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Healthcare Systems Quality Models

Instructor: Maya Shapland

Maya has worked in the clinical, education, and management sections of healthcare for over 25 years and holds bachelor's degree in Speech and associate degree in Nursing.

Models of quality provide a framework for improving patient care. This lesson will describe a few models being used across the country to assist the quality team.

Quality in Healthcare

Karen is a nurse with an innovative approach to problem-solving and strong communication skills to build teams. More about her in a moment. First, let's break down quality in healthcare. It's tasked with providing a framework for improving care provided, measuring the improvements, and assisting patients and staff toward desired outcomes. The focus is patient and family-centered.

Quality models are designed to give direction to improving healthcare.

Quality Models

Karen has invited staff to participate in a quality team to improve the discharge process at her facility. Members of the team bring knowledge and experience from their perspective that can lead to a more well-rounded approach for solving issues. The members will represent clinical staff nurses, unit supervisors, unit managers, and a physician who enters the discharge orders. Quality models

Plan-Do-Study-Act Model

The Plan-Do-Study-Act (PSDA) Model assists Karen's quality team through four steps to speed the improvement process along.

Plan-Do-Study-Act
Plan Do Study Act

  1. Plan - This is the who-what-when-where-why-how for the project needing improvement. The answers to the questions will give form and substance to the improvement plan. How are you going to collect data while the test is being conducted?
  2. Do - Perform the test with the process change you want to make. Observe and record how each part of the test was performed and the results. Analyze what went well and what didn't go well and why?'

Karen's team ran a test on the steps to hasten the discharge process by getting information to the patients to look over before the nurse discharges the patient. The discharge time was reduced by 20 minutes, allowing more time to assess the patient's level of understanding.

  1. Study - Analyze the results of the test as a team. Assess the process, allowing time to consider how this works with the patients and staff. Asking the hard questions now will prevent difficult roll-out of a process with flaws.
  2. Act - Implement the process change. Karen's team tested a couple of options before the time to release the change to the staff. They began the change on a smaller unit and will advance to larger units as they work through any difficulties that arise. While improving healthcare can be dynamic, the well-thought-out pace can mean success.

Model for Improvement

Karen and her team have met to discuss what needs to change in the discharge process, what information or data do they need to know to support this project, and can change make a difference?

The Model for Improvement seeks to help quality teams understand the process further by adding three questions to the PDSA model prior to PDSA:

  • What is the goal of this project?
  • How can we collect data to support the change?
  • Is there actual improvement for the patient and staff in the changes?

This process is similar to being a private detective and collecting facts to solve the problem.

Quality Health Outcomes Model

The patient discharge test conducted by Karen's quality team will assess the patient's needs, response, and perception of the discharge process in their project. The Quality Health Outcomes Model is used to evaluate the value of care and organizational structure to improve the desired health results.

Quality Outcomes Model
Quality systems

Nursing quality professionals generated this quality model to include not only technical aspects of care but relationships between care components surrounding the patient. The quality activities focus on the patient throughout their experience and outcome of that experience.

Six Sigma

In this model, the business world married healthcare to provide data-driven change, lower healthcare costs, aim for an excellent patient experience, and reduce waste. The goal is to reduce as many problems in the patient experience as possible and provide high-quality care in the process. Karen's team is analyzing the Patient Satisfaction Survey, a tool used for improving the patient experience. results to find the areas that need to be improved in the discharge process.

Value-stream mapping is a great tool to assist quality teams to see the process of care, checking for vulnerable points where change can be made, leading to a better workflow by using a drawing similar to a road map.

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