., & Resar, R. K. (2007). Basics of Quality Improvement in Health Care. Mayo Clinic Proceedings, 82(6), 735-739. Retrieved 3 22, 2019, from https://mayoclinicproceedings.org/article/s0025-6196(11)61194-4/fulltext