Quality of care improvement by changes to workload assignment

for safe staffingRoberto Rivera-Olmo

NU420: Leadership and management in the changing health care environment

Barbara FindleyAugust 19h, 2015

Quality of care Quality is defined by Merriam-Webster dictionary as 1)

how good or bad something is or 2) a high level of value or excellence (Quality).

We want to look at quality of care with the second definition in mind, that quality care is the high level of value of healthcare and healthcare excellence. If we work at improving the healthcare we provided to our patients and their family we will be providing quality care.

Quality care requires support from top-level administration to bedside clinicians to support staff (Marquis & Huston, p. 517).

Quality care measurement regulations

Quality of care affects nursing directly at the bedside as well as financially. Recent changes to health care laws under the Affordable Care Act has implemented the need for quality improvement and patient safety (Brooks, 2014). The American Nurses’ Association’s white paper report emphasized on the critical role nurses played in quality improvement due to their direct impact on nursing sensitive indicators, and encourage nurses to go beyond the bedside to be leaders of quality improvement changes system wide (Gallagher, 2010).

Research findings Research shows that clinical nurses at the

bedside who take on additional patients increase the likelihood of morbidity and mortality of patients, and increases the rates of burnout and job dissatisfaction for clinicians (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). Increased morbidity and mortality decreases healthcare quality. It is important for clinical nurses to have a safe nurse to patient ratio as it is a protection for patients, improves work condition for clinicians and increases quality of care.

Workload factors There are many factors that affect the

workload of nurses and a balance must be meet to be productive and economical yet ensure safe, quality care. There are factors that affects clinicians specific to certain patient population. For example a specific patient population workload factor can be due to a language barrier, which consumes more time due to the need to find and communicate through a qualified interpreter. The next slide displays a list of workload factors.

Workload factors Chef Complaint

Co-morbidities

Assistance ADL

Risk factors

Medication Administration

Treatment Complexity

Infection Control

Disease Process

Staff Cognitive Workload

Patient-Family Involvement/Support

Documentation

Support staff

(Connor, LaGrasta & Hickey, 2015)

Hourly rounding A reduction to the nurse to patient ratio

provides better work conditions for staff (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002), as well as allow staff to engage more with patients and families. Hourly rounding gains its full value of improving quality of care when staffing is done adequately to allow full engagement between nurses and patients (Cairns, Wolff, Rack & Dudjak, 2010).

Patient family engagement and quality of care

A key to safe quality care, optimization of delivery of healthcare, and increase patient experience, is engagement of patients and their family (Lavoie-Tremblay, O’Connor, Harripaul, Biron, Ritchie, MacGibbon, & Cyr, 2014). The research done by Lavoie-Tremblay and associates concluded that bedside teams would benefit from “involving patients as partners”, and that for this to occur culture change is required to take patient opinions under consideration just as equally to those of clinicians (Lavoie-Tremblay et al., 2014). Such engagement requires clinicians to spend more time at the bedside, thus requiring the need for fewer patients per clinicians.

Conclusion For all these quality care innovations to transpire,

nurse clinicians would be required to spend more time with individual patients. Under the current system of spreading nurses thin with high nurse to patient ratios, nurses are unable to transform healthcare without either cutting corners or ignoring some patients over others. This is way it is vital for nurses to have a staffing ratio that takes into account all workload factors that are required to provide not only safe, but high quality care that increases the patient experience and sets a model for other facilities to copy.

References Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., Silber, J. H.

(2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction (p. 1987-1993). Journal of the American Medical Association.

Brooks, J. A. (2014). Quality counts: The new world of health care quality and measurement (p. 57-59). American journal of nursing.

Cairns, L. L.; Wolff, K. K.; Rack, L. L.; Dudjak, L. A. (2010). From our readers… Hourly rounding benefits patients and staff. American Nurse Today. Retrieved from http://www.americannursetoday.com/from-our-readershourly-rounding-benefits-patients-and-staff/

Connor, J. A., LaGrasta, C. & Hickey, P. A. (2015). Complexity assessment and monitoring to ensure optimal outcomes tool for measuring pediatric critical care nursing (p. 297-308). American journal of critical care.

Gallagher, R. M. (2010). The impact of nursing care on quality. American nurses association. Retrieved from http://www.nursingworld.org/mainmenucategories/thepracticeofprofessionalnursing/patientsafetyquality/reasearch-measurement/nursing-and-quality.pdf

Lavoie-Tremblay, M.; O’Connor, P.; Harripaul, A.; Biron, A.; Ritchie, J.; MacGibbon, B.; Cyr, G. (2014). The perceptions of health care team members about engaging patients in care redesign (p. 38-46). American journal of nursing.

Marquis, B. L. & Huston, C. J. (2012). Quality control (p. 517). Leadership roles and management functions in nursing: Theory and application (7th ed). Lippincott Williams & Wilkins, Philadelphia, PA.

Merriam-Webster dictionary. (n.d.) Quality. Retrieved from http://www.merriam-webster.com/dictionary/quality