NURS 8301 Week 10 Executive QI Proposal Example

Ready on the Day: An Executive Quality Improvement Proposal Pairing a Sound Technical Plan With a Named Sponsor and Chartered Team

Student Name

College of Nursing, Walden University

NURS 8301: Effectively Leading Organizations in Quality Improvement Initiatives

Instructor Name

Month Day, Year

Ready on the Day: An Executive Quality Improvement Proposal Pairing a Sound Technical Plan With a Named Sponsor and Chartered Team

Executive Summary

Request. Approval to charter a nine-month improvement project in the outpatient surgery department aimed at the morning-of cancellations that better preparation could prevent, with a named executive sponsor, protected team time and funding for evening call hours.

Aim. Cut the readiness-related cancellation rate for general surgery and urology patients from an illustrative 3.8% to 1.5% by month nine, hold it for a further three months and then carry the work to orthopedics and gynecology.

Why now. Each avoidable cancellation wastes operating room time, frustrates patients who fasted and arranged time off and displaces another patient. National work has shown that many cancellations stem from patient and facility factors that could be anticipated (Argo et al., 2009).

Decision needed. Sponsor assignment and approval of resources by the next surgical services committee meeting.

The Technical Plan

Problem and definitions. An avoidable patient-readiness cancellation is a scheduled elective case that does not proceed for one of five preventable reasons: eating or drinking against instructions, a medication that was not held, no adult to drive the patient home, incomplete testing or clearance, or a no-show the department could not contact. The denominator is all scheduled elective cases.

Framework. The project is organized under the Model for Improvement, so every change is tried at small scale and studied before it is adopted (Langley et al., 2009), and two Lean tools inside it: a process map of patient preparation and standard work for the readiness call.

Theory of change. The driver diagram names four primary drivers: consistent instructions, reliable contact before surgery, safe medication management and removal of practical barriers. Each has change ideas, such as a shared instruction sheet in the patient's language, an evening readiness call two business days ahead, an anesthesia-approved medication hold guide and escort confirmation at scheduling.

Testing ramp. The first test covers a single surgeon's list for one working week, and later cycles expand in three further cycles to all general surgery and urology cases within about two months, with predictions recorded before each cycle.

Measurement

Table 1 lists the measures leadership will see each month.

Table 1

Project Measures Reported to Leadership

Each measure is plotted monthly over time, with the dates of tested changes marked, so leaders can see whether movement follows the tested changes.

Leadership and Team

Executive sponsor. The vice president for perioperative services, who can remove barriers across surgeon offices, anesthesia and scheduling, will attend a monthly review and resolve issues the team cannot.

Project lead. A DNP-prepared nurse leader in the surgery department, with four hours a week protected for the project.

Team. Two preoperative nurses, a scheduler, an anesthesiologist, a pharmacist and the office managers of two participating surgical practices. The team charter specifies a one-hour weekly meeting, decision rights for testing changes within the department and escalation to the sponsor for changes that affect surgeon offices or policy.

Resources. Evening call hours, about six nurse hours a week during testing, and time from the pharmacist for anticoagulant reviews. Printing and translation of the shared instruction sheet into the department's three most common languages other than English.

Sustainment and Spread

Sustainment and spread are planned separately with different owners. The preoperative nurse manager will own sustainment in the pilot services: evening hours written into the staffing template, the instruction sheet built into scheduling and a standing dashboard measure, with the team reconvened if the rate exceeds target for two consecutive months. Research on the sustainability of new programs shows that partial continuation is common and that embedding changes in routines supports lasting results (Wiltsey Stirman et al., 2012). The project lead will own spread, beginning with one orthopedic and one gynecologic surgeon and adapting the call to their patients through short cycles before expansion.

Quality Improvement Determination

The project is designed as quality improvement: it tests changes to an existing clinical process in order to improve local care, uses data already collected for operations and does not assign patients to receive or not receive a change for the purpose of producing generalizable knowledge. Ethical guidance on improvement work holds that such projects still carry obligations, including protection of patient information and review proportionate to risk (Lynn et al., 2007). The proposal has been submitted to the organization's review process, which will confirm whether the work is quality improvement not requiring research review, and no data will be collected for the project before that determination is recorded.

Timeline

Months one and two cover team formation, the process map, agreement on the shared instruction sheet with the two participating practices and the first two testing cycles. Months three and four extend the evening call and the medication hold guide to all general surgery and urology cases and add text follow-up for patients not reached. Months five through nine focus on holding the change: building evening hours into the staffing template, adding the instruction sheet to the scheduling system and reviewing the run charts monthly with the sponsor. Spread planning for orthopedics and gynecology begins in month seven, so that a first orthopedic surgeon can start testing as soon as the pilot services have held the target for three months.

The sponsor will receive a one-page update each month showing the outcome run chart, the two process measures and any barrier needing executive action. A final report at month twelve will follow the SQUIRE reporting structure so that the work can be shared within the health system and, if the organization chooses, beyond it.

Risks

Three risks are named. Surgeon offices may not adopt the shared instruction sheet; the sponsor's role includes securing agreement. Nurse workload may rise; the balancing measure will show it, and call hours are funded. Medication changes carry safety risk; all medication guidance will be approved by anesthesia and pharmacy before testing.

References

Argo, J. L., Vick, C. C., Graham, L. A., Itani, K. M. F., Bishop, M. J., & Hawn, M. T. (2009). Elective surgical case cancellation in the Veterans Health Administration system: Identifying areas for improvement. The American Journal of Surgery, 198(5), 600-606. https://doi.org/10.1016/j.amjsurg.2009.07.005

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Lynn, J., Baily, M. A., Bottrell, M., Jennings, B., Levine, R. J., Davidoff, F., Casarett, D., Corrigan, J., Fox, E., Wynia, M. K., Agich, G. J., O'Kane, M., Speroff, T., Schyve, P., Batalden, P., Tunis, S., Berlinger, N., Cronenwett, L., Fitzmaurice, J. M., ... James, B. (2007). The ethics of using quality improvement methods in health care. Annals of Internal Medicine, 146(9), 666-673. https://doi.org/10.7326/0003-4819-146-9-200705010-00155

Wiltsey Stirman, S., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012). The sustainability of new programs and innovations: A review of the empirical literature and recommendations for future research. Implementation Science, 7, Article 17. https://doi.org/10.1186/1748-5908-7-17