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Quality Improvement Initiative Proposal

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Introduction

Patient satisfaction and quality health outcomes are, by all means, regarded as key productivity indicators in terms of healthcare professionals’ competence. However, the overall perception of quality care is sometimes distorted by the professionals’ focus on the medical aspects of intervention and the abandonment of meaningful communication and connection with a patient.

According to researchers, a lack of communication between practitioners, patients, and their families frequently results in a lack of trust in terms of treatment, poor patient outcomes, and a lack of adherence to the treatment plan (Lotfi et al., 2019). The notion of quality improvement stands for systematic intervention strategies designed to immediately improve health care (Hughes, 2008).

Quality improvement differs from the research by a degree of immediacy (“Is this quality improvement or research?” 2015). The present paper aims at outlining a quality improvement intervention in a hospital setting in order to improve patient satisfaction rates through extensive use of bedside whiteboards both by nurses and physicians.

Problem Overview

The existing culture of achieving maximum results and efficiency in limited time has contributed to the medical professionals’ level of emotional burnout and inability to dedicate enough time to the communication and check-up on the patient’s satisfaction with the care provided (Ardalan et al., 2018). Facing many new patients on a daily basis, nurses frequently do not have the ability to connect with the individuals on a more personal level, as they are expected to provide quality medical intervention and physician support.

The diverse background of the patients is also a detrimental contributor to the quality of communication. Frequently, nurses are unable to reach a necessary level of cultural competence in such a limited amount of time allocated for diagnostics (Ardalan et al., 2018). The most common barriers in terms of nurse-patient communication comprise age, gender, culture, and religion (Ardalan et al., 2018).

Although the closure of the aforementioned barriers requires extensive intervention and cultural competence skills enhancement, some of the barriers in communication derive exclusively from the nurses’ perception of communication. For example, nurses feel a lack of interest and motivation, lack of attention from the authorities, poor interprofessional communication, and lack of standards related to proper treatment and interaction.

As far as the public hospital setting is concerned, the roots of poor communication with patients derive from a lack of communication between nurses and physicians. Essentially, when nurses’ shifts are changed, nurses who start their shifts receive limited information on the patient’s progress, and patients are barely aware of the names of nurses who assist them. For this reason, quality improvement initiatives in a public hospital should concern the use of bedside whiteboards in order to improve communication with patients and their oval awareness of the personnel working with them and their treatment progress.

Relevance of Quality Improvement Initiative

The issue of miscommunication between nurses and patients remains a challenging aspect of quality treatment security in public hospitals where the workload per professional sometimes gains unprecedented rates. According to the latest research, the overwhelming majority of patients remain dissatisfied with their communication with nurses, as nearly 80% of the patients do not know the name of their treating nurse (Lotfi et al., 2018).

Moreover, the aspects of interprofessional communication within a hospital setting contribute greatly to the quality of care, as frequently, valuable information concerning one’s health condition and progress is lost during the transition. It happens because one of the parties, namely nurses and physicians, either subjectively categorizes this information as irrelevant for other professionals or forgets to mention it (Tan et al., 2017).

The implementation of whiteboards is generally considered an efficient tool in terms of organizing key information on the treatment process and sharing it with the patients. Thus, it is expected that improving the patterns of bedside whiteboard organization would enhance the overall communication with patients and patients’ recognition of their practitioners.

Previous Research

Bedside whiteboards may be defined as tools for writing down key information on the patient’s profile in a hospital ward so it could be accessed by treating clinicians and patients. Initially, it is necessary to note that the process of data visualization contributes positively to the levels of patient satisfaction.

In a study conducted by Hitawala et al. (2020), in terms of the quality improvement initiative, the patients of the Cleveland Clinic-Fairview Hospital were provided with visual handouts that included staff names and positions, contact numbers, and essential information on the patient’s health conditions. Such an intervention has resulted in a significant increase in the patient satisfaction rate, with more than 90% of the hospital residents being satisfied with patient-provider communication (Hitawala et al., 2020). Thus, the study projected results to achieve levels of patient satisfaction with communication greater than 90% were successfully fulfilled.

As far as whiteboard-oriented studies are concerned, the results may not be as overwhelmingly positive, yet the overall outcomes project beneficial outcomes. For example, the research conducted by Virapongse & Witkowski (2018) demonstrates that 29% of the patients taking part in the survey consider the whiteboard to be an efficient assisting tool in terms of communication, outrunning business cards, more frequent visits, and fewer providers (“Results” section).

In another study presented by Goyal et al. (2020), the findings outline that more than 60% of patients refer to the bedside whiteboards to obtain relevant information about their health state and care provider (p. 4). Thus, a quality improvement initiative on enhancing the use of whiteboards by nurses and physicians may result in a positive tendency in communication and, consequently, patient satisfaction.

Finally, to emphasize the importance of whiteboards as visual tools, it is necessary to outline that in the vast majority of studies conducted on the matter, the impact on communication and the satisfaction of patients was highly positive. As noted in a systematic literature review by Goyal et al. (2017), four out of five studies indicated an improvement of patient-provider communication with the help of visual tools, whereas an improvement in satisfaction was proved positive in six studies out of eight. Thus, it may be concluded that quality improvement initiatives through the realization of more systematic and meaningful use of bedside whiteboards may rightfully project a positive outcome for patient satisfaction with the treatment experience.

Implementation Steps

Initially, it is vital to conduct a preliminary assessment of the patient’s current level of satisfaction with communication and awareness of the whiteboard access and the aims of the tool. Next, it is vital to secure a communicative intervention for the treating clinicians on the matter of their current whiteboard use habits and prospects of more efficient utilization of the tool.

Once practitioners are aware of the benefits, it is necessary for the hospital administration to present a blueprint of using a whiteboard by outlining the information that should be written and updated on a daily basis. For one week, nurses and physicians are to actively use whiteboards and encourage patients to either voice or write down their wishes and concerns. After the intervention, patients will be surveyed on the matter of their satisfaction rates.

Quality Improvement Evaluation

The target population of the present intervention will include patients who are relatively independent in terms of performing ADLs and processing information. Thus, patients who are incapable of accessing whiteboards and reading the information will be excluded from the sample. The intervention itself will be quantitative in nature, yet the variables used will be mainly qualitative (Rutberg & Bouikidis, 2018). The quality improvement initiative will be evaluated with the help of pre-and post-intervention surveys that encompass both continuous and ordinal variables (Helbig, 2018).

An independent continuous variable will include the patient’s age. The independent ordinal variables during the pre-intervention survey will include the assessment of communication quality ranked on a scale from 1 to 10, and the assessment of current satisfaction rate ranked on a scale of 5 options from “completely dissatisfied” to “completely satisfied.” The dependent variable will concern the change in both communication and satisfaction after the intervention, with patients completing the same survey one week later. The hypotheses of the initiative may be outlined as follows:

  • H0 = There is no correlation between the patients’ satisfaction rate and quality improvement of using bedside whiteboards.
  • H1 = There is an interrelation between the patients’ satisfaction rate and quality improvement of using bedside whiteboards.

The statistical test applied to evaluate the data will be the method of a frequency distribution (“Frequency distribution,” 2009). Such an approach is the most relevant option in terms of comparing ordinal variables.

Conclusion

Patient-provider communication is regarded as one of the crucial factors of patient satisfaction. Thus, it is highly recommended to enhance communication skills in order to positively influence patient satisfaction with the treatment process. A quality improvement initiative proposed in the paper concerns the promotion of active use of bedside whiteboards during treatment intervention. Considering the fact that previous research justifies the positive outcomes of such an initiative, it may be concluded that such quality improvement intervention will result in higher patient satisfaction rates in the future.

References

Ardalan, F., Bagheri-Saweh, M. I., Etemadi-Sanandaji, M., Nouri, B., & Valiee, S. (2018). Barriers of nurse-patient communication from the nurses’ point of view in educational hospitals affiliated to the Kurdistan University of Medical Sciences. Nursing Practice Today, 5(3), 326-334.

(2009). The Visual Learner.

Goyal, A. A., Tur, K., Mann, J., Townsend, W., Flanders, S. A., & Chopra, V. (2017). Journal of Hospital Medicine, 12(11), 930-936.

Goyal, A., Glanzman, H., Quinn, M., Tur, K., Singh, S., Winter, S., Shyder, A., & Chopra, V. (2020). . BMJ Quality & Safety, 29(10), 1-2.

Helbig, J. (2018). Statistical analysis. In Applied statistics for healthcare (Chapter 4). Grand Canyon University.

Hitawala, A., Flores, M., Alomari, M., Kumar, S., Padbidri, V., Muthukuru, S., Rahman, S., Alomari, A., Khazaaleh, S., Gopalakrishna, K. V., & Michael, M. (2020).. Cureus, 12(4).

Hughes, R. G. (Ed.). (2008). Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality.

(2015). American Nurse.

Lotfi, M., Zamanzadeh, V., Valizadeh, L., & Khajehgoodari, M. (2019). Nursing Open, 6(3), 1189-1196.

Rutberg, S., & Bouikidis, C. D. (2018). Focusing on the fundamentals: A simplistic differentiation between qualitative and quantitative research. Nephrology Nursing Journal, 45(2), 209-213.

Tan, T. C., Zhou, H., & Kelly, M. (2017). Journal of Clinical Nursing, 26(23-24), 3974-3989.

Virapongse, A., & Witowski, S. (2018).. Journal of Hospital Medicine.

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