Post a brief explanation of how you would identify a quality improvement practice gap in your practice or organization. Describe a potential quality improvement practice gap you might use for your DNP project, and explain why. Then, explain at least two types of tools and/or methods you might use to address this quality improvement practice gap, and explain why. Be specific and provide examples.
Patient Centered Medical Home is a model of healthcare delivery that is thought to improve health care by transforming how primary care is organized and delivered. The Agency for Healthcare Research and Quality (AHRQ) has acknowledged that the PCMH is not just a place of healthcare delivery, but a model of the organization of primary care that delivers the core functions of primary health care (AHRQ, n.d). The Military Health care system has transformed their outpatient clinics into PCMHs in an effort to deliver the best quality healthcare to the Soldiers, their families, and some Retirees. The PCMH uses five attributes and functions for quality improvement practices; Patient-Centered care, Comprehensive Care, Coordinated Care, Access to care services, and Quality and Safety. The aim is to provide cost effective care, improve quality outcomes, improve patient satisfaction, and garner satisfaction from the healthcare team. Quality outcomes starts at the points of care delivery and is assessed for practice gaps.
Within the MHS, quality improvement practice gaps can be identified by using satisfaction surveys. Research has shown that patient satisfaction is an important quality outcome indicator to measure success of services delivery system (Al-Abri & AlBalushi, 2014). Patient satisfaction provides opportunity for improvement in healthcare delivery. The Joint Outpatient Experience Survey, or JOES, is the standardize methods used by the Army, Navy, Air Force and Defense Health Agency to learn about healthcare experiences and patient satisfaction. The survey provides a comprehensive look at the patients’ opinions about their health, ease of access to care, preventative care services, overall satisfaction, preventative care, and customer service. (Health.mil, n.d). Feedback on surveys drives improvement of quality of care at the PCMH.
Staff feedback survey is also a great tool that can be used to bridge the gap for quality improvement practice in a PCMH. A cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH, concluded that staff and provider satisfaction are important metrics for assessing experiences with features of a PCMH model (Scammon, et. al). Other research has shown that the effect of the PCMH on providers and staff is especially important because of personnel turnover rate and the overall working environment. However, success and sustainability of a PCMH is dependent on those providers and staff buy-in for that model of healthcare delivery (Lewis, Nocon,Tang, 2012).
My DNP project will evaluate staff feedback on the PCMH care delivery model with a goal for improving practices based on the features of the PCMH model at my designated field experience facility. I will consider using the Continuous Quality Improvement (CQI) method of Lean for performance improvement and Plan-Do-Study-Act (PDSA) model to address the quality improvement practice gap. Plan-Do-Study-Act (PDSA) model is used to make positive changes in health care processes to effect favorable outcomes and rapid cycle improvement (Christoff, 2018). As an example, in the plan phase, I will develop a questionnaire to obtain staff ‘s knowledge about the PCMH and their satisfaction of carrying out the tasks of the PCMH with regard to the Who, What, When, and where. The Data and results obtained will be analyzed; and based on the feedback from the staff, a plan will be developed to be either adopted or abandoned. Lean is healthcare for ongoing process improvement in patient satisfaction and healthcare cost reduction.
The use of Lean process outcomes has been proven as a successful, sustainable integration of primary care clinics (Wu, et. al 2019). Lean can be used successfully to promote PCMH transformation and create a culture of continuous PI in primary care (Wu, et. al 2019). I will incorporate Lean following the staff survey feedback. The main focus will be on shared vision; staff roles and responsibilities; and barriers to change. The implications of these findings for primary care practices can substantially shine a light on the quality of care being rendered in the PCMH.
References
Agency for Healthcare Research and Quality. (2020). Section 4: Ways to Approach the Quality Improvement Process.
https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html
Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman medical journal, 29(1), 3–7. https://doi.org/10.5001/omj.2014.02