How might you identify quality improvement practice gaps in your practice or organization? What tools and methods might you recommend to address these gaps?

Successful quality improvement relies on appropriate data and its analysis. It is not enough to just want to improve care and safety. Instead, measures and tools must be considered, analyzed, and evaluated to ensure that their implementation aligns with what the data demonstrates as a potential area for quality improvement. Furthermore, the application of quality improvement measures and tools must also be considered in light of the and with the quality improvement goals and expectations set forth by the needs of the organization or nursing practice.

This week, you will explore and analyze the different approaches of data collection and analysis as it relates to identifying an area for quality improvement. You will consider the importance of identifying practice gaps and explore recommendations for improvement.

Learning Objectives

Students will:

• Analyze how to identify quality improvement practice gaps related to healthcare organizations and nursing practice
• Evaluate potential DNP project quality improvement practice gaps
• Recommend tools and methods to address DNP project quality improvement practice gaps
• Analyze rate-based measures for nursing practice and healthcare delivery*
• Analyze measurement systems and methods for rate-based measures*
• Evaluate rate-based measure definitions, benchmarks, and comparisons related to organizational performance and metrics*
• Analyze rate-based measures to an organization or clinical setting*
• Analyze the relationship between rate-based measures and organizational performance metrics for patient safety, healthcare quality, and cost of healthcare*

*Assigned in Week 3 of Module 2 and submitted in Week 4 of Module 2

Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Discussion: Identifying Practice Gaps for Quality Improvement

• What should be happening in practice? What is happening or observed in practice?
  These two questions help to identify where quality improvement practice gaps might exist in nursing practice. If we know what should be happening does not coincide with what is happening, we know there is an issue, or more appropriately, a practice gap.

• Photo Credit: Getty Images/iStockphoto

A practice gap is the difference between a desirable or achievable state of practice and current reality. For example, a common gap in practice in healthcare organizations today, are healthcare associated infections (HAIs), such as central line associated blood stream infections (CLABSIs), or catheter associated urinary tract infections (CAUTIs).

The ongoing identification of practice gaps is critical to quality improvement and involves identifying the current state, comparing that current state to the desired state, identifying the causes of the gaps in practice, and validating those gaps to develop a process for improvement.

For this Discussion, reflect on quality improvement practice gaps that may exist in your practice or organization. Consider what quality improvement methods and/or tools might be useful in improving this practice gap. Then, think about how you might address these challenges and what strategies you might implement as a future DNP-prepared nurse.

To Prepare:

• Review the Learning Resources on tools and methods for quality improvement.
• Reflect on a potential quality improvement practice gap, you have seen in your practice or organization, which you might consider using for your DNP project.
• Consider the tools and methods you might use to address this quality improvement practice gap.

By Day 3 of Week 3

Post a brief explanation of how you would identify a quality improvement practice gap in your practice or organization. Describe a potential quality improvement practice gap you might use for your DNP project, and explain why. Then, explain at least two types of tools and/or methods you might use to address this quality improvement practice gap, and explain why. Be specific and provide examples.

By Day 6 of Week 3

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post and suggesting alternative tools and/or methods your colleague might consider using to address the quality improvement practice gap they selected.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 of Week 3 and Respond by Day 6 of Week 3

To Participate in this Discussion:

Week 3 Discussion

Assignment: Tools for Measuring Quality

• How do we determine quality? Quality in other areas of our lives can be subjective, so as it relates to our nursing practice, how do we specifically ensure that quality is clearly defined and measurable?
  Tools for measuring quality are used to assess the value measured, collected, or compared. These tools allow for subjectivity to be replaced with objectivity through data, formula, ranking, and analysis.

• Photo Credit: Getty Images/iStockphoto

For this Assignment, you will explore at least three rate-based measures of quality. You will deconstruct each measure to explore your understanding of the it, including its importance and its impact on patient safety, the cost of healthcare, and the overall quality of healthcare.

To Prepare:

• Review the Learning Resources for this week, and reflect on tools for measuring quality in nursing practice.
• Select three rate-based measurements of quality that you would like to focus on for this Assignment.
  • Note: These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care, and for the purposes of this Assignment, an analysis of staffing levels is not permitted.
  • You can find useful information on quality indicators that are of interest to you on these websites and resources. You may choose only one of the three measures to be some form of patient satisfaction measure.
• Consider how the three rate-based measures (you will select) are defined, how the rates were determined or calculated, how the measures were collected, and how these measures are communicated to both internal and external stakeholders.
• Reflect on how the three rate-based measures (you will select) may relate to organizational goals for improved performance.
• Reflect on the three rate-based measures (you will select), and consider the importance of these measures on patient safety, cost of healthcare, and overall quality of healthcare.

The Assignment: (8–10 pages)

• Describe the three rate-based measures of quality you selected, and explain why.
• Deconstruct each measure to include the following:
  • Describe the definition of the measure.
  • Explain the numerical description of how the measure is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.).
  • Explain how the data for this measure are collected.
  • Describe how the measurement is compared externally to other like settings, and differentiate between the actual rate and a percentile ranking. Be specific.
  • Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
  • Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace. Be specific and provide examples.
• Describe the importance of each measure to a chosen clinical organization and setting.
  • Using the websites and resources you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic, or private office. A total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might home in a particular health plan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings.
  • Note: Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the Instructor for guidance. You do not need actual data from a given organization to complete this Assignment.
• Explain how each measure you selected relates to patient safety, to the cost of poor quality, and to the overall cost of healthcare delivery. Be specific and provide examples.

By Day 7

There is nothing to submit this week. This Assignment is due by Day 7 of Week 4.

What’s Coming Up in Week 4?

Next week, you will continue to analyze tools used for quality improvement and will explore the application of project management for a quality improvement practice gap.

Next Week