Nowadays, the healthcare industry is changing rapidly, especially with the advancement in medical technologies and new scientific discoveries. Right now, it is easier than ever to make breakthroughs in the field. Despite that, it is evident that many medical institutions struggle to adapt to the new reality and improve the quality of care they deliver. Thus, healthcare facilities have followed the example of massive corporations and started to implement effective managerial strategies to do just that. The majority of existing hospitals develop their own frameworks consisting of complex strategies to achieve better results. Moreover, quality improvement specialists need to be able to measure, evaluate, and control these initiatives. Achieving sustained progress in the quality of care delivered to patients requires commitment and collaboration. The top management has to plan such initiatives carefully to ensure they are focused on one specific problem and not go off in all the different directions. The purpose of this report is to evaluate the quality improvement program initiated by medical directors at Baptist Health South Florida. The target audience includes primarily nursing staff with an interest in the condition of bed sores.
Although the assignment asks students to write about the organization they are currently employed at, I work for an insurance company and, thus, am unable to follow these instructions. However, after consulting with my professor, I made a decision to evaluate a theoretical quality improvement initiative, which aims to prevent bed sores, also known as pressure ulcers. The institution I want to base this paper on is Baptist Health South Florida, which is the biggest healthcare institution in the area. It provides a wide range of services and includes Baptist Children’s Hospital, Doctors Hospital, Fishermen’s Community Hospital, West Kendall Baptist Hospital, Bethesda Hospital East, and many others (Baptist Health South Florida, 2017). The organization has its own Baptist Health Quality Network, which is a famous center of excellence across multiple counties (Baptist Health South Florida, 2017). Baptist Health describes itself as “a not-for-profit organization supported by philanthropy and committed to our faith-based charitable mission of medical excellence” (Baptist Health South Florida, 2017, para. 6). Employing thousands of qualified and highly competent medical professionals, it is recognized as one of the best U.S. companies for employees by Fortune (Baptist Health South Florida, 2017). Although it is evident that such a large and influential institution invests a lot in improving the quality of care it delivers, there is also space to make treatments more effective and patients – more satisfied.
In order to discuss the intervention program, it is first important to recognize the reasons why the issue of pressure ulcers gains attention. The growing number of patients developing the condition while staying at one of the Baptist Health facilities could be what prompted the intervention. After all, according to Richardson et al. (2016), “reported incidence of pressure ulcers in critical care varies from 3% [3] to 20% suggesting a potential opportunity to reduce avoidable harm” (p. 433). Apart from resulting in serious consequences for the patients, including intense pain, bed sores leading to infections, increased utilization of resources, and many other financial implications of a prolonged hospital stay. Critical care patients are especially vulnerable to the development of pressure ulcers due to immobility, malnutrition, and tissue perfusion. For a non-profit institution such as Baptist Health South Florida, spending more money on treating patients with preventable bed sores is a great monetary threat, which is why the quality improvement initiative could potentially be implemented at the organization.
The setting of the theoretical intervention for quality improvement is four critical care units for adults located on different hospital sites. These locations are prioritized because they have the highest rates of patients developing bed sores. The primary objectives were to reduce the incidence of pressure ulcers and to follow preventative strategies to avoid treatment. Based on the challenges Baptist Health has faced, which are going to be discussed later, it is apparent that implementing a multidisciplinary team approach should have also been one of the goals.
After conducting an initial assessment, it was clear that the biggest gaps in practice were non-compliance to preventative care measures as well as frequent unavailability of barrier creams. Thus, Baptist Health introduced an improvement initiative, which was comprised of multiple complex steps, using the Model for Improvement (MI). The MI is a framework, which dictates the structure of an improvement initiative for it to include a clear aim statement, outcome measures, and potentially beneficial changes worth testing (Gupta et al., 2020). While the objectives (aim statement) have already been defined, it is important to assess the changes that Baptist Health South Florida considered worthy. They included revising nursing care plans and documentation, controlling the availability of barrier creams, and introducing new mattresses to relieve stress. However, these changes were very limited and did not consider risk assessment as a crucial part of any preventative strategy. It would have been beneficial for Baptist Health to include developing a risk-assessment tool or re-educate the nursing staff on the use of the Braden Scale to conduct that task.
Although the results of the intervention may have been impressive, the program could have been more effective if medical directors ensured there was an extensive process of risk assessment before the intervention itself. Healthcare organizations that evaluate the risk of someone developing a condition highlight the gaps in practice and allow medical staff to structure preventative measures accordingly (Richardson et al., 2016). Nurses are rarely re-educated on the use of the Braden Scale for making assessments although they can make many mistakes since they are not used to working with it (Gupta et al., 2020). As for the outcome measures used during the intervention, they included incidence rates (monthly), prevalence surveys (quarterly), and impressions of the staff on the success of the proposed changes (annually). However, it would be also beneficial to add risk assessment and pressure ulcers prevention education module completion as another outcome measure. The main benchmark was the reduction of hospital-acquired pressure ulcers in the four units chosen over the course of 36 months.
When it comes to the functionality and effectiveness of the team working on the improvement intervention, ulcer prevention requires a multi-disciplinary approach. Baptist Health would most likely create a specific task group dedicated to reducing bed sores by using the outlined strategies. It is important to acknowledge that no individual medical professional, no matter their qualifications or experience, can prevent such a massive number of pressure ulcers from developing. Therefore, there has to be a team comprised of consultants, critical care nurses, data monitoring specialists, educators, nutritionists, as well as medical directors. In order to implement the care plan, the team needs to have a high level of coordination, which can be determined by the intervention success rates and staff surveys. It is possible for Baptist Health to introduce such a team to reduce bed sores because the organization has been established for long enough to have a proper organizational culture and networks of communication channels.
While the scenario is imaginary and I cannot interview the medical staff at Baptist Health, I can only assume what they might have said in regards to such an intervention. It is most likely that the critical care nursing consultants and quality improvement specialists would raise alarm over the lack of educational resources available to nurses for efficient risk assessment. In addition, I believe medical directors and the institution’s executive board would put more emphasis on cutting costs as an important benefit of reducing bed sores in patients.
Apart from the lack of risk assessment training in staff, it is important to mention the implications of using a bundle intervention approach as an add-on to the limitations of the quality improvement program discussed. Although studies demonstrate them to be extremely effective, it is difficult to evaluate the effectiveness of each of the bundle intervention’s many components (Marini et al., 2016). Thus, medical directors face the challenge of shortening the list of changes to the ones that actually work and are critical to the improvements.
In conclusion, it is evident that quality improvement initiatives are much needed in healthcare to ensure patients receive the best and safest care possible. In addition, the reduction of hospital-acquired infections and other conditions saves hospitals a variety of resources, which could be utilized elsewhere. Prevention of pressure ulcers requires multi-disciplinary, well-coordinated teams to conduct risk assessments, implement and evaluate the processes, as well as make alterations according to the outcomes.
References
Baptist Health South Florida. (2017). Baptist Health South Florida hospitals receive national recognition for quality surgical care. Newsroom Baptist Health. Web.
Gupta, P., Shiju, S., Chacko, G., Thomas, M., Abas, A., Savarimuthu, I., Omari, E., Al-Balushi, S. Jessymol, P., Mathew, S., Quinto, M., McDonald, I., & Andrews, W. (2020). A quality improvement program to reduce hospital-acquired pressure injuries. BMJ Open Quality, 9(3), 1–9.
Marini, A. L., Khan, R., & Mundekkadan, S. (2016). Multifaceted bundle interventions have shown effective in reducing VAP rates in our multidisciplinary ICUs. BMJ Quality Improvement Reports, 5(1).
Richardson, A., Peart, J., Wright, S. E., & McCullagh, I. J. (2016). Reducing the incidence of pressure ulcers in critical care units: a 4-year quality improvement. International Journal for Quality in Health Care, 29(3), 433–439.