+1 862 207 3288 Case study to be analyzed is presented below at the end of project instructions. Also I have the case study listed in the comments section of the order. Please let me know if you have any questions.
This paper is a collaboration of four milestone papers, when combined flow nicely into one continuous paper.
APA Format
12 in text cited references
Use subheadings for each section for an easy to follow format.
Each topic needs to be discussed appropriately.
Each Milestone to be at least 4 pages
OVERVIEW
Your assessment for this course is an executive summary that provides justified proposals for quality improvement within a specific organization. The proposal will address strategies for improving a quality patient indicator within the healthcare organization, utilizing evidence-based, peer-reviewed research and careful analysis of organizational processes, organizational structures, leadership responsibilities, and value-based reimbursement. In addition, the executive summary will need to include a concise plan for implementation and evaluation of the proposal from organizational, financial, and patient-care perspectives.
Most importantly, this assessment will provide you with the opportunity to demonstrate sophisticated and critical research, analysis, and communication skills by allowing you the opportunity to synthesize your own research into a qualified, well-articulated presentation to leadership to improve the quality of patient care. These skills and abilities are essential for nursing professionals who hope to drive positive, sound organizational change within the healthcare industry.
This assessment will address the following course outcomes:
• • Evaluate tracer methodology as an effective and sustainable means of measuring quality delivery of care
• • Assess theories of change for their applicability and use in promoting performance improvement initiatives in healthcare organizations
• • Analyze organizational processes that facilitate communication and flow of survey-required quality data throughout the healthcare institution
• • Recommend interprofessional strategies that improve nursing-sensitive quality indicators
• • Articulate the role of leadership in the planning, analysis, and implementation of performance improvement initiatives within the organization
• • Analyze the relationship between quality outcomes and value-based reimbursement in healthcare for improvement opportunities
MILESTONE 1: Introduction
The milestone assignments in this course, including this one (Introduction), are to help you prepare for the final executive summary presentation. In the executive summary, you will present a proposal for addressing or improving a quality patient indicator within a healthcare organization. The executive summary presentation includes an introduction, evidence-based, peer-reviewed support, an implementation plan, and considerations of organizational and leadership roles. The Introduction sets the stage for your proposal, briefly laying out for the reader (or the healthcare executive) the importance of the issue at hand. As this is a scholarly endeavor, you must use at least two evidence-based sources in this opening or introduction. All APA requirements must be met. Feedback that is provided by the faculty in this and future milestones is to be incorporated into the final project assignment. Prompt: In your milestone, make sure to address the following topics:
1. Organization: Analyze the organization to determine the key characteristics (including organizational values, if applicable) important for consideration when developing plans for change and implementation of quality indicator proposals.
2. Improvement Opportunity: What is the issue(s) involving patient safety and financial considerations within the organization that needs to be addressed? Explain the connection between patient safety and financial state of the organization in terms of opportunity presented.
3. Purpose: Articulate the overall purpose of your proposal/proposed initiative for improving quality of care within your organization. In other words, what is your intended initiative for addressing the issue(s)/improvement opportunity identified?
4. Proposal Initiative: Detail the initiative you are proposing in terms of its application to your organization. In other words, what is it that you are proposing, and why is it relevant for your organization?
5. Leadership: Articulate the role leadership plays in the current situation/environment that needs to be addressed. In other words, in presenting your proposal to leadership, you will need to articulate the overall role they play in the current environment, such as whether leadership is attempting to address the issue, is unintentionally furthering the issue, or has not yet identified your concerns as an organizational issue.
Guidelines for Submission: This paper should be 3–5 pages, not including the cover page or reference page. APA format is to be used for the reference list and all internal citations (at least two evidence-based sources are required).
MILESTONE 2: Research and Support
In Milestone Two, you will review the literature to determine what information is available in the evidence-based literature on the topic for the executive summary. Whenever providing an informative presentation to a healthcare executive, it is vital that there be inclusion of evidence-based sources. This is a foundation for the rest of the paper. In this section, you must include at least three evidence-based sources. Please cite and reference using correct APA format. When writing the literature review, you may use the headings below to help organize this brief paper. All faculty feedback on the milestones is to be incorporated into the final executive summary assignment.
Prompt: In your milestone, make sure to address the following topics:
6. Proposal Care Support: Summarize the research from evidence-based studies and peer-reviewed sources that led you to believe that your proposal would improve quality delivery of care within your organization.
7. Value-Based Support: Summarize the research from evidence-based studies and peer-reviewed sources that led you to believe that your proposal would improve value-based reimbursement for your organization.
8. Data Evidence: Detail the data from the organization or that you collected yourself that indicated the need for improvement and explain how you drew your conclusions. Note: This data should include, but not be limited to, tracer data, performance improvement data, benchmarks, and so on.
9. Strategies: Detail existing interprofessional strategies that could be applied to your initiative and organization.
10. Strategy Defense: Defend your recommended strategies in terms of their ability to improve nursing-sensitive quality indicators based on relevant,
reliable research.
11. Change Theory: Analyze relevant theories of change that informed your proposed initiative and could help with implementation.
12. Change Assessment: How applicable are change theories to promoting your intended initiative and to the type and structure of your healthcare
organization?
Rubric
Guidelines for Submission: This paper should be 3–5 pages, not including the cover page or reference page. APA format is to be used for the reference list and all
internal citations (at least three evidence-based sources are required).
MILESTONE 3: Implementation
In this milestone, you will now write specifically on your chosen initiative. So far, you have introduced the topic and completed a literature review. Did your literature review convince you of the merits of your proposal? In this section, please provide at least three evidence-based sources to support your initiative or proposal. APA format is required. You may use the areas below as subheadings for your paper. Remember, the final project is an executive summary, so write persuasively and convincingly about your proposal. As noted in prior milestone overviews, all faculty feedback should be incorporated into the final executive summary.
Prompt: In your milestone, make sure to address the following topics:
13. Quality Outcomes: What are the desired quality outcomes you hope to achieve through implementation of your initiative? Your outcomes should be reasonable, measurable, and time-considerate to help monitor progress.
14. Communication: Analyze the organizational processes for communicating change initiatives to determine the most effective paths/methods for promoting the proposed initiative.
15. Data Flow:Discuss how the existing organizational processes will allow for improved or maintained flow of survey-required quality data that may be valuable for tracking your initiative.
16. Needed Leadership: Describe the behaviors of leadership and the role of leadership in implementing these strategies for change within the organization. In other words, what responsibilities do leaders within your organization hold to ensure the implementation of the initiative?
Guidelines for Submission: This paper should be 2–3 pages, not including the cover page or reference page. APA format is to be used for the reference list and all internal citations (at least three evidence-based sources are required).
MILESTONE 4: Evaluation
In this milestone, you will address the plan for evaluating the proposed change. So far, you have introduced the topic, completed a literature review, and discussed the specific plan and its implementation in the healthcare organization. In this section, provide at least three evidence-based sources to support your chosen evaluation methods for your proposed initiative. APA form is required. You may use the areas below as subheadings for your paper. Remember, the final project is an executive summary, so write clearly about your methods for evaluation. As noted in prior milestone overviews, all faculty feedback should be incorporated into the final executive summary.
Prompt: In your milestone, make sure to address the following topics:
17. Plan: What is your plan for evaluation of the strategies using performance improvement data and tracers? What tracers will you use? Include necessary detail to deliver key points and requirements, such as specific data collection methods, timeframes for evaluation, and intended re-evaluation.
18. Plan Evaluation: How effective and sustainable is your plan? In other words, evaluate the effectiveness and the ease of use, timeliness, and efficiency of your plan for the progress and success of your initiative.
Guidelines for Submission: This paper should be 2–3 pages, not including the cover page or reference page. APA format is to be used for the reference list and all internal citations (at least three evidence-based sources are required).
NUR 400 Case Study to be Topic of milestones.
Long View Memorial Hospital is an acute care hospital that is owned by the Marley Corporation. The corporate offices are in Dallas, and Marley Corporation (for-profit) owns 20 other acute care hospitals located in Kansas, Utah, Arizona, and New Mexico. Long View Memorial Hospital (LVMH) is a 54-bed facility licensed by CMS and accredited by the Joint Commission (TJC). The next on-site survey by TJC is to be sometime within the next three months. During the last quarter, all reportable core measures were at 87%. This was a decline from the previous quarter, when all core measures were at 93%. In addition, performance improvement indicators for all hospital-acquired infections (HAIs) had declined by 5% during the last quarter.
The leadership at LVMH consists of a chief executive officer (CEO), a chief nursing officer (CNO), a chief financial officer (CFO), and a chief quality officer (CQO). The chief of staff has been in her role for one year, and the Medical Executive Committee consists of the medical and surgical specialties that are offered by LVMH. Those are internal medicine, surgery, urology, cardiac medical, obstetrics, orthopedics, and emergency medicine.
Organizationally, the communication structure is hierarchical. The aforementioned executive C-suite reports to the CEO, and the nursing unit directors report to the CNO. The CEO is accountable to Marley Corporation.
Nursing staff and several directors are primarily associate-degree graduates, though there is some verbal push from corporate headquarters for advanced education of its staff and nursing directors.
Financially, the facility is solvent due to average daily census being at hospital capacity for the past six months. There has been some decline in reimbursement due to the new restrictions under the Affordable Care Act. A number of patients are being readmitted for pneumonia and heart failure exacerbation under the 30-day requirement, and hence reimbursement for these diagnoses is being financially penalized. The recent increase in the number of HAIs and the decline in core measures also pose financial reimbursement challenges for the hospital.
The Case
Marcellina has been the clinical manager in surgical intensive care for five years. She has observed an increasing level of change in technology and clinical practice over the past five years in the surgical intensive care unit. She is also pursuing her master’s degree, as this is required for her position and for future advancement.
New capital expenditures to accommodate new technological advances have been required, and Marcellina has met with the leadership concerning budget allocations for these purchases. Because of the new technology, patients who are more seriously ill are now receiving higher levels of complex and intense care. At the same time, the demand to reduce the length of stay has accelerated as costs have increased and the revenue margin has tightened. The once-diligent performance monitoring of surgical site infections and hospital-acquired MRSA and C. difficile infections in Marcellina’s unit has declined given the acuity of patients combined with decreased staff and increased sick calls by staff.
The nursing staff have varied levels of education. Two nurses with 20+ years of critical care experience are resisting returning to school. Several nurses are pursuing the baccalaureate degree. At times,
Marcellina is indecisive as to how to proceed with the diverse viewpoints of her staff and providers pertaining to changing practice patterns that accompany new technological advances. Marcellina’s immediate supervisor, the director of nursing is, at times, openly critical of Marcellina’s efforts to rally her staff, and she also tends to denigrate Marcellina’s contributions at meetings of the leadership team.
Some staff members have been talking about ways to improve matters on the unit. The ideas involve more shared governance as pertains to staffing and input at staff meetings. Marcellina is at once pleased and a bit concerned about the staff nurses’ initiative. Is she “losing her edge” in this stressful mid-level management role?
The leadership at Marcellina’s organization tends to manage from their offices at the front of the healthcare facility. The strategic plan has been approved by the Board of Trustees, and nursing managers are expected to begin implementation of the plan’s initiatives at the start of the next fiscal year, two months from now.
Marcellina just learned today that a deceased patient’s family has named two of her staff nurses in a negligence lawsuit for a patient’s fall and resulting injuries and death subsequent to the fall. Marcellina may be added to the suit pending initial review by plaintiff’s counsel. Marcellina has never carried liability insurance. Marcellina is certain that the healthcare organization will provide her and her staff with an excellent defense.
