Slide 1: Hello, I am ________. This presentation aims at recommending a high-level quality improvement initiative.

Slide 2: NURS FPX 8010 Assessment 4: Quality Improvement Proposal Organizational quality improvement activities in healthcare organizations are important in improving functionality and organizational goals and objectives in ways that prompt improved patient experiences. The task given for this assessment is to reduce the average length of stay (LOS) by 5% every year in a department at Cleveland Clinic. Consequently, the rationale bounding this process can be associated with the enhancement of patient and overall resource circulation. This falls under the strategic priority of the department and enhances the bigger picture of Cleveland Clinic of delivering superior operations while providing standard patient care and increased efficiency.

The Rationale for Strategic Priority

Slide 3: The strategic priority to establish an average reduction of 5% each year in LOS rests on two strategic imperatives: enhancing production efficiency and also the standard of patient care (Cadel et al., 2021). The longer the stay in a hospital bed, the higher the increase in physician claim costs, the higher the possibility of the patient acquiring HAIs, and the lower possibility the of patient turnover, which is crucial to capacity and fiscal viability at the hospitals. Lower LOS means that resources and patient experience are used better.

The overall aim of the quality improvement initiative proposed would therefore be to enhance patient flow to enhance the process of discharge planning as well as inter-disciplinary relations. The probably aim is going to be devoted to enhancing operational integration across different departments and patient monitoring by employing technological support as well as proper early preparedness for discharge check-ups. To reduce the LOS by 5 % on an annual basis, would help to free up capacity but also help improve patient outcomes, and reduce costs bringing Cleveland Clinic in line with its mission which is to offer excellent care at the lowest possible price.

SWOT Analysis

Slide 4: Reducing the LOS by 5% every year at Cleveland Clinic can be explored using the SWOT analysis framework as illustrated below:

Strengths

Cleveland Clinic possesses all the necessary organizational prerequisites to advance LOS emerging solutions, as well as efficient interdisciplinary expertise, and strong technological support, including EHRs and CDS (Feo et al., 2022). The clinic demonstrates an operational focus that is very much in line with the end goal: LOS reduction which in turn increases the chances of better client outcomes and avert compromising quality service delivery.

Weaknesses

One possibility of weakness is that the processes could be so embedded that it is difficult to change them or to build resistance against change coming from the clinical staff. Such a reduction in LOS would require close cooperation between several departments in the organization (Gallifant et al., 2023). As we have seen where coordination is distorted nothing progresses forward. There is also the danger that the reduction in LOS could be viewed as an attempt to discharge some patients too early while to continue offering quality care it will have to be properly managed. The only risk that the hospital can encounter is readmission if a proper discharge plan and post-discharge care are not put into practice.

Opportunities

There are more innovation opportunities when adopting health IT solutions and data analyses to assess and enhance patient discharge (Gallifant et al., 2023). This may be a bet for Cleveland Clinic to be on the front lines of health care’s future, including the potential of testing out entirely new technologies and processes to help achieve this vision. Another factor that indicates interest in the health industry is value-based care – a further incentive encouraging a decrease in LOS.

Threats

Threats would emanate from external landscape health care if insurance service providers or the relevant authorities set penalties for readmission or set even rigorous conditions for discharge (Hayajneh et al., 2020). The continually evolving political setting concerning healthcare too could birth new factors that affect the way reimbursement is done or throw new restrictions on hospital operation which would complicate the effort.

Key Performance Indicators for Measuring the Success

Slide 5: The aims formulated for the evaluation of the effectiveness of the quality improvement initiative, regarding the average length of stay greater than 5%, can be considered relevant at the strategic level. All of these evaluations are consistent with the goals of increased patient throughput, efficiency, and continuing patient care at Cleveland Clinic.

• Average Length of Stay (LOS): There are a few QA metric targets for this program but the most obvious one is the true day reduction of average length of stay per patient. Any diminution greater than 5 percent per annum would require measurement and analysis based on the patient’s age, gender, disease types, and care delivery teams to identify work success and failure (Hayajneh et al., 2020).
• Readmission Rates: The rate of readmission cannot be allowed to go up while at the same time, the LOS has to be reduced. To minimize patient admission at the wrong time i.e., early time, the number of patients who are readmitted within one month of discharge is controlled as a KPI. While it may not be around for increasing readmission rates to give the impression that there may be issues with the discharge planning or care coordination process that may affect the longevity of the project.
• Patient Satisfaction Scores: Other measurable by which parole discharge experience and LOS may be assessed include patient satisfaction. They should see that when patient satisfaction is high – 90% and above, it will demonstrate that LOS reduction does not have a poor impression on the patient.
• Bed Utilization Rate: The same will be monitored by the bed usage rate, for same shall provide information on whether short LOS is indeed impacting on overall bed strength of the hospital or not (Hayajneh et al., 2020). The first positive changes in patient flow and minimizing of unrequired delays in discharge that will give clinics a possibility to improve bed turnover rates with more number of patients to be treated effectively.

Value of Stakeholders’ Feedback

Slide 6: The responses of the stakeholders need to be given great regard to enhance the possible quality improvement intervention against the mean length of stay. Value for stakeholder feedback is found in adopting multiple viewpoints, perceiving best-known practical issues, and plausible solutions that cannot be seen on a managerial level (Moheet et al, 2020). By this I mean the direct actors, both givers, and receivers of care; the frontline personnel such as doctors and nurses that are most affected by these care processes and thus are a direct target for the improvement wish of this initiative. Staff at all levels must be involved because they are most aware of operations that create inefficiency in the LOS, and their answers could provide solutions. Furthermore, the perception of LOS reduction and that the experience of the patients did not go down well would be arrived at through studies and focus group feedback.

Slide 7: The only major players in this plan are the clinical staff and the patients. The hospital administrators also have a very important function. Any change to this or in the discharge process or the interactions with other disciplines can only be effective and efficient where these changes are supported by clinicians. Principals are also important because they offer the resources, policy changes, and organizational support required to sustain such efforts (Samanta et al., 2023). Credible communication for the different stakeholders will be done with the use of a feedback loop. The official and unofficial channels, in which the carrying out of the engagement dialogue will be continued throughout the entire project, will be critical, as these can offer the real key through which bottlenecks and new notions can be gathered through achieved surveys, roundtable discussions, and online fora where complaints can be sounded and novelty proposed. This feedback mechanism will be installed with the stakeholder’s requirement that the message be attended to urgently as changes can be made in real-time about potential modifications, and it can be more effective.

Contemporary Change Theory

Slide 8: Another general theory of change that could be applied best in approaching the changes evidenced in quality improvement including the LOS average could be Kotter’s 8-step change model. The steps, enshrined in the Model, can help to perform a change process in an organization with/through leadership and involving stakeholders, systemically and systematically. Thus, on one hand, we establish the first of the Kotter models, which is to create a sense of urgency: The persuasive data on inefficiencies of LOS can be developed at the present moment, as well as hypothetical possibilities for improvement of patients’ outcomes, bed multi-density, and reduction of costs (Vadlamudi et al., 2020). This would educate several of the driving forces, consisting of clinical staff members and hospital administrators, both in and outside of the hospital, on the finance and operation aspects of the current LOS and the competing advantage if increases.

Kotter also emphasizes the establishment of a vision that can be described as an efficient caring process, which has patient focus, decreased LOS, and still meets and exceeds patient satisfaction (Wackers et al., 2021). This too must be done, at least, in equal measures to the other forms of communication so that everyone from the corporate crank to the mail clerk knows what this is all about and what part s/he must play in getting the intended results. As stated in Kotter’s model, empowering the employee helps remove several barriers, staff can enhance and redesign anything from their discharge planning to communication within care teams.

Policy Recommendations

Slide 9: As part of enhancing the quality improvement program to reduce LOS by 5% each year, the following are recommended policies. First, there is a need to adopt a new policy in the field of interprofessional collaboration. This would help to make legally structured communication protocols when dealing with physicians, our nursing team, discharge planners, and social workers (Moheet et al., 2020). The above policy will effectively ensure that the complicated cases go through the required interdisciplinary rounds and check-in, and that, top-up on the real-time information sharing will help reduce the LOS.

This is compounded by the fact that the discharge readiness criteria were embedded in the EHR systems, therefore the clinicians would get easy access to those tools, for prompt discharge of patients. Suspend or set aside any current patient admission and discharge documentation procedures that are too time-consuming or redundant. Removing or decreasing the number of documents in some cases eliminates duplicate-documentation procedures that would otherwise occupy the time of staff in clinical care as well as enhance flow, as mentioned earlier in LOS decreases.

Slide 10: The above recommendations call for positive organizational policies in the organization hence enhancing the organization toy-boy big (Vadlamudi et al., 2020). An official inter-departmental care coordination policy will ensure that the departments involved are in touch with one another and hence fasten up decisions needed as well as promote better care co-ordination. Hopefully, it should improve patient care and create operational efficiency. Increasing the quality of the discharge processes and developing discharge criteria for the patients in EHRs can enhance the patient handover process, and bed distribution and may result in augmented availability of hospital beds with less resource investment.

Conclusion

Slide 11: The observable concrete quality improvement initiative proposed is that a specific measure must see an average length of stay cut by 5% annually. This is strategic because it satisfies one of the established criteria of being a multiple-approach strategy to deal with the clinic’s shortcomings in focusing on its operational capacity, and at the same time provide for patient satisfaction (Vadlamudi et al., 2020). However, when a department focuses on the reduction of LOS it can always key into general organizational goals, use more resources more probably improving on patient satisfaction for general conditions. In essence, this is a continuous improvement commitment and has the same spirit as Cleveland Clinic’s mission of providing the best care, and good operational scenes.

References

Cadel, L., Guilcher, S. J. T., Kokorelias, K. M., Sutherland, J., Glasby, J., Kiran, T., & Kuluski, K. (2021). Initiatives for improving delayed discharge from a hospital setting: A scoping review. BMJ Open, 11(2), e044291. https://doi.org/10.1136/bmjopen-2020-044291

Feo, R., Urry, K., Conroy, T., & Kitson, A. L. (2022). Why reducing avoidable hospital readmissions is a “wicked” problem for leaders: A qualitative exploration of nursing and allied health perceptions. Journal of Advanced Nursing. https://doi.org/10.1111/jan.15220

Gallifant, J., Griffin, M., Pierce, R. L., & Celi, L. A. (2023). From quality improvement to equality improvement projects: A scoping review and framework. iScience, 26(10), 107924. https://doi.org/10.1016/j.isci.2023.107924

Hayajneh, A. A., Hweidi, I. M., & Abu, M. W. (2020). Nurses’ knowledge, perception and practice toward discharge planning in acute care settings: A systematic review. Nursing Open, 7(5), 1313–1320. https://doi.org/10.1002/nop2.547

Moheet, A. M., & Livesay, S. L. (2020). Quality improvement in neurocritical care: current state and looking to the future. Current Opinion in Critical Care, 26(2), 97–102. https://doi.org/10.1097/MCC.0000000000000714

Samanta, A. K., Varaprasad, G., Gurumurthy, A., & Antony, J. (2023). Implementing Lean Six Sigma in a multispecialty hospital through a change management approach. The Tqm Journal. https://doi.org/10.1108/tqm-02-2023-0043