Week 4 Assignment 1: Project Management and Tools for Measuring Quality

Week 4 Assignment 1: Project Management and Tools for Measuring Quality

Week 4 Assignment 1: Project Management and Tools for Measuring Quality

Assignment 1: Applying Project Management Approaches for a Quality Improvement Practice Gap

            The primary goal of every healthcare organization is to provide quality, safe, and efficient health care to all patients. Nonetheless, the capacity to provide quality and safe patient care is compromised by issues reported in the clinical practice. Medical facilities should examine and implement the most appropriate improvement initiative to address a clinical issue reported in practice, improving the quality and safety of patient care. This paper presents the quality improvement practice gap identified in our nursing practice, SMART objectives applicable in the project planning or execution phase to resolve the identified practice gap, and project management activities that should be used in the proposed quality improvement project.

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Quality Improvement Practice Gap Identified in our Nursing Practice

            The quality improvement practice gap identified in our nursing practice is a high rate of falls among hospitalized patients. The national benchmark for patient fall rate is 3.44 falls/1000 patient days in three units, including general medical, medical-surgical, and surgical units (Venema et al., 2019). Patient falls incidence is relatively high in these departments due to mobility and stability issues among patients receiving treatment in these units (Montejano-Lozoya et al., 2020). On the other hand, our clinical practice reports a patient fall rate of 15 falls/1000 patient days in the three units. This patient fall rate is about five times higher than the national benchmark, indicating that the rate of patient fall in practice is substantially high. LeLaurin and Shorr (2019) reported that patient falls impose significant economic and physical burdens on patients. These burdens occur due to a high rate of fall-related injuries, deaths, and reduced quality of life. Similarly, in nursing, the high rate of patient falls results in adverse patient outcomes, including disability risk, high mortality rates, and an increase in treatment cost.

 Based on data from the practice’s dashboard, approximately 80% of these falls occur while patients leave their beds. Therefore, a quality improvement intervention targeting this area should be implemented in nursing to reduce the high rate of patient falls in the highly affected units, including general medical, medical-surgical, and surgical units. The proposed quality improvement intervention involves installing a bed alarm system in the units that are highly affected by patient falls. Mileski et al. (2021) said bed alarm sensors significantly reduced fall rates in long-term care (LTC) facilities. Hence, a bed alarm system should be adopted as an evidence-based intervention for preventing patient falls long-term in the nursing practice. The alarm systems will alert medical staff on duty when patients at a high risk of falling attempt to leave a bed without assistance. The healthcare professional will then assist the patient in leaving the bed, preventing falls and related events. Additionally, the alarm system will remind a patient to seek assistance anytime he or she is leaving the bed, preventing falls. Therefore, installing a bed alarm system will reduce the high incidence of patient falls in the highly affected units, including general medical, medical-surgical, and surgical units.

SMART Objectives Applicable in the Project Planning Phase or Execution Phase to Resolve Identified Practice Gap

The execution phase is one of the most important stages during project implementation. This phase involves the actual implementation of the proposed change project. In addressing the identified practice gap, the execution phase will involve implementing the proposed quality improvement project. The following two objectives will be achieved at this phase.

Objective 1

Specific: Install a bed alarm system in three general medical, medical-surgical, and surgical units.

Measurable: Increase in alarm notifications by 80%.

Attainable: The 80% increase in alarm notifications will be achieved by installing alarm systems in beds with a high risk of falling.

Relevant: An alarm will notify staff on duty that a patient wants to leave his or her bed once more pressure is exerted on the bed.

Time: The 80% increase in alarm notifications will be achieved by 31st September 2022.

Objective 2

Specific: Increase assistance provided to patients in general medical, medical-surgical, and surgical units while leaving their beds.

Measurable: Reduce patient falls rate in the three units by 80%.

Attainable: The 80% decline in patient falls rate will be achieved by assisting a patient while leaving his or her bed.

Relevant: An attempt to leave the bed without assistance is a significant factor contributing to patient falls.

Time: The 80% decline in patient fall rate will be achieved by 31st December 2022.

Project Management Activities that should be used in the Proposed Quality Improvement Project

            The proposed quality improvement project involves installing a bed alarm system in the three units highly affected by patient falls. Project management activities will guide the implementation of this quality improvement intervention. The first activity involves defining the project’s objectives. The project team needs to determine the project’s goals and objectives before executing it to ensure that it is implemented as planned. Changes are made if the project does not align with the objectives to achieve the desired results. The second activity involves identifying key stakeholders to be involved during project implementation. This activity is essential since stakeholders’ support contributes to the successful implementation of a change project (Dwivedi & Dwivedi, 2021). Thus, determining the stakeholders involved during the project implementation will contribute to its success.

            Overall, the proposed quality improvement project involves installing a bed alarm system in the three units highly affected by patient falls. The project will achieve two objectives: installing an alarm bed system and reducing the high rate of patient falls. Project management activities that will guide the implementation of this quality improvement intervention include defining the project’s objectives and identifying key stakeholders to be involved during project implementation.  

Part 2: Assignment: Tools for Measuring Quality

Improving the quality and safety of patient care is the primary goal of every healthcare organization. Quality health care refers to the extent to which health services provided to individual patients and the entire community align with the current professional knowledge and meet health outcomes (Allen‐Duck et al., 2019). However, the performance of today’s health care sector does not meet the expectations, resulting in tools for measuring quality. These tools focus on measuring the quality of patient care and adherence to the set quality standards. Improving the quality of patient care enhances the safety and effectiveness of health care, achieving the desired health outcomes and preventing adverse patient outcomes. This paper presents three rate-based measures of quality, including the rationale for selecting them; the significance of each measure to a selected clinical organization and setting; and the relationship between the selected measure and various components, including patient safety, the cost of poor quality, and to the overall healthcare delivery cost.

Description of the Selected Rate-Based Measures of Quality

            Quality performance can be measured using processes, structure, and outcomes measures. Structure measures evaluate the availability, accessibility, and quality of resources. Process measures evaluate how clinical officers deliver health care services to individual patients. Outcome measures evaluate health care delivery results (Lorini et al., 2018). National organizations such as the Joint Commission (JC) and the Centers for Medicare & Medicaid Services (CMS) use quality measures to evaluate significant aspects of patient care, including quality, safety, and effectiveness. The quality assessment results guide nurses and other healthcare providers in proposing and implementing a quality improvement initiative for addressing a specific clinical issue to enhance patient care quality, safety, or effectiveness, meeting the national quality benchmarks.

Quality measures are further classified into various categories. However, this paper focuses on rate-based indicators, the most commonly used form of indicators. These quality measures are expressed as rates or proportions (Jazieh, 2020). The denominators and numerators are clearly defined in rate-based indicators. The rate-based indicators evaluate the quality of care provided to patients in a specific area of health care. The results indicate if healthcare services provided to the patients align with national guidelines or evidence-based practices. According to Hashish et al. (2020), evidence-based practices provide healthcare professionals with a basis for providing quality and safe patient care. Therefore, by adhering to evidence-based practices during care delivery, healthcare providers offer quality, safe, and effective patient-centered care, optimizing health outcomes.

Rate-based measures of quality selected for this paper include the proportion of inpatient falls during an acute care admission, the rate of patient falls in medical/surgical units, and the proportion of patient falls in the inpatient unit. The three rate-based quality measures were preferred since they portray the connection between the quality of care provided to patients in the nursing practice and patient falls and fall-related adverse health outcomes. Therefore, these measures indicate areas of patient care that should be improved to reduce the high rate of patient falls, which is a significant clinical issue facing the nursing practice.

Deconstruction of each Rate-Based Measure

The Proportion of Inpatient Falls during an Acute Care Admission

            Inpatients’ fall rate in an acute care unit measures patient falls reported among patients receiving healthcare services for other medical conditions at the acute care unit. This measure is constructed by dividing the number of inpatient falls reported in the acute care unit by 1000 patient days. Therefore, this measure is expressed as x/1000 patient days, where inpatient falls are reported in the acute care unit. The data for inpatient fall rates during an acute care admission is collected by reviewing the number of falls among patients admitted in the acute unit for 1000 days from the organization’s dashboard. For instance, if 50 falls were reported in the acute care unit over 1000 patient days, the rate is expressed as 50 per 1000 patient days or 50/per 1000 patient days. This measurement is compared externally to the national benchmark or other healthcare settings. The national benchmark for inpatient falls in the acute care unit ranges from 1/1000 to 17/1000 patient days (Cuttler et al., 2017). Therefore, the acute admission fall rate of 50/1000 patient days in nursing is relatively high since it is 3 times higher than the national benchmark. Additionally, the patient fall rate in the acute care unit of 50/1000 patient days can be compared to other healthcare organizations. The organization’s acute unit fall rate is higher than medical facilities, with less than 50 patient falls in this unit over 1000 patient days. On the other hand, the organization’s patient fall rate in the acute care unit of 50/1000 patient days is less than medical facilities that have reported more than 50 patient falls in this unit over 1000 patient days.

            This falling rate can also be expressed in terms of the actual rate and a percentile ranking. The actual rate refers to the patient falls expressed in 1000 patient days. If the patient falls in the acute care unit were 50, then the actual rate is expressed as 50/1000 patient days. On the other hand, the percentile of a score is its percentage expressed in its frequency distribution, which is lower than or equal to it. The percentile is expressed by dividing the number of values below the score by the total number of scores, and the answer is then multiplied by 100. The proportion of inpatient falls rate during an acute care admission is risk-adjusted. The proportion of patient falls in the acute care unit portrays the safety of patients receiving healthcare services in this unit. According to LeLaurin and Shorr (2019), a high rate of falls among inpatients leads to safety issues. Therefore, various interventions, including hourly rounding and installing bed alarm systems, should be adopted to prevent patient falls in the acute care unit, improving patient safety and health outcomes. The nursing practice can set goals for the proportion of inpatient falls during an acute care admission by stating the desired rate of patient falls. For instance, inpatient falls should reduce to align with the national benchmark for falls in the acute unit (1-17 per 1000 patient-days) in the next six months. Achieving this goal will indicate improved patient safety and a decline in safety issues. For instance, reporting a fall rate of 5/1000 patient days in the acute unit indicate the provision of high-quality, safe, and effective patient care in this department. Consequently, more patients will seek healthcare services from the clinic’s acute care unit, enabling the organization to achieve a competitive advantage over its competitors and excel in the marketplace.

The Proportion of Patient Falls in Medical/Surgical Units

            The proportion of patient falls in medical/surgical units evaluates patient falls that occur when individuals receive healthcare services in medical/surgical units. This rate is expressed in terms of patient falls reported over 1000 patient days in these units. It is expressed as patient falls per 1000 patient days. Additionally, this measure is expressed in terms of the numerator (patient falls)/denominator (1000 patient-days). If 35 falls are reported in the medical/surgical units over 1000 patient days, this rate is expressed as 35 per 1000 patient days or 35/per 1000 patient days. Data for constructing this measure is collected by reviewing the organization’s dashboard for patient falls reported in medical/surgical units over 1000 days. The proportion of patient falls in medical/surgical units is directly proportional to patient falls reported in these units over a particular period. The rate increases if high patient falls are reported in medical/surgical units, while the proportion decreases if fewer patient falls are reported in these departments.

            This falling rate can also be expressed in terms of the actual rate and a percentile ranking. The actual rate when a patient falls in medical/surgical units is expressed in 1000 patient days. In an example where 35 patient falls were reported in the surgical/medical units over 1000, the actual rate is expressed as 35 per 1000 patient days or 35/1000 patient days. On the contrary, the percentile ranking is when the patient falls score is expressed as a percentage in its frequency distribution. The distribution is either lower than or equal to the score. In calculating the percentile, the total score is divided by the number of values below it and multiplied by 100. In this case, the percentile can be calculated by dividing 34/35 and multiplying the answer by 100.

The rate of inpatient falls in medical/surgical units can be compared externally with the national benchmark of quality care or other healthcare organizations. The national benchmark for inpatient falls in medical/surgical units is 3.44 falls/1000 patient days (Venema et al., 2019). On the other hand, the rate of inpatient falls in medical/surgical units in the nursing practice is 35 per 1000 patient days or 35/1000 patient days. Hence, the rate of patient falls in the medical/surgical units is 10 times higher than the national benchmark, indicating non-compliance with national guidelines on this quality measure. Additionally, the proportion of inpatient falls in medical/surgical units is higher than in other healthcare organizations, with a patient fall score below 35/1000 patient days. On the contrary, the clinic’s rate of patient falls in the medical/surgical units is below other medical facilities, with a rate higher than35/1000 patient days.

The rate of inpatient falls in medical/surgical units is risk-adjusted. According to Hemsley et al. (2019), the high rate of patient falls is the most adverse event reported in healthcare organizations. Patient falls lead to patient safety issues, including high morbidity and mortality rates, longer stay, and high cost of healthcare services. Therefore, patient safety is high when this measure is low, while a high proportion of patient falls in the medical/surgical unit portray patient safety issues. The goals for this measure focus on reducing the high rate of patient falls and related outcomes in the medical/surgical units. For example, inpatient falls in medical/surgical units in nursing practice should reduce from 35/1000 patient days to 2/1000 patient days. By achieving the new patient fall rate of 2/1000 patient days, the nursing practice will adhere to the national benchmark for inpatient falls in medical/surgical units, which is 3.44 falls/1000 patient days (Venema et al., 2019). Additionally, the new score will indicate improved patient safety, attracting more patients, increasing the clinic’s revenue and profitability, and enabling the organization to survive in a highly competitive market.

The Proportion of Patient Falls in the Inpatient Unit

This rate-based measure evaluates overall patient falls reported in the inpatient unit. The measure is constructed by expressing falls reported in the inpatient unit in 1000 bed days. Therefore, this rate is expressed as X (falls in the inpatient units) per 1000 bed days. Additionally, it is expressed as a fraction; X/1000 bed days. Data for constructing this measure is collected by reviewing the hospital’s records for patient falls reported in the inpatient unit over 1000 bed days. For instance, 15 falls were reported in the inpatient unit over 1000 bed days; the measure is expressed as 15 per 1000 bed days, or 15/1000 bed days. This expression is known as the actual rate. Additionally, the measure can be expressed as percentile ranking in which patient falls score is expressed as a percentage in its frequency distribution. The national benchmark for this measure is 3-5 per 1000 bed days. This measure is compared externally with the national benchmark or other healthcare organizations. The inpatient fall rate of 15 per 1000 bed days is five times higher than the national benchmark (3 per 1000 bed days). Additionally, this measure is risk-adjusted since it portrays a healthcare organization’s level of safety issues. The goal for this measure can be set by targeting to reduce the high rate of falls in the inpatient unit to enhance safety in this department. Improving safety will attract more clients, thus giving the organization a competitive advantage over other industry players.

Describe the Importance of each Measure to the Selected Nursing Practice

            The selected rate-based measures include the proportion of inpatient falls during an acute care admission, the rate of patient falls in medical/surgical units, and the proportion of patient falls in the inpatient unit. The fall rate in an acute care unit measures patient falls reported among patients receiving healthcare services for other medical conditions at the acute care unit. This measure will indicate the rate of patient falls among patients receiving health care in the acute unit in the selected nursing practice. The quality assessment results indicate an evidence-based intervention such as hourly rounding (Shin & Park, 2018). The quality improvement initiative will then be adopted to prevent and reduce patient falls in the acute department. Secondly, the proportion of patient falls in medical/surgical units evaluates patient falls that occur when individuals are receiving healthcare services in medical/surgical units. This measure will assess the rate of patient falls in these departments. The results will be based on the national guidelines to determine the severity of patient falls in these units. Evidence-based interventions will then be adopted to reduce the high prevalence of falls in medical/surgical units, addressing the most significant clinical issue in the selected nursing practice. Lastly, the proportion of patient falls in the inpatient unit can be used to evaluate overall patient falls reported in the inpatient unit in the selected nursing practice. Quality assessment results will be used as the guideline for quality improvement intervention for reducing patient falls in the inpatient department. Therefore, the three rate-based measures will significantly reduce the high rate of falls among hospitalized patients in the selected nursing practice, which is the most significant clinical issue in the setting.

How does each Rate-Based Measure Relate to Patient Safety, Cost of Poor Quality, and Overall Cost of Healthcare Delivery?

            The selected rate based-measures include the proportion of inpatient falls during an acute care admission, the rate of patient falls in medical/surgical units, and the proportion of patient falls in the inpatient unit. The proportion of inpatient falls during an acute care admission focuses on assessing the fall rate in the acute care unit. The quality assessment score indicates the severity of falls in this unit, which is a significant patient safety issue. Evidence-based interventions are adopted based on the quality of improvement score, improving patient safety. Additionally, improving patient safety will lower the cost of poor quality, such as the cost of treating fall-related fractures and the overall cost of healthcare delivery following the elimination of additional care required to cater to a prolonged hospital stay. Furthermore, the proportion of patient falls in medical/surgical units will indicate the rate of patient falls reported among individuals receiving healthcare services in medical/surgical units. The assessment results will guide in selecting the most effective quality initiative that should be adopted to eliminate patient falls in these departments, improving patient safety, which will eliminate the cost incurred in treating fall-related injuries. For instance, the cost incurred in treating a fall-related hip fracture in these units will be eliminated. Additionally, improved patient safety will reduce the high cost of healthcare care, which would be incurred due to prolonged stay. Lastly, the proportion of patient falls in the inpatient unit results will be used to improve the quality of care in the entire inpatient unit, eliminating the amount incurred in treating fall-related complications and the high cost associated with prolonged stay.

            Overall, three rate-based measures, including the proportion of inpatient falls during an acute care admission, the rate of patient falls in medical/surgical units, and the proportion of patient falls in the inpatient unit, measure the patient falls in various clinical units. These quality indicators have been selected since they will result in evidence-based interventions, reducing patient falls and related healthcare costs in various care units, including medical/surgical units, acute care units, and inpatient units.

References

Allen‐Duck, A., Robinson, J. C., & Stewart, M. W. (2017, October). Healthcare quality: a concept analysis. In Nursing forum (Vol. 52, No. 4, pp. 377-386). Doi: 10.1111/nuf.12207

Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons, and alarms. BMJ Open Quality, 6(2), e000119. https://bmjopenquality.bmj.com/content/6/2/e000119.

Dwivedi, R., & Dwivedi, P. (2021). Role of Stakeholders in Project Success: Theoretical Background and Approach. International Journal of Finance, Insurance and Risk Management XI (1), 38-49. https://www.researchgate.net/publication/351638322_Role_of_Stakeholders_in_Project_Success_Theoretical_Background_and_Approach

Hashish, A., Aly, E., & Alsayed, S. (2020). Evidence-Based Practice and its Relationship to Quality Improvement: A Cross-Sectional Study among‎ Egyptian Nurses. The Open Nursing Journal, 14(1). DOI: 10.2174/1874434602014010254.

Hemsley, B., Steel, J., Worrall, L., Hill, S., Bryant, L., Johnston, L., … & Balandin, S. (2019). A systematic review of falls in hospital for patients with communication disability: Highlighting an invisible population. Journal of safety research, 68, 89-105. https://doi.org/10.1016/j.jsr.2018.11.004

Jazieh, A. R. (2020). Quality Measures: Types, Selection, and Application in Health Care Quality Improvement Projects. Global Journal on Quality and Safety in Healthcare, 3(4), 144-146. https://doi.org/10.36401/JQSH-20-X6

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273-283. Doi: 10.1016/j.cger.2019.01.007

Lorini, C., Porchia, B. R., Pieralli, F., & Bonaccorsi, G. (2018). Process, structural, and outcome quality indicators of nutritional care in nursing homes: a systematic review. BMC health services research, 18(1), 1-14. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-2828-0.

Mileski, M., Brooks, M., Topinka, J. B., Hamilton, G., Land, C., Mitchell, T., … & McClay, R. (2019, March). Alarming and/or alerting device effectiveness in reducing falls in long-term care (LTC) facilities? A systematic review. In Healthcare (Vol. 7, No. 1, p. 51). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare7010051

Montejano-Lozoya, R., Miguel-Montoya, I., Gea-Caballero, V., Mármol-López, M. I., Ruíz-Hontangas, A., & Ortí-Lucas, R. (2020). Impact of Nurses’ Intervention in the Prevention of Falls in Hospitalized Patients. International Journal of Environmental Research and Public Health, 17(17), 6048. Doi: 10.3390/ijerph17176048

Shin, N., & Park, J. (2018). The Effect of Intentional Nursing Rounds Based on the Care Model on Patients’ Perceived Nursing Quality and Satisfaction with Nursing Services. Asian Nursing Research, 12(3), 203-208. Doi: 10.1016/j.anr.2018.08.003

Venema, D. M., Skinner, A. M., Nailon, R., Conley, D., High, R., & Jones, K. J. (2019). An observational study of patient and system factors associated with unassisted and injurious falls in hospitals. BMC Geriatrics, 19(1), 1-10. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1368-8

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Assignment 1: Applying Project Management Approaches for a Quality Improvement Practice Gap
Project management allows for a clear and focused workflow to approach an issue or task. These approaches streamline a process, allow for checks and balances, and ensure all stakeholders are active participants in the process. Project management approaches often utilize SMART objectives to define and set the objectives for the project.

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Each letter of the acronym SMART defines a different criterion for the objective. A SMART objective is specific, measurable, assignable, realistic, and timely. These objectives help to steer the work and direct the stakeholders to the completion of the project.
For this Assignment, you will reflect on project management approaches that could be used to address a quality improvement practice gap. You will develop SMART objectives for the planning and execution of a quality improvement project, and will consider potential project management approaches or activities that could be used in executing this project.
To Prepare:
• Review the Learning Resources for this week, and consider the approaches of project management.
• Refer to the Week 3 Discussion, and reflect on the quality improvement practice gap you identified.
• Consider how you might apply the project management approaches examined this week to address the quality improvement practice gap you identified.
• Think about how you might develop SMART objectives for the planning and execution of a project to address the quality improvement practice gap you identified.
• Consider any other project management approaches or activities you might recommend using for your project that will address the quality improvement practice gap you identified.
The Assignment: (2–3 pages)
• Briefly describe the quality improvement practice gap you identified in your nursing practice or organization. Be specific.
• Develop at least two SMART objectives you might apply in the project planning phase or execution phase to address the quality improvement practice gap you identified.
• Recommend at least two project management activities you would use for your project, addressing the quality improvement practice gap you identified. Explain your justification for why these activities would provide the best support. Be specific and provide examples.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Part 2

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.

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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.
o 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.
o 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:
o Describe the definition of the measure.
o Explain the numerical description of how the measure is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.).
o Explain how the data for this measure are collected.
o Describe how the measurement is compared externally to other like settings, and differentiate between the actual rate and a percentile ranking. Be specific.
o Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
o 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.
o 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.
o 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.

Resources

Sipes, C. (2020). Project management for the advanced practice nurse (2nd ed.). Springer Publishing Company.

Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.

http://www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx

http://www.ihi.org/resources/Pages/Tools/RCA2-Improving-Root-Cause-Analyses-and-Actions-to-Prevent-Harm.aspx

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Grading rubric for Applying Project Management Approaches for a Quality Improvement Practice Gap		Excellent	Good	Fair	Poor
Briefly describe the quality improvement practice gap you identified in your nursing practice or organization. Be specific.		23 (23%) – 25 (25%) The response accurately and clearly describes in detail the quality improvement practice gap identified in their nursing practice or organization. The response provides accurate and specific details that fully support the selection of the quality improvement practice gap identified.	20 (20%) – 22 (22%) The response accurately describes the quality improvement practice gap identified in their nursing practice or organization. The response provides accurate details that support the selection of the quality improvement practice gap identified.	18 (18%) – 19 (19%) The response inaccurately or vaguely describes the quality improvement practice gap identified in their nursing practice or organization. The response provides inaccurate or vague details that may support the selection of the quality improvement practice gap identified.	0 (0%) – 17 (17%) The response inaccurately and vaguely describes the quality improvement practice gap identified in their nursing practice or organization, or it is missing. The response provides inaccurate and vague details that do not support the selection of the quality improvement practice gap identified, or it is missing.
Develop at least two SMART objectives you might apply in the project planning phase or execution phase to address the quality improvement practice gap you identified.		32 (32%) – 35 (35%) The response accurately and completely develops two SMART objectives that comprehensively address the quality improvement gap identified.	28 (28%) – 31 (31%) The response accurately develops two SMART objectives to address the quality improvement gap identified.	25 (25%) – 27 (27%) The response inaccurately or vaguely develops two SMART objectives to address the quality improvement gap identified. OR The response develops less than two SMART objectives.	0 (0%) – 24 (24%) The response inaccurately and vaguely develops two SMART objectives to address the quality improvement gap identified, or it is missing.
Recommend at least two project management activities you would use for your project addressing the quality improvement practice gap you identified, and explain your justification for why these activities would provide the best support. Be specific, and provide examples.		23 (23%) – 25 (25%) The response accurately and clearly describes in detail two project management activities to address the quality improvement practice gap identified. The response includes relevant, specific, and appropriate examples that fully support the justification for the use of project management activities to address the quality improvement practice gap identified.	20 (20%) – 22 (22%) The response accurately describes two project management activities to address the quality improvement practice gap identified. The response includes relevant, specific, and accurate examples that support the justification for the use of project management activities to address the quality improvement practice gap identified.	18 (18%) – 19 (19%) The response inaccurately or vaguely describes two project management activities to address the quality improvement practice gap identified. OR The response recommends less than two project management activities. The response includes inaccurate and irrelevant examples that may support the justification for the use of project management activities to address the quality improvement practice gap identified.	0 (0%) – 17 (17%) The response inaccurately and vaguely describes two project management activities to address the quality improvement practice gap identified, or it is missing. The response includes inaccurate and vague examples that do not support the justification for the use of project management activities to address the quality improvement practice gap identified, or it is missing.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.		5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.	3 (3%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	0 (0%) – 2 (2%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement,ntroduction, or conclusion was provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation		5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	4 (4%) – 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors.	3 (3%) – 3 (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors.	0 (0%) – 2 (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.		5 (5%) – 5 (5%) Uses correct APA format with no errors.	4 (4%) – 4 (4%) Contains a few (1 or 2) APA format errors.	3 (3%) – 3 (3%) Contains several (3 or 4) APA format errors.	0 (0%) – 2 (2%) Contains many (≥ 5) APA format errors.
	Total Points: 100

Rubric for Tools for Measuring Quality

	Excellent	Good	Fair	Poor
Describe the three rate-based measures of quality you selected, and explain why.	18 (18%) – 20 (20%) The response accurately and clearly describes in detail three rate-based measures of quality. The response provides accurate and specific details that fully support the selection of the three rate-based measures described.	16 (16%) – 17 (17%) The response accurately describes three rate-based measures of quality. The response provides accurate details that support the selection of the three rate-based measures described.	14 (14%) – 15 (15%) The response inaccurately or vaguely describes three rate-based measures of quality. OR The response describes less than three rate-based measures of quality. The response provides inaccurate or vague details that may support the selection of the rate-based measures described.	0 (0%) – 13 (13%) The response inaccurately and vaguely describes three rate-based measures of quality, or it is missing. The response provides inaccurate and vague details that do not support the selection of the rate-based measures described, or it is missing.
Deconstruct each rate-based measure to include the definition of each measure, explanation of the numerical description of how the measure is constructed, explanation of how the data is collected, description of how the measure is compared externally, explanation of whether or not the measure is risk adjusted, and a description of the how goals might be set for each measure. Be specific, and provide examples.	23 (23%) – 25 (25%) The response accurately and clearly explains in detail each of the three rate-based measures. The response accurately and clearly explains all elements of each measure, including: the definition of the measure, explanation of the numerical description, explanation of how the data is collected, description of how the measure is compared, explanation of risk, and description of goals. The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the three rate-based measures described.	20 (20%) – 22 (22%) The response accurately explains each of the three rate-based measures. The response accurately explains the elements of each measure, including: the definition of the measure, explanation of the numerical description, explanation of how the data is collected, description of how the measure is compared, explanation of risk, and description of goals. The response includes relevant, specific, and accurate examples that support the explanations provided for each of the three rate-based measures described.	18 (18%) – 19 (19%) The response inaccurately or vaguely explains each of the three rate-based measures. The response inaccurately or vaguely explains the elements of each measure. The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the three rate-based measures described.	0 (0%) – 17 (17%) The response inaccurately or vaguely explains each of the three rate-based measures, or it is missing. The response inaccurately or vaguely explains the elements of each measure, or it is missing. The response includes inaccurate and vague examples that do not support the explanations provided for each of the three rate-based measures described, or it is missing.
Describe the importance of each measure to a chosen clinical organization and setting. Be specific as to the setting.	18 (18%) – 20 (20%) The response accurately and clearly explains in detail the importance of each measure to a chosen clinical organization and setting. The response provides accurate and specific details that fully support the selection of the three rate-based measures and the clinical organization or setting described.	16 (16%) – 17 (17%) The response accurately explains the importance of each measure to a chosen clinical organization and setting. The response provides accurate details that support the selection of the three rate-based measures and the clinical organization or setting described.	14 (14%) – 15 (15%) The response inaccurately or vaguely explains the importance of each measure to a chosen clinical organization and setting. The response inaccurately or vaguely provides details that may support the selection of the three rate-based measures and the clinical organization or setting described.	0 (0%) – 13 (13%) The response inaccurately and vaguely explains the importance of each measure to a chosen clinical organization and setting, or it is missing. The response inaccurately and vaguely provides details that do not support the selection of the three rate-based measures and the clinical organization or setting described, or it is missing.
Explain how each rate-based 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.	18 (18%) – 20 (20%) The response accurately and clearly explains in detail how each rate-based measure relates to patient safety, cost of poor quality, and overall cost of healthcare delivery. The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the rate-based measures described.	16 (16%) – 17 (17%) The response accurately explains how each measure relates to patient safety, cost of poor quality, and overall cost of healthcare delivery. The response includes relevant, specific, and accurate examples that support the explanations provided for each of the rate-based measures described.	14 (14%) – 15 (15%) The response inaccurately or vaguely explains how each measure relates to patient safety, cost of poor quality, and overall cost of healthcare delivery. The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the rate-based measures described.	0 (0%) – 13 (13%) The response inaccurately and vaguely explains how each measure relates to patient safety, cost of poor quality, and overall cost of healthcare delivery, or it is missing. The response includes inaccurate and vague examples that do not support the explanations provided for each of the rate-based measures described, or it is missing.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.	3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion was provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	4 (4%) – 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors.	3.5 (3.5%) – 3.5 (3.5%) Contains several (3 or 4) grammar, spelling, and punctuation errors.	0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	5 (5%) – 5 (5%) Uses correct APA format with no errors.	4 (4%) – 4 (4%) Contains a few (1 or 2) APA format errors.	3.5 (3.5%) – 3.5 (3.5%) Contains several (3 or 4) APA format errors.	0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors.