pdsa model of change in nursing essay

pdsa model of change in nursing essay

pdsa model of change in nursing essay

Quality/Safety Improvement Model

Quality/Safety Improvement Model

Medical errors depict a severe public wellbeing issue and pose a risk to the security of patients. As health centers introduce an ‘error’ as a research and clinical need, the response to maybe the most crucial inquiry remains indefinable: How can you define a medical error? To diminish therapeutic faults, exact measurements of its occurrences, founded on definite, and predictable definitions, are critical essentials for successful actions. In spite of having a growing literature and research body to study on errors in medicine, few undertakings have measured or defined the issue unswervingly. Rather, analysts have embraced substitute measures of error that to a great extent rely on antagonistic patient injury or outcomes (that is outcome-dependent). pdsa model of change in nursing essay. An absence of institutionalized classification and the utilization of various and overlapping meanings of medical error have barred data analysis, synthesis, collaborative work, and assessment of the effects of alteration in health care conveyance. The essential goal of this audit is to highlight the requirement for a robust, wide-ranging and collectively acknowledged meaning of therapeutic error that unambiguously incorporates the crucial areas of error causative ness and catches the defective procedures that cause errors, independent of result.


Quality/Safety Improvement Model
The issue of patient safety plays a significant role in health care. The prominence of the issue is fueled by the intensifying body of research that demonstrates a high frequency of medical error combined with a couple broadcasted therapeutic error cases that have over the years raised a public concern over the issue of patient safety in the contemporary health care conveyance. Medical faults can be said to be avoidable adverse effect or event of care. They are a leading cause of many deaths in several parts of the world and even in most cases exceed the deaths caused by vehicle accidents, heart failure, or even breast cancer (Palmieri et al., 2008). They comprise of incomplete or erroneous treatment or diagnosis, and incorrect execution of an appropriate care method. Errors caused by humans have been involved in about 80 percent of adversative happenings that happen in complex healthcare units. The dominant part of medical errors emanates from faulty systems and inadequately composed procedures versus incompetent practitioners or poor practices.
According to a study conducted by Gitomer, the vulnerability of medicine to error is turning out to be deceptive (2005). The research revealed that the errors are more prevalent in intensive care units whereby nurses are involved in the medical recovery of the error (that is recognizing, interposing, and correcting them) and preventing adverse effects. Despite the fact that medical practitioners have been identified for preventing errors from occurring, only lately have approaches for error retrieval been designated in the literature. Analysis that have recently shown that failure results from a system and human failures have given people a call to action to start systematically addressing the issue. pdsa model of change in nursing essay.

Problem of Discussion
The issue of medical errors was recently brought to the public following a series of deaths caused by health systems and human faults. Several reports introduced the issues of health safety into the awareness of the people and stressed on four key points. That medical errors are costly and frequent, they are caused by systems, can be prevented and safety enhanced, and medication-connected adverse events are the primary causes of injuries. Recent attempts have been made to think about what can be done to achieve the next level of health safety (Gitomer, 2005). Medical experts have recommended that the security of patients depend more on averting overwhelming incidents by improving systems as it relies on increasing people’s ability to the point of health care to eliminate dangerous situations by recognizing those errors.
To minimize the occurrence of medical mistakes, medicinal service providers should identify their causes, device measures, and quantify the success of improvement endeavors. In addition, exact estimations of the occurrence of error founded on precise and steady definitions, are crucial essentials for powerful actions. pdsa model of change in nursing essay. Unfortunately, what is viewed as a medical error has been affected by contrasting settings and purposes, for example, quality control, legislation, research, insurance, statutory regulations, morals, and legal action. Subsequently, an absence of institutionalized terminology and the utilization of various and covering meanings of restorative error has hindered data analysis and synthesis, evaluation, and collaboration of the effect of changes on medicinal services delivery (Thomas &Brennan, 2011). Researchers have adopted surrogate error measures, such as critical incidents, preventable adverse activities, violations, slips, iatrogenic illness, potentially compensable occurrence, and noxious episodes pdsa model of change in nursing essay.
Programs to reduce Medication Errors
The objective of this discussion is to study programs, which have over the years proved to be effective in the reduction of medical errors. The systematic nature of medication errors involves a multi-disciplinary approach. Programs projected in the medical literature need the involvement of drug manufacturers, pharmacists, communication efforts, as well as information systems (personnel, software/hardware) of hospital staff to minimize medication errors. Technological programs to offer solutions to the medication errors will continue to transpire as healthcare continues with their efforts to improve quality and safety in all health aspects of healthcare delivery (Cohen, 2007). Despite that there is evidence of the advantages and improvement in centers due to the implementation of such programs, inquiries continue to arise. There have been writings showing the business case of programs, such as the MFI (Model for Improvement) and PDSA (Plan-Do-Study-Act) tools pdsa model of change in nursing essay. To recognize the full advantages of these approaches, implementations should be combined with adequate training and support, engaged at all levels, easy to utilize, counterpart prevailing protocols, and tools within the organization and be a part of the all-inclusive Quality Care Program (QCP) or Quality Improvement (QI).
Intended Improvement
Utilization of MFI and PDSA as project Management Resources
Conveying changes in the quality and security of healthcare remains a worldwide challenge. Currently, Quality improvement (QI) systems, for example, the MFI and PSDA cycles have been utilized as part of an endeavor to drive such enhancements. The system is used as a part of medicinal services change; nevertheless there is a small overall assessment of how the strategy is connected (Schilling & Joint Commission Resources, Inc., 2009). This paper proposes a hypothetical structure for surveying the nature of the use of MFI and PDSA cycles and investigates the superiority and steadiness of PDSA cycle presentation against this basis as recognized in several peer-review journals. pdsa model of change in nursing essay.
It is important to bring into practice several quality improvement techniques and tools, which enable the identification of ineffectiveness and inefficiency in the health services and propose the practical changes that can be brought to the system. One of the most recommended tools is the Model for Improvement (MFI) and Plan-Do-Study-Act (PDSA), which comprises of a standard theoretical accounting, supported by the Institute of Healthcare Improvement (IHI) and National Health Service (NHS) as a primary approach to promoting and fostering exertions in quality management (John Corrigan &Donaldson, 2007) pdsa model of change in nursing essay. It incorporates execution appraisal and the utilization of evidence-based discoveries as a method for affecting the desired change in the medicinal services division, a zone where the need for security and quality change cannot be disregarded.
IHI endorses the MFI as an approach to guide improvement activities. It was developed by Associates in Process Improvement, is a very simple, yet very influential implement for accelerating medical error recovery. The tool is advantageous in that it does not replace any other change models that health centers may have adopted but is meant to increase growth. It has over the years been implemented successfully by numerous health care firms in many nations to advance many distinct medical procedures and effects pdsa model of change in nursing essay.
The MFI has two major parts, which include the Plan-Do-Study-Act (PSDA) cycle meant to test changes in the health settings. The cycle is important as it guides the change test to determine if it is an improvement. The other part is the three central questions, which are addressed in any order. The MFI and PSDA tool requires an organization to include the right people in the procedure improvement team to ensure that the medical error is alienated. Teams tend to differ in composition and size. Therefore, each organization can focus on building a team that suits its own requirements (Barach &Small, 2010). pdsa model of change in nursing essay. To implement the tools, an organization should first set its aims. The goals should be measurable as well as time-specific and should be able to outline the particular patient population, or any other system that may be affected.
Outcome Measure to delineate the Goal
Increased enthusiasm for patient wellbeing, error elimination, and the nature of human services has prompted the improvement of various execution measures (procedures and results) to assess frameworks of consideration. pdsa model of change in nursing essay. In considering precise results measures, it is unclear that national post-mortem examination rates keep on declining in light of the way that post-mortems have generally served as the “best quality level” in the quality certification of therapeutic consideration. Progresses in therapeutic innovation, including complex imaging systems, percutaneous biopsy, fine needle yearning, and a large number of new research center strategies, have strengthened symptomatic carelessness and have prompted the discernment that post-mortem examinations are no longer essential (Thomas & Brennan, 2011). Despite the fact that new indicative procedures can give definitive clinical data, these strategies can likewise add to False-positive and false negative conclusions and do not apparently diminish the rate of misdiagnosed as found via post-mortem examination.
Nevertheless, doctors have persuaded themselves and their patients that new therapeutic innovation has come to such an abnormal state of symptomatic exactness that the post-mortem is out of date. The fact of the matter is that when the last result is demise, the autopsy still remains the best accessible instrument for assessing symptomatic exactness (Stamatis, 2011). In this manner, when appropriately utilized, post-mortem information has a colossal potential for the distinguishing proof of correctable orderly mistakes in indicative processes. When medical errors occur and if physicians are blamed, then the society develops a preventive culture and 3 sorts of strategies may follow: an endeavor to (1) “execute the person,” (2) “distort the information, corrupt the standard, get control of the unsafe procedure,” and (3) “diverse attention”(Stamatis, 2011).
Critical Analysis of the Value of the Tool to Supporting the Initiative pdsa model of change in nursing essay.
In spite of expanded interest in examination of the change of medication errors, evidence of sustainable QI intercession remains blended, proof of viable QI intercessions stays blended, with numerous deliberate audits inferring that interventions are just compelling in particular settings. To comprehend these discoveries, it is imperative to appreciate that conveying changes in medicinal services require the modification of procedures within complex social frameworks that change after some time in anticipated and unanticipated ways. Research discoveries highpoint the persuasive impact that local context can have on the achievement of an intervention and, in that capacity, “single bullet” medications are not anticipated to convey predictable enhancements (Joint Commission Resources, Inc., 2009). Rather, viable intermediations should be multi-faceted, complex, and developed iteratively to adjust to the publics and react to unexpected obstacles and inadvertent effects. pdsa model of change in nursing essay. Finding powerful QI systems to bolster iterative improvement to evaluate and test interpositions to care is important for high-value and high-quality delivery care in financially constrained settings.
MFI and PSDA tools provide a technique for structuring iterative advancement of variation, either as an impartial strategy or as a significance aspect of more extensive QI methodologies, for example, Total Quality Management (TTM), Lean, Continuous QI, or Six Sigma. Despite expanded utilization of QI strategies, the indication basis for their adequacy is reduced and under-theorized (McLaughlin & Kaluzny, 2014). MFI and PDSA cycles are regularly a focal component of QI activities; however, a couple of formal target assessments of their viability or application have been conveyed out (Cohen, 2007). Some MFI and PDSA methodologies have been exhibited to result in massive changes in consideration and patient effects while some have shown no changes at all.
Tool- Major Discussion
Healthcare centers need to be ready to learn how to use the MFI tool, and especially, how to undertake continuous and systematic procedures for trusting and implementing improvements to eliminate medical faults by applying the PSDA improvement cycles. Their primary focus is to instill the two models in their daily practices. pdsa model of change in nursing essay. Each advancement activity chosen by experts should be a prospect to persuade them to consider a data-driven and a systematic methodology to testing, implementing, and supporting change (Stamatis, 2011). A significant part of presenting a culture of quality is through enabling the practice to change its attention from individuals to procedures. Health organizations can get hindered in looking for people to blame for less than optimal results, a model that can produce a problem-focused and a punitive work context. Medical experts can employ the MFI and PSDA tools to aid practices in proposing a changed to thinking about their system and how they can modify them to increase productivity.
The MFI and PDSA cycles are straightforward yet powerful models that assist in developing of practices. One of the most ultimate methodologies to doing this is to urge the practice to undergo the control of completing a change structure in light of the MFI (Graham, 2005).The minor demonstration of finishing the structure aids in strengthening the thought and fabricates the inward discipline and ability to utilize a characterized procedure for testing and embracing changes to the typical course of business.
The MFI and PDSA models work hand-in-hand and are the standard used QI approaches in healthcare. The MFI utilizes a rapid cycle processes, which are the PDSA cycles to test the impacts of minimal changes, make them, and eventually spread the efficient transformation through the practice or the institution. The PDSA users follow a recommended four-stage cyclic study approach to acclimatize to changes geared towards improvements. In the first stage, which is plan, change to lead the growth is developed, the second stage “do” is whereby the change is tested, while the “study” stage scrutinizes the success of that particular change (Graham, 2005). The final stage, which is “act” recognizes adaptation and the process can lead to the formation of a new cycle (See Appendix 1). You may not achieve the expected results when changing the methods, so it is efficient and safer to test out progress on a small group afore making them the solutions. Utilizing the PDSA cycles is essential as it enable individuals to test out modifications before the final implementation and offer stakeholders with an opportunity to see if that change will work. pdsa model of change in nursing essay.
The PDSA cycle encompasses testing the new changes for instance, try the contemporary ways of giving drugs to patients or even attempting to use new patient data sheet with a designated patient groups before introducing that change to all healthcare systems. It is essential to test change before applying it as it saves time, money, and risk, it is secure and less disruptive for staff and patients, and usually there is less resistance (Speroff & O’Connor, 2014).The following are the recommended ways of how to test the PDSA models:-
• An arrangement of various cycles to test thoughts. One can adjust these from the administration change direct, so there is proof that the change meets expectations
• Test on a small group of people. For instance, begin with a patient or a physician at one evening facility and expand the rates as you improve the thoughts
• Test the projected change with individuals who have faith in the change. Try not to attempt to change individuals into tolerating the adjustment at this step
• Just actualize the thought when convinced that you have considered and tried all the conceivable methods for accomplishing the change
• The MFI, model on the other hand, starts by asking three main questions:
• What is the organization trying to achieve?
• How will one know if a modification is a progress? pdsa model of change in nursing essay.
• What are the changes that we choose that results in improvement? (See Appendix 2)
QI members, therefore, present and examine changes deliberated to attain the aims of development using sequential PDSA cycles till they achieve the change that the organizations believe will eliminate medication errors (Thomas & Brennan, 2011). By answering the above three questions, teams will be focused towards setting vibrant and engrossed goals. These objectives require clinical leadership and should emphasis on issues that raise concern. The statement objectives should be bold in its aims, be consistent with goals, and should have clear and predictable targets. For instance, to reduce errors in cancer treatment, health practitioners should focus on improving access, diagnosis speed, treatment speed as well as the patient care of individuals who are susceptible of suffering from bowel cancer. The reduction of medical errors using the MFI model cab be achieved by initiating booked appointments and admissions, minimizing the time from referral to initial exact treatment to not more than 15 weeks, and lastly, guaranteeing that 80% of patients are deliberated by the multidisciplinary team.
How to realize if the modification is a progress after applying the MFI and PSDA models
Physicians should quantify results, for example, diminishment in the period a patient needs to hold up so as to answer this inquiry. In the event that they make an improvement, this ought to influence the measures and exhibit over time if the transformation has prompted feasible adjustment (Fain, 2013). The steps in this model are instruments for learning and showing change, not for judgment. Every task group ought to gather information to exhibit whether changes result in change. They should report change monthly on time arrangement diagrams known as ‘run charts’ or measurable procedure control graphs. There are numerous probable changes that a team can make. Though, scientific literature evidence and past advancement programmes propose that there are fewer chances that are likely to lead to improvement. It is probable that numerous PDSA cycles could be running simultaneously or sequentially (See Appendix 3 and 4 respectively).
To accomplish effective change endeavors in a given erroneous health care system framework the MFI and PDSA models accentuates the need to select the most appropriate personnel, which is critical to the general change in quality procedure. Just as the incorporation of different health care providers with fluctuated training levels and executive sponsors is vital to the development of a successful team, so is the consideration of team members acquainted with the different components of the procedure needing change (Boaden et al., 2008). pdsa model of change in nursing essay The decision of these members depend on the requirement for the group to speak to four distinctive key zones of specialization in the given human services foundation: every day authority of the organization, official sponsorship, clinical administration, and specialized abilities. It is not until the decision of colleagues is deliberately and precisely impacted, that achievement will be acknowledged in the manageability and usage of the proposed enhancements in quality.
Thinking of the consistent choice of the significant goals of the change extend typically takes after the group’s determination when utilizing the MFI and PDSA device for quality change. The apparatus proposes the definition of objectives that are reasonable, achievable, time cognizant, quantifiable, and particular. For the change’s achievement of value undertakings, outside and inner monetary backing is essential as it encourages mere execution of the task, investigation of the outcomes and reasonable usage of the proposed changes (See Appendix 5).
With an end goal to answer this quality change instrument’s inquiry of how the proposed change can promote upgrades in quality, a hypothetical bookkeeping of the measures identifying with the structure, procedure and results is recommended as it gives a guideline to the group’s usage learning of the association needing the change (Fain, 2013). By doing this, significant structure changes are sure to be, and this may, in the long run, lead to a decent result. The estimation method most regularly utilized is the utilization of procedure measures, and this is basic, particularly given that most ventures of enhancing quality are organized with the fundamental point of changing a predetermined defective system. In addition, a method for measuring the spontaneous ramifications of the foreseen change is additionally a need for the quality change group. The procedure’s determination and result means go before a relatively dreary methodology of gathering pattern information (Langley et al., 2009). This information accumulation technique mostly depends on relevant choices, for example, to where the information will be gotten, the amount of information ought to be gathered, the recurrence with which it will be examined, the venture orchestrators, and how the outcomes will be introduced to the venture’s partners.
Further investigation of the MFI and PDSA uncovers that after the doable change thoughts have been chosen, trying of these progressions begins quickly. It additionally stresses the need to investigate all the conceivable picked up thoughts considering that all sequences do come full circle into upgrades yet rather, all enhancements emerge from specific changes. The last and most imperative step of the MFI and PDSA quality change instrument is the execution and sustainment of the proposed modification thoughts (Gitomer, 2005). It incorporates the foundation of a demonstrated rundown of proposals that can be controlled to offer ascent to broad framework changes considered for enhancing social insurance results pdsa model of change in nursing essay.
MFI and PDSA are practices that every medical practitioner should become familiar with and feel comfortable using them. They are essential tools for organizations or individuals trying to advance quality, especially in health institutions. In the clinical context, doctors are focused on minimizing waiting times in emergency divisions, improving safety standards compliance in surgical and medical units, and lessening infections through increased hand washing acquiescence. The success of using the tools involves participation, communication, and organization of the entire medical team by ensuring that all units are ready to implement the changes. The MFI and PDSA models are a successful and famous instrument that are utilized to deliberately accomplish positive results as for upgrades in quality pdsa model of change in nursing essay. It is additionally apparent from the content that change in quality is to a great extent subject to five achievement components: advancing and keeping up a society of dynamism and well-being, including significant partners, a building up a comprehension of the current issue, testing of the recommended change thoughts, and a dynamic checking of the discoveries with respect to reporting and execution in endeavors to keep up the coveted change. Every one of these components has been analyzed in the analysis of these tools.
Barach P., & Small S. D. (2010). Reporting and preventing medical mishaps. Lessons from non medical near miss reporting, 320, 759-763.
Boaden R., Harvey G., Moxham C., & Proudlove N. (2008). Quality improvement: theory and practice in healthcare. NHS Institute for Innovation and Improvement. University of Warwick: Coventry UK.
Cohen M. R. (2007). Medication Errors (2nd Edition). Washington, DC: American Pharmacist’s Association.
Fain, J. A. (2013). Reading, Understanding, and Applying Nursing Research. Philadelphia: F.A. Davis Company.
Gitomer R. S. (2005). Improving access, quality of care, and patient satisfaction in a general internal medicine practice. Journal of Clinical Outcomes Management, 12(5), 245-249.
Graham, N. O. (2005). Quality in health care: Theory, application, and evolution. Gaithersburg, Md: Aspen Publishers. pdsa model of change in nursing essay.
John L.T., Corrigan J.M., & Donaldson M. (2007). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press.
Joint Commission Resources, Inc. (2009). Cost-effective performance improvement in behavioral health care. Oakbrook Terrace, IL: Joint Commission Resources.
Langley G. L., Nolan K. M., Nolan T.W., Norman C. L., & Provost L. P (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers.
McLaughlin, C. P., & Kaluzny, A. D. (2014). Continuous quality improvement in health care: Theory, implementation and applications. Gaithersburg, Md: Aspen Publishers, Inc.
Palmieri, P. A., DeLucia, P. R., Ott, T. E., Peterson, L. T., & Green, A. (2008). The anatomy and physiology of error in averse healthcare events. Advances in Health Care Management. Advances in Health Care Management, 7, 33—68.
Schilling, L., & Joint Commission Resources, Inc. (2009). Implementing and sustaining improvement in health care. Oak Brook, IL: Joint Commission Resources.
Speroff T., & O’Connor G. T. (2014). Study designs for PDSA quality improvement research. Quality Management in Healthcare, 13, 17-32.
Stamatis, D. H. (2011). Essentials for the improvement of healthcare using Lean & Six Sigma. Boca Raton: CRC Press pdsa model of change in nursing essay.
Thomas E., & Brennan T. A. (2011). Errors and adverse events in medicine: an overview. In: Vincent C, editor. Clinical risk management: enhancing patient safety, 1, 31-43.

Quality Improvement Project for Patient Prescription Record

The aim of this quality improvement project is to ensure that nurses record in the designated box on patients Prescription and administration record (to be referred to as: Kardex) if High Dose Antipsychotics Monitoring is Applicable YES or NO (to be referred as: applicable Y/N) and subsequently if yes, that the High Dose Antipsychotic Therapy monitoring form (to be referred to as: Monitoring form and the Early Warning Signs (EWS) Form have been activated for completion. The purpose of this is to secure patient safety from the side effects of the medication.

There is widespread evidence which clearly links antipsychotic medication contributing to physical health problems such as cardiovascular problems, weight gain, endocrine problems, metabolic syndrome and sudden death (Gumber et al, 2010; Churchword et al, 2009; Tyson et al, 1999). Many premature deaths of people with serious mental illness are due to poor medical care that fails to monitor risk factors which may be due to side effects of medication (Cohen & Hove, 2001). A council report by the Royal College of Psychiatrists (2006) revealed that past audits of high dose antipsychotic prescribing for in- patients showed poor adherence to monitoring recommendations. All patients on high dose antipsychotic treatment must be monitored. These guidelines attempt to clarify the identification of patients on high dose antipsychotics, factors to be taken into account before such prescribing and the documentation required when antipsychotics are prescribed in high dose; furthermore it is a policy requirement of Forth Valley that this documentation is completed for these patients (Forth Valley, 2011) pdsa model of change in nursing essay.

The charge nurse highlighted a concern when evaluating the patients Kardex audit, it showed 100% non-compliance for the completion of the Yes/No response for high dose antipsychotics monitoring. Subsequently when the patients are receiving high dose antipsychotics, there was inconsistency of the completion of the Therapy monitoring form and EWS form. A recent audit of patient Kardexes confirmed the charges nurse finding (see Pareto chart, Appendix B).

To begin the process of the quality improvement project, a general ward meeting was held and attended by all staff in the ward that was on shift. During the meeting the charge nurse highlighted the recent findings of the Kardex audit. pdsa model of change in nursing essay. Concerns were raised that many areas on the Kardex were not being completed, and reminded staff nurses that this is not acceptable and needs to be improved. As a nurse it is extremely important to keep accurate documentation, good record keeping is an fundamental part of nursing practice, and is necessary to the delivery of safe and effective care (Nursing and Midwifery Council, (NMC) 2010).

As an attempt to focus the quality improvement project more specifically the results of the audit were presented using a Pareto chart (Appendix B). The data confirmed the areas on the Kardex which were not being completed however, high dose antipsychotic monitoring Yes/No was the highest at 100% non-completion, therefore it was agreed that a new strategy would be implemented to improve this. McLaughlin and Kaluzny (2006) state that the defect focused on does not necessarily need to be the greatest frequency to be improved first, but attention should be given to that defect that may have a devastating result, such as an adverse event or even death. However the defect in this instance was the highest and potentially could cause an adverse event.

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Following the meeting a questionnaire (Appendix C) was devised and completed anonymously by the pharmacists, consultants and staff nurses to identify the root causes of why this area on the Kardex was not completed. A fishbone diagram was used to illustrate the findings (Appendix D). When populating the fishbone diagram with the data, it was clear to see that there were many reasons that each member of the multidisciplinary team had not completed the applicable area on the Kardex. Role confusion was a common theme from each member of the team. Hill-Smith et al (2012) claims that this is not unusual within multi-disciplinary teams and that respectful communication and clear instructions is of high importance in the delivery of high quality clinical care pdsa model of change in nursing essay. Therefore based on these findings PDSA one was developed (Appendix G1). This tested whether the nurse attending the MDT meeting completes the Applicable Y/N on the patients’ Kardex following an email reminder and a verbal prompt from charge nurse before attending the meeting. The test confirmed there was a breakdown in communication, the nurse did not receive the email or a verbal reminder from the charge nurse prior to attending the MDT meeting therefore they were not aware of the procedure that had been discussed and as a consequence the applicable area on the form was not completed, this was confirmed by an audit of the Kardex (Appendix H). This informed the decision for PDSA two (Appendix G2). The nurse coordinating the shift should use the visual prompt situated on the shift coordinating sheet to remind the nurse attending the MDT meeting, to update applicable Y/N on the patients Kardex. The small change of a visual reminder on the shift coordinating sheet proved to be success. It reminded the coordinating nurse to verbally prompt the nurse attending the MDT meeting to complete the patient’s Kardex in the applicable area, which was shown by the Kardex audit after the shift; all patients’ Kardexes were completed and as a consequently the Therapy form and EWS from were also initiated for completion. These findings are consistent with Simpson (2007) research, where teams have clear operating procedures in place, care coordinating is enhanced.

The assumption was that the email and verbally prompt from the charge nurse would result in nurses completing the Applicable Y/N on all patients Kardexes, following the MDT meeting by 23rd February 2014 by 100%. Furthermore, if yes the Therapy form and the EWS form activated for completion pdsa model of change in nursing essay.

Audits were carried out on the dates shown to give a snapshot of the completion of Applicable Y/N on all patients Kardexes in the IPCU ward at that time. Initial findings of the first audit by the charge nurse on 01/02/2014 revealed that Applicable Y/N was completed 0%. The second audit carried out to confirm the previous results on 08/02/2014 which confirmed the charge nurses findings of 0% compliance of Applicable Y/N. PDSA one was carried out on 10/2/2014 the change revealed 0% improvement in the completion of Applicable Y/N. PDSA two was implemented on 21/2/2014 the change was successful, the results of the audit revealed that Applicable Y/N was completed on all patients Kardexes by 100% this in turn activated the completion of the Therapy form and EWS Form.

Comparison of questions, predictions, and analysis of data:

Engaging with the quality improvement (QI) project has required me to learn and apply new skills in practice.

The process of plan, do, study, act (PDSA) cycles were a new technical skill which I had to not only learn myself, but teach fellow staff nurses on the ward, as this was also, a new process to them. I learnt that PDSA cycles provisionally test an idea by testing a change and assessing its impact. After implementing the first cycle, I learnt that it does not always get the results expected when making changes to your process; it taught me that it was better, and more effective to trial a small change to see if it made a difference, before implementing the change permanently. This also gave staff the opportunity to be involved and offer suggestions and see if the proposed changes would work.

I also learnt that communication is an essential and fundamental process during the course of the QI. According to Adams (1999), to persuade others to make an improvement or change, the negotiator must be influential. The Charge nurse in this instance was the influential position to lead change. Unfortunately they were not able to fulfil their obligation in PDSA one, but they carried out the ward meeting and used this as a platform to discuss the Kardex audits with the staff which informed them of the need to make an improvement in practice. Once the need for the new process was established and its principles by the email from the charge nurse, informing the reasoning for a change in practice, this was used as a base for PDSA two pdsa model of change in nursing essay. I learnt that it is just as important to define the risk of not making a change (Plummer, 2000) and in this circumstance, changing practice would not only enhance quality of care to patients, but it would promote the involvement between staff nurses and the MDT, building trust and confidence to make the change, whereas the risk of not making the change, could potentially cause an adverse event

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A final learning point I would like to include was how staff nurses initially were resistant to change. In my opinion from observing, the nurses were quite defensive as though they were being blamed for not doing their job correctly. The questionnaire used was an effective communication tool and successful resource for managing this resistance. It give staff the opportunity to anonymously feedback their reasons for not completing the applicable area on the Kardex, it also let them express their opinion without being condemned. Also, I feel that during this time, they were able to adjust and prepare for the change which minimised resistance (Bernhard and Walsh, 1995). I felt it was essential to take note of all their views as individuals and as team members, which provided further explanation of their reasoning for non-completion. Accountability was a consistent reason used by nurses for their reason for non-completion, as they felt it was a doctor or the pharmacist role and they did not want to be accountable for making the decision. When it was clarified that it was a team decision, by email from the charge nurse, the nursing staff felt supported. Mitchell (2001) states that accountability in nursing is a complex issue and acknowledged the importance of team support in the identification of roles and responsibilities. Frequent ideas and conversations with staff were held over the ten days, in advance of the change in PDSA two which I feel made the improvement successful and run smoother as nursing staff were aware of the new change.

I have learnt that within nursing it is important to continually improve the way we work. Working at every level developing the knowledge, technical skills, including leadership, are vital for long-term improvement. Continually learning may be important not only to ensure that we have the skills needed to improve the quality of healthcare, but also to enhance the motivation to do so.

Discuss the project’s significance on the local system and any findings that may be generalizable to other systems:

Relocation to a new site change what been good practice and now a gap had appeared in the process of monitoring patient.

The outcome of this project was a success. It was predicted that by 23rd February 2014 applicable Y/N would be completed by 100%. By establishing the success of the visual prompt in PDSA two on the co-ordinating sheet, was a very small but effective change.

As a consequence, at the following staff meeting it was decided that the visual prompt would be a permanent fixture on the coordinating sheet, as it was a sustainable reminder to future shift coordinators, thus improving the initiation of therapy monitoring and EWS forms, and overall patient safety outcomes. pdsa model of change in nursing essay.

Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from doing this project? What are your reflections on the role of the team?

The factors which promoted success in the project were support and leadership from the charge nurse at the beginning of my placement. They helped identify areas in the ward which they felt needed improvement. Furthermore, as a student who had never been in a mental health ward, I felt overwhelmed with the task and this support and guidance helped me through the project.

The use of the tools were a great way to involve staff on the ward to feel part of the project and broke down the barriers of pointing blame and focussed their attention in a systematic way, and explored the potential causes of the non-completions.

I was amazed as how such a small change help facilitate and test change in a manageable way. I now understand that Quality improvement as a way of approaching change in healthcare that focuses on self-reflection, assessing needs and gaps, and considering how to improve in a multifaceted manner. I feel I have gained an enormous understanding in about quality improvement in that it aims to create an ethos of continuous reflection and a commitment to ongoing improvement. It provides nurses to gain an the skills and knowledge needed to assess the performance of healthcare and individual and population needs, to understand the gaps between current activities and best practice and to have the tools and confidence to develop activities to reduce these gaps pdsa model of change in nursing essay.

Thus, the scan did not focus only on narrowly defined quality improvement models such as ‘plan, do, study, act’ (PDSA) cycles.

Nurse Standards And Documentation Nursing Essay

Nursing standards are expectations that contribute to public protection. They inform nurses of their accountabilities and the public of what to expect of nurses. Standards apply to all nurses regardless of their roles, job description or areas of practice.(College of Nurses Ontario, 2008, para.1).

Documentation is one of the vital components of ethical, safe and effective nursing practices that provide comprehensible image of the client health status and their outcomes. (Practice Standards, 2008, para.2).Whether the documentation is in electronic or written format, hence documentation communicates the nurse observations, decisions, and outcomes for the client. According to the Aga Khan University policy of Documentation of Nursing Care (2008), “documentation is a direct nursing activity that ensures the evidence for provision of nursing care and continuity of care.” (p.1.1). The quotation indicates that for every events and record it is very important to do documentation as evidence so that the staff would legally be safe. Moreover nursing care provides good and healthy communication between the staff and the patient and further this provides the good continuity of care to the patient. According to Kimberly (2003),”if it wasn’t documented, it wasn’t done.” (para.1). This revealed that in the clinical setting, if the documentation is not complete, then the work will be count incomplete pdsa model of change in nursing essay.

During my senior electives in my practice setting in Private Wing II (medicine unit) I encountered many issues regarding documentation on bedside files. I observed most of the nursing staff not following the documentation policy. For example, absence of events related to abnormal vital signs, patient response during invasive and non invasive procedures, abdominal pain complaint and its monitoring scale, errors in 24 hours calculations of intake output flow sheet that can impact on patient negative and positive balance pdsa model of change in nursing essay. Moreover, issues related Nasogastric feeding and patient’s tolerance ability, absence of initials and dates on weekends and wrong addressograph of patient on intake output flow sheets, non useable abbreviations, illegible writing and inaccuracy of nursing notes, all these issues identified during rounds and in morning over. So, I planned and decided to bring these documentation issues in front of my preceptor and manager not only to approve my project, but really want staff to work on it so that they would legally be safe and performance of the organization should be maintained. My preceptor and manager appreciated me and approved my project and this is how my project journey begins. We all nurses knew that documentation is an ethical and legal issue and making a single error in documentation can put the staff in lawsuit. Therefore to bring improvement in staff documentation practices and to observe staff knowledge I developed a questionnaire tool. At last, I come to conclusion that staff really needs to work on documentation as there is a gap identified in some of the staffs knowledge about documentation. Both preceptor and manager appreciated me and permit me to work on it as issues of documentation on clinical setting quite common now a day that does not only put the staff in trouble but this can affect the organization. Therefore, I discussed all the related issues regarding documentation with preceptor and manager and finally the project approved by them. Nursing manager and preceptor considered that work on documentation is a good project so that staff should think of it and work on it in order to bring improvement in their documentation and not make further errors that can affect the patient quality of care as this is an ethical issue. For assessing the need of the selected topic, I developed a pre test questionnaire based on staff knowledge about nursing documentation and finally I come to conclusion via assessment that staffs really have to work on documentation as some of the staff had lack of knowledge regarding nursing documentation. Some of the staff have knowledge but do not show accountability which can put the unit and other staff in trouble. I also identified other issues for practice based project. Firstly, non compliance to infection controls policy. The purpose of not selected the topic was that, all the units Head nurses, Clinical Nurse Instructors (CNI) and Infection Control Staff members are working together on it pdsa model of change in nursing essay. In addition, they do reinforce unit staffs to attend the infection control sessions on constant basis not only to prevent them but also prevent the other members and patients from infectious diseases. Secondly, bed sore issues are the most common problem I identified in unit. The reason for not selecting the topic was as the Case Manager of the unit already made a project on it, she performed rounds on daily basis and every month she takes sessions on bed sores for the staff. Thirdly, communication gap among the staff and patient. For that, CNI and Head Nurse (HN) are taking classes of morning and evening shift staffs on regular basis.

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In order to support the need of the project, I reviewed the previous quarterly internal audits results of nursing documentation, which showed that staff does not following the principles and the policy of nursing documentation. The main observations in these audits were non useable abbreviations in nursing notes and in flow sheets i.e. @, cc, KCL, etc. Moreover, unauthorized staff documentation, wrong addressograph and wrong calculations of 24 hours documented and identified in intake output flow sheet in the month of February 2010 – May 2010. The major observations which I found during the rounds were almost same except one which has not mentioned in audits observation was the events of patient complain, abnormal vital signs and invasive and non invasive procedure that I identified. All these issues have now become the priority of a unit. Therefore, being a responsible staff I decided to take this project as a challenge and plan to work on it. As the documentation is an ethical and legal concern that provides quality care to the patient. Moreover, documentation is a basic tool of communication in which nurse does assess patient’s condition in order to document patient’s records, so that staff would legally be safe and patient care not compromised pdsa model of change in nursing essay.

Based on above observations and from the audits results, I developed a pre test questionnaire according to staff need that contains 15 questions. For maintaining reliability of the questionnaire it was checked by the preceptor and facilitator. After substantiation of the pre test, I made it fill with the Nursing Assistant (NA’s) and Registered Nurses (RN’s). I took 20 samples of the staffs that were 40% staffs of the unit. Although pre test require 15 questions but I scrutinize the five major priority questions of the test. An assessment results reveals that 65% staffs answer correctly about the best definition of nursing documentation. Moreover, 50% staffs did correct answer on purpose of 24 hours of intake output balance documentation. Furthermore, 25% staffs answer correctly on purpose of intake out put documentation in flow sheet. Besides this, 50% staffs gave correct answer on responsible of documenting IV fluids and intake output calculations of 24 hours.

Analysis of the issue with evidence based literature:

According to Aga Khan Policy of Documentation in Nursing Care (2008), “Patient record is a legal document; therefore must present legible, accurate, timely, objective and complete information about patient and intervention. (1.2). This definition clearly explains the standard documentation that are necessary for all nursing staff in order to be legally safe as documentation is an ethical and legal issue all over the world. According to Connor, K. et al (2007), “nursing documentation has a high priority in all trusts because analysis of records of care and observations has revealed that use of multiple charts and repetitive recording causes practical and legal issues.”(para.2). The above quotation indicates that repetitive records can affect patient’s quality of care. Moreover, this can take the staff in law suit. Furthermore, organization performances would get affected if it’s taken in the court. Hence, this has been observed that lack of thorough documentation and nurse accountability reveals many complaints and investigations arising from clinical incidents which were leading to indefensible claims for the staff. According to NMC (2002), “Vigilance is required to ensure high standards in record keeping, whether records are in written or electronic form. The audit of patient documentation is a facet of risk management that can help to promote quality of care.” Wood, C., (2003) believe that any notes or records demand legal documentation, and if any judgment, vague or unsubstantiated documentation found, it would be difficult to maintain professional reliability in the court. (para.2). Hence, good record keeping promotes better communication as well as continuity, consistency, efficiency that further reinforce professionalism within nursing. pdsa model of change in nursing essay.

Integration of the Model:

I run this project through PDSA model, visualized by Walter Shewhart in 1930’s and further this was adopted by W. Edwards Deming in 1950’s. This model is known as Shewhart cycle, Deming cycle, Plan-Do-Study-Act cycle, and Plan-Do-Check-Act cycle. Also known as Learning and Improvement cycle. In this model, the cycle shows the framework for the improvement of a process or system. (Refer Appendix A). According to Kevin (2008), once target improvement areas identified, the model will provides a framework that can further used to guide the entire project or to develop the specific objects. (para.2). Furthermore, the PDSA cycle also used when starting a new improvement project or when implementing any change. Besides this, PDSA cycle also used as a model for continuous improvement in quality care. According to Tague (2004), The PDSA cycle has 4 steps for carrying out the change. Just the circle has no end; it should be repeated again and again for continuous improvement (para.3). Taking this point I would add that in the same manner unless the staff brings change and improvement in them, ongoing sessions for the documentation, activities of documenting notes quizzes and review of policies should be continue. Here I would integrate this model with my project. The first step is plan, in this step I identified the area that needs improvement pdsa model of change in nursing essay. Furthermore, I collected data and planned strategies accordingly for change. I identified four issues from the unit and analyzed the significance of each issue. I discussed each problem with my preceptor and planned for prioritizing the issues. Moreover, CNI planned a meeting with unit manager for selection the priority issue for the project. Finally after the discussions and come to conclusion I selected the topic documentation based on staff knowledge, attitude and practices during the clinical setting. I gathered data through observations during rounds and knowledge identified via pre test. I planned strategies for implementations, that is session awareness and develop innovative flyer. Moreover, discuss with CNI that PowerPoint presentation should be done via multimedia and for the nursing notes activity White Board with markers should be needed. The second step is do, in this implementation of the project done. I conducted three sessions on different days for all the staffs. I carried out the session in the evenings shift staffs. Moreover, for each session I developed an innovative flyer, and pasted on noticed board for the announcement of the session. (Refer Table 1. Action Plan). Moreover, I taught and encouraged the staff how to retrieve the policy on the computer pdsa model of change in nursing essay.

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For sustainability of the project, I discussed with all team members about the results of the project. Moreover, I explained them that for effectiveness of the project’s results they have to initiate the staff and take the responsibility to observe the staff’s documentation practices in their shifts. In addition, I arranged a meeting with the nursing documentation monitors of the unit and give them the responsibility conduct in service sessions in every fifteen to twenty days. The third step of the model is study, for that I searched many relevant literature that supports my nursing documentation project. And If I take the component ‘check’ of PDCA model I evaluated the staff by post test; Moreover, I present different scenarios for the staff, based on documentation practices where staffs have to demonstrate documentation according to its principle. Furthermore, I took the redemonstration of the process of retrieving documentation policies and observations to evaluate the staffs on their nursing documentation practices. The fourth and last step of the model is act. In the act phase, first I used power point presentation lecture with two way communication, and showed pamphlets and cards which I made for them for my sustainability. It is decided that the improvement has come in them or not, whether their practices changed or not. Improvement practices bring changed in them or not. For this project the time was short, so I could not able to perform this step completely but I handed all my things to CNI and the volunteers for further proceed the session. pdsa model of change in nursing essay.


Implementation is the most important component of the project. I applied multiple strategies in order to implement the project effectively. My first strategy was to provide knowledge to staff about the documentation and its practices. I searched many literatures on the selected issue and review and retrieved nursing documentation policies and further discuss with my preceptor and facilitator. Also developed PowerPoint presentation slides on the selected project. According to Green, Palfery, Clark & Anastasi 2002, ” The slides are similar to lecture and work well for initial explanation and clarifying the concepts of the learners.” (p.2). To observe the enhancement knowledge of the staff, I showed power point presentation slides to the staff, before conducting the session I also showed the slides to my preceptor and facilitator. After justification of the presentation, I conducted three sessions on different days. The reason for three sessions was to expand information to different groups of staff. I conduct all my sessions in overlapping timings and most of the time evening staff attend my session rather than morning. I considered, this strategy was appropriate and relevant to the practice because mosts of the evening staff does attend the sessions on different topic so they do not have to tense that they are giving extra timings to the project or applying any efforts. Green, Palfrey, Clark & Anastasi 2002, “The slides are similar to lecture and work well for initial explanation and clarifying the concepts of the learners”. (p.2). Moreover, I encouraged the staff to participate actively because this helps the staffs to express out their views and carried out their personal experiences and learn different concepts via groups. “Group discussions are good for problem solving, critical thinking and demonstrating different points of views among learners.”(p.1). My second strategy was to teach the process of retrieving the documentation policy for the staff and encouraged the staff to re demonstrate it. Also redemonstrate the nursing notes in order to observe the practices of the staff following A-G assessment. The strategy was very effective because here I come to know the staff practices and their knowledge. According to Rodrigo, Meredith& Moore 2003, “Kinetics learners learn by doing and prefer learning that involves movement, active participation, and concrete objects. (p.1). My third strategy was to develop an innovative flyers that I pasted on the unit notice board for the reinforcement and remembrance of the staff. pdsa model of change in nursing essay.


In evaluation, for RNs I distributed nursing notes paper to observe their documentation

practices Moreover, I asked staffs about the Aga Khan University documentation policy. For

nursing assistant (NA) I distributed intake output flow sheet where I asked them to document

routine amount of fluid intake measurement. Furthermore, I asked the staffs about the

documentation error policy. It is saying that no project will be successful without knowing its

outcomes. After the implementation I performed an evaluation of my presentation. After

providing them the session on documentation, I found t nursing staffs were able to clarify their

concepts about the documentation and its error policy. To observe the base line knowledge

among staff regarding nursing documentation. For that purpose, I have utilized evaluation tool

on nursing documentation formulated by me, after preceptor’s guidance and approval. (See

results of evaluation (Refer Appendix B). The implementation analysis indicates that 85% of my

project went successfully (Refer Appendix C). In addition, staff participated well; share the

realistic examples related clinical. Moreover, suggested to have these kinds of sessions on

quarterly basis so that to improve the knowledge. Furthermore, also suggested to have an activity

on nursing notes so that they can bring change in documentation practices.


Time period for project was short that is why unable to involve all staff in

implementation of the project. Another reason for not attending the session by staff was, most of

the staffs were busy in providing care to the patient. Moreover, for the evaluation of project I

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have two weeks in identifying needs, selecting priority issue, observations, assessment and

evaluation of the project which was a great challenge for me. Furthermore, lack of resources was

a big issue as Learning Resource Center was full most of the time and lots of budgeting issues

for assessment, evaluation and on articles but with the great support of preceptor and ongoing

facilitation by my facilitator made my life easy in the completion of running the project

successfully, smoothly and timely pdsa model of change in nursing essay.


There are certain recommendations in regards of nursing documentation. Policy of

Documentation should be reviewed on daily basis in unit for the knowledge and bring

improvement in nursing documentation. Secondly, sessions, quizzes on the nursing

documentation should be conducted every month by assigned nursing staffs or Clinical

Nurse Instructor (CNI) in order to observe staff knowledge. Furthermore, 8 steps of

audit checklist need to be followed and referred. Moreover, nursing documentation should be

done by utilizing audit tool every quarterly, for the improvement of practices

and monitoring of compliance to documentation policy.


To conclude, I will say that documentation plays a vital role in nursing practice because

this communicates health care providers about patient assessment, planning, interventions

and evaluation of the patient condition. Moreover, it an ethical issue that is a legal

documentation and ultimately this safe staff for any legal actions. Documentation shows

honesty and care for the patient which should be done on time. If care is not documented, it

means it’s not done.

In the last, I would say that this project enhanced my learning. It provided me an

opportunity to work as a team member with staff, Head Nurse (HN) and Clinical Nurse

Instructor (CNI). This project also enhanced my leadership style what I learned the concept in

class. Despite of all this, the project helped me to work independently and to study about

nursing documentation in depth. Moreover I learned to integrate new concepts and model that

would further help me in my profession career.

The Plan Do Check Act Information Technology Essay


Quality can be defined as standard; it is the degree of excellence of something compared to things of similar kind, continuous improvement is the major factor that effects the level of quality of a good or service where emphasis is achieving the approved standard for a routine basis, by only producing or providing services on or above standard but never below par. It is about meeting the needs of customers on a regular basis as for the price they are paying; they need the standard quality to be maintained for the goods and services they purchase. Good functions, long life, consistency and reliability are some of the attributes of quality which have to be maintained pdsa model of change in nursing essay.

There are several quality improvements systems which could to be followed:


The PDCA cycle is also known as the demand cycle; it is a tool which could be followed to solve problems of quality management, its first step includes plan, which lists down the goals which have to be accomplished, the barriers in getting those goals and the strategy and tactics used for coping up with them. This step provides a route or guideline for the next step and it acts as the pillar of achieving the targets. The next phase is the Do phase, once the information has be gathered and a guide line be made, it is time to implement on those plans; this could be done on minute scale or in a lab which could be tested outside the usual production procedure. After, doing what had been planned it is time to check what has been tested, take out valid information on the way used in the testing, the final step which rounds of this cycle Is the Act phase, which completes the cycle though the action been taken on the process. It could be positive or negative based on the information gathered from the act phase, thus the entire cycle or process makes sure that quality is maintained on a continuous basis where procedures are tested and implemented to carry out the plans until the best could be achieved.

As Donald W. Benbow et al. said,” It has been observed that many organizations are pretty good at the Do and Check phases, but falls down on the plan and act phases. Perhaps this is partly due to the impulses to “Don’t just stand there, do something” (p.6) pdsa model of change in nursing essay.

Donabedian Model

In 1996 Avedis Donabedian published the frame work for quality evaluation in health care. According to Donabedian (Donabedian, 2003, 52) this assessment is based on the premise that heath care quality is more effectively measured by scrutinizing care in domain of structure, process and outcome. A set criterion is developed to assess past performance.

The structure in the model relates to the integrity within the health care institute to check if resources needed to carry out high –quality care are sufficient and used proficiently. After the structure the process includes evaluating the actual heath care activities by comparing it with the standard made by the peer groups. The last part in the model consists of outcome, According to Rick Daniels, Rick Daniels (2006), “Outcome is in terms of the recovery, restoration of function, and of survival. (p.493). this method also states about the importance of being customer focused whether it be internal customers as employees or external customers which have not been employed but who uses the services of the association.

ISO – 9000 Standard

The ISO -9000 basically covers the rules at to the complete quality management system. It states the value of good business practice and just guides line on the ways which have to be implemented to perform such actions. There are 5 groups which make up this Standard,

Quality management system: There are requirements which apply to all aspects of the process; it gives guidelines on the responsibilities, control process and the records which have to be documented.

Management responsibility: Such requirements explain the role of the upper management in assessing customer needs, planning and the reviewing of performance pdsa model of change in nursing essay.

Resource Management: This covers the requirements on how to administer the resources of the organization through activities such as employee training and other tools to develop the human capital.

Product comprehension : This group is the core of this standard, it involves all and responsibilities and the necessary requirements of how to manufacture your product or deliver your services

Analysis and improvement: This requirement involves the process to check on the performance and fix if any gap exists between the standard and the actual.

As stated by (Larry Webber, 2011), “ISO 9000 Certification is simply a way to prove to your customer that you know how to run your business” (p. 30).

ISO 9000 benefits firms as it provides a system for continuous improvement which increases efficiency and decreases the cost associated with the production.

Lean Production:

Lean is a process which was derived from the Toyota production system, it emphasizes on the flow and speed of the production cycle of goods and services in an organization. It helps in minimizing waste which could be caused through over production, carrying of products, inventory management, idle employee or even the entire activity in the process of the product. The focus it to add value to the entire system and decrease the cost of production. Lean management includes several processes including Kanban, Total productive maintenance, Quick change over and others. This system eliminates the main problem associated with production and highlights the causes and improves it for a fast cycle. The lean methods in regards to heath care are standard processes and realizable methods as mentioned by (Jackson, 2011) (p. 19 ) .

Six Sigma:

This process focuses on the expectations of the customers by applying the best use of scare resources to generate profits for an organization. It is a product enhancement method where the entire 6 processes enable the solution to quality problems pdsa model of change in nursing essay. The six steps which include to enable the process to meet the objective are:

Introduce works and management to the system by letting them know about your intension to follow Six Sigma and make them aware that it will now be used as the new standard for operations

Assign someone to manage and check the process in getting the set quality; appoint auditors form the Six Sigma belt to verify operations on a regular basis.

Explain the main attributes of the satisfaction wanted by customers regarding your product or service, and recognize what they consider vital in the purchase.

Recognize any mistake or errors found in the process, check out the level of complains and evaluate the require repairs.

Identify the main causes of the error or the mistake and the inefficiency caused to the customers, improve the product according to needs or redesign if necessary.

Keep on reviewing it until perfect Six Sigma standard is achieved. pdsa model of change in nursing essay.

The benefit of this method is focuses on the continuous devolvement of business improvement by achieving and maintaining quality in an organization.

The Donabedian’s model standard used in a health care Institution for providing safety to patients, the structure-process outcome model has helped in a lot of health service institutions, for examining health services and patients outcome. A structure as defined by Donabedian has to be implemented in the institute for providing services and creating value for patients.

A number of medical training programme have been made to assist in the strategy, purpose and effectiveness to provide best results for the patients, the model allows for the extent variability related to the client and the providers including nurses or physicians by giving the best outcome through a complete process which includes, cost reduction and patient / provider satisfaction. It is important for the health care institution to allow care to their customers according to the benchmark set with a continuous process. There are several factors which has to be implemented by the institute to be quality orientated, these factors would include:

As mentioned by (James, 1989) certain factory are necessary for the institute to meet certain standards including Hospital cleanliness, Smoothness of admission/discharge, Accuracy and clarity of billing statements, Courtesy of hospital employees, Level of technology available , Nurse competence and availability of physician specialists. (p. 20) pdsa model of change in nursing essay.


All these models and steps used in sectors for quality improvement, are the basis on which every company should work nowadays, companies are getting more efficient and productive when they use the above standards in their production processes, it helps them minimize cost by reducing wastage if any and also making the best out of the scare resources of labor and capital. Implementing these models could be costly for institutes, as forms, documentations and practices are measured and checked, but it leads to the safety and success of the organization and also it provides value for the customers which are the highest priority for every institution to generate profits pdsa model of change in nursing essay.

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