Quality Improvement of Health Information Management Report Essay

Hello, this should be in apa format, in text citation included. Fully detailed (please follow the rubric)- paper should be formatted as is. So A1, A2 and etc should have own section and be labeled.

A. Write a report to the director of health information management (HIM) that analyzes current quality improvement initiatives at Fielder Medical Center by doing the following:

1. Summarize three quality improvement initiatives at Fielder Medical Center and justify why the initiatives are necessary to the center.

2. Evaluate whether each of the three quality improvement initiatives at Fielder Medical Center comply with their internal organizational processes.

3. Evaluate whether Fielder Medical Center’s three quality improvement initiatives comply with applicable standards established by federal external agencies.

4. Evaluate how Fielder Medical Center’s three quality improvement initiatives are in compliance with the necessary federal and state legal requirements.

B. Discuss how HIM professionals play a significant role in the quality and patient safety initiatives at Western View Hospital.

C. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

Data Analysis and Quality Improvement Initiative Proposal

Healthcare institutions constantly change to accommodate changing policies, regulations, and patient needs. They also change to be at par with the contemporary world of technology, the emergence of new conditions, and complications. The world is also changing, and people have increased knowledge of human rights and the desire to get quality, safe and affordable healthcare services. The local and state governments and other organizations such as the World Health Organization and the Center for Disease Control also regulate healthcare services and set care and patient safety standards.

These policies and regulations ensure that organizations meet patient needs. In addition, existing studies, healthcare leaders, multidisciplinary collaboration help organizations meet their needs. Healthcare data is thus important in helping organizations understand their position about these policies and regulations and other organizations. This paper assumes the role of a quality analyst focuses on a health care issue and proposed mitigation strategies from data analysis from St. Anthony Medical Center (SAMC’s).

Problem and Needs

Nurse Managers play vital roles in implementing QI in healthcare settings because they regulate the largest healthcare professional group and those closest to the patients. SAMC’s 2014-2015 safety report on the in-home hospice program produced by the quality assurance department shows significant data on adverse events and near misses. The report encompasses four quality indicators; length of stay less than seven days, IPU admissions, pain level 7-10 more than 24 hours, and inadequate symptoms relief more than 24 hours.

Proposed Solution

The In-home hospice program entails patient monitoring at their respective homes by healthcare professionals (nurses and physicians). Routine care involves a physical examination and consultation services using laptops with remote access to healthcare information systems. The patients requiring advanced care and admission are admitted to the IPU for a short time because the IPU resources are limited to short-term care. According to Bhatnagar and Lagnese (2021), healthcare providers manage complex symptoms, pain (mainstay service), and psychological needs. They focus on pain and symptoms relief and not cure, and pain is the most common factor affecting the quality of patients’ lives.

Analysis of dashboard metrics to Identify Quality Issues

SAMC’s hospice program data shows a decrease in the number of patients with a hospital stay in the IPU of less than seven days with seven patients (50-43). The reasons attributed to the declining rates include hasty discharges to accommodate the high patients’ influx in the IPU and late patient referral hence a limited patient management window, and they die prematurely. The IPU admissions dropped by 20 from 47 to 27. The drop could indicate better home services. The inadequate symptoms relief for more than 24 hours increased from 13 to 17. The pain level at 7-10 for more than 24 hours metrics increased by four from 13 to 17. These last two metrics are the basis of the quality improvement project. The table below shows these variations in the data.

Table 1.1

SAMC quality and safety report 2014-2015

	LOS less than seven days	IPU Admission	Pain level 7-10 more than 24 hours	Inadequate symptom relief more than 24 hours	Total
2014	50	47	13	13	126
2015	46	27	17	22	112

 

Pain and other symptoms management are the most important quality indicators for home care services. Pain and symptoms relief rely on quality physical assessment and history taking. These two activities are exclusively nursing roles. Makrides et al. (2018) state that a correct diagnosis and management interventions rely heavily on quality physical assessment and history. Pain is common in the elderly due to chronic diseases such as cancer, arthritis, diabetes, and heart diseases. These conditions have overlapping presentations such as abdominal pain, headaches, backache, nausea, and vomiting (Bhatnagar & Lagnese, 2021). Symptoms relief is thus dependent on an in-depth physical exam and history taking to ensure a correct diagnosis.

According to Yang et al. (2020), hospice care requires proactive pain and symptoms relief. The WHO pain management ladder is the recommended approach to pain management, initially developed to manage the notorious cancer pain. Pain interventions range from simple non-pharmacologic interventions such as music therapy to strong pharmacologic interventions such as morphine. Symptoms such as nausea also respond to various interventions such as eating crackers and avoiding spicy foods. At the same time, in some instances, it may require pharmacologic interventions such as ondansetron and metoclopramide. The two metrics, pain level 7-10 more than 24 hours and inadequate symptoms relief more than 24 hours, are thus crucial in hospice care patients’ management.

Outline for the Quality Improvement Initiative Proposal

Poor pain management and symptom relief are the identified healthcare gaps from the SAMC’s safety report. Nurse Managers and charge nurses develop short-term and long-term care plans to manage patients adequately. The major causes of these care gaps are deficient healthcare providers’ knowledge and inadequate patient assessment. Nurses and physicians may not have adequate knowledge and skills to perform physical exams and make correct diagnoses. Training healthcare providers is thus an important intervention in cubing the problem identified. Inadequate patient assessment can be attributed to lack of supervision and hasty assessment to finish early or provide care to many patients.

The quality improvement initiative will entail several integrated interventions: thorough provider training, standardized nursing terminologies for patient assessment, and setting alerts to help monitor data entry in healthcare information systems. Staff training is an evidence-based intervention that improves provider confidence, knowledge, skills, and immediacy of care delivery (Lamppu & Pitkala, 2021). Teaching providers the competencies for patient assessment will also enhance their skills and promote professional responsibility. Kang et al. (2021) state that standardized nursing terminologies provide a standard and easy care delivery.

A standardized patient assessment tool will help care providers collect all necessary information which will aid correct diagnosing and patient management. Trained staff will also use these standardized terminologies to determine patient needs and provide adequate symptoms relief. Alerts by the healthcare institutions to show when certain information in the healthcare technologies is missed will be integral in ensuring healthcare providers exhibit professional responsibility. Lintern and Motavalli (2018) show that healthcare information systems help healthcare leaders determine gaps, hence preventing them. Healthcare providers’ training, standardized nursing technologies, and system alerts on missed data entry will significantly enhance the management of the existing problem.

Proposed Model of the QI Outline

Several quality improvement models are suitable for healthcare institutions, such as the Six Sigma, Donobedian, and PDSA cycle models. The DMAIC model is widely used in healthcare settings due to its applicability and flexibility. Healthcare leaders play a significant role in change management, and the Six Sigma model an indispensable tool. Anthony et al. (2018) state that change management is integral in QI’s implementation. Quality improvement project helps develop projects that meet all the desired patient needs.

The Six Sigma model is a five-step model. The first step, define, entails explaining the initiatives in detail. It also entails the development of organizational goals and objectives that align with local, regional, and national benchmarks. The step also helps identify the scope of the QI major stakeholders and develop the project charter. The second step, measure, entails data collection by stating which data, where, how, and by whom, and its analysis entails internal and external benchmarking (Anthony et al., 2018). The third step, analysis, entails differentiating good and bad performances and causes of inefficiencies. At this stage, healthcare leaders use benchmark data to determine possible solutions and determine priority areas requiring more urgent attention.

The fourth step, improve, involves revising the improvement process to determine improvement areas and improve them. At this stage, the leaders develop the action plan based on the project charter, share it with stakeholders, seek feedback, incorporate it, and implement the QI. Mistake proofing, asking the five whys, brainstorming, and hypothesis testing are effective tools to aid success in these third and fourth stages (Anthony et al., 2018). The last step, controlling, entails ascertaining and measuring progress as stipulated in the action plan and project charter using a well-written controlling plan. By following this model, the healthcare leaders will fully implement the QI and determine its effectiveness.

Knowledge Gaps, Uncertainty, Unanswered Questions, and Missing information

Quality improvement projects also face drawbacks that would affect their successful implementation. The data provided for the In-home hospice program has only four indicators. The four indicators help point to a problem. However, they do not provide details on the causes, making it challenging to develop the cause-effect relationship, which is vital for quality improvement projects. The quality indicators should be varied to include the reasons for admission and discharge from the IPU, IPU to home death rates ratio, and patient satisfaction rates to provide vital data for the quality improvement project.

The data provided is limited to IPU and home settings and does not include other departments. Hospice care is different from care in other hospital departments but also bears many similarities. Organizational culture reflects across all departments. Comparing similar indicators such as wrong diagnosing, medication errors, and gaps in healthcare data collection would help determine if the problem only affects the hospice program or the entire hospital. Hence, the information would determine the need for organizational and or departmental change.

Integration of Interprofessional Perspectives That Support Quality Improvement

The QI’s major stakeholders are the healthcare leaders, nurses, physicians, and patients, and they all have vital roles to play. Healthcare leaders coordinate all other stakeholders by leading the team. They also play a critical role in influencing other professionals to buy into the quality improvement project. Healthcare leaders approve projects and provide financial resources, important aspects of the QI. Nurses and physicians will execute the set interventions such as standardized interventions and learned knowledge for better patient outcomes, report on the various care aspects, and provide data. The patients are important stakeholders in the execution face, whose primary role is providing feedback and collaborating in the care provision process.

Leaders must ensure that all healthcare professionals play their roles in the QI to ensure that healthcare leaders practice open and free communication (Anderson et al., 2019). It ensures that professionals understand their roles, promote responsibility, and avoid role confusion. Open and free communication ensures the free flow of information and feedback, speeding up the project processes. Professionals communicate freely with their leaders, increasing deliberation and creating room for decision-making. In addition, errors are noted and mended early before problems arise, thus promoting efficiency and success.

 Shared decision-making is an effective strategy in promoting interprofessional collaboration. Healthcare professionals are more likely to participate in quality improvement projects when they perceive that they are respected and that their input is valued (Hanum & Findyartini, 2020). Individuals also tend to put more effort into projects they feel part of than projects developed without their knowledge or consultation. Shared decision-making also helps build trust between leaders and their subordinates, improving interprofessional collaboration (Hanum & Findyartini, 2020).

Electronic health records are excellent healthcare data sources for quality improvement initiatives evaluation (Wani & Malhotra, 2018). The outcomes are linked to the quality indicators. The change in the number of patients reporting pain levels of 7-10 for more than 24 hours and inadequate symptom relief more than 24 hours will determine the effectiveness of the QI. The Heath information alerts analysis will also help determine the professionals’ compliance to standardized terminologies set for the QI project.

An assumption for the success of the QI is that professionals will execute their roles in collaboration with each other. Interprofessional collaboration is important for the success of a QI, and its absence leads to utter failure. A QI will always fail if some professionals fail to collaborate to play the different roles in a QI. Lutfiyya et al. (2019) state that interprofessional collaboration leads to better patient outcomes, quality care, and patient safety. It also enhances the achievement of goals leading to job satisfaction and the subsequent increase in productivity. Success is a compelling psychological reward to the healthcare providers who collaborate in care delivery. The QI will increase the professional’s knowledge, thus improving their confidence and efficiency at work. Better patient outcomes lead to a better working environment and better quality lives (Lutfiyya et al., 2019). Integration of the interprofessional perspectives and the Six Sigma/DMAIC model will greatly help improve the quality of the QI.

Effective Communication Strategies to Promote Quality Improvement

Communication is a major predictor of success in healthcare settings; it impacts all interactions, healthcare relationships, and care collaboration. Anderson et al. (2019) state that effective communication is important when handling hospice care patients due to the moment’s tension. Communication takes on different tones and strategies with varying audiences and environments. There are several assumptions to consider when deciding on the communications strategy of choice. One of these assumptions is that the strategy must ensure a common ground is determined, and the presenter utilizes the common ground to deliver the required information. In addition, both parties should have excellent communication skills to ensure quality feedback for the QI and clinical practice is guided by autonomy based on the existing knowledge and the available options. The last assumption is that a communication culture is the backbone of information flow at the organizational level. These assumptions imply that proper and detailed communication will help get buy-in from the stakeholders in this QI.

Communication will entail multimedia interventions, that is, audio and visual presentations. Multimedia interventions effectively deliver messages because information seen and heard tends to stick more than information only seen or only heard. A PowerPoint presentation with detailed visuals (videos, pictures, graphs, pie charts, and tables) will help show the exact problem to the stakeholders and convince them to play their roles in the QI (Soicher & Becker‐Blease, 2020). Understanding the underlying issue will then promote buy-in and participation by these stakeholders. The presentation should be detailed and audience sensitive to exclusively meet their needs and enlighten them on their roles.

Process mapping presentations is an effective communication strategy that compiles all information of a project, its activities, and the roles and responsibilities of the various stakeholders (Antonacci et al., 2019). Process mapping is an effective communication tool that fills in all stakeholders’ roles by stating the project’s problem, objectives, roles, budgeting, controlling, and evaluation processes. Process mapping can be done as a presentation or produced as a document to the stakeholders, thus creating a buy-in. People often make the best decisions when they have all the information. The possibility of their involvement until completion also increases when they have all the information from the beginning (Antonacci et al., 2019). Process mapping is essential for healthcare providers and donors (in projects requiring donors) because it provides a step-to-step analysis of the QI, making it easy to follow during execution.

The choice communication model is the CUS. The model helps healthcare providers air problems and begin seeking QI changes to address the issues of concern. From the data analyzed, I am uncomfortable because the hospice program inadequately manages pains and relieves symptoms, which are the backbone of hospice care. The safety of the hospice care patients is at risk because poor pain and symptom relief lead to poor quality of life for these patients. The CUS model will inform the problem analysis and problem presentation stages of the QI.

Adverse Event or Near-Miss Data Must be factored into Outcomes and Recommendations.

Patient evaluation and follow-up in the nursing process are often ignored. Lack of patient revaluation after initiating therapy may lead to overlooked complications, leading to complications, adverse events, and near misses. For example, opioid analgesics may cause constipation and tolerance, making pain relief difficult (Mercadante, 2019).

QIs should factor in an adverse event and near-miss data into outcomes and recommendations. Aggressive pain and symptom relief may become another safety issue for this QI. Patients easily tolerate medications for pain and symptoms management. Thus, they are offered in tapered dosages, which can have various adverse effects on these individuals. These drugs have side effects, and data on the development of adverse drug effects on hospice care patients should also be factored in this QI. Adverse effects and near-miss data for drug interactions should also be factored in. In addition, readmissions that indicate poor pain and symptoms management will be an important metric in future quality improvement (DeAngelis & Lowry, 2021).

Conclusion

Healthcare institutions constantly analyze their data to determine areas for improvement and plan quality improvement projects. Thorough data analysis helps determine errors in care delivery and their possible causes. SAMC’s In-home hospice program 2014- 2o15 data shows significant pain and symptom relief problems. Standardized terminologies, health information systems data entry alerts, and staff training on patient assessment data are proposed to manage this problem. Interprofessional collaboration is a critical factor in determining the success of the QI. Process mapping presentations using multimedia such as PowerPoint presentations will help get buy-in from the stakeholders. LL these factors will enhance the successful implementation of the QI.

 

 

 

 

 

 

References

Anderson, R. J., Bloch, S., Armstrong, M., Stone, P. C., & Low, J. T. (2019). Communication between healthcare professionals and relatives of patients approaching the end-of-life: a systematic review of qualitative evidence. Palliative Medicine, 33(8), 926-941. https://doi.org/10.1177/0269216319852007

Antonacci, G., Reed, J. E., Lennox, L., & Barlow, J. (2018). The use of process mapping in healthcare quality improvement projects. Health Services Management Research, 31(2), 74-84. https://doi.org/10.1177/0951484818770411

Antony, J., Palsuk, P., Gupta, S., Mishra, D., & Barach, P. (2018). Six Sigma in healthcare: a systematic review of the literature. International Journal of Quality & Reliability Management. https://doi.org/10.1108/IJQRM-02-2017-0027

Bhatnagar, M., & Lagnese, K. R. (2021). Hospice care. (1st Ed.). StatPearls [Internet].

DeAngelis, J., & Lowry, M. F. (2021). Hospital readmissions in hospice patients: evaluation of medication-related causes for readmission. American Journal of Hospice and Palliative Medicine®, 38(7), 745-749. https://doi.org/10.1177/1049909120959641

Lamppu, P. J., & Pitkala, K. H. (2021). Staff training interventions to improve end-of-life care of nursing home residents: A systematic review. Journal of the American Medical Directors Association, 22(2), 268-278. https://doi.org/10.1016/j.jamda.2020.09.011

Lintern, G., & Motavalli, A. (2018). Healthcare information systems: the cognitive challenge. BMC Medical Informatics And Decision Making, 18(1), 1-10. https://doi.org/10.1186/s12911-018-0584-z

Lutfiyya, M. N., Chang, L. F., McGrath, C., Dana, C., & Lipsky, M. S. (2019). The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes-based literature published between 2010 and 2018. PloS One, 14(6), e0218578. https://doi.org/10.1371/journal.pone.0218578

Makrides, T., Baranowski, L., & Helmer, J. (2021). Advanced care or advanced life support–what are we providing? Australasian Journal of Paramedicine, 18. https://doi.org/10.33151/ajp.18.950

Mercadante, S. (2019). Opioid analgesics adverse effects: the other side of the coin. Current Pharmaceutical Design, 25(30), 3197-3202. https://doi.org/10.2174/1381612825666190717152226

Yang, J., Bauer, B. A., Wahner-Roedler, D. L., Chon, T. Y., & Xiao, L. (2020). The modified WHO analgesic ladder: is it appropriate for chronic non-cancer pain? Journal of Pain Research, 13, 411. https://dx.doi.org/10.2147/JPR.S244173

Campione, J., & Famolaro, T. (2018). Promising practices for improving hospital patient safety culture. The Joint Commission Journal on Quality and Patient Safety, 44(1), 23-32. https://doi.org/10.1016/j.jcjq.2017.09.001

Hanum, C., & Findyartini, A. (2020). Interprofessional shared decision-making: a literature review. Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education, 9(1), 81-94. https://doi.org/10.22146/jpki.49207

Wani, D., & Malhotra, M. (2018). Does the meaningful use of electronic health records improve patient outcomes?. Journal of Operations Management, 60, 1-18. https://doi.org/10.1001/jamanetworkopen.2019.1709

Soicher, R. N., & Becker‐Blease, K. A. (2020). Testing the segmentation effect of multimedia learning in a biological system. Journal of Computer Assisted Learning, 36(6), 825-837. https://doi.org/10.1111/jcal.12485