Quiz 2 Leadership
Multiple Factors and Inequities drive Health Disparities
(Social and Economic Inequities) Economic Stability Eighborhood and Physical Environment Education Food Community, Safety, & Social Context Health Care System
Benefits of Quality Management:
- Designated as a high-reliability organization - Increased reimbursement through value-based payment - Reduced malpractice - Increased job satisfaction
Quality Improvement Steps
- Identify Needs - Assemble Team - Collect Data - Establish Outcomes & Quality Indicators (NQI/benchmarking) - Select & Implement Plan - Collect data to evaluate
2023 Hospital National Patient Safety Goals
- Identify pts correctly - Improve staff communication - Use medicines safely - Use alarms safely - Prevent infection - Identify pt safety risks - Prevent mistakes in surgery
EXAMPLES: Encouraged Pt Safety Practices
- Multicomponent interventions (reduce falls) - Use of clinical pharmacists (reduce adverse drug events) - Documentation of pt preferences (life-sustaining tax) - Obtaining informed consent (improve pts understanding of potential risks of procedures) - Team training - Medication reconciliation - Practices to reduce radiation exposure from fluoroscopy/CT scans - Surgical outcome measurements use + report cards (ex. American College of Surgeons National Surgical Quality Improvement Program) - Rapid Response Systems - Computerized provider order entry - Simulation exercises in pt safety efforts - Utilization of complementary methods for detecting adverse events/medical errors to monitor for pt safety problems
Principles of Quality Management
- Need flat, democratic organization FLAT = nurses have more control over decisions of environment - Shared commitment to quality improvement - Improve systems and processes - don't assign blame - Outcomes focused - Relies on data-driven decisions
Techniques to Promote Pt Safety
- Peer Checking - Self-checking (STAR) STOP THINK ACT REVIEW (The action) & know what it is for - promoting pt safety - Validation & Verification - Standardized Communication Handoffs- (SBAR)
EXAMPLES: Strongly Encouraged Pt Safety Practices
- Pre-Op/Anesthesia checklists (prevent intra/post-op events) - Central Line-Associated Bloodstream Infections bundles - include checklists - Reduce Urinary Catheter Use interventions (reminders, stop orders, nurse-initiated removal protocols) - Bundles for: Head-of-bed elevation Sedation vacations Oral care c chlorhexidine Subglottic-suction ET tubes (prevent VAP) - Hand hygiene - "Do Not Use" list for hazardous abbrev - Multicomponent intervxns: reduce pressure ulcers - Barrier precautions: prevent HAI (hospital-associated infxns) - Use real-time ultrasound for central-line placement - Improve prophylaxis interventions for venous thromboembolisms
Risk =
- Severity of Failure - Likelihood of Failure - Chance of Detecting Failure Before it Happens
Human Error Classification (3 Major Categories)
- Skill-based errors: auto-pilot, lapse in attention - Rule-based errors: wrong rule, misapplication, non-compliance - Knowledge-based errors: decision-making, problem solving
Culture of Safety
1 Corinthians 12:12 Failure to comply is NOT an option. All employees have the power to speak up & stop axn that may harm someone Common Traits: - acknowledgement of high-risk, error prone nature of organization's activities - blame-free environment where individuals able to report errors/close calls w/o punishment - expectations of collab across ranks to seek slns to vulnerabilities - willingness on part of org to direct resources to address safety concerns
Diversity in the Healthcare: Leadership and Management Perspective
1. Accepting principles of multiculturalism, cross-culturalism, and transculturalism important to nursing leaders due to ethnic, cultural, and lifestyle diversity of potential patients and healthcare staff. 2. Provide culturally sensitive care to patients and balance a culturally diverse staff. 3. Respect cultural diversity in the team which fosters cooperation and sound decision making.
Seven Steps to Become a More Culturally Sensitive Nurse
1. Awareness 2. Avoid Making Assumptions 3. Learn About Other Cultures 4. Build Trust and Rapport 5. Overcome Language Barriers 6. Educate Patients About Medical Practices 7. Practice Active Listening Cultural Sensitivity in the healthcare community is no longer an option. Barriers that ae created by cultural differences: Language, cultural traditions, health literacy, and cultural assumption.
The Impact of Culture: 4 Factors
1. Culture develops over time and is responsive to its members and their familial and social environments. 2. A culture's members learnit and share it. It is passed from one generation to the next. 3. Culture is essential for survival and acceptance. 4. Culture changes with difficulty.
SDH (Social Determinants of Health)
1. Education Access and Quality 2. Health Care Access and Quality 3. Neighborhood and Built Environment 4. Social and Community Context 5. Economic Stability Def: conditions in environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks.
Objectives of DEIB
1. Evaluate the concepts of diversity, equity, inclusion, and belonging. 2. Evaluate the use of concepts of principles of acculturation, culture, culture diversity, and cultural sensitivity in leading and managing situations. 3. Analyze inequities in healthcare/health disparities and what nurses can do to minimize them. 4. Evaluate individual and societal factors involved with cultural diversity. 5. Value the contributions that a diverse workforce can make to the care of a diverse population of people.
Current Initiatives: to reach Health Equity among pts/staff
1. Office of Minority Health developed 3 priorities related to health equity a. Supporting states, territories, and tribes in identifying and sustaining health equity promoting policies, programs, and practices. b. Expanding the utilization of community health workers to address health and social services needs within communities of color. c. Srengthening cultural competence among healthcare professionals.
6 Domains of Healthcare Quality
1. Safe 2. Effective 3. Patient-centered 4. Timely 5. Efficient 6. Equitable
Magnet Recognition Program
14 Forces of Magnetism Focuses on pt safety & quality care/improvement National designation that acknowledges nursing excellence
Implicit Bias
Always present. Found in every situation. Innately influences health professionals without their knowledge and despite their best intentions.
Risk Management (They)
Analyze problems + minimize losses AFTER adverse event Trying to minimize these events. Never events = errors: Identifiable Preventable Serious in consequences Always events should occur 100% of the time (ex. Hand-washing) (what needs to change in the system to always having it occur) Sentinel event = serious unexpected occurrence Near miss = unplanned event c potential to result in harm RCA (root cause analysis) performed for BOTH sentinel events & near miss's.
Def of DEIB
Applies to all 'isms in society: age, disability, gender, ethnicity, lifestyle, race, religion, etc. Changes have been small over decades but don't feel big. Applies to both pts and staff. Provides guidelines for actively incorporating diverse as[ects into rolles of leading and managing in healthcare. Goal = embrace cultural differences while recognizing disparities and taking action regarding that
Speak Up for Safety Components
Ask - do you think we should....? Advocate - I think we need.... Assert - I'm concerned that.... If unsuccessful, use chain of command Speak directly to person but can use chain of command.
SDOH & Healthy People 2030 (United States Health Equity Efforts)
Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.
National Quality Forum (NQF) Safety & Quality Standards)
Created the "Nurse-sensitive Care Standards" MEMBERSHIP-based organization designed to: develop & implement a NATIONAL strategy for healthcare quality management & reporting ****Centers for Medicare & Medicaid Services (CMS) formed its no-pay policy based on the NQF's "never events" work
Cultural Concepts
Cultural diversity/multiculturalism Cultural sensitivity Ethnocentrism Cultural imposition Cultural acculturation Cross culturalism Cultural humility Cultural marginality
Accountability Measures
Data = public/found online Factors most important to customers = measured Performance (on accountability measures) = collected & reported
DEIB
Diversity, Equity, Inclusion, Belonging
Quality Assurance
Ensures conformity to process standards Often- through chart audit tools: Ex. Report called to unit & pts transferred w/in 1 hr? Often- FEELS punitive, BUT meant to improve pt care DID YOU DO WHAT YOU SAID YOU WOULD DO = (looking at chart)
Quality and Safety Education for Nurses (QSEN) (Quality & Safety Standards)
Extremely influential in undergrad/grad NSG programs BUT no authority Centered its program around 2003 IOM competencies for HCP: Teamwork & Collaboration Evidence Based Practice Safety Informatics Quality Improvement Patient-Centered Care
The Joint Commission (TJC) (Quality & Safety Standards)
Has "Deemed" status for CMS- Medicare/Medicaid Regular & unannounced visits ***Annual Patient Safety Goals Issues sentinel events announcements Formally known as JCAHO
Det Norske Veritas (Quality & Safety Standards)
Has "deemed" status for CMS - Medicare/Medicaid Direct competitor to TJC - Joint Commission; surveys ANNUALLY INTERNATIONALLY based organization - provides accreditation in a variety of fields
Organizations Addressing Safety & Quality Standards
National Academy of Medicine AHRQ (Agency for Healthcare Research and Quality) NQF (National Quality Forum) TJC (The Joint Commission) DNV (Det Norse Veritas) QSEN (Quality and Safety Education for Nurses) Magnet Recognition Program IHI (Institute for Healthcare Improvement)
Safety/Leadership, Management, & Followership
Nehemiah 2:17, 18 Followers = active participants in process Managers = address the problem Leaders = recognize safety issues/lead team to address problem All use RCA (root cause analysis) to address system problems that threaten pts
Institute for Healthcare Improvement (IHI) (Quality & Safety Standards)
Not-for-profit Developed the: Triple Aim Quadruple Aim Quintuple Aim
Ex. Implicit bias
Nursing students had fewer negative attitudes towards obesity. Colonoscopy screenings are recommended for ages 45+ when African Americans/POC have earlier incidence of disease.
Quality Improvement
ONGOING process of: Innovative improvements Prevention of error Development of staff used by institutions
Quality Management
Overarching philosophy: -defines a healthcare culture emphasizing: Customer satisfaction Innovation Employee involvement
Agency for Healthcare Research & Quality (AHRQ) (Safety & Quality Standards)
Primary FEDERAL agency devoted to: (of healthcare) Quality Safety Efficiency Effectiveness Resource for providers, researchers, and consumers
AACN Domain 9:
Professional Competency
RCA (Root Cause Analysis) - Examining Safety Threats
RCA is requirement by TJC for all sentinel events/near misses Must be followed by axns to eliminate risks Root Cause Analysis + ACTIONS To identify "root" cause of adverse events = 5 WHYS - method used to eep discussion ab causes focused on SYSTEM vs ppl
National Academy of Medicine (Safety & Quality Standards)
Related problems more to SYSTEMS than individuals Concerns for: Quality Patient Safety (includes nurse's role) Independent non-profit Used to be the IOM (Institute of Medicine) Watershed report 2000 "to err is human"
FMEA (Failure Mode & Effects Analysis)
Systemic proactive method for eval process to: - Identify where & how it might fail - Assess relative impact of diff failures to identify parts of process that most in need of change.
Health Equity DEF (World Health Organization)
The absence of unfair and avoidable or remedial differences in health among population groups defined socially, economically, demographically, or geographically.
RCA Practice/Example
What questions do you ask to determine potential causes? Eliminate: Materials, Mother Nature, Measurement Focus on: Machines, Method, Manpower
Leininger's Theory of Transcultural Nursing Care (Sunrise Model)
Worldview and Cultural/Social Structure Dimensions informs the "sunrise." "Sunrise:" Technological Factors Religious and Philosophical Factors Kinship and Social Factors Cultural Values, Beliefs and Lifeways Political and Legal Factors Economic Factors Educational Factors These sunrise factors inform: Influences - Care expressions, patterns, and practices - Holistic Health/Illness/Death Individuals, families, groups, communities, or institutions in diverse health context of: 1. Generic Folk Care 2. Nursing Care 3. Professional Systems These inform nursing care decisions and actions: -> Cultural care preservation and maintenance -> Cultural care accommodation and negotiation -> Cultural care repatterning and restructuring These inform cultural competent care for health, well-being or dying.