***Complete 2 of the 3 tools you selected using information from the QI case***
1. Focus Group (understand the current process)
2. Fishbone diagram/cause & effect (identify root causes)
3. Pareto Analysis (data display)
***Add an interpretation of the findings of the root causes and/or a summary of the data display or analysis depending on which QI tools you select***
Background:
QI Process
The Lean Six Sigma model would be the best QI process to address the increased fall rates in the rehabilitation unit. Quality is a secondary effect since the Lean model primarily focuses on eliminating wasteful processes (Livesay et al., 2020). However, the Six Sigma model in combination with the Lean model identifies and targets various issues contributing to falls and addresses shortcomings within current practice by reducing variations in care techniques to improve quality (Duquette, 2023). The five steps that make up the framework of the Lean Six Sigma model are: define, measure, analyze, improve, and control (DMAIC) (Takao et al., 2017). In the case of the fall rates QI project, the ANP must first define the problem and identify the needs of the staff and patients (Takao et al., 2017). The primary objective is reducing fall rates by streamlining care delivery amongst RNs and CNAs in the rehabilitation unit. Measurement within the Lean Six Sigma model involves collecting baseline data on the priority issues within the rehabilitation unit (Takao et al., 2017). Measurements should be delineated based on the relationship between the unit RNs and CNAs to analyze the data more easily.
After collecting baseline data, the ANP will analyze the data to identify the direct causes of the problems leading to increased fall rates and prioritize the importance of the problems (Takao et al., 2017). The ANP must assess data that applies to both the RNs and CNAs working in the rehabilitation unit, such as understanding and awareness of functional ability, variability in care, and environmental barriers to adequate care (Loftus et al., 2015). After analyzing the baseline data, the ANP will present, implement, and measure the efficacy of solutions to the problems causing increased falls (Takao et al., 2017). Per Loftus et al. (2015), these improvements, which are intermittently trialed to evaluate the efficacy, should address the initially defined problem and data points analyzed during the analysis step. Based on the efficacy of the trialed improvements, the ANP will implement unit-wide processes and guidelines to ensure long-term fall prevention compliance (Takao et al., 2017).
References
Duquette, C. (2023). Quality improvement models and frameworks for excellence. In M. Joshi, E. Ransom, S. Ransom & D. Nash (Eds.), The healthcare quality book: Vision, strategy, and tools (5th ed.) (pp. 33-43). Health Administration Press
Livesay, S., Zonsius, M., & McNett, M. (2020). Evaluating data to guide care delivery: Quality improvement methods and implementation science. In M. McNett (Ed), Data for nurses (pp. 59-84, focus on pp. 70-77), Elsevier. https://doi.org/10.1016/B978-0-12-816543- 0.00005-4
Loftus, K., Tilley, T., Hoffman, J., Bradburn, E., & Harvey, E. (2015). Use of six sigma strategies to pull the line on central line-associated bloodstream infections in a neurotrauma intensive care unit. Journal of Trauma Nursing, 22(2), 78-86. https://doi.org/10.1097/JTN.0000000000000111
Takao, M. R. V., Woldt, J., & Bento da Silva, I. (2017). Six Sigma methodology advantages for small- and medium-sized enterprises: A case study in the plumbing industry in the United States. Advances in Mechanical Engineering, 9(10), 1–10. https://doi.org/10.1177/1687814017733248