EBP QI: Healthcare Settings, Stakeholders & Implementation

This report explores the application of Evidence-Based Practice (EBP) and Quality Improvement (QI) projects within three distinct healthcare settings in Houston, Texas: St. Joseph Medical Center, Texas Children's Hospital, and Doctors Clinic Houston. It compares these settings based on their patient populations, missions, and organizational structures, highlighting their strengths and weaknesses as potential sites for EBP QI initiatives. The report identifies practical problems within these settings, such as infection control and the provision of high-quality patient care, and explains why these problems are suitable for EBP QI projects. Stakeholder requirements for initiating and implementing such projects are analyzed, and the Doctors Clinic Houston is selected as the focus for a hypothetical presentation to stakeholders, emphasizing the use of the PET model and PDSA cycle for addressing infection-related issues and improving overall patient care quality. The document concludes by underscoring the importance of adopting appropriate frameworks for identifying and resolving practical issues in healthcare organizations through EBP QI projects.

EXPLORING EBP
QUALITY IMPROVEMENT

TABLE OF CONTENTS
PART 1............................................................................................................................................1
Introduction..................................................................................................................................1
Three healthcare setting explored as proposed sites for EBP QI project....................................1
Comparison of settings for strengths and weaknesses as sites for an EBP QI project................2
Explanation of practical problem explored based upon identified needs of the health care
settings.........................................................................................................................................3
Explanation of reason because of which each problem is a potential focus for an EBP QI
project..........................................................................................................................................3
For each health care setting, provide description of stakeholders whose approval would be
required to initiate an EBP QI project and implement the results...............................................4
Comparison of similarities and differences in stakeholder requirements across the settings......4
Identification of one proposed health care setting and one proposed practice problem selected
to be presented to stakeholders with explanation of choice........................................................5
Conclusion...................................................................................................................................6
PART 2............................................................................................................................................6
REFERENCES................................................................................................................................7

PART 1
Introduction
Evidence based practice and quality improvement project are those projects that helps in
bringing improvement within healthcare settings (Kean and Milner, 2020). These kinds of
projects can further help in bringing improvement within healthcare settings can further help in
resolving issues within organizations. In this assessment three different healthcare settings in
Houston, Texas, USA will be focused upon and issues faced by these healthcare settings. Further
in this assessment ways in which EBP QI project can be implement for resolving issues faced by
these settings will be identified.
Three healthcare setting explored as proposed sites for EBP QI project
There are various healthcare settings that can be explored and proposed for Evidence
Based Quality improvement projects. All the three selected and proposed healthcare setting can
be explored on the basis of patient population, mission, public or private entity, members of
corporation etc. Three selected and proposed healthcare settings are:
St. Joseph Medical Center
This healthcare setting is a general acute care hospital that has capacity of approximately
700 beds. Their main mission is to being improvement within healing of people especially
vulnerable people. It is a private entity owned by Steward Health Care. This healthcare setting is
run by Steward Health Care for profit purpose. Main stakeholders of this hospital are community
partners, digital care partners, employees, board of directors.
Texas Children's Hospital
Another healthcare setting selected for EBP QI project is Texas Children's Hospital that
has capacity of 100 beds approximately in Houston, Texas, USA. It is a non- profitable
organization. Their main mission statement is to create healthier future for children and women
through global community. It is a non-profitable organization owned by Baylor College of
Medicine. It is one of the largest children’s hospitals and is affiliated by Baylor College of
Medicine. Some of the main stakeholders of this healthcare settings are: community partners,
trustees, board of directors, employees.
Doctors Clinic Houston
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It is a kind of healthcare setting that provide quality care in terms of provision of
appropriate medicines. They do not have beds but focused upon ensuing that their patients have
easy access to all the services and facilities. They provide healthcare services to families and
occupational people. Their main mission statement is to provide high quality healthcare services
to their patients. It is a private entity run in partnership. Main stakeholders of this healthcare
settings are: healthcare practitioners, and other employees. As it is a private clinic so it does not
have any board of director. All the main decisions are taken by both the partners.
Comparison of settings for strengths and weaknesses as sites for an EBP QI project
Some of the main strengths and weakness of each of the above identified healthcare
settings:
St. Joseph Medical Center Texas Children's Hospital Doctors Clinic Houston
 Patient care is one of the
main strengths of this
healthcare settings. Their
main focus is always to
provide high quality care
to patients.
 Texas hospital always
focuses upon ensuing that
high quality of care to
children and women is
being provided despite of
being a non- profitable
organization.
 One of main issue which is
being faced by patients of
this healthcare settings is
in terms of patient care of
patients who admit in
clinic.
 St. Joseph Medical center
faced issues in terms of
infection especially during
Covid-19 pandemic as
patients suffered from
infection due to less space
between two beds in this
pandemic situation. Most
of the infection were due
to injury on skin being
avoided
 Focus on proving high
quality care to patients
further help Texas hospital
to reduce chances of
patient suffering from
infection.
 Infection due to side effect
of medicine is an issue
faced by Doctors Clinic
Houston. Approximately
10 such cases occur every
year. Most of the cases of
infection occurred due to
infection on skin
 Providing care for any  Cases of pressure Ulcer  Provision of care for
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kind of pressure ulcers to
their patients is one of
their main strengths but
care of pressure Ulcer is
extremely costly.
are quite few in and as it is
a non- profitable
organization so training
provision for such cases is
also less.
pressure Ulcer is of high
quality and is one of the
main strength of this
healthcare setting.
Explanation of practical problem explored based upon identified needs of the health care settings
Practical problems explored based upon above identified healthcare setting need is
infection due to lack of focus upon any kind of injury to patient’s skin who are admitted. Most of
the hospitals do not focus upon skin of patients who are admitted to healthcare settings and even
if they get injured or get internal injury. Due to this lack of care and focus upon injury on skin, it
can result in increasing changes of patient suffering from infection (Opalinski and Martinez,
2021). Due to this healthcare professionals at forefront in healthcare settings on taking QI
initiatives to implement EBP healthcare interventions in order to overcome or resolve infection
practice issue in healthcare settings.
Then it was also identified that some of the healthcare settings such as Doctors Clinic
Houston face difficulty in terms of provision of high- quality care to their patients. This is
majorly because they provide care in terms of provision of medication to patients and if a patient
need to get admitted then they do face difficulty in terms of provision of care to their patients of
high quality.
Explanation of reason because of which each problem is a potential focus for an EBP QI project
Two main practice problems were identified in the above and each of the identified
problem is an important potential focus for implementing an EBP QI project. First problem
identified was infection and second problem identified was lack of high- quality patient care.
Both the problems are important and interrelated. Resolving one problem with the help of
implementation of EBP QI project, second problem can be resolved easily.
One of the main reason because of which provision of high quality patient care is an
important problem because lack of high quality patient care can result in degradation of overall
health of patient (Graves and et. al., 2018). Not only this, it can further result in development of
infection which is another issue if high quality care is not provided to patients.
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Another problem identified is of infection due to lack of focus upon care of patient. This
carelessness can many times result in getting injured that can further result in development of
chances of infection. Due to this, it becomes an important need of health care settings.
For each health care setting, provide description of stakeholders whose approval would be
required to initiate an EBP QI project and implement the results
St. Joseph Medical Center
St. Joseph medical center has set some general rules and regulation and only on the basis
of those regulations and polices approvals are given. But in most of the cases board of directors
are one of the most important stakeholders whose approval is required for initiating any kind of
quality improvement project and for implementation of its results.
Texas Children's Hospital
It is a non- profitable organization in which is any kind of quality improvement project is
required to be implemented then in such case approval from trustees of hospital is required to be
taken. It is important for all the Board of Trustees to provide approval for taking initiative for
EBP QI project only then its results can be implemented.
Doctors Clinic Houston
It is a private partnership organization in which all the main decisions and approvals are
provided by both the partners. Only after approval of both the partners EBP QI project and then
it can be initiated. In this, approval of both the partners is important and approval of single
partners is not sufficient.
Comparison of similarities and differences in stakeholder requirements across the settings
Similarities:
 One of the main similarities between St. Joseph Medical center and Texas Children’s
Hospital is that in both the hospital settings approval of either board of directors or board of
trustees is important.
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 Another similarity between all the three settings is that majority of members of both St.
Joseph Medical center and Texas Children’s Hospital should give their approval i.e., more
than 50 percent.
St. Joseph Medical Center Texas Children's Hospital Doctors Clinic Houston
 Majority of board of
directors should provide
their approval.
 More than 50 percent
board of trustees should
provide approval then
project can be initiated. It
does not matter if a single
trustee do not provide their
approval.
 Even if one partner of
Doctors Clinic Houston
then approval cannot be
provided.
 Funding of project is first
of all approved by board
of directors
 Fundings is approved by
Trustees first of all
 Funding should be
approved by both the
partners.
Identification of one proposed health care setting and one proposed practice problem selected to
be presented to stakeholders with explanation of choice
One proposed healthcare setting selected for implementation of EBP QI project is
Doctors Clinic Houston. This is because of main problem that has been provided for which
evidence- based practice project would be implemented is infection. This can be identified with
the help of implementation framework- PET model that can help in analyzing practical issue to
be addressed (Kessler and Alverson, 2019). As per this model: P stands for practical question
which is generated by staff members. In this, answering of questions such as why is the patient
care provided in the manner it is? Why infection issue is being faced by patients? How it affects
overall health and care of patients? E stands for evidence. Every year identified infection cases
due to lack of high- quality care of patients is one of the main evidences that helps in
understanding that it is one of the main issues. Whereas, T stands for translation or
recommendations for evidence (Ruzafa-Martínez, 2019). Recommendation for evidence
identified for resolving this problem is provision or implementation of training to nurses and
other healthcare practitioners.
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Process required for an EBP QI project that would be used for following this framework
is Plan- do- Check- Action process. This PDSA process will directly help in bringing
improvement within current problem faced by identified healthcare settings. In Planning stage
initiative of EBP will be taken (Ordonez and et. al., 2020). Then in second stage all the initiatives
will be taken for quality improvement, at this stage approvals from stakeholders will also be
taken. At third stage checking of identified initiatives will be done in order to ensure that EBP is
being implemented in an appropriate manner or not and whether it will be being improvement
within overall quality or not (Ruzafa-Martínez, 2019). Lastly in action stage, main actions or
initiatives will be implemented.
Conclusion
It has further been concluded that in order to identify practical issues faced by healthcare
organizations for implementation of EBP QI project it is important to adopt an appropriate
framework or model. It can directly help in identifying problem proposed to be resolved for
bringing improvement within overall quality of care provided to patients. It has further been
concluded that there are various kinds of frameworks and models that can be adopted for
implementing evidence- based practice quality improvement project. PET model is one of the
most appropriate model that can be adopted for implementing EBP project in an appropriate
manner within a healthcare setting.
PART 2
Covered in ppt
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REFERENCES
Books and Journals
Graves, B.A., and et. al., 2018. EBP design and translation: teaching how to begin a scholarly
practice project. Worldviews on Evidence
‐Based Nursing. 15(2). pp.152-154.
Kean, L. and Milner, K.A., 2020. Implementation of Open Visitation in an Adult Intensive Care
Unit: An Evidence-Based Practice Quality Improvement Project. Critical care
nurse. 40(2). pp.76-79.
Kessler, T. and Alverson, E., 2019. An undergraduate student-faculty collaborative EBP project
supporting a campus-wide tobacco free campus. Journal of Nursing Education and
Practice. 9(3).
Opalinski, A.S. and Martinez, L.A., 2021. Mindfulness and self-regulation in a summer camp
setting: An EBP project. Journal of Pediatric Nursing. 57. pp.73-78.
Ordonez, A.A., and et. al., 2020. Caspase-based PET for evaluating pro-apoptotic treatments in a
tuberculosis mouse model. Molecular imaging and biology. 22(6). pp.1489-1494.
Ruzafa-Martínez, M., 2019. EBP e-toolkit project: Providing a teaching and learning open and
innovative toolkit for evidence-based practice to nursing European curriculum. Central
European Journal of Nursing and Midwifery. 10(2). p.1017.
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