DISCUSSION 1

I believe that the definition of quality is providing the highly reliable care that increases patient outcomes and decreases processes that take away from positive outcomes. Quality care is patient-centered and takes into consideration professional knowledge. According to Spath (2018), quality is meeting and exceeding customer expectations. This is a dynamic process that is constantly changing to improve outcomes. Since reliability is necessary for quality, I have included it in my definition. Spath (2018) also says that reliability ends when failure occurs. This is why it is necessary to ensure all processes are reliable as well. This includes medication passes, tests ordered, transport systems, etc. All aspects of the health care model are affected. As care both in the acute and community setting have become patient-centered, all settings should focus on quality of care. Prevention in the community is just as important as acute care.

Donabedian was an expert in developing and defining health care delivery. From the 1960s through out the early 2000s, he created not only a framework for health care quality, but also reminded people that the heart of health care is love – love of the job, love of the patient. If we love what we do then we can make improvements to the system (Ayanian & Markel, 2016).  Throughout my nursing career, I have seen many wasteful practices in every imaginable setting. From trauma outreach programs to the ICU during this COVID pandemic, all systems can be improved. One specific example that I can think of is in my current role as a PACU nurse.

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We have a bariatric program at my hospital. On Monday and Tuesday all the gastric sleeve surgeries are done. While caring for these patients, it was noticed that they have a lot of post op nausea that is not regularly relieved by traditional anti-emetics. Aromatherapy sticks for anti-nausea seem to help the patients and cut down on the need for unnecessary medications. The patient’s length of stay is also decreased as the nausea is relieved and the patient can get up, ambulate, and meet the requirements for discharge sooner. By using the latest evidence based practice, we are able to deliver highly reliable, and therefore quality, care that improves patient outcomes and cuts down on cost.

DISCUSSION 2

Quality care in regards to healthcare is the degree in which outcomes of patient care is carried out to the highest capability, and with the most current evidence based standards. All healthcare facilities should practice current professional knowledge that holds evidence based interventions. Up to date care allows for hospital staff and healthcare workers to be consistent in each practice all across the board.

Joseph M. Juran was a quality management consultant who lived form 1904-2008. Joseph’s idea of quality care was directed towards focusing on the human side of quality, instead of the statistical side (QP staff, 2010). Joseph changed the way companies viewed quality and how to approach it. The Pareto principle was applied to the way Juran viewed quality care, stating the issue came from the causes and not the problem (QP staff, 2010). In healthcare, the cause of an issue related to patient care should be focused on, which will aid in fixing the problem.

As a nurse, there are many problems faced in the hospital each day. One in particular regarding patient care is hospital acquired pressure ulcers. Working on a surgical trauma floor, there are many patients who are unable to ambulate immediately after admission. There are patients who are transferred to us from ICU who have been immobile for long periods of time. Not too long ago, the hospital created an evidence based practice protocol called turn teams. Turn teams allows each patient who is at risk for pressure injuries to be turned every 2 hours. Two nurses are assigned one time a day to turn all patients who are on turn teams, allowing more time for nurse/ patient interaction. Prior to the turn teams intervention, a nurse would have to turn all of their patients every 2 hours.

Since the invention of turn teams, the hospital acquired pressure injuries have been reduced to almost 50%. The cause for the problem was how time consuming it takes for a nurse to rotate each patient every two hours for a 12 hour shift. Quality care is centered on patient care. When nurses have more time to focus on total care for each individual patient, there is an increase on overall satisfaction.

DISCUSSION 3

To me, quality is the all-encompassing, measurable result of how well something performs. Quality is comprised of factors such as consistency in meeting expectations, cost-to-benefit ratio, and accessibility. My definition follows most closely with healthcare’s triple aim. The triple aim framework provides a structure for health systems to optimize performance by evaluating patient care experiences, population health, and ways to reduce healthcare costs (Triple aim for populations, 2019). This approach has been expanded to what is now called the quadruple aim. The quadruple aim also considers the work-life of the healthcare team as part of its quality measures (Yoder-Wise, 2019). The quadruple aim acknowledges that excellent health care is dependent on how well the healthcare team does their jobs.

I had an experience as a patient of wasteful practices a few years ago. I was seen in the Emergency Room (ER) of a critical care access hospital. During my initial visit, I had all the required diagnostic lab and x rays needed to confirm I needed inpatient care. Unfortunately, the hospital did not have a bed available, so I was transferred to another hospital within the system. The Level III hospital required me to register through their ER, where they insisted on redoing all the labs and x rays even though there had been no change in my condition. I challenged the wastefulness stating that everything had already been done at the previous facility, which was within the system, and all the records were available in the electronic record. The physician insisted on retesting based on a lack of confidence in the results from the previous hospital.

Eliminating repeated diagnostics would have improved my experience in multiple ways. Primarily, I would have felt like I was listened to and considered a partner in my care. Secondly, when the receiving ER physician shared the lack of confidence in the previous hospital, it made me question the overall quality of the first hospital. I had never considered the care offered by the local hospital would be “not as good” as somewhere else, and the idea was unsettling. Looking back on my scenario, I see the feelings I had were completely unnecessary and were because of the second ER physician. The third impact was financial. Duplicate testing impacts the overall costs for the patient (Ayabakan et al., 2017). The duplicate tests were not done free of charge, and I was responsible for covering the additional costs.

Evaluating this experience with my definition of quality and the triple aim goals of improved patient experience and cost management, I would say that the ER I was transferred to had room for improvement. It did not meet my expectation that physicians would consider care given across the system to be of equal value, which negatively impacted my experience. I also had additional unnecessary costs. Electronic data sharing should be used to reduce healthcare costs and expedite patient care (Ayabakan et al., 2017). The second ER did not meet that target because it did not fully utilize its technology (the electronic records) to expedite and cost manage my care

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