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Advocating For Institutional Policy Changes Discussion Paper

Advocating For Institutional Policy Changes Discussion Paper

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In advocating for institutional policy changes related to local, state, or federal health care laws or policies, health leaders must be able to develop and present clear and well-written policy and practice guideline proposals that will enable a team, a unit, or an organization as a whole to resolve relevant performance issues and bring about improvements in the quality and safety of health care. This assignment offers you an opportunity to take the lead in proposing such changes.
As a master’s-level health care practitioner, you have a valuable viewpoint and voice to bring to discussions about policy development, both inside and outside your care setting. Developing policy for internal purposes can be a valuable process toward quality and safety improvement, as well as ensuring compliance with various health care regulatory pressures. This assignment offers you an opportunity to take the lead in proposing such changes. Advocating For Institutional Policy Changes Discussion Paper

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Introduction

In advocating for institutional policy changes related to local, state, or federal health care laws or policies, health leaders must be able to develop and present clear and well-written policy and practice guideline proposals that will enable a team, a unit, or an organization as a whole to resolve relevant performance issues and bring about improvements in the quality and safety of health care. This assignment offers you an opportunity to take the lead in proposing such changes.

As a master’s-level health care practitioner, you have a valuable viewpoint and voice to bring to discussions about policy development, both inside and outside your care setting. Developing policy for internal purposes can be a valuable process toward quality and safety improvement, as well as ensuring compliance with various health care regulatory pressures. This assignment offers you an opportunity to take the lead in proposing such changes.

Instructions

Propose an organizational policy and practice guidelines that you believe will lead to an improvement in quality and performance associated with the benchmark underperformance you advocated for improving in Week 4. Be precise, professional, and persuasive in demonstrating the merit of your proposed actions.

Requirements

The policy proposal requirements outlined below correspond to the rubric criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, be sure to note the requirements for document format and length and for supporting evidence.

  • Explain the need for creating a policy and practice guidelines to address a shortfall in meeting a benchmark metric prescribed by local, state, or federal health care policies or laws.
    • What is the current benchmark for the organization and the numeric score for the underperformance?
    • How is the benchmark underperformance potentially affecting the provision of quality care or the operations of the organization?
    • What are the potential repercussions of not making any changes?
      • What evidence supports your conclusions? Advocating For Institutional Policy Changes Discussion Paper
  • Summarize your proposed organizational policy and practice guidelines.
    • Identify applicable local, state, or federal health care policy or law that prescribes relevant performance benchmarks that your policy proposal addresses.
    • Keep your audience in mind when creating this summary.
  • Analyze the potential effects of environmental factors on your recommended practice guidelines.
    • What regulatory considerations could affect your recommended guidelines?
    • What resources could affect your recommended guidelines (staffing, financial, and logistical considerations, or support services)?
  • Explain ethical, evidence-based practice guidelines to improve targeted benchmark performance and the impact the proposed changes will have on the targeted group.
    • What does the evidence-based literature suggest are potential strategies to improve performance for your targeted benchmark?
    • How would these strategies ensure performance improvement or compliance with applicable local, state, or federal health care policy or law?
    • How can you ensure that these strategies are ethical and culturally inclusive in their application?
    • What is the direct impact of these changes on the stakeholders’ work setting/job requirements?
  • Explain why particular stakeholders and groups must be involved in further development and implementation of your proposed policy and practice guidelines.
    • Why is it important to engage these stakeholders and groups?
    • How can their participation produce a stronger policy and facilitate its implementation?
  • Present strategies for collaborating with the stakeholder group to implement your proposed policy and practice guidelines.
    • What role will the stakeholder group play in implementing your proposal?
    • Why is the stakeholder group and their collaboration important for successful implementation?
  • Organize content so ideas flow logically with smooth transitions.
    • Proofread your proposal, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your proposal.
  • Use paraphrasing and summarization to represent ideas from external sources.
    • Be sure to apply correct APA formatting to source citations and references.

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Dashboard Metrics Evaluation

The report provides a comprehensive analysis of Saint Anthony Hospital in Chicago. Accordingly, Saint Anthony Hospital has been one of the top health organizations providing health services to families on the West and Southwest sides of Chicago, irrespective of their ability to pay, for over 125 years. The hospital is well-equipped to provide healthcare to the community members. The organization primarily offers medical and surgical care to different populations, emphasizing low and middle-income people. This report aims to understand and address the benchmark underperformance in light of the healthcare regulations implemented in Saint Anthony Hospital in Chicago.

Brief Description of Organization Setting

Saint Anthony Hospital is located in Chicago and is a prominent health institution providing medical services to the community. The organization is medium-sized and serves diverse people of Chicago (The new SAH – Saint Anthony Hospital – Chicago, n.d.)Advocating For Institutional Policy Changes Discussion Paper. The hospital has specialized units, including an emergency department, an expanded surgical suite, and a diagnostic imaging and laboratory service department. The facility is equipped to offer comprehensive medical and surgical care. It caters to diverse health needs, including medical care, surgical procedures, pediatrics, orthopedics, and obstetrics, to mention a few. The community served is characterized by diversity. The patients are from different cultural and ethnic backgrounds, including Hispanic, African-American, Caucasian, and Asian. The diversity enriches the health setting and reinforces commitment to providing culturally competent care. The facility primarily focuses on serving people and families from low to middle-income backgrounds. The challenges and health needs of the population form a critical part of the organization’s mission to ensure high-quality health services are provided to community members.

Evaluation of Dashboard Metrics

At Saint Anthony Hospital in Chicago, a comprehensive evaluation was made on the performance dashboard, encompassing various aspects of patient care. The review has identified several metrics not meeting the prescribed benchmarks established by the local, state, and federal healthcare policies and laws (Karami et al., 2017). The metrics include readmission rates, infection control, patient satisfaction, and timely access to care. For the rates of readmission rates, the hospital is experiencing an increase in patient readmissions, especially within 30 days of discharge. The metric directly impacts patient outcomes and costs of healthcare. The readmission rates affect commitment to delivering quality care and could have financial implications for the organization.

Based on the guidelines set by the Centers for Disease Control and Prevention (CDC) and state health departments, infection control is not consistently met in all hospital areas. Adherence to hand hygiene protocols, sterilization processes, and containment of health-associated infections require improvement. Despite the efforts, patient satisfaction scores have consistently declined as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Mainly, this shows gaps in delivering patient-centered care and meeting the expectations of the diverse patient population. The commitment to providing timely patient access is hindered by extended wait times in the emergency department and prolonged appointment scheduling. Mainly, this impacts patient experiences and raises concerns about the efficacy and effectiveness of health delivery.

The policies and laws relevant to the benchmarks include the Affordable Care Act (ACA) that emphasizes the reduction of hospital readmissions and the need for high-quality services over quantity in healthcare delivery (Kuznetsova et al., 2021). The Joint Commission’s guidelines on infection control and prevention are critical to maintaining health standards. The benchmarks on patient satisfaction are linked to patient rights, while timely access to care is aligned with regulations set by the Health Resources and Services Administration (HRSA). The benchmarks are met in some instances, but a significant portion of the performance data falls short. The discrepancy calls for examining the existing health policies and a commitment to aligning the services with the standards set by laws and policies. There is a need to address the shortfalls to remain compliant with the regulations and ensure that the patient’s well-being and long-term sustainability are enabled at Saint Anthony Hospital. Advocating For Institutional Policy Changes Discussion Paper

Consequences of Benchmark Underperformance

The consequences of not meeting the prescribed benchmarks are far-reaching. They affect an organization’s mission resource constraints, compromise the commitment to cultural diversity, and undermine the skills of the staff members. The lack of adequate procedures and processes leads to benchmark underperformance. The assumptions for these conclusions stem from analyzing historical performance data and observations within the organizations. Like other health organizations, Saint Anthony Hospital has a mission of providing high-quality and patient-centered care to the community. The underperformance threatens to compromise the mission. When the organization falls short of the metrics through readmission rates and patient satisfaction, the challenge is posed to the commitment to providing the best possible care to patients. Such a lack of alignment with the mission impacts the organization’s reputation and eradicates trust.

Additionally, the underperformance of the benchmark leads to resource constraints in different ways and increased readmissions, including inpatient beds, staff time, and financial resources. The financial implications are substantial, with penalties associated with excessive readmissions lowering capital funding and operations. The constraints limit the ability to invest in technologies, staff developments, and critical improvements. Saint Anthony Hospital delights in serving a multicultural community in Chicago. Commitment to cultural diversity is a core value that ensures equitable healthcare access. Benchmark underperformance in the satisfaction of the patient could signal the existence of a disconnect between the care provided and the unique needs and expectations of people from different cultural and ethnic groups, hence compromising the commitment to cultural diversity, leading to disparities in health access and outcomes.

Benchmark Underperformance for Improvement

The underperformance of the benchmark with the most substantial impact is the high rate of readmissions. Mainly, this issue affects the mission and the most significant number of patients. Not addressing the problem affects the quality of care. At the same time, this also jeopardizes the health of the community. The opportunity for improvement is centered on redesigning patient discharge processes and providing targeted interventions for patients who are at risk (Zhuang et al., 2022)Advocating For Institutional Policy Changes Discussion Paper. Mainly, the changes could play an integral role in improving the quality of care and, ultimately, patient satisfaction through bettered outcomes.

Advocacy for Ethical and Sustainable Actions

Addressing the high readmission rate at Saint Anthony Hospital would require a well-coordinated effort led by a committee for quality improvement in conjunction with the medical and nursing staff. The stakeholders are positioned to initiate targeted interventions to improve the identified benchmark metric (Rabiei & Almasi, 2022). The reasons for the approach tend to be diverse. One of the propositions is expertise and insight. The committee can bring together professionals who deeply understand health quality and performance improvement. Their expertise allows for analyzing the root causes of high readmission rates, allowing for evidence-based interventions. Besides, collaboration with the medical and nursing staff is integral. Health providers have direct contact with patients and know the need to address the issue of high readmission rates.

Additionally, readmissions must be reduced to ensure they align perfectly with the mission to provide a high standard of care to the community. The commitment to the task is not just a statement but a promise to the patients and reflects the dedication to the health and well-being of the people served. A series of actions can be undertaken in the facility to improve the services rendered. They include having a post-discharge follow-up, implementing care transition programs, collaborating with community partners, and making data-driven decisions. These solutions could play an integral role in improving the quality of services rendered at the facility.

Conclusion

The report contains the results for a benchmark of underperformance at Saint Anthony Hospital. The findings show that the issue of hospital readmissions remains profound in the organization. Saint Anthony Hospital should take immediate action to address the benchmark’s underperformance. Improving the readmission rates and compliance with health policies and laws could help enhance the quality of care and secure the organization’s financial viability. Collaboration is needed to meet the challenges and continue providing high-quality care to the community.

References

Karami, M., Langarizadeh, M., & Fatehi, M. (2017). Evaluation of effective dashboards: Key concepts and criteria. The Open Medical Informatics Journal, 11(1), 52-57. https://doi.org/10.2174/1874431101711010052

Kuznetsova, M., Frits, M. L., Dulgarian, S., Iannaccone, C., Mort, E., Bates, D. W., & Salmasian, H. (2021). An analysis of the structure and content of dashboards used to monitor patient safety in the inpatient setting. JAMIA Open, 4(4). https://doi.org/10.1093/jamiaopen/ooab096

Rabiei, R., & Almasi, S. (2022). Requirements and challenges of hospital dashboards: A systematic literature review. BMC Medical Informatics and Decision Making. https://doi.org/10.21203/rs.3.rs-1450850/v1

The new SAH – Saint Anthony Hospital – Chicago. (n.d.). https://sahchicago.org/the-new-sah

Zhuang, M., Concannon, D., & Manley, E. (2022). A framework for evaluating dashboards in healthcare. IEEE Transactions on Visualization and Computer Graphics, 28(4), 1715-1731. https://doi.org/10.1109/tvcg.2022.3147154

Executive Summary

Healthcare organizations should meet performance benchmarks at different levels. Additionally, they must ensure that performance in a particular performance area aligns with the set target. Thus, the healthcare organization’s performance must be evaluated regularly to identify areas that must be improved to achieve the desired score or align with the set benchmark. This project aims to improve the quality of care in underperforming inpatient units based on performance scores indicated on the dashboard. Advocating For Institutional Policy Changes Discussion Paper

Dashboard Metrics Evaluation

            The QSEN focuses on equipping nurses with the six competencies, preparing them to improve the safety and quality of patient care. Nurse practitioners (NPs) apply their evidence-based practice (EBP) and quality improvement (QI) skills to address gaps in their practice for better health outcomes. Thus, NPs advocate for institutional policy changes depending on the practice area that requires improvement to align with health care policies at the local, state, or federal levels. NPs formulate a well-written practice guideline proposal and present it to the stakeholders, including top management, for approval. The proposed policy must indicate how the proposed policy will resolve the identified clinical issue at the unit or organizational level. This paper proposes changes needed to reduce the high rate of patient falls in the medical-surgical units.

 Evaluating Underperforming Matrix

Medical and surgical units are experiencing a significantly high rate of patient falls. The current target for patient fall rate in these units is approximately 6.0 falls/1000 patient days. However, the prevalence of patient falls in the surgical and medical departments is about 19.48 falls per 1000 patient days based on data gathered from the healthcare facility’s dashboard. Hence, the actual inpatient fall score is over three times higher than the organization’s set target for patient falls. Consequently, an evidence-based guideline should be adopted in the affected inpatient units to lower the high patient fall rates, achieving the organization’s target for inpatient falls.

Consequences of the Underperforming Matrix

A relatively high rate of inpatients characterizes the underperforming matrix falls in the surgical and medical departments. This clinical issue compromises the provision of quality care in the entire healthcare organization. About 25% of inpatient falls result in severe injuries and fractures (Trinh et al., 2020). The high prevalence of injuries and fractures increases healthcare providers’ workload, compromising their ability to provide effective and timely medical care to patients seeking treatment for various medical conditions. Failure to implement policy measures for addressing patient falls would negatively affect the entire healthcare organization. First, the medical facility’s reputation would be damaged due to the increased rate of fall-related severe fractures and injuries, resulting in prolonged hospital stays and increased treatment costs (Su et al., 2021). The cost of treating fall-related injuries is relatively high, exposing the affected inpatient units to a massive financial burden. Su et al. (2021) reported significantly high fall-related injuries and total hospitalization costs in the geriatric unit. Therefore, failure to propose practice guidelines for improving fall rates in the surgical and medical units would increase the overall cost of treatment in the affected departments, jeopardizing the healthcare organization’s operations.

The Recommended Practice Guidelines and Organizational Policy

            The federal health care law benchmarks inpatient fall rates in the surgical and medical units. The national benchmark for patient fall rate in the surgical and medical units in the United States is about 3.44 falls/1000 patient days (Venema et al., 2019). On the other hand, the fall rate in the two units in the healthcare facility is 19.48. This fall score is approximately six times higher than the national benchmark for patient falls (3.44). Therefore, the inpatient fall score in the two units is significantly higher than the national benchmark. For this reason, an organizational policy must be implemented in the affected departments to lower the high rate of inpatient falls. The proposed practice guidelines involve introducing bed and chair alarm systems in the surgical and medical units. Studies indicate the efficacy of alarm systems in preventing falls in inpatient units (LeLaurin & Shorr, 2019)Advocating For Institutional Policy Changes Discussion Paper. The bed or chair alarm system sends signals when an individual is about to fall, alerting the healthcare provider on shift. The clinician assists the individual patient in leaving the bed or chair, reducing the possibility of a fall. Therefore, implementing this EB policy in the healthcare organization will significantly lower the rate of falls in the affected department, achieving the national benchmark for inpatient falls.

Potential Impacts of Environmental Factors on the Proposed Practice Guidelines

            The proposed practice change entails installing alarm systems (bed and chair) in the surgical and medical units. Implementing this EB change intervention in the affected departments might result in noise pollution. Dash et al. (2022) reported that medical alarm systems result in noise pollution. Medical equipment noise hinders communication and exposes patients to noise-triggered stress (Dash, 2022). Therefore, the project implementation team must consider all safety measures and precautions during alarm system installation to prevent potential noise pollution and related challenges. Dash et al. (2022) reported that educating healthcare workers, particularly nurses, on managing the equipment reduced the alarm systems’ noise level while keeping them alert. Thus, nurses working in surgical and medical units will be educated on minimising alarm system-related noise to ensure the new practice guideline meets regulatory measures for noise pollution.

Additionally, the successful implementation of the new intervention will significantly depend on the availability of various resources. First, the efficacy of the alarm system in preventing falls will significantly depend on staffing rates in the surgical and medical departments. Healthcare providers, in particular nurses, must be readily available to meet the patient’s immediate needs upon receiving an alarm system’s alert to prevent an individual patient at a high fall risk from falling. Moreover, alarm systems would be affected by the availability of support services required post-implementation stage to enhance the efficacy of the alarms in preventing patient falls in the surgical and medical units. Advocating For Institutional Policy Changes Discussion Paper

Ethical Impact of the Alarm Systems on Patients at High Fall Risk

            The proposed EB practice change involves adopting an alarm system in inpatient units with a relatively high rate of patient falls. LeLaurin and Shorr (2019) reported the effectiveness of alarm systems in preventing falls in inpatient units. Thus, chair and bed alarms will prevent patient falls in the surgical and medical units. Consequently, the rate of inpatient falls in these departments will reduce significantly from the current score of approximately 19.48 to 3.44 falls/1000 patient days, the national benchmark for inpatient falls (Venema et al., 2019). The proposed practice guideline focuses on preventing falls in the inpatient units with a relatively high fall score. This initiative will prevent patients from fall-related severe fractures and injuries. Consequently, the new practice guideline will align with the ethical principle of nonmaleficence, which advocates for patient protection from potential harm (Varkey, 2021). Moreover, the proposed policy will consider the cultural beliefs of individual patients. For this reason, alarm systems will not be installed in beds or chairs of patients whose cultural beliefs are against using digital devices, such as alarm systems and the Internet of Things. The new strategies will directly impact stakeholders’ job requirements. Specifically, nurses working in the surgical and medical departments must undergo training to acquire the knowledge and skills needed to operate the alarm system.

Stakeholders Involved in the Implementation Process

Successful implementation of the proposed policy significantly depends on stakeholder’s support. Stakeholders and groups involved in practice guideline implementation include department heads, IT experts, and nurses working in the surgical and medical units. These teams will perform various roles in system design and implementation. The contribution of every group will impact the implementation process positively. Thus, involving these groups and stakeholders during project implementation is recommended since they will work together to prevent inpatient falls in the affected units.  Advocating For Institutional Policy Changes Discussion Paper

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Strategies for Collaborating with the Stakeholder Group during EB Change Implementation

Change project team members collaborate with key stakeholders’ groups during practice guideline implementation. The team members should assign different roles to various stakeholder groups. First, heads of surgical and medical units will approve the implementation of alarm systems in their departments. Furthermore, IT experts will design and install an alarm system that effectively prevents falls in underperforming units. Moreover, nurses will prevent patients who are more likely to fall from falling by responding to alarm alerts. The stakeholder groups’ collaboration is essential since their roles contribute to successfully implementing the proposed practice guideline.

Conclusion

The underperforming area in the medical facility is the significantly high inpatient fall rate in the surgical and medical units. This clinical issue is justified by the significantly high rate of actual inpatient falls, exceeding the organization’s score and the national benchmark for falls. This underperforming matrix can be improved by implementing policy guidelines involving installing bed and chair alarm systems. The new system will alert nurses on duty when a patient is at a high risk of falling. Nurses’ response will reduce the likelihood of falls, reducing overall fall rates in the affected departments. The new practice guideline aligns with nonmaleficence since it will prevent individuals with significantly high fall risk from fall-related injuries and fractures. Stakeholders’ collaboration will contribute to successfully implementing the proposed practice change since stakeholders’ groups will play various roles during alarm system implementation. Advocating For Institutional Policy Changes Discussion Paper

References

Dash S. (2022). Identifying Noise Sources & Alarm Hazards in ICUs – Occurrences. Tools to Minimize. Salud Cienc. Tecnol; 2(S2):236.

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in Geriatric Medicine35(2), 273-283.

Su, F. Y., Fu, M. L., Zhao, Q. H., Huang, H. H., Luo, D., & Xiao, M. Z. (2021). Analysis of hospitalization costs related to fall injuries in elderly patients. World journal of clinical cases9(6), 1271.

Trinh, L. T. T., Assareh, H., Wood, M., Addison-Wilson, C., & Sathiyaseelan, Y. (2020). Falls in hospital causing injury. The Journal for Healthcare Quality (JHQ)42(1), 1-11.

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice30(1), 17-28.

Venema, D. M., Skinner, A. M., Nailon, R., Conley, D., High, R., & Jones, K. J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study. BMC Geriatrics19, 1-10. Advocating For Institutional Policy Changes Discussion Paper

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