Quality Improvement Case Study Research Articles

Social workers roles in achieving health quality metrics in primary care: a quality improvement case study

ABSTRACT Value-based payment models may improve patient health by targeting quality of care over quantity of health services. Social workers in primary care settings are well-positioned to improve the quality of health services for vulnerable patients by identifying and addressing patients’ social determinants of health. This case study describes a Plan Do Study Act (PDSA) quality improvement approach implemented and refined by social workers to proactively address clinical quality gaps in one family medicine practice. The studied program – entitled Gap Closure Day – was led by a team of social workers to improve quality outcomes of patients. Findings highlight the important roles of social workers as members of health care teams to improve the quality of health services and address health equity.

Quality and safety education for nurses: A bibliometric analysis.

Since its origin in the United States in 2005, Quality and Safety Education for Nurses (QSEN) has guided nurses' preparation for alleviating preventable harm and improving quality safe care. QSEN's value is illustrated through specific inclusion in the competency-based 2021 American Association for Colleges of Nursing (AACN) Essentials. The purpose of this bibliometric analysis is to explore publication patterns of the extant QSEN literature to assess QSEN's spread and global penetration and to map the available knowledge and data regarding quality and safety education for nurses. Bibliometric analysis. Two QSEN investigators and two health science librarians completed database searches to identify articles with keywords QSEN or Quality and safety education for nursing. Inclusion criteria were (1) QSEN-specific and (2) published in a peer-reviewed journal. Using PRISMA screening, the final sample included 221 articles between 2007 and 2021. Average annual QSEN publications was 14.5 articles; the highest was 26 publications in 2017. Article types were 84 research, 77 descriptive/reviews, 28 quality improvement projects or case studies, 20 statements, and 12 editorials. Focus analysis revealed 165 education articles, 35 clinical practice, 17 professional development, and 4 leadership/administration. Fourteen journals published three or more; eight were education journals. Nine topic clusters indicated areas of publication focus, including clinical teaching, simulations, performance, context, and criteria of analysis, factors of efficacy, innovation and advanced practice, patient care and outcomes, academic concepts, and research frameworks. Results reveal far less QSEN penetration for guiding professional practice, research measuring outcomes and impact, and global collaboration to examine cultural implications for diversity and inclusion. Results present future recommendations to assure all nurses worldwide have access to competency development to alleviate preventable healthcare harm. Originating in the United States (US), the QSEN project provided the seminal framework for transforming education and practice through defining the six quality and safety competencies (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics) essential to alleviate preventable healthcare harm. Results reveal opportunities to advance QSEN penetration in developing professional practice, guiding research measuring outcomes and impact, and extending global collaboration to examine cultural implications for diversity and inclusion.

A Case Study of Educational Quality Improvement of Community College through Outcomes-based Assessment in USA : Focused on Implication of the College Education in Korea

A Case Study of Educational Quality Improvement of Community College through Outcomes-based Assessment in USA : Focused on Implication of the College Education in Korea

Quality improvement and audits in clinical practice

Veterinary Evidence champions the use of evidence to enhance the quality of care provided to animals, and I am pleased to announce that the Journal will now include quality improvement case studies.

Audit and feedback of therapist-assisted internet-delivered cognitive behaviour therapy within routine care: A quality improvement case study

With the growing use of ICBT in routine care clinics there is a need for literature on how to monitor and improve the quality of therapist behaviours in clinical practice. In this paper, we first provide background literature on Audit and Feedback (A&F), a common quality improvement technique, and then present a case study regarding the use of A&F to improve quality of therapist behaviours in emails sent to patients provided with ICBT in routine care. The A&F measure used was derived from previous research on therapist's email behaviours in ICBT. Fifteen undesirable therapist behaviours (e.g., Did Not Message, Unresponsive to Symptom Increase, Does Not Address Patient Concern) were audited in 1840 emails sent from eight therapists to 198 randomly selected patients, representing 18% of 1114 patients who started between one and five lessons of ICBT in the previous year and did not formally withdraw from treatment (n = 31 patients). The therapists who were audited were provided feedback four times over a one-year period from October 2018 to September 2019. Overall, in all audit periods, we found a low percentage of undesirable therapist behaviours (i.e., therapists displayed the behaviour in 12% or less of the total emails sent). For most therapist behaviours, we saw a trend towards improvement across the four audit cycles. Three therapist behaviours (i.e., Failure to Ask One Question to the Patient, Poor Instructions, Not Linking Email to Course Content) did not follow this pattern and were flagged for clinical discussion to determine why behaviours were elevated and whether these behaviours represented unrealistic expectations. The process was valuable for monitoring and improving therapist behaviours and highlights the need for future research on standards for therapist behaviours (e.g., which behaviours to focus on, setting acceptable levels of undesirable behaviour).

Thank you to our 2019 reviewers

As Editor-in-chief I would like to thank all of our editors and reviewers for their continued support of the Veterinary Evidence journal and their diligence in meeting demanding timelines. Their knowledge, expertise and insights are duly acknowledged and highly valued. All reviewers who have taken the time to review for Veterinary Evidence are listed in the full text.
 The Veterinary Evidence Editorial Board Meeting was held on November 8th. There were some important strategic initiatives discussed and some key action points defined. These included the implementation and promotion of the new format of the clinical bottom line, the implementation of a systematic approach for generating knowledge summary questions for important conditions, initiatives to increase the engagement and scope of topics submitted by veterinary nurses, commissioning of articles on work-placed based education and other key topics, the publication of consolidated annual lists of knowledge summaries identifying weak or no evidence to sign post areas requiring future research and the promotion of quality improvement and audit case studies. I look forward to realising these important initiatives in the coming year and acknowledge the support and dedication of everyone involved in the continued innovation and success of the Journal.

Seeing the quality improvement forest through the quality improvement trees: A meta-synthesis of case studies in Florida and Georgia.

Objectives:To identify important characteristics of quality improvement applications for population health and healthcare settings and to explore the use of quality improvement as a model for implementing and disseminating evidence-based or best practices.Methods:A meta-synthesis was used to examine published quality improvement case studies. A total of 10 published studies that were conducted in Florida and Georgia were examined and synthesized using meta-synthesis (a qualitative research methodology) for meaningful insights and lessons learned using defined meta-synthesis inclusion criteria. The primary focus of the analysis and synthesis were the reported processes and findings that included responses to structured questioning in addition to emergent results from direct observation and semi-structured open-ended interviewing.Results:The key insights for the use of quality improvement in public health and healthcare settings included (1) the essential importance of data monitoring, analysis, and data-based decision making; (2) the need to focus on internal mutable factors within organizations; (3) the critical role of quality improvement team group dynamics; (4) the value of using a quality improvement collaborative or multi-clinic quality council/committee for sharing and comparing performance on key metrics; and (5) the need to identify a quality improvement approach and methods for clarification as a structured quality improvement intervention.Conclusion:In addition to the advantages of using quality improvement to enhance or improve healthcare and public health services, there is also potential for quality improvement to serve as a model for enhancing the adoption of evidence-based practices within the context of dissemination and implementation research.

Evaluating willingness to pay for the temporal distribution of different air quality improvements: Is China's clean air target adequate to ensure welfare maximization?

AbstractStated preference analyses seeking to determine the public's value for air quality improvements often estimate willingness to pay (WTP) for days at a specified minimum quality threshold (e.g., days with clean air), but do not consider the temporal distribution of pollution levels below this threshold. This paper develops a choice experiment designed to evaluate WTP for a more complete distribution of air quality improvements, including the number of days per year at multiple air quality levels. The model is applied to a case study of air quality improvement in the core districts of Xi'an City, China. Results from a linearly constrained mixed logit model demonstrate that average household WTP for improving a lightly polluted, moderately polluted, heavily polluted, or severely polluted day to a clean air day is 7.42, 8.90, 13.06, and 24.28 RMB per year, respectively. These results show that WTP depends not only on the total number of clean air days, but on the total distribution of pollution levels across all days of the year. Results are directly relevant to the development of clean air policies in China, for which benefit estimates are currently unavailable.

The sustainability of Lean in pediatric healthcare: a realist review

BackgroundLean is a quality improvement management system from the Toyota manufacturing industry. Since the early 2000’s, Lean has been used as an intervention for healthcare improvement. Lean is intended to reduce costs and improve customer value through continuous improvement. Despite its extensive use, the contextual factors and mechanisms that influence the sustainability of Lean in healthcare have not been well studied. Realist synthesis is one approach to “unpack” the causal explanations of how and why Lean is sustained or not in healthcare. We conducted a realist synthesis using the context (C) + mechanim (M) = outcome (O) heuristic, to further develop and refine an initial program theory with seven CMO hypotheses, on the sustainability of Lean efforts across pediatric healthcare.MethodsOur search strategy was multi-pronged, iterative, and purposeful in nature, consisting of database, gray literature, and contact with three healthcare organizations known for Lean implementation. We included primary research studies, published and unpublished case studies or reports, if they included Lean implementation with a pediatric focus and sustainability outcome. We used the Normalization Process Theory and the National Health Services Sustainability Model, an operational definition for Lean and a comprehensive definition for sustainability as guidance for data extraction and analysis. Our initial program theory with was refined using a blend of abductive and retroductive analytical processes.ResultsWe identified six published primary research studies, two published quality improvement case studies, and three unpublished quality improvement case reports. Five CMO hypotheses from our initial program theory were substantially supported after synthesis, “sense-making and value congruency,” “staff engagement and empowerment,” and the “ripple effect” or causal pathway between Lean implementation outcomes that served as facilitating or hindering contexts for sustainability. Overall, there was variation with the conceptualization and measurement of sustainability.ConclusionsThis study is the first to examine Lean sustainability in pediatric healthcare using realist methods. Future research should examine whether the predictors of implementation are the same or different to sustainability and evaluate the underlying mechanisms that influence the sustainability of Lean. There is also a need for research to develop and test conceptual models and frameworks on sustainability.Systematic review registrationPROSPERO-CRD42015032252.

Unpacking the black box of improvement.

During the Salzburg Global Seminar Session 565—‘Better Health Care: How do we learn about improvement?’, participants discussed the need to unpack the ‘black box’ of improvement. The ‘black box’ refers to the fact that when quality improvement interventions are described or evaluated, there is a tendency to assume a simple, linear path between the intervention and the outcomes it yields. It is also assumed that it is enough to evaluate the results without understanding the process of by which the improvement took place. However, quality improvement interventions are complex, nonlinear and evolve in response to local settings. To accurately assess the effectiveness of quality improvement and disseminate the learning, there must be a greater understanding of the complexity of quality improvement work. To remain consistent with the language used in Salzburg, we refer to this as ‘unpacking the black box’ of improvement. To illustrate the complexity of improvement, this article introduces four quality improvement case studies. In unpacking the black box, we present and demonstrate how Cynefin framework from complexity theory can be used to categorize and evaluate quality improvement interventions. Many quality improvement projects are implemented in complex contexts, necessitating an approach defined as ‘probe-sense-respond’. In this approach, teams experiment, learn and adapt their changes to their local setting. Quality improvement professionals intuitively use the probe-sense-respond approach in their work but document and evaluate their projects using language for ‘simple’ or ‘complicated’ contexts, rather than the ‘complex’ contexts in which they work. As a result, evaluations tend to ask ‘How can we attribute outcomes to the intervention?’, rather than ‘What were the adaptations that took place?’. By unpacking the black box of improvement, improvers can more accurately document and describe their interventions, allowing evaluators to ask the right questions and more adequately evaluate quality improvement interventions.

UPMC Prescription for Wellness: A Quality Improvement Case Study for Supporting Patient Engagement and Health Behavior Change.

Addressing patient health and care behaviors that underlie much of chronic disease continues to challenge providers, medical practices, health systems, and insurers. Improving health and care as described by the Quadruple Aim requires innovation at the front lines of clinical care: the doctor-patient interaction and office practice. This article describes the use of Lean Six Sigma in a quality improvement (QI) effort to design an effective and scalable method for physicians to prescribe health coaching for healthy behaviors in a primary care medical home within a large integrated delivery and financing system. Building on the national Agency for Healthcare Research and Quality and Robert Wood Johnson Foundation-funded Prescription for Health multisite demonstration, this QI case study provides important lessons for transforming patient-physician-practice support systems to better address lifestyle and care management challenges critical to producing better outcomes.

Aligning Professional Development to Continuous Quality Improvement: A Case Study of Los Angeles Unified School District’s Beyond the Bell Branch

Abstract There is a strong, empirical link between facets of afterschool program quality and a range of positive youth outcomes. However, implementing quality programs that are more likely to produce positive youth development require a high-level of knowledge and expertise among program staff. Training staff on the critical components of high-quality programming requires approaches that are systematic, ongoing, data-driven, inclusive of all staff, embedded into their organizational roles, and supported by organizational leadership. We present a case study of preliminary continuous quality improvement (CQI) system at the Beyond the Bell (BTB) Branch of the Los Angeles Unified School District. We discuss the components of a CQI system (i.e., strategic planning, development of tools, staff development and data use) as well as reflect on important organizational factors that promote CQI. Keywords: after school programming, program quality, professional development, continuous quality improvement ----- Bibl iography: Berryl, Tiffany/Sloper, Michelle/Pickar, Hannah/Talbot, Harry: Aligning Professional Development to Continuous Quality Improvement: A Case Study of Los Angeles Unified School District’s Beyond the Bell Branch, IJREE, Vol. 4, Issue 1-2016, pp. 65-84. https://doi.org/10.3224/ijree.v4i1.24776

Quality Tools and TRIZ Based Quality Improvement Case Study at PT ‘X’ A Plastic Moulding Manufacturing Industry

Theory of Inventive Problem Solving (TRIZ) is a creative encouraging problem solving method. TRIZ is prepared by Altshuller for product design. Altshuller prepared contradiction matrix and suggestion to solve contradictions usually occur in product design. This paper try to combine TRIZ with quality tools such as Pareto and Fault Tree Analysis (FTA) to solve contradiction in quality improvement problem, neither than product design problem. Pareto used to identify defect priority, FTA used to analysis and identify root cause of defect. When there is contradiction in solving defect causes, TRIZ used to find creative problem solving. As a case study, PT ’X’, a plastic molding manufacturing industry was taken. PT ‘X’ using traditional press machine to produce plastic thread cone. There are 5 defect types that might occur in plastic thread cone production, incomplete form, dirty, mottle, excessive form, rugged. Research about quality improvement effort using DMAIC at PT ‘X’ have been done by Fory Candra. From this research, defect types, priority, root cause from FTA, recommendation from FMEA. In this research, from FTA reviewed, contradictions found among causes troublesome quality improvement efforts. TRIZ used to solve the contradictions and quality improvement effort can be made effectively.

Engaging Clinical Nurses in Manuscript Preparation and Publication

Engaging Clinical Nurses in Manuscript Preparation and Publication

The Anatomy of Primary Care and Mental Health Clinician Communication: A Quality Improvement Case Study

The high prevalence of comorbid physical and mental illnesses among veterans is well known. Therefore, ensuring effective communication between primary care (PC) and mental health (MH) clinicians in the Veterans Affairs (VA) health care system is essential. The VA's Patient Aligned Care Teams (PACT) initiative has further raised awareness of the need for communication between PC and MH. Improving such communication, however, has proven challenging. To qualitatively understand barriers to PC-MH communication in an academic community-based clinic by using continuous quality improvement (CQI) tools and then initiate a change strategy. An interdisciplinary quality improvement (QI) work group composed of 11 on-site PC and MH providers, administrators, and researchers identified communication barriers and facilitators using fishbone diagrams and process flow maps. The work group then verified and provided context for the diagram and flow maps through medical record review (32 patients who received both PC and MH care), interviews (6 stakeholders), and reports from four previously completed focus groups. Based on these findings and a previous systematic review of interventions to improve interspecialty communication, the team initiated plans for improvement. Key communication barriers included lack of effective standardized communication processes, practice style differences, and inadequate PC training in MH. Clinicians often accessed advice or formal consultation based on pre-existing across-discipline personal relationships. The work group identified collocated collaborative care, joint care planning, and joint case conferences as feasible, evidence-based interventions for improving communication. CQI tools enabled providers to systematically assess local communication barriers and facilitators and engaged stakeholders in developing possible solutions. A locally tailored CQI process focusing on communication helped initiate change strategies and ongoing improvement efforts.

The Leader's Role in Quality Improvement Education: A Framework for Change

OPEN ACCESSMarch 11, 2013The Leader's Role in Quality Improvement Education: A Framework for Change Jack Scott, EdD, MPH, Lori Spitz Jack Scott, EdD, MPH Winthrop University Hospital Google Scholar More articles by this author , Lori Spitz Winthrop University Hospital Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9362 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: Implementing sound and effective educational interventions that set a vision for changing attitudes and behaviors among interprofessional teams is a fundamental role for educational leaders. This is particular challenging for educational leaders due to the lack of integration of quality teams across the academic health care continuum, especially in regards to the lack of integrated competencies in quality improvement (i.e., common medical education competencies with quality indicators). To address this, we created a turn-key approach to organizing and conducting a workshop on quality improvement in leadership for professional development facilitators. The interactive, case-based methods session guides participants through the creation of a quality improvement plan of action for a patient safety case. The case, although representative, may be easily modified for site-specific quality improvement needs (e.g., postoperation infections, hospital readmissions, etc.). Methods: This resource contains a facilitator manual, a PowerPoint slide set, and a leadership strengths self-assessment. The facilitator manual includes the lesson plan with instructional session timelines and the related instructional activities and materials need to guide a multidiscplinary group of learners through the case. Facilitators use the PowerPoint slide set to review the blood specimen mislabeling case, and review key factors in facilitating organizational change processes. Participants complete the self-assessment both before and after the session, and the results are compared to measure participant knowledge and self-efficacy, which is used as a proxy for skills application in daily practice. Results: This instructional module was initially conceived and implemented in a peer-reviewed session at the AAMC Education Conference on Academic Leadership with 20 academic health center leaders. Session outcome measures (pre-/postsession participant rating factors) revealed increased knowledge and self-efficacy. Additionally, the module was modified for a recent AAMC Quality Improvement conference for 80 multi-disciplinary healthcare leaders with similar increased outcome measures. Discussion: Each of these instructional tools provides an efficient and effective strategy in professional educational development. Further, this resource provides educational leaders with essential tools when guiding and sustaining change. Particular aspects include self-assessment in leadership and conflict resolution traits in healthcare settings. Identifying one's unique leadership traits is an essential precursor to self-efficacy in team leadership. Educational Objectives By the end of this session, learners will be able to: Identify leadership behaviors to enhance team performance.Discuss how leadership behaviors affect change and manage conflict.Recognize the effect of human factors in quality improvement.Examine educational leadership strategies in a quality improvement case study when leading the change process.Promote reflective practices for self-improvement in leading the education team. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Eight Stage Process Change.pdf MedEdPORTAL QI Ldsp Facilitator Manual.doc MedEdPORTAL QI Ldsp HC Matrix.docx MedEdPORTAL QI Ldsp.ppt QI Leadership Lesson Plan SAMPLE.docx QI Leadership Participant Materials.doc QI Leadership Post-session Assmt.docx QI Leadership Pre-session Assmt.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2013 Scott and Spitz. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsTeamworkeHealth Disclosures None to report. Funding/Support None to report. Prior Presentations Workshop presented at: AAMC Quality Improvement conference “Integrating Quality”; June 2012; Chicago, IL. Loading ...

Preventing central-line-associated bloodstream infections in pediatric specialized care units: A case study of successful quality improvement

Central line associated bloodstream infections in pediatric intensive care units extend the intensive care unit length of stay and increase the cost of hospitalization. These infections, once thought to be an accepted complication of central vascular access, are now known to be preventable. Despite using hand hygiene, full barrier protection, and proper skin disinfection with 70% isopropyl alcohol/20% chlorhexidine gluconate for pediatric central venous catheter insertion, our catheter associated bloodstream infection rate remained high. We instituted a new practice involving scrubbing the catheter hub and performing dressing changes with 70% isopropyl alcohol/20% chlorhexidine gluconate in a combined pediatric intensive care and pediatric cardiac intensive care unit. We removed alternative products from the bedside thereby making it easier for the staff to follow procedure and reducing the need for training and monitoring. This change reduced our catheter associated bloodstream infection rate from 7.1 episodes per 1000 line days to 1.5 episodes per 1000 line days. We describe the barriers we encountered in instituting this practice change, evaluating the impact of the change with limited resources, and in eventually implementing the change in other units system-wide. The most commonly encountered obstacle to change was not a lack of resources, but the insistence by the medical staff that the incidence of these infections was a result of differences in patient populations and not differences in compliance with standardized procedure.

Plagiarism: A case study of quality improvement in a taught postgraduate programme

Background: Plagiarism is a common issue in education. Software can detect plagiarism but little is known about prevention.Aims: To identify ways to reduce the incidence of plagiarism in a postgraduate programme.Methods: From 2006, all student assignments were monitored using plagiarism detection software (Turn It In) to produce percentage text matches for each assignment. In 2007, students were advised software was being used, and that plagiarism would result in penalties. In 2008, students attending a key module took part in an additional interactive seminar on plagiarism. A separate cohort of students did not attend the seminar, allowing comparison between attendees and non-attendees.Results: Between 2006 and 2007, mean percentage text match values were consistent with a stable process, indicating advice and warnings were ineffective. Control chart analysis revealed that between 2007 and 2008, mean percentage text match changes showed a reduced text match in all nine modules, where students attended the interactive seminar, but none where students did not. This indicated that the interactive seminar had an effect. In 2008, there were no occurrences of plagiarism. Improvements were maintained in 2009.Conclusions: Advice and warnings against plagiarism were ineffective but a subsequent interactive seminar was effective at reducing plagiarism.

Eliminating Catheter-Associated Urinary Tract Infections

This article is the first in a two-part series focusing on catheter-associated urinary tract infections. There is a convergence of factors necessitating zero tolerance toward catheter-associated urinary tract infections, including the risks associated with patient safety and to a lesser extent the changes in reimbursement. Part I of this series focuses on the most significant modifiable risk factor, avoiding use of urethral catheters. A quality improvement case study is highlighted along with a practice bundle for evidence-based practice. Part II focuses on the second most significant risk factor, reducing urethral catheter-days.

Translating evidence into practice for people with osteoarthritis of the hip and knee

There is an international focus on improving the quality of care for people with chronic conditions, including those with chronic rheumatic conditions such as osteoarthritis (OA). A number of evidence-based clinical practice guidelines exist to guide clinician management of OA of the hip and knee. However, gaps and delays in the integration of these recommendations into practice still remain. This paper reviews the role of clinical practice guidelines within the contemporary discourse and practice of information translation. This discussion paper uses an OA quality improvement case study to illustrate how evidence for effective implementation strategies can be used in conjunction with a practical implementation model to plan and implement quality improvement projects.