Improvement Plan

This paper attempts to explain some areas of potential improvement for the Veteran Affairs (VA) organization in a surgical department. Describe the data that needs to be collected and the tools to be use. Also, it will be identified and compared the types of information collected based on the different tools used. Presenting the Quality Improvements (QI) tools needed to accomplish the goal and describe the information obtained from it. In addition, establish how are these tools helpful for the health care organizations.

Areas of Potential Improvements for the Organization The areas to be considered are; on- call Practices, preoperative personnel are assigned designated times, in addition to their regular work hours, to be available on an “on-call” basis for unplanned , urgent, emergent procedures or to provide care for patients whose procedure run past schedule time periods. Call hours may vary from four hours or more. Actual hours worked during the call period are unpredictable and can range from 30 minutes to the entire length of the call period.

A large body of research exists about fatigue and sleep deprivation and their effect on performance. Research also suggest that work periods of 12 hours or more are associated with higher probability of making an error and increase in risk-taking behaviors. The Time-Out: While technologies and other innovations have advanced health care, these advancements have also led to failures in the delivery of safe patient care. Rates of wrong site surgery are still shocking and incidences of retained foreign bodies persist.

Of great concern is wrong-site surgery (WSS), which encompasses surgery performed on the wrong side or site of the body, wrong surgical procedure performed, and surgery performed on the wrong patient. This definition also includes “any invasive procedure that exposes patients to more than minimal risk, including procedures performed in settings other than the OR (operating room), such as a special procedures unit, an endoscopy unit, and an interventional radiology suite.

WSS is also defined as a sentinel event (i. e., an unexpected occurrence involving death or serious physical or psychological injures, or the risk thereof) by the Joint Commission (formerly called the Joint Commission on Accreditation of Healthcare Organizations), which found WSSs to be the third-highest-ranking event. The incidence of reported WSS has increased in recent years. From the inception of the Joint Commission’s Sentinel Event program, the number of WSSs reported has increased from 15 cases in 1998, to a total of 592 cases reported by June 30, 2007.

Of these, WSSs most commonly occur in orthopedic or podiatric procedures, general surgery, and urological and neurosurgical procedures. In response to the occurrence of these preventable errors, the Joint Commission issued two National Patient Safety Goals on January 1, 2003 to target wrong-site surgery: Goal one; to improve the accuracy of patient identification by using two patient identifiers and a “time-out” procedure before invasive procedures.

Goal four; to eliminate wrong-site, wrong-patient, and wrong-procedure surgery using a preoperative verification process to confirm documents, and to implement a process to mark the surgical site and involve the patient/family. Data Needed. Data Collection Tools, Type of Information Collected in Comparison. Depending on the nature of the information to be gathered, different instruments are used to conduct the assessment: forms for gathering data from official sources such as police or school records; surveys/interviews to gather information from youth, community residents, and others; and focus groups to elicit free-flowing perspectives.

Self-administered survey, have special strengths and weaknesses. They are useful in describing the characteristics of a large population and make large samples feasible. In one sense, these surveys are flexible, making it possible to ask many questions on a given topic. This also provides flexibility in the analysis of the responses. On the other hand, standardized questionnaire items often represent the least common denominator in assessing people’s attitudes, orientations, circumstances, and experiences.

By designing questions that will be appropriate for all respondents, it is possible to miss what is most appropriate to many of the respondents (Babbie, 1992). Some advantages of the self-administered survey are: Low cost. Extensive training is not required to administer the survey. Processing and analysis are usually simpler and cheaper than for other methods. The reduction in bias error. The questionnaire reduces the bias that might result from personal characteristics of interviewers and/or their interviewing skills. Greater anonymity, absence of an interviewer provides greater anonymity for the respondent.

This is especially helpful when the survey deals with sensitive issues such as questions about involvement in a gang, because respondents are more likely to respond to sensitive questions when they are not face to face with an interviewer. Some of the disadvantages are: Requires simple questions. The questions must be straightforward enough to be comprehended solely on the basis of printed instructions and definitions. No opportunity for probing. The answers must be accepted as final. Researchers have no opportunity to clarify ambiguous answers.

The interview is an alternative method of collecting survey data. Rather than asking respondents to fill out surveys, interviewers ask questions orally and record respondents’ answers. Some of the advantages of the personal interview are: Flexibility. Allows flexibility in the questioning process and allows the interviewer to clarify terms that are unclear. Control of the interview situation. Can ensure that the interview is conducted in private, and respondents do not have the opportunity to consult one another before giving their answers. High response rate.

Respondents who would not normally respond to a mail questionnaire will often respond to a request for a personal interview. Some of the disadvantages are: Higher cost. Costs are involved in selecting, training, and supervising interviewers; perhaps in paying them; and in the travel and time required to conduct interviews. Interviewer bias. The advantage of flexibility leaves room for the interviewer’s personal influence and bias, making an interview subject to interviewer bias. Lack of anonymity. Often the interviewer knows all or many of the respondents.

Respondents may feel threatened or intimidated by the interviewer, especially if a respondent is sensitive to the topic or to some of the questions (Frankfort-Nachmias and Nachmias, 1996). Another method of collecting information is the focus group. Focus groups are useful in obtaining a particular kind of information that would be difficult to obtain using other methodologies. A focus group typically can be defined as a group of people who possess certain characteristics and provide information of a qualitative nature in a focused discussion. Focus groups generally are composed of six to twelve people.

Size is conditioned by two factors: the group must be small enough for everyone to participate, yet large enough to provide diversity. This group is special in terms of purpose, size, composition, and procedures. Participants are selected because they have certain characteristics in common that relate to the topic at hand, such as parents of gang members, and, generally, the participants are unfamiliar with each other. Typically, more than one focus group should be convened, since a group of seven to twelve people could be too atypical to offer any general insights on the gang problem.

A trained moderator probes for different perceptions and points of view, without pressure to reach consensus. Focus groups offer several advantages: Flexibility allows the moderator to probe for more in-depth analysis and ask participants to elaborate on their responses. Outcomes are quickly known. They may cost less in terms of planning and conducting than large surveys and personal interviews. Limitations include: A skilled moderator is essential. Differences between groups can be troublesome to analyze because of the qualitative nature of the data. Groups are difficult to assemble.

People must take the time to come to a designated place at a particular time. Participants may be less candid in their responses in front of peers. Tools to measure QI Describe types of Info compare Usefulness of the tools for the organizations Conclusion References http://www. nationalgangcenter. gov/Content/Documents/Assessment-Guide/Assessmen (Frankfort-Nachmias and Nachmias, 1996). (Babbie, 1992). http://www. aorn. org/News. aspx? id=20304&terms=time%20out http://www. iom. edu/Reports/2003/Keeping-Patients-Safe-Transforming-the-Work-Environment-of-Nurses. aspx.

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