Analysis of Quality Improvement in Healthcare Settings: A Report

This report analyzes quality improvement strategies within healthcare settings, drawing on research and real-world observations. The author, using the HCAHPS Survey Instrument, identifies patient dissatisfaction related to nursing care, particularly concerning patient autonomy, dignity, and communication. The report emphasizes the importance of person-centered care, advocating for nurse training sessions to promote empathetic approaches and shared decision-making. Addressing nurse shortages is also recommended. Furthermore, the report examines the effectiveness of audit and feedback interventions, suggesting evidence-based practices and theory-driven approaches to overcome limitations. In addition, the report highlights the significance of effective team communication and relational coordination among healthcare professionals, proposing multidisciplinary team meetings and team climate development to improve care quality and hospital reputation. The author references multiple studies to support their claims and proposes implementing these strategies to enhance patient outcomes.

Running head: QUALITY IMPROVEMENT IN HEALTHCARE SETTINGS
QUALITY IMPROVEMENT IN HEALTHCARE SETTINGS
Name of the student:
Name of the university:
Author note:

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QUALITY IMPROVEMENT IN HEALTHCARE SETTINGS
The tool called HCAHPS Survey Instrument is helpful in getting idea about the patient’s
satisfactions in service delivery (Jadotte et al., 2017). With the use of the HCAHPS Survey
Instrument, it was noted that the patients was quite dissatisfied with the quality of care provided
by the nurses. As it was a survey, it was not possible to develop a broad idea about the feelings
of the patients but it seemed inevitable form the interviews that the patients seemed themselves
vulnerable and developed a feeling of disempowerment. They felt that the nurses did not respect
the autonomy as well as the dignity of the patients and often tried to impress their own
interventions on them. They did not like to participate in any discussions with the patients which
made them vulnerable. These made them upset and as a result they were getting depressed or
agitated. There is indeed evidences which suggest that the way nurses provide care to patients are
important in helping patients to recover the disorders. The quality of nursing care provided in
healthcare settings are often researched by different researchers and they have come to the view
that person centered care is helpful in making patient’s condition stable and develop a
therapeutic relationship with them (Melnyk et al., 2014). The patients in my appointed hospitals
was never given a chance to participate in decision making and were not properly educated them
with the intervention they were applying. A similar chapter was selected where more or less a
similar scenario was suggested where the patients complained of lack of readiness and
preparedness of the nurses when they visited them. Lack of shared decision making activities
were noted by them. They also complained of delayed nurse’s responses as they have noticed
nurse shortages as a reason . The researchers of one primary article suggested misalignments in
systems, care processes and also improper nurses’ response affected the quality of care by
making patients disempowered and increased their sense of vulnerability. The post intervention
phase where they used inculcation of various strategies to develop person centered care was

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indeed found to be fruitful (Storm et al., 2014). Patients suggested that the nurses became more
compassionate and empathetic and considered every one as family members. The nurses develop
proper ways of engaging themselves with patients and developed a relationship which helped
them to maintain the patient’s autonomy and dignity (Yost et al., 2015). Thereby by following
the above mentioned researches, the main intervention that I would apply is to introduce training
sessions for the nurses to provide them how to adapt strategies of inculcating person centered
approaches. Moreover the issue of nurse shortages would be to handle to the HR department so
that work pressure and burnout do not hamper the quality of care provided to patients.
Another process to review the quality of service provided to patients is to use audits and
feedback interventions. In spite of carrying on regular audits and feedbacks in my organisation,
results have been found to be null and therefore the result were becoming futile even after proper
audits and feedbacks were conducted. This forced the healthcare center to get confused as they
were not finding the right tool for judging the quality. This scenario of my organisation can be
explained with the work of Ivers et al in the year 2014. According to this researcher and his
team, the ‘business as usual’ mode of audit and feedback never bas become successful in one
quarter of their tested healthcare centers but have again failed miserably in another quarter of
their tested healthcare centers as they have provided null effect on the development of quality of
services (Gould et al., 2014). They have suggested that understanding their mechanism of actions
and identifying the key active ingredients is extremely important to make the intervention
successful. Often following the business as usual approach that evaluates two arm trials of audit
and feedback interventions against usual care for common issues and different settings do not
bring out proper results. They fail to help in providing new generalizable settings. They continue
to keep themselves restricted only to the known areas of healthcare practice and do not allow

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testing the effectivity of any new idea that could be introduced for betterment (Zorio et al.,
2013). Researchers here therefore have come to conclusions that the audit and feedback sessions
of the future should incorporate evidence as well as theory based practices and they should be so
arranged that they will address the known gaps in the literatures (Ivers et al., 2014). All the audit
components, feedback components, nature of the behaviour change required and target goals and
action plans should be fixed before the audit is carried out. They have proposed a tentative audit
plan which if implemented in the audit and feedback pieces will bring out change in quality of
the service. Hence, I would also try to follow the paper closely and by the guidance of the
researchers will alter the audit and feedback.
Another important issue that has been marked by me in the healthcare center that often
hampers the quality of the service provided is the inappropriate communication of the team
members. It has been already proposed before to the professionals that they need to work in a
team in order to provide a quality care to the patients. However, though teams are allocated with
proper ration of each type of healthcare professionals, they do not bring out the best effects. It
has been noted that often medical specialists experience a power over the other professionals and
do not properly cooperate with everyone and hence different complexes are seen to arise among
different individuals who ultimately fail them to participate in effective teamwork. A similar
such issue was depicted by Hartgerink et al., in the year 2013. His study has shown that although
nurses try to communicate with all professionals and try to implement interventions after
discussing with every team members, medical specialists do not pay importance to other’s work
and tend to change their intervention without discussing with anyone. This often leads to
confused state of treatment and the patients are mostly the victims for it (Ajeigbe et al., 2013). In
order to reduce the tensions among the team members and to develop the communication and

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relational coordination among the healthcare professionals, it is very important to make every
team members meet in the multi-disciplinary team meetings and participate in team climate
development procedures (Hartgernick et al., 2014). The researchers have clearly concluded that
the success of this quality improvement technique will not only depend on the frequency of team
meetings but also the number of the professionals represented that has a positive influence. The
coordinated response for the different types of activities as well as different information which
result from relational coordination is mainly believed to be significant in for effective and
efficient care delivery (Sacks et al., 2015). Therefore form this paper I have learnt that I will also
try to implement the interventions of conducting weekly multidisciplinary team meetings and
development of team climate to make the quality of care better for the patients and to raise the
reputation of the hospitals.

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References:
Ajeigbe, D. O., McNeese-Smith, D., Leach, L. S., & Phillips, L. R. (2013). Nurse-physician
teamwork in the emergency department: impact on perceptions of job environment,
autonomy, and control over practice. Journal of Nursing Administration, 43(3), 142-148.
Gould, N. J., Lorencatto, F., Stanworth, S. J., Michie, S., Prior, M. E., Glidewell, L., ... &
Francis, J. J. (2014). Application of theory to enhance audit and feedback interventions to
increase the uptake of evidence-based transfusion practice: an intervention development
protocol. Implementation Science, 9(1), 92.
Hartgerink, J. M., Cramm, J. M., Bakker, T. J. E. M., Eijsden, A. M., Mackenbach, J. P., &
Nieboer, A. P. (2014). The importance of multidisciplinary teamwork and team climate
for relational coordination among teams delivering care to older patients. Journal of
Advanced Nursing, 70(4), 791-799.
Ivers, N. M., Sales, A., Colquhoun, H., Michie, S., Foy, R., Francis, J. J., & Grimshaw, J. M.
(2014). No more ‘business as usual’with audit and feedback interventions: towards an
agenda for a reinvigorated intervention. Implementation Science, 9(1), 14.
Jadotte, Y. T., Chase, S. M., Qureshi, R. I., Holly, C., & Salmond, S. (2017). The HCAHPS
Survey as a Potential Tool for Measuring Organizational Interprofessional Competency at
American Hospitals Nationwide: A Content Analysis Study of Concept Validity. Health
and Interprofessional Practice, 3(2), 1.

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Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The
establishment of evidence‐based practice competencies for practicing registered nurses
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