The concept of quality is one of the most studied topics in healthcare research. Nurses are interested in quality improvement initiatives which impact all areas of patient care. However, to discuss quality, it is necessary to understand what it is and which aspects of it can influence the medical sphere. In regards to healthcare, one can define quality as a standard of excellence for which all participants should strive.
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This description of quality implies, however, that quality is not a static measure but an ever-evolving concept which considers the needs of major stakeholders. This definition can be connected to the works of Deming, a quality theorist who proposed the Deming cycle of continuous improvement (QP Staff, 2010). Moreover, he also noted that the quality of performance could not be viewed separately for people and the facility’s internal system. The cycle also reflects this viewpoint of quality, since it provides people with four steps (“plan-do-study-act”) which they can use in order to achieve quality (QP Staff, 2010, p. 17). Deming’s belief in leadership and transparency of the process makes this definition of quality realistic and achievable.
One of the significant practice problems with which I have some experience is pressure ulcers in patients. This issue affects people with limited mobility, regardless of whether it affects them in short- or long-term. According to Qaseem, Mir, Starkey, and Denberg (2015), before 2001, pressure ulcers were among one of the causes of death of patients in hospitals. However, the problem persists in many facilities to this day since many risk factors exist for patients, and practices for quality improvement are not always implemented effectively. One of the possible options to mitigate the issue is to eliminate wasteful practices.
The second one is to institute changes based on evidence and reliable recommendations. For example, beds that do not provide patients with comfort may lead to pressure ulcers, and their acquisition and continued use are wasteful to clinics. As Qaseem et al. (2015) advise, advanced static mattresses and overlays can significantly improve the situation and reduce the rate of pressure ulcers’ development. Furthermore, an effective data gathering and analyzing framework can replace ineffective systems and help clinicians to prevent pressure ulcers or treat them more effectively (Padula, Mishra, Makic, & Valuck, 2014). Finally, a set repositioning regimen may improve nurses’ performance and ensure standardization (Padula et al., 2015). These examples of introducing effective changes can affect the experiences of the hospital.
In the discussed case, the proposed definition of quality suggests that the facility should strive towards change and better outcomes for patients, paying attention to other prominent members at the same time. Patients, nurses, and physicians are all stakeholders of healthcare organizations. Hence, their needs should be considered in the method of quality improvement. For patients, all aspects of eliminating the issue of pressure ulcers are essential.
For medical workers, the initiatives should be well-defined, standardized, and transparent. Otherwise, the changes will not be implemented successfully in the end. As Deming stated, if people cannot explain their actions as a process, they do not know what they are doing (QP Staff, 2010). The proposed definition of quality suggests that its attainability should be seen as a continuous process that is performed in steps and its goal is well-established. Overall, the problem of pressure ulcers in patients can be subjected to clear and effective quality improvement measures.
Padula, W. V., Makic, M. B. F., Mishra, M. K., Campbell, J. D., Nair, K. V., Wald, H. L., & Valuck, R. J. (2015). Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States. The Joint Commission Journal on Quality and Patient Safety, 41(6), 246-256.
Padula, W. V., Mishra, M. K., Makic, M. B. F., & Valuck, R. J. (2014). A framework of quality improvement interventions to implement evidence-based practices for pressure ulcer prevention. Advances in Skin & Wound Care, 27(6), 280-284.
Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 359-369.
QP Staff. (2010). Guru guide: Six thought leaders who changed the quality world forever. Quality Progress, 43(11), 14-21.