Reducing the Door-to-Balloon Time in Healthcare Facilities

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Continuous quality improvement (CQI) for healthcare practice is a prerequisite for augmented patients’ outcomes. However, adopting optimal services and procedures has never been attained (Weston & Roberts, 2013). Each time an objective is accomplished, a new and a higher goal is set to ensure the best results. As such, organizational changes are inevitable and are always necessary aspects in healthcare delivery (Hader, 2013).

For an organizational change to be effective and efficient, appropriate mechanisms must be put in place. Some of the key elements that propel organizational change projects include philosophies, models and theories. The three aspects must be aligned with change projects for successful management of change and quality improvement.

This report demonstrates how philosophies, theories and models are used in an organizational change project pertinent to reducing the Door-to-balloon time in STEMI healthcare facilities. The alignment of theories, philosophies, and models with organizational change projects will relatively improve D2B time as recommended by the AHA and other cardiovascular diseases accrediting organizations.

Nursing philosophy

The Lean six sigma is a generally recommended philosophy in change projects aimed at improving D2B times and augmenting STEMI patients’ outcomes. The philosophy is a combination of the lean strategy and the six-sigma approach (Ellahham, Aljabbari, Mananghaya, Raji, & Zubaidi, 2015). The main concepts of the philosophy are, eliminating wastage and improving efficiency. As such, hospitals strive to achieve the best results using as little resources as possible. It is common knowledge that many healthcare facilities lack sufficient resources, especially when it comes to emergency departments.

Improving D2B times is dependent on medical resources and, therefore, the lean six sigma is an important philosophy in the reducing D2B time change project. For instance, the philosophy will be vital in ensuring that all resources, including cath labs, operation rooms, nurses and time resources are used efficiently while minimizing wastage.

The philosophy has been used in change projects in hospitals to reduce the D2B time and exceptionally good results were achieved (Kelly, et al., 2010).

Nursing model

The intentional rounding model is a vital tool for any change project aimed at improving the D2B time in STEMI patients. The model has been used in major hospitals emergency departments yielding exceptional results in improving services delivery (Patterson, 2014). The intentional rounding model has a number of concepts, including scheduled intentional nursing rounds, nursing teaching rounds, nursing grand rounds, and nursing ward rounds. Essentially, the intentional rounding model concepts are aimed at ensuring the best patient experience, and equipping the emergency departments to deal with STEMI patients in manners that improve D2B time (Kirk & Kane, 2016).

The model is relevant to the change project since it will be used in improving communication between hospital staff and the patients and hence augment satisfaction and outcomes.

Nursing theory

The theory of Juran is very crucial in reducing the D2B times. The major idea of the theory is the need to make good use of available time “time is muscle”. Three major concepts of the Juran’ Theory include quality planning, quality control, and quality improvement. The quality-planning concept entails the building of quality into procedures and policies. The control concept is concerned with the evaluation of performance in relation to the set goals and objectives and taking the appropriate actions. Quality improvement entails encouraging attainment of set goal while setting new ones.

The Juran Theory will be used in this change project, especially in the quality improvement within a given time and streamlining the process involved in the D2B and STEMI patients. Additionally, the project will engage the theory in time tracking in the STEMI patients’ intervention.

Nursing Philosophies, Models, and Theories Worksheet.

Nursing Philosophy Main concept of Philosophy Project significance
Lean six sigma
  • Achieve more with less
  • improving flow in the

value stream

  • eliminating waste
  • eliminating defects
  • reducing variation in processes
Improving efficiency and effectiveness
In the emergency rooms
Nursing Model Main concept of Model Project significance
Intentional nursing round models
  • Scheduled intentional nursing rounds
  • Nursing teaching rounds
  • Nursing teaching rounds
  • Nursing grand rounds
  • Nursing ward rounds
  • Benefits on achieving quality indicators and targets
  • More open staff/ patients communication
  • More timely response and satisfaction
  • Improved patient care
  • Adapting for the emergency department
  • Current unmanageability
Nursing Theory Main concept of Theory Project significance
JM Juran
  • Quality improvement
  • Quality control
  • Quality planning
  • Proper use of time
The setting of goals and objectives
Control management
Quality improvement
Tracking time

Definitions of terms and their relevance to the change project


Philosophy can be defined as thoughts, beliefs, and truths and it involves conceptual analysis and assessment of argument (Selanders & Crane, 2012). The role of philosophy in the change project is crucial as the issues involved pertain to metaphysical and epistemological features. Of particular interest are the metaphysical aspects of time and patient outcomes.

Philosophy will be vital in the entire project, as it will inform most of the decisions and activities involved in the reduction of the D2B times in STEMI patients. As such, a specific and appropriate philosophy should be aligned with the change project to enhance efficiency and effectiveness of both the project and the implementations of the projected plans.


A nursing model can be defined as an abstract framework that links facts and phenomena that assist in the planning of healthcare delivery. It is a conceptual tool adopted by healthcare delivery professions to comprehend and internalize complex phenomena (Burggraf, 2012). Additionally, nursing models can be used to investigate STEMI and D2B problem and study the outcomes while improving the D2B times.


A nursing theory is a “set of concepts, definitions, relationships, and assumptions derived from nursing models. Nursing theories are vital in the generating nursing knowledge while providing principles to support nursing practice” to realize the desired patient outcomes (Matney, Avant, & Staggers, 2016).

A nursing theory will shape the project practice illustrating the vital ideas in the organizational change process pertinent to the improving of the D2B time. A theory is required to describe, explain, predict, and prescribe the activities involved in the organizational change project (Matney, Avant, & Staggers, 2016). As such, a theory will be a framework to provide systematic and consistent techniques of carrying out the activities involved in the improvement of D2B time for STEMI patients. Nonetheless, a specific and a particular theory should be structured to guide the organizational change.

Nursing meta-paradigm

Nursing meta-paradigm can be defined as “the global concepts that identify the phenomenon of central interest to a discipline, the global propositions that describe the concepts, and the global propositions that state the relations between or among the concepts. Nursing meta-paradigms are classified into the person, nursing, health, and environment” (Bhanji, 2012).

Nursing meta-paradigms are vital in the identification of the project central issues while describing the relationships of all the matters of STEMI healthcare delivery and the initiatives to improve D2B times. As such, nursing meta-paradigms are essential in the change project since the project entails the nursing environment


Bhanji, S. M. (2012). Comparison and Contrast of Orem’s Self Care Theory and Roy’s Adaptation Model. Journal of Nursing 2012, 1(1), 48-53.

Burggraf, V. (2012). Overview and Summary: The New Millennium: Evolving and Emerging Nursing Roles. The Online Journal of Issues in Nursing, 17, (2). Web.

Ellahham, S., Aljabbari, S., Mananghaya, T. H., Raji, S. J., & Zubaidi, A. A. (2015). Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement. BMJ Quality Improvement Report, 4(1). Web.

Hader, R. (2013). The Only Constant is Change. The Journal of Exellence in Nursing Leadership, 44(5), 6. Web.

Kelly, E., Kelly, J., Hiestand, B., Wells-Kiser, K., Starling, S., & Hoekstra, J. (2010). Six Sigma Process Utilization in Reducing Door-to-Balloon Time at a Single Academic Tertiary Care Center. Progress in Cardiovascular Diseases, 53(3), 219-26. Web.

Kirk, K., & Kane, R. (2016). A Qualitative Exploration of Intentional Nursing Round Models in the Emergency Department Setting: investigating the barriers to their use and success. Journal of Clinical Nursing. Web.

Matney, S. A., Avant, K., & Staggers, N. (2016). Toward an Understanding of Wisdom in Nursing. The Online Journal of Issues in Nursing, 21(1). Web.

Patterson, L. (2014). Preparing Staff for Intentional Rounding: A Process Yielding Success on a General Surgical Unit. Journal for Nurses in Professional Development, 30(1), 16–20.

Selanders, L. C., & Crane, P. C. (2012). The Voice of Florence Nightingale on Advocacy. Online Journal of Issues in Nursing, 17(1), 1. Web.

Weston, M., & Roberts, D. W. (2013). The Influence of Quality Improvement Efforts on Patient Outcomes And Nursing Work: A Perspective from Chief Nursing Officers at Three Large Health Systems. The Online Journal of Issues in Nursing, 18(3), 2. Web.

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