Steps Used in Assessing Organizational Gaps or Problems
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Steps Used in Assessing Organizational Gaps or Problems
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The purpose of this discussion is to assess for organizational gaps or problems, allowing us to explore the process you would follow to assess the organization.
Reflect upon your readings and consider a practice problem or the practice problem you have identified for your DNP project and respond to the following:
Describe the process you would follow to assess the organization where you plan to conduct your project for opportunities for improvement including the identification of stakeholders.
Determine the ultimate goals for your DNP project and how they relate to the organization’s mission and vision.
This week you are working on a plan for assessing your organization. As you think through that process, are you able to see how your project might affect patient safety in the focus area?
Use an APA 7 style and a minimum of 250 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no
more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. Include the Doi or URL link.
- Textbooks are not considered scholarly sources.
- Wikipedia, Wikis, .com website or blogs should not be used
Continuous Organizational Improvement and High Reliability
In the United States, healthcare costs are increasing with little improvement to the quality and efficiency of care. Dynamic healthcare organizations recognize the need for continuous organizational improvement and high
reliability of services delivered to achieve quality outcomes, efficiency, and patient satisfaction. Organizations that are not able to adapt to changes externally, with internal mobilization, will not be sustainable over time.
The main driver of continuous organizational improvement is the customer: patients. Research shows that successful organizations are very similar to their competitors, but what sets them apart is that they are better in
adapting quickly to meet or exceed patient needs, and evaluating frequently to sustain the change or initiate a new improvement (Bastian et al., 2016). Consequently, healthcare organizations who have mechanisms that support
continuous organizational improvement not only excel in their outcomes but are also resilient regarding changes in healthcare.
Healthcare organizations are complex, but must provide high quality care to succeed regardless of associated risk factors (Davenport et al., 2018). These healthcare organizations have few to zero adverse events despite
operating daily under hazardous conditions. In high reliability environments, the focus on safety is paramount and methods to prevent accidents or errors are well defined and followed by all levels of the organization. The result
is an organization that a patient can trust.
How can the DNP-prepared nurse contribute to both continuous organizational improvement and high reliability performance?
Culture of Safety
DNP practice scholars create high-reliability organizations and are committed to safety. In these organizations, everyone is aware of the interconnected and dynamic nature of daily operations and that a change in one area or
process can ripple to other areas within the organization. DNP practice scholars speak directly with frontline nurses and caregivers through executive rounds and open forums and focus on resources the employees need to
provide safe care to patients and families.
One challenge to safety and quality practices in healthcare is the complex regulatory entities that set goals for organizations to achieve and systematically collects and analyzes reports for broad dissemination to ensure that
safety best practice and safety alerts are communicated across all healthcare settings.
Review the activity below to discover various organizations impacting a culture of safety:
Important drivers of quality improvement include payors and purchasers, regulators, certifiers and creditors, professional organizations, and technical support organizations. Purchasers and payors have considerable influence on
quality and make decisions about the selection of health plans to be offered to their constituents, especially with the implementation of the Affordable Care Act and the increased obligation of employers to offer health insurance
to employees. As the cost of health insurance increases, those charged with paying for coverage are looking more closely at the value of that which is offered in exchange for their money.
The U.S. healthcare system is the most expensive in the world, yet outcomes are continually less acceptable than those obtained in other developed countries that proportionally spend less on healthcare. Especially since 2010,
there have been attempts to improve outcomes in a variety of ways. The greatest impetus to quality improvement efforts has been through the implementation of the concept of value-based purchasing, particularly by the federal
government through the Centers for Medicare and Medicaid Services, since the implementation of the Affordable Care Act (Barton, 2010).
Value-based purchasing looks not at the number of procedures performed but instead focuses on outcomes accomplished (Spaulding et al., 2018). Success under this methodology will be determined through performance in
patient quality measurements through various patient satisfaction scores, and these measurements will be assessed from available national benchmark quality metrics.
One way to implement improvement in the delivery of healthcare is through the development of Accountable Care Organizations (ACO). This is a new mechanism for the delivery of healthcare designed to manage the care of an
entire organization at a fixed cost. If the organization can accomplish the measure for less than the contracted rate, it will be more profitable; if it fails to achieve designated goals, the cost of the deficiency falls to the
organization. A key factor in defining accountable-care organizations is that the organizations need to have a robust quality measurement and improvement capacity across settings.
Quality Measures and HCAHPS
Benchmarking is a method that assists in comparing outcomes of two or more entities. Benchmarking is an excellent tool to share improvements not only in a place or time but how patient and nurse outcomes in one hospital
compare to others.
Over the past few years, the stakes have been raised as more knowledgeable consumers actively select where they will receive care, and their evaluation of their care experience begins to have an effect on payment patterns. The
federal government uses its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (Centers for Medicare & Medicaid Services, n.d.) survey to measure patients’ perceptions of their hospital
experience. Publicly available posts may be found here (Links to an external site.) . This is the first tool to help consumers compare hospitals nationally on key variables that include communication, responsiveness, cleanliness,
noise and specifically related to nursing performance. This allows for comparisons across organizations. New accreditation standards and federal regulations for hospitals provide a powerful stimulus toward culture of patient
and family-centered care.
Access the HCAHPS (Links to an external site.) link here and review and compare hospital scores related to nursing performance (e.g., nurses are respectful, nurses listen, nurses do everything to control pain). Reflect on your
thoughts about the scores and the strengths and weaknesses of those hospitals that you compared.
Strategies and Frameworks for Change
The DNP leader will play a critical role in change at this macrosystem level, as well as at the mesosystem and microsystem levels. A sound assessment of organizational culture is a method DNP leader can use to identify and
mitigate risk stemming from the organization’s culture and subcultures. Organizational culture is an abstract conception of an organization’s values, beliefs, and assumptions.
Although these basic values, beliefs, and assumptions are difficult to identify, they can have a strong effect on how a project is perceived and whether staff members are willing to collaborate on the project. Culture can be overtly
apparent, such as in the case of an organization that displays a value statement in the entry of the hospital, stating that the organization values employee input. However, culture is more subtly manifested, such as the
observation that an employee hesitates to offer a viewpoint that differs from that of upper management.
The DNP leader has an essential role in understanding the way culture influences projects and must be prepared to intervene to guide projects toward completion within a variety of organizational subcultures.
Examine your organizational culture. Does it have the hallmarks of a culture of excellence? If not, what is lacking? What changes could you, as a DNP leader, institute to improve the culture? This next portion of this lesson gives
recommendations on how a DNP leader can influence the culture of an organization.
Leadership is the first component in the transformational model and the fundamental currency of cultures of excellence. The DNP leader is the driver for instigating change. Leadership begins with a respectful environment and
the creation of trust that creates the potential for relationships. The second major component of creating a culture of excellence, beyond leadership and people, is embedding a process for continuous improvement into the
culture. The component for building excellence is using models and guiding principles. Magnet Recognition Program (ANCC, 2013) is an excellent performance model that considers the dynamic flow of organizations. Criteria-
based programs provide a map for the journey. These programs with their integrated models can be templates, applied to, or assessed against.
Change requires strong DNP leadership and commitment to engage followers. Changing a culture, moving it from mediocrity to excellence or from chaos to stability, can require an extended period of time because it involves
adjustments in every aspect of the structure and function. For successful change, there are several key roles that must be identified, and the DNP leader must adequately consider who is in what role, whether they are clear in
their role, and how their participation can be optimized in support of the change.
Readiness for change is perhaps the most difficult to achieve but is essential for successful quality and safety transformation. In order for change to happen, the workforce’s motivation must align with the goals and the process
of the organization. Readiness depends on a culture of learning. Change is a continuous process, and DNP leaders have many forces to consider. Transition has three steps, as detailed below.
- Ending—letting go of the old
- Neutral zone—the stage between when the old is gone and the new is not in place
The neutral zone can be a dangerous place where old weaknesses return, historical resentments flourish, and an increase in errors, illness, and absenteeism occurs. During this period of time, organizational performance can
deteriorate, and it is vitally important to be clear about the new process, communicate constantly and supportively, and keep the neutral zone as short as possible.
There are multiple proven strategies that can be applied to assist with performance improvement activities. It is important for the DNP leader to begin with Donabedian’s quality framework when instigating change (1980).
Donabedian stated that structural factors of the organization influence the process of care, which then impacts the effect of changes in care on the outcomes. Each element in this chain produces an effect on the element that
follows and is affected by the element that precedes it.
Donabedian defined structure as the relatively stable characteristics of the system, including providers of care, tools and resources they have at their disposal, and the physical and organizational setting in which they work.
Processes of care refer to the activities in which professionals engage to provide services to patients.
They indicate the mechanisms responsible for producing the intended outcomes and include continuity of care and technical and interpersonal management of patient care. As such, these factors explain the processes
responsible for producing the desired outcomes and subsequently the effectiveness of the organization. Donabedian noted that good structure increases the likelihood of good process, which increases the likelihood of good
Plan-Do-Study-Act Model (PDSA) (NHS Institute for Innovation and Improvement, 2008) is a successive cycle that starts off small to test potential effects on process but then gradually leads to larger, more targeted change.
Step 1: Identify the Purpose—What is known, what is not known, what will you do with the information, and what are your biases?
Step 2: Population— Who is being assessed (community, patient, organization,department, service, provider), what do stakeholders say about the population and approaches to measuring need (conduct focus groups to
determine this information), how is confidentiality maintained, is private health information(PHI) to be collected?
Step 3: Method—Will a survey be used, is data collection anonymous, will data collection be via direct observation, will data collection be quantitative, which kind of sampling method will be used?
Step 4: Instrument—Are there reliable and valid tools used, will new tools be developed, are questions clearly stated without bias, how are responses recorded and measured, is the tool easy to use, does the tool have culturally
competent language, can results be easily summarized and analyzed, will IRB and approval be required?
Step 5: Data Collection—Is there a system for collecting and analyzing data, is there a data dictionary, are there key data categories, what calculation methods will be used, and how will missing or incomplete data be managed?
Step 6: Analyses—What are the results and what are the assessment limitations?
Step 7: Use of Results—Short-term and long-term goals, resource allocation,summarized findings, and dissemination plans
National and International Practices and Health System Framework
DNP-prepared nurses should thoroughly understand that the delivery of patient care within their system will be directly linked to the macro-, meso-, and microsystems that create the care. They will be challenged with the task of
transforming and creating the culture within the organization that enables the intertwined linkages of the macro-, meso-, and microsystems to function successfully and recognize that improvement necessitates change.
Following are national frameworks and health system practices that have been developed and popularized to optimize the three levels of the healthcare system.
Steps Used in Assessing Organizational Gaps or Problems
NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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Steps Used in Assessing Organizational Gaps or Problems