Professional Writing on "Continuous Quality Improvement Project"

Professional Writing 8 pages (2125 words) Sources: 1+

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CQI Project

Description/Background of Project -- Memorial Herman Hospital is the largest not-for-profit healthcare system in the State of Texas and serves the greater Houston metropolitan area through eleven hospitals, a network of affiliated physicians, and a number of specialty programs and services. The hospital employees almost 20,000 employees and has won numerous awards for Quality Healthcare. The organization is committed to creating healthcare solutions that meet the needs of the 21st century and understand that many people count on the organization for quality, cost-efficient healthcare. More than anything, the organization is a collaborative effort that is dedicated to the continual progress of its staff and departments. In line with this, Customer Satisfaction is a continual priority for each and every unit within the hospital organization (Memorial Herman - About Us, 2010).

Customer satisfaction is not just about external customers. In many large organizations, customer satisfaction is about internal customers and stakeholders. To measure employee satisfaction, the regular survey instrument is nothing new. In my case, I am a Registered Nurse at Memorial Herman, and have seen the way surveys are distributed and the attitude of many employees regarding their use and veracity. Each quarter, MH sends out an email with a link asking employees to rate differing aspects of job satisfaction. The email states that the responses will be 100% confidential, but many employees remain leery about the degree to which they can be honest in the survey.

The questions range from the following: (1) Do you have the necessary skills to do your job; (2) Does your manager or supervisor encourage additional learning opportunities; (3) Does your manager or supervisor evaluate you on your job performance. (4) Are you satisfied with the level of rewards or recognition from your management team? A large percentage of the nursing staff were, in fact, quite dissatisfied with the level of rewards and recognition received from management. Specifically, that dissatisfaction focused on listening to employee concerns, establishing procedures to affect change, and working with upper management to address the major concerns.

Project Aim -- It is with this level of reward/recognition that this CQI project will focus. The aim of the project is to increase morale and satisfaction with rewards within the nursing staff and to bring to the attention of management the need to address relationship issues with their staff. Inattention, often resulting in a lack of staff retention, hurts the hospital overall, poses a serious obstacle to quality patient care, and indeed, makes it difficult to construct a healthy work environment. Actualization of employees is not always based on financial rewards, though, and it will be shown that there are a number of congruent actions that may be immediately implemented that would dramatically improve the satisfaction level of the nursing staff. Basic thesis can be measured easily by a before and after satisfaction survey; trends in the before research -- implementation of new satisfaction program(s) -- measurement of those programs.

Literature Review -- Customer Satisfaction - Customer satisfaction, both internal and external, is an important component of a Balanced Scorecard. A Balanced Scorecard approach is often seen as one of the key tools that translate strategy into performance. . The balanced scorecard model is a clear direction outlining what the organization should measure to balance the financial output. The scorecard retains financial measurement as a summary of their business performance. Moreover, the scorecard will highlight an integrated set of measurement that will link customers, processes, resources, and performance to long-term financial success. The balanced scorecard is a tool that provides the company the framework that translates vision and strategy into actionable tasks. The scorecard is a set of performance measures allowing management a dashboard view of their business. These performance measurements are used to aid the company in setting goals and manage the business's strategic plan. The balanced scorecard model will support the strategic plan and implementation by uniting all actions of an organization into a common understanding of the goal; it will provide feedback for both internal processes and the external outcome to improve strategic performances and results continuously (Lanabeer and Napiewocki, 2000; Stevens, et.al., 2006).

Customer satisfaction, however, is a rather abstract concept -- what one person perceives as a baseline for performance is not the same as another. This is particularly true when looking internally and is very dependent upon the careful way a particular survey is worded. For instance, what employee would not respond to questions such as: Do you think you should have more financial compensation for what you do at work? Instead, to get at the gist of internal satisfaction, careful baseline measurements must occur as well as reasonable and measurable outcomes. Thus, the purpose of this type of information collection is the building a relationship of honesty, integrity, and trust, among organization employees, the results should be communicated effectively and acted upon by the organization. It is imperative that the organization's managers track progress and communicate implementation successes and failures. In effect, the overall philosophy is then, how to link customer and employee satisfaction to the ROI and profitability of the organization? (Allen and Wilburn, 2002).

Results/Data- current- Of the 20,000 employees within the MH organization, there are approximately 2500 Registered Nurses on staff. The most recent survey of these 2500 RNs found that over 43% were "Very dissatisfied" and another 26% "Dissatisfied" with the manner in which managers rewarded them, either verbally, socially (awards, recognition, etc.), or fiscally (bonus, days off, etc.). If one adds the bottom two categories, there is a huge majority of 69% dissatisfaction rate among MH Registered Nurses. With almost three-quarters of a given subset of the population dissatisfied, this cannot help but contribute to morale and production issues. In addition, it is likely that the 13% who answered neutral were still too fearful of their positions to answer the questionnaire honestly.

PDSA Model Overview -- The PDSA Model, or Plan, Do, Study, Act, is of particular use within the healthcare field. It is organized into four parts: 1) Plan -- Plan a change or test of how something might work; 2) Do -- Carry out the Plan; 3) Study -- Review and interpret the results; and 4) Act -- Decide what action should be taken to improve. The power of this model is its ability to be repeated as needed until the desired goal is realized. Typically, the PDSA model will result in fewer meetings "deciding" what to do, assigning tasks, and getting to the core of an issue (Corrigan, Greiner and Erickson, 2003, 49) .

For our purposes the initial step of the PDSA Model will consist of the following:

Plan -- The conceptual problem is clear. We have a serious situation with Registered Nurses within the hospital. Most (almost 75%) do not feel that the reward system is even close to adequate. Since an employee satisfaction survey is already part of the regular system, there is no need to continually retest. Instead, put a phased Performance Reward Plan into effect and then retest for the plan's efficacy.

Do -- Produce a Performance Reward Plan and implement.

Study- Use 1-2 iterations of the regular hospital quarterly satisfaction survey, but buttress those results with a short, but more open ended, qualitative questionnaire sent out in the 5th month after implementation of the PRP. Send this out to RNs only.

Act -- The plan may or not be efficacious at this point; the results should show a dramatic improvement of the "Very" and "Dissatisfied" responses to be valid. Our best guess estimate/goal would be a minimum of 50% improvement within the first 5-6 months of implementation.

Improvement Tools -- When we carefully analyze the actual preliminary data we actually find that there are four major reasons for RN dissatisfaction that cover over 90% of the total defects: 1) Lack of positive feedback (36%); 2) Lack of Adequate Manager/Nurse communication (22%); Lack of recognition for a job well done, or exceptional dedication (23%); Some semblance of reward system (nonfinancial) (13%). These four total 92.2% of the total defects within the system. (Note that only 8% were dissatisfied because of fiscal or salary issues):

Rank

Causes

Defects

Cumulative %

1

Lack of Positive Feedback

36%

35.3%

2

Lack of Adequate Management/Nurse Communication

22%

56.9%

3

Lack of Recognition for job well done or working beyond the call of duty

23%

79.4%

4

Lack of Reward system (non-fiscal)

14%

92.2%

5

Salary, Fiscal Issues

8%

It is quite clear, then, that changing the salary structure as a way to drastically improve RN satisfaction is not the complete answer. Instead, if one looks qualitatively at the four major issues, they all involve some sort of interpersonal communication and/or recognition from management. Further, the literature shows that modern nursing is a rewarding, but challenging, career choice. The modern nurse's role is not limited only to assist the doctor in procedures, however. Instead, the contemporary nursing professional takes on a partnership role with both the doctor and patient as advocate caregiver, teacher, researcher, counselor,… READ MORE

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