Leadership and Quality Improvement Change Process

1.  Selected leadership theory and how it will be incorporated in this QI process plan. 1-3 paragraphs w/reference(s).

The transformational theory involves using one owns the ability to boost leadership potential in other people. The theory focuses on quality improvement in an organization by focusing on leadership in enlightening workers in the organization to impact desired change. By use of this theory, the leaders display a charismatic personality (Ayers et.al, 2005) which influences other workers to work as the leaders do. The leaders should have inspirational motivation whereby he/she is able to inspire sense of purpose and confidence to the workers in quality improvement of services. Articulation of clear vision and state expectations to the team involved shows that he/she is committed to the goals in place. Transformative leadership not only value intellectual stimulation of the team members but also an individualized consideration. Leaders must consider individual needs of their followers as this has a direct impact on their activity levels.

Transformational theory should be incorporated into quality care competencies to yield best results. Throughout the change process, the healthcare provider should ensure that the project is patient- based (Finkelman, 2015). This is because the aim of a change process in a health care center would be for the purpose of improving patients’ safety. Fostering adoption of change by the people involved in transformative action should not only engage interdisciplinary working but also evidence-based operations. Utilizing information available on previous research was done on quality improvement is also crucial.

2. Identify the key IHI Change concept(s) and discuss why relevant to your project. 1-2 paragraphs w/reference(s)

An important concept of the model is in the quality improvement process is the establishment of a team (Ayers et.al, 2005). The team comprises an influential leader and team members likened to stakeholders in the healthcare center. According to IHI model, the leader of the quality improvement project should initialize the task by setting the central aim of the project. Goal setting should then follow so as to set clarity of the outcome anticipated for to the team leader and team players. Additionally, brainstorming of the current outcomes and the reason for the occurrence should be done. Issues that are closely linked to the outcomes should be pointed out. Consequently, the Plan. Do, Study, Act (PDSA) should be incorporated to enable continued health care to patients even as the change process continues.

3. Brief evidence-based summary of patient safety issue identified (ie: background information, how this might inform components of your QI process) 1-2 paragraphs w/at least 2 scholarly (non-IHI) references.

Research shows that there are health issues associated with diabetic foot progression if it is not examined regularly and detected at an earlier stage (Singh et.al, 2005). Research further shows that the development of diabetic foot is very preventable and treatable. Health caregivers are called upon to put up measures in place to curb this medical problem by the improved conduct of foot examination for diabetes patients. There are abnormalities associated with diabetic foot including lower- extremity amputation and ulcers (Viswanathan et.al, 2005). According to Viswanathan et.al, these abnormalities can yield substantial morbidity, disability, and loss of quality of life. Other research shows that there is need to recognize and manage diabetic patients with the risk of foot ulcers development and amputations.

Due to the cases of the medical complications resulting foot diabetic foot, measures ought to be put in place to enhance early detection for easier management. A change process involving improvement of foot examination to diabetic patients would be relevant to curb the problem. Involvement of a team with an influential leader would help in working together towards the achievement of the objectives. Brainstorming of the outcomes is necessary to prevent past mistakes. The change process should also examine the current situation of the subject. In addition, PDSA cycles should be incorporated in the change process.

Brief Description of Problem:

There are many incidences of diabetic foot complications development by the patients all over the world. The major causes have been identified as a failure for early detection and management of diabetic foot. Hence there is a need for health facilities to improve diabetic foot exam in their care services.

Team members by area of practice:

Leader (such as system administrator): diabetic unit matron

Leader (Day to day such as charge nurse): nursing officer

Clinical Expertise: diabetic unit clinical officer

Technical Expertise: triage nurse

Other members as needed (depending on the focus of the QI):

AIM Statement (STEEP): 

The aim of the project is to increase numbers of diabetic patients with documented foot examination in the healthcare record every year

Outcome Measures (TWO)

1. Conducting foot exam to all patients that attend the healthcare facility for diabetes care

2. Early detection and management of the diabetic foot-related issues identified

Process Measures (TWO)

1. setting up new rules in the diabetic unit and informing the staff to conduct foot exam to all the patients that come in. 

2. enlightening diabetic patients of the change process and advocating for its acceptance.

Balancing Measure (ONE)

1. Ensuring that patients informed of the need for regular foot examination from care providers during the examination process to boost their acceptance of the issue.

PLAN - Identify TWO Change strategies that could be tested in PDSA Cycles to help achieve the AIM.  Include what ‘category’ this change is from using IHI change concepts tool (table), and briefly describe how / where you might implement these tests of change and for how long.  (for example, with one provider team in the clinic for 1 week; or with 4 RNs in the ICU for 3 shifts, etc)

First Test of Change: 

The percentage increment of patients with documented diabetic foot examination should be evaluated after six months’ period.

PDSA cycle:

There should be a developed plan to cause change while still conducting normal operations in the diabetic unit. Firstly, the staff in the diabetic unit would be required to ask diabetic patients to remove shoes every time they get to triage room. The change process would be continued for a short period of time at first. Team members at this point should pick ten medical cards and determine how many patients have received the exam out of the ten. The next action would be determined by the results found. The team would choose to change the process if results are negative. The team could also adopt the change process upon its successful results. Actions could further be taken to either extend some time for further observation or abandon the process if there are no signs of achievement of outcomes.

Second Test of Change:

The percentage decrease of developing medical complications from diabetic foot should also be tested

PDSA Cycle:

Firstly, the staff in the diabetic unit would be required to conduct an evaluation of the patients who have developed medical complications from a diabetic foot from their health records. After six months of the change process, they should evaluate the cases of acquiring complications from the diabetic foot. The results gotten should determine the percentage decrease in diabetic foot complications development.  The team could then adopt the change process upon its successful results or neglect it upon negative results.

Reflection: – Summarize what you learned and what will be helpful in your nursing practice. (At least two paragraphs).

In nursing care, quality improvement is important in service areas that seem inadequate. A leadership role in a project related to change process calls for an individual to provide a patient  centered care (Finkelman, 2015) that improves the safety of the patients. In conducting such a process, there is need to incorporate Institute for Health Improvement components as they are a benchmark to a valid and effective change process (Ayers et.al, 2005). In impacting change there is need to gather a team to work with so as they can implement change required. PDSA components are important for incorporation while running the change process as they ensure the smooth running of activities even in the change process.

In the aspect of leadership in a change process, it is inevitable to involve staff from other disciplines (Finkelman, 2015) as different cadres in health care center work together in the achievement of common goals. Improvement of quality of services offered is a key character of a nurse. This is because services offered in a hospital are often insufficient for the safety of patients. Key attention should be paid to investigate whether all the services provided are meeting requirements for nursing practice. Consequently, change process of is an essential thing in quality improvement of services.

References

Ayers, L. R., Beyea, S. C., Godfrey, M. M., Harper, D. C., Nelson, E. C., & Batalden, P. B. (2005). Quality improvement learning collaboratives. Quality Management in Healthcare, 14(4), 234-247.

Finkelman, A. (2015). Leadership and management for nurses: Core competencies for quality care. Pearson.

Singh, N., Armstrong, D. G., & Lipsky, B. A. (2005). Preventing foot ulcers in patients with diabetes. Jama, 293(2), 217-228.

Viswanathan, V., Thomas, N., Tandon, N., Asirvatham, A., & Rajasekar, S. (2005). Profile of diabetic foot complications and its associated complications-a multicentric study from India. JAPI, 53, 933-6.