NURS 6231: Healthcare System and Quality Measurements Essay Paper

NURS 6231: Healthcare System and Quality Measurements Essay Paper

NURS 6231: Healthcare System and Quality Measurements Essay Paper

THIS IS A 2 PART ASSIGNMENT. THE ORGANIZATION THAT I NEED THIS TO BE ON IS : Regional One Health, located in Memphis, TN. The quality improvement issue is RN/nurse Retention.

Project: Promoting Health Care
Section 3: Quality Measurement and Assessment

This week you continue working on Section 3 of your Course Project, which was introduced in Week 6. Through your work in previous weeks of this course, you have likely gained critical insights into the organization that serves as the focus for your quality improvement plan. Integrating this knowledge of the organization into your plan for addressing a quality improvement issue is essential for successfully facilitating change. NURS 6231: Healthcare System and Quality Measurements Essay Paper


As you deepen your analysis of your selected organization, consider how the information presented in this week’s Learning Resources relates to strategic priorities as well as to the uniquely collaborative and competitive dynamic that binds organizations in health care.

To prepare:

Think about the quality improvement issue that you are addressing and the associated plan that you are developing. Consider the following:
What is the overall purpose, or aim, of doing this work?
What would you hope to achieve for the organization by undertaking this project? What are the objectives of this initiative?
What value would this work add to the organization?
How would this work improve practice and create outcomes with impact?
Review Chapter 7 of the Sadeghi, Barzi, Mikhail, and Shabot course text. Consider how addressing this quality improvement issue would align with the organization’s mission, vision, values, and strategic goals and objectives. How does it relate to regulatory issues, and other matters that are significant for the organization? If you notice a misalignment, use this as an opportunity to refine your focus.
With this in mind, continue to hone your development of this Assignment, integrating the concepts addressed here into Section 3. NURS 6231: Healthcare System and Quality Measurements Essay Paper

To complete:

Write a 3- to 5-page paper that includes:

An introduction to your quality improvement plan, including the overarching aim of this initiative and an explanation of how it aligns with the mission, vision, values, and strategic goals and objectives of the organization, as well as regulatory issues and other matters that are significant for the organization
An overview of the current situation with regard to this quality improvement issue in the organization
A description of measures and indicators
A presentation on data related to this issue, including:
Actual historical and current data and/or a description of the methods that you would use to collect and analyze the data
Methods for collecting and analyzing data in the future, including when you would do this
A description of realistic, evidence-based targets

Be sure to cite evidence from the literature to justify your selection of the measures and indicators, as well as the performance targets. This section of the Course Project serves as the Portfolio Assignment for this course. NURS 6231: Healthcare System and Quality Measurements Essay Paper

Due by Day 7 of Week 8.

Section 4: Quality Improvement Strategies

Through your work on Section 3 of the Course Project, you have examined the gap between current performance and evidence-based targets and considered how addressing this gap relates to organizational priorities and large-scale aims for quality improvement.

In this section of the Course Project, you begin to think about quality improvement strategies that could help to bridge this gap. As noted in the Sadeghi, Barzi, Mikhail, and Shabot text, this is referred to as performance-driven planning.

Since the publication of the Institute of Medicine’s report “Crossing the Quality Chasm,” a good deal of attention has been paid to the need to examine processes that contribute to outcomes (Ernst, Wooldridge, Conway, Dressman, Weiland, Tucker, and Seid). As the USAID has noted, interventions “will not create the desired outcome to improve the quality of care unless the overall process of care delivery is also improved.” Therefore, attention to process redesign is a central aspect of cultivating strategies for improvement.

To prepare:

Refer to the modified Donabedian model (access, structure, process, outcome, and patient experience) presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text.
Recall the performance targets that you identified for Section 3 (in Week 6). What does the recommendation that performance-driven planning should “begin with the end in mind” suggest given your established goals?
Review the information presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text, and think about how you would assess the organization’s strengths and weaknesses related to the performance gaps you identified in Section 3 (Week 6). NURS 6231: Healthcare System and Quality Measurements Essay Paper
Based on the above, start to think of specific evidence-based strategies that could be implemented to close/minimize the performance gaps you have identified. Consider both interventions (what) and processes (how). Focus on strategies that are supported by the latest research and could create systems-level change. These may be tentative for now, but be sure to identify at least one that specifically lends itself to a change in process (i.e., practice, protocol, pathway, activity).

Additional instructions for Section 4 are presented next week. To complete this Assignment, you will create a process map and write a paper describing quality improvement strategies. This Assignment is due by Day 7 of Week 8.


Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional resources. NURS 6231: Healthcare System and Quality Measurements Essay Paper
Submission and Grading Information
Grading Criteria

To access your rubric:
Week 8 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:
Week 8 Discussion

Project 1: Promoting Health Care Quality
Section 3: Quality Measurement and Assessment
By Day 7

Review the complete Assignment description presented in Weeks 6 and 7. Submit Section 3.

Submission and Grading Information

To submit your completed Project for review and grading, do the following:

Please save your Project using the naming convention “WK8Proj1+last name+first initial.(extension)” as the name.
Click the Week 8 Project Rubric to review the Grading Criteria for the Project.
Click the Week 8 Project link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Proj+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission. NURS 6231: Healthcare System and Quality Measurements Essay Paper
Grading Criteria

To access your rubric:
Week 8 Project 1 Rubric

Check Your Project Draft for Authenticity

To check your Assignment draft for authenticity:
Submit your Week 8 Project 1 draft and review the originality report.

Submit Your Project by Day 7

To submit your Project:
Week 8 Project 1

Project 2: Promoting Health Care Quality
Section 4: Quality Improvement Strategies

Throughout this course you have been considering the relationship between structure, process, and outcomes as it relates to health care quality. Looking at outcomes, alone, may not tell the “whole story.” For instance, if you are concerned with improving fall rates, evaluating the process—related activities or practices—can help you identify factors that contribute to outcomes and develop strategies for improving them.

For this section of your Course Project, you create a process map to examine a current process related to your quality improvement issue. You will use the results of the process mapping to redesign a process to help minimize or close the performance gap(s). As you proceed, keep in mind the importance of maintaining a patient-centered focus so the patient experience is not negatively affected by any changes in process. NURS 6231: Healthcare System and Quality Measurements Essay Paper

To prepare:

Review the instructions provided in the Learning Resources for creating a process map.
With your quality improvement issue in mind, as well as the other work you have completed on your Course Project thus far, think about how creating a process map could help you to better understand your quality improvement issue and redesign an associated process.
Create a process map using Microsoft Word or PowerPoint.
Refine the strategies for promoting systems-level change to minimize or close the performance gap(s) that you began to think about in Week 7. As part of this, identify a way to redesign at least one process based on your analysis of the process map that you have created.

What gets measured gets done’ if you don’t measure result you won’t be able to tell success from failure. ‘Performance measurement means different things to different people, how performance is been measured in the service industry is different from how it’s measured in production companies. Performance measurement was defined by Neely, A., as “the process of quantifying the efficiency and effectiveness of past actions through acquisition, collation, sorting, analysis, interpretation and dissemination of appropriate data”. Performance measurement system comprise a set of coherent activities designed to enable management to determine, directly or indirectly, how an organizational system is performing, improving or deteriorating, in or out of control, whilst providing information in support of decisions and actions aimed at improving performance of the system. A performance measurement system embraces the things we do to find out how things are been done and decide how it can be done better. Why organizations measure performance? The reason varies from one organization to another. NURS 6231: Healthcare System and Quality Measurements Essay Paper

To identify if the needs of customers or service users are met

It helps to understand organizational processes

To ensure that decisions taken are based on facts and not on bias or emotion

To show if improvement plan has been actualized

It is used to identify an organization success


Cost management has become a primary topic in health care. Improving the

quality of health care and measuring the performance of care are major public and

Political issues challenging health care organizations. Delivering excellent health services requires a high standard of performance on a wide range of factors, including clinical care, patient satisfaction, and short waiting times, cost control, and learning from best practice elsewhere. Due to dynamics in the health care organizations in recent terms, they are been pressurized to reduce costs, develop the quality of care and meet rigid general rules, has compelled the health care professionals to evaluate how their performance system is been evaluated. Innovation and strive for excellence has made many health care organizations to realise that evaluating performance is beyond financial measures , although a lot of the health care sector still find it difficult to decide what to measure and also how to use the results derived from the measurement. Suffice to say the health care professionals need to improve the performance measurement system by following a few steps. “The trend of new public management has seen the use of performance measurement (PM) to drive a more efficient, effective and accountable public sector, the government recognized the need for commitment by National Health Service (NHS) to deliver effective service and quality treatment. The government launched a new directive called The NHS Plan (DOH, 2000a) which highlights investments and reform in NHS” (Ritchie 2002) the following were recognized as challenges facing the NHS (Ritchie 2002); NURS 6231: Healthcare System and Quality Measurements Essay Paper

 a lack of national standards  

old-fashioned demarcations between staff and barriers between services  

a lack of clear incentives and levers to improve performance  

over-centralization and disempowered patients

The quality of care provided by the health services needs to be assessed objectively not only to motivate clinicians and managers to make improvement but also to ensure public accountability, to enable patients make informed choices. Health care quality improvement has become a major concern for stakeholders in the health care system, the federal and state government, health care professionals, providers of health care and also consumers. “The design of an effective performance measurement system, that includes the selection of an appropriate measures and approaches in analyzing results, is central to aligning an organizational operation with its strategic direction. Despite its importance, this is one area that many organizations fail to address effectively” [Purbey S. ‘et al’]. NURS 6231: Healthcare System and Quality Measurements Essay Paper


The aim of this research is to investigate how performance is measured in the health care sector, and to explore some of the key factors that drive improvement in the NHS and health care.

The proposal will address the following question

What is the current approach to performance measurement and improvement?

Does measurement lead to quality improvement?

What are the steps to be taken in improving measurement and performance in the future?

How can the chosen system be managed?

What are the Limitations of the framework used to measure performance?

“The effective management of hospitals has become an important political and social issue over the last decade, and demographic trends in the USA indicate that the issues associated with better hospital management will only become increasingly important as the domestic population continues to age. As hospitals face an increasingly complex list of challenges (e.g. aging population, cost pressures, and increasing concerns for patient safety)” [Stock N and Mcdermott C.] Most of the government policies in the UK are centered on NHS performance measurement, in a recent development; the government has adapted Kaplan and Norton’s (1992) BSC to construct the NHS Performance Assessment Framework (PAF) [Chang L., et, al 2002]. The PAF introduced by the government. The PAF covers six dimensions; NURS 6231: Healthcare System and Quality Measurements Essay Paper

Health improvement;

Fair access;

Effective delivery of appropriate healthcare;


Patient/carer experience; and

Health outcomes of NHS health care.

Health improvement:

deaths from all causes (ages 15-64);

death from all causes (ages 65-74);

deaths from cancer;

deaths from all circulatory diseases;

suicide rates;

deaths from accidents; and

Serious injury from accidents.

Fair access:

inpatient waiting list;

adult dental registrations;

early detection of cancer;


cancer waiting times;

number of GPs;

GP practice availability;

elective surgery rates;

Surgery rates – coronary heart disease.

Effective delivery of appropriate health care:

childhood immunisations;

inappropriately used surgery; NURS 6231: Healthcare System and Quality Measurements Essay Paper

acute care management;

chronic care management;

mental health in primary care;

cost effective prescribing;

returning home following treatment for a stroke;

Returning home following treatment for a fractured hip.


day case rate;

length of stay;

maternity unit costs;

mental health unit costs;

Generic prescribing.

Patient/carer experience of the NHS:

patients who wait less than two hours for emergency admission (through A&E);

cancelled operations;

delayed discharge;

first outpatient appointments for which patients did not attend;

outpatients seen within 13 weeks of GP referral;

percentage of those on waiting lists waiting 18 months or more;

Patient satisfaction.

6 Health outcomes of NHS health care:

conceptions below age 18;

decayed, missing or filled teeth in five-year-old children;

readmission to hospital following discharge;

emergency admissions of older people;NURS 6231: Healthcare System and Quality Measurements Essay Paper

emergency psychiatric re-admissions;

stillbirths and infant deaths;

breast cancer survival;

cervical cancer survival;

lung cancer survival;

colon cancer survival;

deaths in hospital following surgery (emergency admissions);

deaths in hospital following surgery (non-emergency admissions);

deaths in hospital following a heart attack (ages 35-74);

deaths in hospital following a fractured hip [Source: NHS Executive, 1999]

Health improvement is measured in terms of reduction in key seven indicators, deaths from all causes (15-64 & 65-74), and death from cancer, death due to circulatory diseases, death due to accident, suicide rates, and incidence from injuries due to accident. “It is argued that the relationship between inputs, outputs and outcomes in the NHS is complicated and not easy to measure. Improvement in the health care is not only about reducing death rates. It involves improving emotional fitness and spiritual health and a lot of effort and resources have been invested in these dimensions of care services. These sorts of activities are usually not captured within the PAF framework however, perhaps because their invisible outcomes are difficult to quantify within a service-oriented public sector (Audit Commission, 2000). Their omission means that the scope of the PAF is limited, rendering it less comprehensive as a strategic measurement and management system” [Chang, L., Lin, S., & Northcott, D. (2002)]. The establishment of normalized criteria and standards for appropriate and safe health care provision as well as mechanisms for evaluating the systems and organization’s performance, country and worldwide, is still a crucial issue in need of a valid and recognized answer [Simon J., 2004]. Healthcare costs have become an important issue, so the use of cost improvement or cost containment as a performance measure has been very common in healthcare research. Quality has also been very widely used as a performance outcome in healthcare research measured by many different means, including self-reported quality measures, medical errors, and mortality rates. Organizational performance in a hospital, particularly from a strategic perspective, can also be viewed as a construct that combines multiple dimensions, such as clinical outcomes, financial performance, productivity, and operational measures”. Performance measurement takes capacity [Stock N. & Mcdermott C. (2007)]. The reasons for the lack of evaluation research include the methodological challenges of measuring performance and the complexity of the health care system [Ovretveit and Gustafson (2002)]. Furthermore moeller et al (2001), observed that ‘health care is receiving increasing attention, not only for its tremendous impact on the economic resources available to a population, but also for its elementary value to that specific population. In many countries today, regardless of their size or wealth, the health of the population and how that health care is provided is a major concern. And all who manage health care delivery strive to achieve the highest quality care possible within the resources available. Evaluation of health services is, therefore, required. According to Purbey, S., Mukherjee, k. & Bhar, C. (2007), various authors have suggested different performance measurement frameworks for measuring performance of an organization. Some of the important performance measurement frameworks are discussed below; NURS 6231: Healthcare System and Quality Measurements Essay Paper

Balanced performance measurement matrix

Performance measures for time-based competition

Performance pyramid system

Balanced scorecard framework

Brown’s input, processes, outputs and outcomes framework

Performance prism

All this above mention performance frameworks has been faulted, the balanced performance measurement matrix was said to be too complex as it does not explicitly link between different dimensions of business performance. [Anderson K. & McAdam (2004)] The performance pyramid system approach was seen to fail to specify the detail relating to the form of measures of performance or the process for developing them, with no apparent scope for lead measures of performance. [Hudson M., Smart A. & Bourne M. (2001)] The Balance scorecard framework lack consideration to the measurement of human resources, employee satisfaction, supplier performance, product/service quality and environmental/community perspective [Brown M.G. (1996)]. Performance prism suggest some areas in which measures of performance might be useful, but provide little guidance on how the appropriate measures can be identified, introduced and ultimately used to manage the business [Medori D. & Steeple D. (2002)]. Quality means different things to different people, in today’s world there is no single accepted definition of quality, it is usually meant to distinguish one organization, products, services, person, and action from another. Given that quality is meeting the needs of service users, it is not enough to satisfy some requirements and not others. NURS 6231: Healthcare System and Quality Measurements Essay Paper

Implication of poor quality in a hospital [Moullin, M.]

Description implication for patient implication for staff cost implication

Inadequate delays to patients extra work for extra pathology costs

Clinical details risks of incorrect test pathology staff increased length of stay

to pathology extra conversation fewer patients treated

dept. With clinical customer more complaints some appointments


Porters not delays in operations staff kept waiting expensive staff and

available to sicker patients delays in operations plant underused

move patients patients in for longer inter-staff aggravation more costly

to operating treatments for patients

theatre worsened condition higher accommodation cost

Insufficient car patients late for staff late for staff (patients) kept

parking facilities appointments appointments waiting increased anxiety low morale capital equipment not used to fullest capacity repeated appointment

Health record frustration at having histories need extra time spent

missing or out to repeat history taking again searching or taking

of date wrong treatment internal inquiries histories

offered extra consultation

expensive/complex. NURS 6231: Healthcare System and Quality Measurements Essay Paper

remedial treatments

Discharge delayed longer stay unnecessary work higher accommodation

because drugs to longer waits for for all staff costs

take home are new patient slower throughput

not available

patients kept stress and ambulances held extra staff time

waiting over an frustration up on explaining and

hour for pre- cant park as car staff on the mollifying

booked parks over -full defensive need for larger

appointments waiting rooms and

car parks

“As organizations move away from traditional approaches of management towards continous quality improvement and other more customer oriented approaches, the measures of performance they use need to reflect their changing priorities. Traditional measures of quality and performance have a number of weaknesses for measuring service quality. They are often inwardly focused rather than focused on patients and service users. They also emphasize output and machine or server utilization much more than quality”. [Moullin M]. NURS 6231: Healthcare System and Quality Measurements Essay Paper


Before the researcher would start the study of the chosen organizations, an approval will be obtained from the National Research Ethics Service. An informed consent will also be obtained by the researchers from the entire study participant. A mixed method approach of data collection will be employed in the study (qualitative and quantitative). Data will be collected using questionnaire and also an in-depth interview would be conducted to get the views of management on performance management. The participants will be interviewed alone using similar questions being posed several times in each interview. Interview will be conducted within one month with each interview lasting between 25-30 minutes. The interview would be audio-taped and transcribed verbatim. The first interview will be conducted at the beginning of the study, the participant would be asked on what performance measurement indicators are been used and also who are those involved. The questionnaire would be used to collect information about the participant knowledge, beliefs, attitudes, and behaviour towards quality. Interview would be conducted with an unstructured approach, but the researcher would have made enough preparation beforehand. Activity 1 Conduct a literature review on performance measurement in health care. Activity 2 Observe the group [nurses, doctors, clinicians] for few hours every week, observing mostly on service delivery to patients. Activity 3 Questionnaires would be distributed to staffs and service users, and the analysis of the questionnaire would be followed up with an interview. Activity 4 The researcher will attempt to conduct these interviews shortly after discussing area of interest with participant. While the interviews will not be formal or structured, the researcher would start off the interview with broad questions and follow up on the interviewee’s responses to capture the interviewee’s point of view without providing leading questions. NURS 6231: Healthcare System and Quality Measurements Essay Paper

Activity 5 Analysis of the collected data would be done and inference made from the result in the reports.



The literature search will aim to be comprehensive, but restricted access to primary literature, for example due to the remote location of material sought, will exclude consideration of some sources in the actual literature review. The collection of primary data will be based on a survey of 30 Scottish hospitals, the number in the sample limited due to the restrictions of time to complete the project and resources to support it. While the review into the application of performance measures has resulted in a significant amount of material, the majority of the articles were either early research, or theoretical systems requiring practical application or validation. By being in the organization for only a few hours a day, there is bound to be an aspect of service delivery that will not be revealed during my observations. Being an outsider may limit what is revealed to the researcher. The researcher might not get full cooperation of NHS management. NURS 6231: Healthcare System and Quality Measurements Essay Paper

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