NU 613 Quality Improvement Paper. Health, Medicine, Nursing Essay

Quality Improvement Process for Standardization of Infant Deliveries in the Operating Room
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NU 613 Quality Improvement Paper
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Introduction
Quality improvement of infant deliveries in the operating room is necessary to track the core performance, while monitoring the performance against the best practices. Infants are born in operating room in the case of a cesarean section and in the labor and delivery room if the birth is vaginal (Schorn et al., 2015). The caesarean section is a surgical operation to deliver an infant. Continuous performance improvement is possible when there is understanding how to implement quality improvement practices in the delivery of infants, but are should be exercised to identify the indicators that are most relevant to show the impact of quality improvement (Brady, Bulpitt & Chiarelli, 2014). Even though, hospitals adopt different quality processes, standardization on the quality improvement indicators is important to measure performance and evaluate performance using the indicators and the best evidence available. Patient outcomes and knowledge of the standardization of infant deliveries among healthcare team members before and after 2 months after implementing quality improvement intervention is evaluated.
Background/context
When there is standardization of infant deliveries in the operating room, best practices are adopted to meet clinical needs without compromising the health and safety of the infant and the mother. In the operating and delivery rooms, quality improvement focuses on quality, safety, cost and outcomes The institute of medicine (IOM) Six Domains of Health Care Quality guide quality measurement of health care organizations based on the structure, process or the outcome measures (Almassi & Goldman, 2018). There are various recommendations to improve infant deliveries in the operating room, and while surgical procedures are common, practices and procedures influence outcomes.
Diagnosis and timely management of infant delivery will reduce maternal and perinatal morbidity and mortality, and the operating room personnel is informed on the best course of action to improve outcomes. Increase in cesarean birth rate, is at times associated with an increase in rates of neonatal morbidity and mortality decisions made on infant delivery in the delivery rooms are clinically justified cases.
Availability of human resources and hospital resources is important to ensure the success of the interventions in operating rooms and it is easier to undertake corrective actions when there are resources. Hospital practices include the use of scorecards or dashboards, to track measure and monitor performance over a period of time based on certain performance indicators (Maturo et al., 2017). The general objective is to provide clinical recommendations based on the best scientific evidence on quality improvement of infant deliveries in the operating room. Operating room performance measures are hospital-centric and patient-centric, based on the quality improvement considerations (Lapcharoensap, 2017).
Theory of change
Kurt Lewin proposed a three-phase change management model, he parallels the process of change in ice and the three phases are: Unfreezing-Change-Freezing. This model guides the process of change so that it takes place in an orderly manner, and proper preparation to implement the change (Cummings, Bridgman & Brown, 2016). Unfreezing occurs where here is a need to change including practices and beliefs that impede growth. This first stage presents numerous challenges because of resistance to change the negative and positive factors affecting goal achievement, and then there is readiness to integrate changes.
After the change of beliefs and practices the next step is change and even when there is lack of experience, relying on standards and protocols guides the team when taking action. Uncertainty and fear of the unknown affect implementing changes, but changes in the practices and beliefs must come from within rather than being imposed. Having change agents who champion change, lead the way and support change makes it easier for others to integrate changes.
In the freezing stage, when the new practices are implemented they must become part of the new culture of the organization so that they guarantee their long-term success (Cummings, Bridgman & Brown, 2016). The changes become routine and to consolidate these changes, rewards system can be used to motivate the health practitioners to implement the changes successfully. It is also necessary for the change agents to communicate about the benefits that the change will bring to the organization so that health care team workers feel part of that improvement process. Change will be reinforced to ensure organizational change.
Improvement tools
Root cause analysis is a sequential process of structured questions to discover underlying causes of an adverse event. The root cause is the fundamental reason or reasons that explain the failure of a situation where the performance does not meet the expected requirements or there is inefficiency of the care process. In this case, it is the lack of standardization of infant deliveries in the operational room. Root cause-analysis is oriented to the process, so it associated with exhaustive review of the elements that affect the event including the people, equipment, procedures, information, environments and external contingencies. The root cause analysis approach also requires recommendations to improve outcomes and to prevent deterioration in outcomes, it also useful to support participation in the care process. Systematically root-cause analysis is most beneficial when there is evidence of results to make conclusions, and the likelihood of recurrence of adverse events/sentient is prevented.
The fishbone cause and effect diagram is also a useful tool in quality improvements where information on current hospital policies and procedures on infant deliveries is collected. This is linked to implementing changes and organizational culture to improve outcomes where the causes are linked to the effects (Cox & Sandberg, 2018). The cause and effect tool analyzes problems by representing the relationship between an effect (problem) and all the possible causes, where the aim is to ensure that there is standardization of the infant delivery process. Thus, identifying the causes of the problem and classifying them to determine the best way to improve outcomes. The data to be collected is how people, policies, processes and systems affect efficiency in the operating room (OR) where the information is then organized and visualized with focus on the contributing factors to the issue (O’Rourke-Suchoff et al., 2016).
Six Sigma model for the quality improvement project
The Six Sigma methodology provides a structured approach to eliminate "defects" in a process, and the structured approach entails a measurable reduction in costs, quality, efficiency and overall improvement. When the principles of Six Sigma are applied in health care settings the tool helps in eliminating defects and variations in processes, simplifying procedures, reducing costs, improving patient care and the overall results (Deblois & Lepanto, 2016). Thus, adopting and implementing the Six Sigma management tool help to improve the quality of care and reduce waste and this is necessary to achieve the set goals. It is expected that there will be effective performance improvements when the Six Sigma tool is used.
Using the structured methodology for problem solving will help to improve standardization of infant deliveries in the operating room. The Six Sigm...