Performance Quality Improvement (Nursing)

00:02 Hi, I'm Jessica Spellman. We're going to be reviewing Performance Improvement.

00:08 Let's review the objectives for this course. After this course, you will be able to understand the concepts involved in performance improvement; identify the components of a system; identify how performance improvement initiatives are identified; recognize the PSDA model for process improvement; and recognize the role of nurses in performing performance improvement projects.

00:36 The process of performance improvement is comprised of many concepts. Quality assurance, process improvement, are two of the terms you may hear when discussing performance improvement.

00:49 So what do they mean? Let's review some definitions.

00:53 The American Healthcare Association defines these concepts for us. Quality assurance, or QA, is the process of meeting quality standards and assuring that care reaches an acceptable level.

01:07 Performance improvement, or PI, is continuously analyzing performance and developing systematic efforts to improve it, also known as quality improvement.

01:18 These definitions apply to patient outcomes achieved by healthcare organizations, not necessarily individual performance.

01:26 And performance appraisal, and that's individual job performance evaluation.

01:32 So while performance appraisals are an important part of a nurse's role to help determine areas for professional growth and staff development, performance improvement is a broader term used to measure and improve patient outcomes in a system.

01:47 So the next question is: what is a system? A system is comprised of three parts. You have input into the system, processes within the system, and then an output that is created. Example, a hospital is a system. The patient is the input.

02:08 The patient comes to the hospital and receives care. The care is the processes and then the result of the care provided is the output. So this is a very general example of a healthcare system. Performance improvement is about looking at the processes performed by the personnel in the hospital and measuring them.

02:31 There are four purposes for measuring performance in healthcare organizations.

02:37 First, healthcare organizations strengths and areas for improvement are identified by it.

02:44 Consumers demand it. Healthcare consumers make decisions about which organizations to use for their healthcare needs based upon reporting of certain measures. Third, accreditation requires it.

02:58 National Committee for Quality Assurance, NCQA, and The Joint Commission accredited healthcare institutions and they mandate that there is performance improvement.

03:11 And fourth, financial incentives are tied to it. The Centers for Medicare and Medicaid Services use outcome measurements of morbidity, mortality and readmission rates for certain disease processes as a guide for reimbursement for healthcare organizations.

03:29 So performance improvement is comprised of many quality indicators or criteria used to measure outcomes.

03:36 Health information technology, or Health IT, is an important tool and accurate and reliable reporting of outcomes data.

03:45 An example of this is HEDIS. HEDIS is the Healthcare Effectiveness Data and Information Set.

03:52 It is a performance management tool created by the NCQA.

03:57 It helps organizations measure and report their data in specific areas.

04:03 More than 90% of America's health plans use HEDIS to measure important dimensions of care.

04:10 So HEDIS collects and measures data on a number of important health issues, a small number of these we're gonna review. Things like asthma medication used, they collect data on. The use of beta blocker treatment after a heart attack is another thing they measure. How we control high blood pressure is another measure.

04:33 Comprehensive diabetes care and breast cancer screening are items that they also collect data on and measure healthcare organizations on that data. So Press Ganey is another performance improvement tool that is used to measure quality indicators from a patients perspective.

04:52 These surveys are sent to a random sampling of patients served at a healthcare organization.

04:58 The survey consists of 27 questions in the following areas: communication with doctors, communication with nurses, responsiveness of hospital staff, pain control and communication about medications.

05:16 So first we collect the data and then we analyze the data and then we benchmark the data. So what is benchmarking? It is the process of comparing an organization's performance improvement measures against another organization's data. This is how we create standards for healthcare.

05:34 Standards are the minimum outcome measures that an organization is expected to meet.

05:40 When an organization falls below a standard, that is an area that the organization should identify as appropriate for process improvement or performance improvement efforts. Once that area has been identified, we use a process called PDSA model for process improvement.

06:02 And process improvement is just that, a process. And it continues on and there's never really an end to it.

06:10 So the 'P' in PDSA stands for plan. This is the area where we talk about what the objectives of the project are going to be and what are the steps necessary to achieve the desired outcome.

06:24 'D' is for do. In this area we want to implement steps identified in a plan on a small scale.

06:32 We wanna identify problems and unexpected outcomes on that small scale implementation.

06:39 'S' is for study. We analyze the data from the small scale study and then the outcomes and what was learnt from that to decide if we wanna act.

06:50 Do we want to, at this point, redesign the project before we implement it on a large scale or is it ready to go into large scaled implementation at this point? This is a cycle. It continues even after we think the project is over, we will continue to collect data to make sure that the process is still working.

07:15 So the Institute for Healthcare Improvement has identified three questions that health organizations can ask themselves when working in the PDSA cycle.

07:27 The first question is: what are we trying to accomplish? And that is the aim of the project.

07:33 The next question is: how will we know that a change is an improvement? And that's how we measure the improvement. And then what changes can we make that will result in improvement? And that's where ideas come forth about how to make changes and implement.

07:51 Nursing role in all of these is that there are so many quality indicators that need collected. Criteria are measured and outcomes are expected for healthcare organizations and it is a complicated and ongoing process. So it's a team effort to collect and analyze data, identify areas for improvement, initiate process improvement projects and evaluate outcomes.

08:17 So nursing is responsible for being part of that team. Providing quality care is everyone's responsibility, not just nurses'. And it is important to understand the purpose of measuring outcomes and the role of nurses in collecting, analyzing and implementing performance improvement measures.

08:36 So individually, nurses can report ineffective processes to management; they can identify areas of interest for staff development; they can complete and participate in performance appraisals; they can conduct review of literature to examine possible solutions to identified problems; and they can recognize that there is data being collected on nursing quality indicators such as the fall rate or fall injury rate, skin integrity, pressure ulcer monitoring, restraint utilization and medication error reporting and outcomes.

09:16 Nurse's role across the organization involves recognizing the importance of documenting accurate care in the chart, performing chart audits to collect data, sitting on committees that look at quality data and process improvement efforts and implementing the PDSA model on specific units.

09:39 So let's review performance improvement. Performance improvement is a complicated process of continuously analyzing a system's performance, and implementing improvement processes to improve outcomes.

09:53 A system is comprised of three parts: the input, the processes and the output.

10:00 Performance measurement is about looking at the processes performed in the hospital and measuring them.

10:07 The purpose of performance improvement is multi-faceted.

10:11 One, healthcare organizations strengths are identified by it. Consumers demand it.

10:18 Accreditation requires it, and financial reimbursement is tied to it.

10:24 Performance improvement includes data collection, analysis, benchmarking, process improvement.

10:36 The Plan, Do, Study, Act is a process improvement model used by many organizations to formulate process improvement projects.

10:45 Providing quality care is everyone's responsibility, not just nurses but especially nurses.

10:53 It is important to understand the purpose of measuring outcomes and the role of nurses in collecting, analyzing, and implementing performance improvement data.

11:03 This has been Performance Improvement and I'm Jessica Spellman.