Leadership Analysis

Running head: LEADERSHIP ANALYSIS
Leadership Strategy Analysis-Quality Improvement Process

Lindsey Zolynsky
Ferris State University
Leadership Strategy Analysis-Quality Improvement Process

As stated in the Journal of Nursing Management (2015), understanding the factors
affecting evidence-based practice and quality improvement activities and their relationships with
clinical errors is important for designing strategies to promote evidence based practice, quality
improvement and safety. One factor contributing to an opportunity for error and a breech in
patient safety is the process of clinical handover. Clinical handover is the transfer of professional
responsibility and accountability for some or all aspects of care for a patient, or group of patients,
to another person or professional group on a temporary or permanent basis (Kerr, McKay, Klim,
Kelly, McCann, 2013). During the admission process of a patient from the emergency
department to the inpatient unit, careful care and attention must be placed on clinical handover. A
rapid improvement event was help to address the current state and plan the future state of the
handover process. Conclusions were formed based on implementation and evaluation to enhance
the process and improve patient overall satisfaction and safety.
Clinical Need
The current state of clinical handover was reviewed, and it was discovered that giving
report over the phone during the admission process was slowing the process of admission and
detouring patients from receiving quality care due to lengthy stays in the Emergency
Department. Admitting physicians write orders for patients going to the inpatient unit that they
expect an inpatient nurse to perform. If patients are unable to get to the floor in a timely fashion
due to the inability for nurses to connect over the phone then the patients safety is being
threatened. Emergency nurses and inpatient nurses, though both nurses capable of performing
tasks that are ordered, are accustomed to a much different set of orders and have different skill
sets based around the type of nursing they perform. For example, Emergency nurses are not as
familiar with sliding scale glucose checks and corrections, so if a patient is in diabetic
ketoacidosis it is essential that the patient be sent to a floor to be cared for by a nurse who is an
expert in this field rather than staying in an environment where this type of care is unfamiliar.
The admission process therefore needed to be evaluated and changes needed to be made to
ensure these patients reached the floor in a timely fashion and received expert care. The process
trialed to be implemented was titled bedside report, in which the nurse would transport the
patient to the floor and give report to the receiving nurse at the bedside.
In a recent study performed to evaluate the attitudes of emergency department patients
about handover at the bedside, it was found that participants preferred listening to the handover
conversation at the bedside, as it provided an important opportunity for them to clarify and
contribute further important information and to promote safe and high-quality care (Kerr et al.,
2013). Numerous studies have shown that when patients contribute to conversations between
healthcare professionals, a potential advantage of bedside handover, there are reduced risk of
adverse events and enhanced continuity of care (Kerr et al., p. 1686, 2013). Many processes are
compared and contrasted by researching techniques that work for other hospitals, and after
finding research supporting bed side report, the leadership team formed a quality improvement
team and begin the implementation of change.
Interdisciplinary Team
The book states that quality improvement (QI) team members should represent a cross
section of workers who are involved with the problem (Yoder-Wise, 2015). For this particular QI
event, it was important for representatives from the emergency department and the inpatient units
to be present. Four inpatient nurses (two charge and two staff), four emergency nurses, (one
manager, one charge and two staff), an inpatient doctor, two emergency physicians, two
emergency nursing technicians, a QI nurse, a process improvement (PI) coach, a clinical nurse
specialist (CNS), a sensei, and a patient and family advisory council member were in attendance
for the event. The QI nurse, PI coach, CNS, and sensei ran the event and explained expectations,
goals, and team rules each day. The guidance of these team members was essential to reaching
the end goal, because they are trained in process improvement and understand what effective
change processes look like. Without their guidance and assistance, effective change processes
would be lengthier and require added resources. The patient and family advisory council member
is an important part of the team because they are a pair of fresh eyes and can state what they see
working and not working from a patient and/or family member perspective. All members of the
team worked together to build a plan to advocate for quality patient care and safety.
Data Collection
During this four-day event, every minute was used to repair a broken process and
implement a plan to correct an area that needed improvement. On day one, the current state was
discussed and a current state map was developed to visualize areas of waste that could be
removed. A spaghetti diagram was created to illustrate current movement, and a communication
circle was drawn up to represent handoffs during the reporting process. At the end of each day,
lessons learned and team rules were discussed to ensure that everyone was on the same page and
working toward the same goal.
Day two consisted of developing a future state map and a complete gap analysis with a
fishbone diagram to group waste subjects and identify common themes. Root cause statements
were developed for each theme, and a hypothesis was developed to address each theme. As an
example, If we do bedside report, then we expect to have shorter delays in patients moving to
inpatient units. Day three the process was put into action and patients being admitted were
followed through the complete process and times and opinions were recorded to support or deny
the hypothesis. Day four was a review of day three, time to finish a few more experiments, and
the presentation of findings to leadership staff throughout the hospital.
Outcomes
The goal of the implementation and focus on this quality improvement event was to
decrease admitted patients waits in the emergency department, and to advocate for best care
based on evidence based practice (EBP). EBP is a problem-solving approach in which the best
available evidence is used by integrating research evidence, clinical expertise, and patient values
and preferences in order to improve health outcomes (Hwang & Park, 2015). Research has
proven that bedside report promotes patient involvement while putting the patient at ease
regarding their future care.
Patient safety is of utmost importance in the hospital care setting and by forming this
process, it is the goal of all involved to decrease adverse events and increase the overall health
and satisfaction of the patient by placing patients in opportune positions to receive best care. It is
important to reduce waste in the current process and to stream line the future process to enhance
the patient experience and outcomes of their hospital stay. It was thought that by getting the
patient up to the inpatient unit within forty minutes of receiving admitting orders, this would
result in the best outcomes for the patient.
Implementation

Implementation of the process was performed by communicating areas of change with all
staff involved, and having resources available on the process roll out day. The nurses were
informed that they would all be transporting their own patients to the floor and giving bedside
report to the receiving nurse. The nurse technicians were informed that they would no longer be
transporting patients to the floor, but would make themselves available to help in other ways
while the nurse was away. All inpatient units were informed of the changes being implemented,
and bed management was informed to communicate clearly bed availability to reduce delay on
their end as well. All team members worked together effectively to embrace this change and
implement the process. Change is challenging for everyone, so although there was a bit of
resistance, overall the process roll out went well and improvements were made. Active
involvement in patient care improvement efforts can not only promote quality and safety of
patient care, but also positively impact job satisfaction and improve the work environment
(Yoder-Wise, 2015).
Evaluation
It was found through experimentation, that having the nurse transport the patient rather
than the nurse technician and having the nurse give bedside report to the nurse on the inpatient
unit did indeed decrease the amount of time wasted in getting the admitted patient to the
inpatient unit and increase patient safety. In congruence with the study mentioned above, the
patients did enjoy having a say in the admission process and felt more at ease with their
continuum of care when they were able to be a part of bedside report.
Following a patients admission process and recording the length of time it took to go to
the inpatient unit from the emergency department collected this data. If the patient was willing,
they were also included in the process and asked their opinion on whether or not they felt the
process was beneficial to their care at the hospital.
Conclusion
It is important for nurses to stay involved in quality improvement events so they not only
have a say in the changes being made, but stay up to date on the most recent evidence based
practice. Nurse managers that promote an empowered workplace and facilitate teamwork support
higher quality care, less patient risk, and more satisfied nurses (Yoder-Wise, 2015). Making
changes that promote quality care and safety for the patient are essential and will forever be a
part of our careers as nurses. It is important that we keep positive attitudes that support change,
and advocate for best care for our patients.
8
References
Hwang, J., & Park, H. (2015). Relationships between evidence-based practice, quality
improvement and clinical error experience of nurses in Korean hospitals. Journal of
Nursing Management, 23, 651-660. doi:10.1111/jonm.12193
Kerr, D., McKay, K., Klim, S., Kelly, A., & McCann, T. (2013). Attitudes of emergency
department patients about handover at the bedside. Journal of Clinical Nursing, 23, 16851693. doi:10.1111/jocn.12308
Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis: Mosby.

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Running head: LEADERSHIP ANALYSIS

Leadership Strategy Analysis-Quality Improvement Process

Running head: LEADERSHIP ANALYSIS

Leadership Strategy Analysis-Quality Improvement Process

Running head: LEADERSHIP ANALYSIS

Running head: LEADERSHIP ANALYSIS

Running head: LEADERSHIP ANALYSIS

Running head: LEADERSHIP ANALYSIS

Running head: LEADERSHIP ANALYSIS

Running head: LEADERSHIP ANALYSIS

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