Quality Improvement Project Part 3- High Cost of Care Over Quality of Care

Quality Improvement Project Part 3- High Cost of Care Over Quality of Care

Part 1: Quality Improvement Project

The ever-rising cost of surgery care in the United States has been a growing concern, with current costs ranging between $25,000 for simple surgeries such as gastric bypass to $170,000 for heart valve replacement. Operating rooms within surgical units, being major cost centers for hospitals, contribute the majority of healthcare costs (Lee et al., 2019). This paper explores the Med-Surg unit at Fairview St. John’s Hospital, discusses how quality improvement projects are implemented within the hospital and the unit, as well as the cost of surgery care over the quality of care, an issue in the unit. It also discusses the implications of high cost over quality as an issue in units on nurses and patients, outlines the quality improvement process including goal-setting and development of an intervention, and proposes a PDSA cycle to support the implementation of the intervention and continuous quality improvement. It also reflects evidence-based practice in nursing, as well as a personal philosophy with regard to nursing practice and leadership.

Background

Clinical Site Information

The current clinical site is at the Med-Surg Unit of the Fairview St. John’s Hospital. Fairview St. John’s Hospital is an 184-bed facility located in Maplewood, Minnesota. It is a state-of-the-art care awarding-winning facility that is designed to provide a wide range of medical and surgical healthcare services, including diagnostic and therapeutic services. It is also designed to provide complex procedures and specialized treatments based on need. The facility’s services are designed to cater to the needs of the general population, including children, adult, and geriatric patient populations from all social and racial groups. The Fairview St. John’s Hospital is able to provide quality and compassionate care as it employs a patient-centered and collaborative model of care that aligns with its traditions, mission, vision, and values. Its mission is “to heal, discover and educate for longer, healthier lives” while its vision is “driving a healthier future.” The facility’s values are centered on dignity, integrity, service, compassion, and innovation for better care.

The Med-Surg Unit is one major unit within the Fairview St. John’s Hospital. It provides various surgery care services. The Med-Surg Unit within the entire facility is committed to continuous quality improvement (CQI) to further ensure the highest possible patient outcomes and experiences. The hospital and the Med-Surg Unit implement CQI projects through a collaborative approach and a research and data-driven process. The hospital also understands the need for CQI and continuously educates and trains all staff while employing an efficient feedback mechanism in line with its culture of excellence.

Identified Issue

An issue that has been identified in the Med-Surg Unit is the high cost of care. The cost of surgery care has been rising over the years despite the existence of private insurance as well as publicly accessible programs such as Medicare and Medicaid (Kaye et al., 2020. From experience, the high cost of surgery care significantly impacts the quality of care with significant implications for hospitals, nurses, and patients. Notably, high costs of surgeries and surgery care are the leading factors for delayed and canceled surgeries. Delays or cancellations of surgeries lead to financial loss for the hospital and undesired patient outcomes and experiences (Al Talalwah & McIltrot, 2019). For patients, it leads to suboptimal patient outcomes, higher costs of care, poor experiences, and poor satisfaction, while for nurses, the high costs of surgery care threaten their employment as the facility can lose revenue from cancellations in addition to an increase in workload and stress (Jack et al., 2022).

Quality Improvement Process

The quality improvement project aims to optimize the efficiency within the Med-Surg Unit in order to reduce the costs of surgery care within the unit and achieve a higher quality of care. Indicators for change as an improvement will be assessed and tracked based on measurable outcomes such as notable cost reductions after the QI project, patient-reported experiences, and patient satisfaction scores. Some of the changes that the QI project will implement to result in improvement include improving the processes of patient transfer within and from outside the unit, reducing time wastages, and improving efficiency in communication, which enforce evidence-based practices.

SMART Goal

The goal is to reduce the cost of surgery care by 10% through the reduction of the average length of patient stay in the Med-Surg Unit by 10% in 6 months and by 15% in 10 months while ensuring improved surgery care quality and high patient satisfaction scores.

Root Cause Identification

A root-cause analysis of the Med-Surg Unit processes and review of the literature identify two overarching root causes of the high costs over quality of care: delays and inefficiencies in patient transitions to and from the unit with some delays in operating room allocations, as well as longer stays within the unit. Kaye et al. (2020) argue that the high costs of surgical care are majorly due to the poor understanding of the actual costs of care, while (Fu et al., 2020) link such costs to delayed surgeries. Delayed surgeries are a major risk for developing hospital-acquired infections, including surgery site infections, which may contribute to further costs of care (Fu et al., 2020). On the other hand, prolonged inpatient stay post-surgery increases the overall costs of care (Mao et al., 2019).

Chosen Intervention

The QI plan will implement a comprehensive Med Surg Unit operating protocol in which all of the unit’s operations, operating room bookings and allocations, discharge, and prioritization of OR allocations will be automated and centrally coordinated. From a business process management perspective, automation of tasks in healthcare settings significantly influences clinical processes, including key factors such as the involvement of the clinical staff (De Ramón Fernández et al., 2020). Automation of processes also significantly improves communication processes and standardizes all unit and OR processes while creating an environment of learning innovations, which have a significant impact on operating room efficiency, better patient outcomes, and reduction of costs for the health system and the patient (Lee et al., 2019).

Proposed PDSA Cycle

Plan

This will involve the development of the new automated operating protocols, including procuring necessary technologies for the Med-Surg Unit, as well as educating the unit’s staff on the new changes to the operating processes.

Do

This will involve the implementation and integration of the automated operating protocol into daily practice. Plain language and clear communication with the unit’s staff will be employed to ensure successful implementation, adoption, and integration.

Study

The new protocols will be monitored with a focus on key indicators such as patient transition efficiency, length of stay in the unit, prioritization of OR booking, and patient satisfaction scores. Valuable feedback will be collected from the staff and the patients.

Act

Based on key indicator outcomes data and feedback, the automated protocols will be modified accordingly and in line with Fairview St John’s Hospital’s culture of CQI, the staff will continuously be educated on the new processes and the changes reinforced.

Implications and Limitations

Implementing the automated protocols within the Med-Surg Unit is more likely to increase the unit staff’s workload during the initial stages of implementation due to the increased flow of patients. However, it is expected to reduce their workload as efficiency is fully achieved. It will also reduce patients’ waiting times and lengths of stay in the unit, leading to improved experiences and reduced costs of care. Regardless of the efficiency that automating protocols promises, limitations such as staff resistance are anticipated due to the concerns over role replacement with the use of technology and an increase in workload. However, such resistance will be addressed through inclusion in protocol design, clear and regular communication, and staff education to address concerns.

Part 2: Reflection

Evidence-Based Practice

Nurses are critical players in healthcare improvement. As frontline workers, they understand the health system, patient needs, and care delivery challenges. This means they provide first-hand data that can be used in research, design interventions to address issues in healthcare, and thus contribute to the implementation of evidence-based interventions to address issues in healthcare settings. Evidence-based practice is important in healthcare as it supports the implementation of interventions grounded on research data and designed to focus on individual issues and the needs of individual patients.

Personal Philosophy

This QI project has given me new experiences in collaborative practice as well as new perspectives on leadership. I have improved my communication skills, abilities to collaborate, and my skills in leading a team to achieve a set goal in a complex care setting. My leadership skills have also grown, including my ability to identify and overcome challenges in implementing changes in practice settings and ensure teamwork regardless of resistance to achieve and sustain health improvement.

Conclusion

The high costs of care within the Med-Surg Unit have a significant impact on the quality of care, the hospital’s financial performance, and patient care outcomes and experiences. A majority of the costs are due to inefficiencies within the unit. Addressing such inefficiencies can improve the costs of care and maintain the quality of care. Through a collaborative approach, it is possible to implement an automated Med-Surg Unit Operations Protocol, achieve sustainable process changes, ensure sustainable cost reduction, and enhance patient outcomes and experience.

References

Al Talalwah, N., & McIltrot, K. H. (2019). Cancellation of surgeries: Integrative review. Journal of PeriAnesthesia Nursing, 34(1), 86–96. https://doi.org/10.1016/J.JOPAN.2017.09.012

De Ramón Fernández, A., Ruiz Fernández, D., & Sabuco García, Y. (2020). Business process management for optimizing clinical processes: A systematic literature review. Health Informatics Journal, 26(2), 1305–1320. https://doi.org/10.1177/1460458219877092/ASSET/IMAGES/LARGE/10.1177_1460458219877092-FIG3.JPEG

Fu, S. J., George, E. L., Maggio, P. M., Hawn, M., & Nazerali, R. (2020). The consequences of delaying elective surgery: Surgical perspective. Annals of Surgery, 272(2), e79. https://doi.org/10.1097/SLA.0000000000003998

Jack, K., Evans, C., Bramley, L., Cooper, J., Keane, T., Cope, M., & Hendron, E. (2022). Identifying and understanding the non-clinical impacts of delayed or canceled surgery in order to inform prioritization processes: A scoping review. International Journal of Environmental Research and Public Health, 19(9). https://doi.org/10.3390/IJERPH19095542/S1

Kaye, D. R., Luckenbaugh, A. N., Oerline, M., Hollenbeck, B. K., Herrel, L. A., Dimick, J. B., & Hollingsworth, J. M. (2020). Understanding the costs associated with surgical care delivery in the Medicare population. Annals of Surgery, 271(1), 23. https://doi.org/10.1097/SLA.0000000000003165

Lee, D. J., Ding, J., & Guzzo, T. J. (2019). Improving operating room efficiency. Current Urology Reports, 20(6), 1–8. https://doi.org/10.1007/S11934-019-0895-3/METRICS

Mao, H., Milne, T. G. E., O’Grady, G., Vather, R., Edlin, R., & Bissett, I. (2019). Prolonged postoperative ileus significantly increases the cost of inpatient stay for patients undergoing elective colorectal surgery: Results of a multivariate analysis of prospective data at a single institution. Diseases of the Colon and Rectum, 62(5), 631–637. https://doi.org/10.1097/

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Purpose: Utilizes best available evidence and information to guide decision making (PSLO 3), collect outcomes data to provide evidence for quality improvement in a variety of settings (CO 3), and utilize evidence supporting best practices.

Instructions: Students will individually write a scholarly review of their clinical group quality improvement project. They will also reflect on their experience as a nurse leader involved in a change project. The paper is to be written in APA 7^th edition formatting (see sample paper format here). There are no page requirements; ensure that all components are included.

Part 1: Quality Improvement Project

• Introduction
  • What is the purpose of your paper and what will be covered.
• Background
  • Clinical Site information
    • Purpose, patient population, model of care, mission/vision/values.
    • Explain how the site implements quality improvement projects.
  • Identified Issue
    • Include evidence that was found during the shadowing experience and in scholarly resources.
    • Implications of the issue for the nurses and patients.
  • Quality Improvement Process
    • Answer the following questions:
      • What are you trying to accomplish?
      • How will you know whether a change is an improvement?
      • What changes can you make to result in improvement?
    • Include a complete SMART Goal focused on the identified issue.
    • Include an explanation of how the root cause of the issue was identified.
    • Describe the chosen intervention. Support this intervention with scholarly articles to demonstrate that it is evidence-based.
  • Proposed PDSA Cycle
    • Include actionable steps the clinical site will need to take to plan and prepare for the proposed intervention.
    • Include at least two suggestions for implementation of the proposed intervention, such as education and communication.
    • Include implications of how the change could affect the patients, nurses, nursing assistants, and anyone else involved.
    • Explain at least one limitation identified in your plan, and suggest a potential solution.

Part 2: Reflection

• Evidence-Based Practice
  • What is the role of nurses in healthcare improvement?
  • What is the importance of evidence-based practice?
• Personal Philosophy
  • Describe your experience working on a team with your classmates on this quality improvement project.
  • How did your leadership skills grow through this experience?