d)     Quality Management Approach

Plan-Do-Study-Act (PDSA) Cycle: The PDSA cycle is a five-step process used in activities that can lead to significant learning and subsequent knowledge to ensure improvements in a process or product. Implementing projects such as planning, doing, studying, and acting accordingly will increase cleaning and hygiene practices at the general hospital (Hamilton et al., 2022). The PDSA cycle was fundamental in applying and refining the evidence-based interventions.

Data-Driven Decision Making:. Data such as the number of infections, hand washing rates, and patient outcomes were readily measurable and used to determine the success of the intervention and identify areas of further focus. This is appropriate since quality management is premised on a scientific approach, which relies on data to make decisions. This data-driven approach was used to continuously monitor and improve the interventions, ensuring they were effective.

Hand Hygiene Protocol. Hand washing was standardized by instituting a strict protocol requiring staff to follow specific procedures before and after patient treatment. The hospital also ensured that hand sanitizers were strategically placed so that the personnel used them often and adherence was checked. It is emphasized that hand hygiene is the most positive and efficient method of infection control in the healthcare environment (Ferraro et al., 2020).

Patient Safety Risk Reduction:

The building was targeted to achieve the ultimate goal of reducing HAIs and improving patient safety. This is well supported by the Institute of Medicine (I.O.M.) guidelines in healthcare Quality, which strongly consider safety. Using the techniques and protocols to reduce the risk of Healthcare Associated Infections using sanitizers, gloves, and personal protective equipment. It is recommended to use sterilization & disinfection techniques and procedures (Clayton & Miller, 2017).

Monitoring and Feedback: Continuous monitoring and feedback are crucial to increasing the effectiveness of patient safety improvement. Procedures such as Antibiotic stewardship programs need to be implemented. Infection control audits and staff and patient vaccinations need to be adopted. Surveillance and monitoring steps, which include infection surveillance and data analysis, need to be implemented (Jarvis, 2004).

Professional Standards

The following is essential for providing high-quality and a positive impact on patients.

• Alcohol-based rubs should be used as often as necessary if hands are not visibly soiled or if alcohol-based rubs must contain at least 60% alcohol.
• Regularly monitor the health care workers for their hand washing behaviors and their reactions and responses to the performance.
• The gloves must be removed when approaching and/or interacting with blood, body fluids, secretions or excretions, or contaminated material.
• Wear gloves and aprons on the skin and clothes where there are likely to be splashes and sprays during procedures.
• Use the mask for every procedure involving splashes or sprays on the mucous membranes.
• Switch gears and any other fiddly and susceptible surfaces and equipment should be cleaned and disinfected at least once daily.
• Approved E.P.A. disinfectants or those registered under the Drugs, Cosmetic, and Device Act should be diluted and used according to concentration, contact time, and the contact site at the manufacturer’s instructions
• Each injection has to be made with a new, non-reusable syringe and needle.
• Laminate or seal used syringes and dispose of them in sharps disposal containers for the physical disposal of sharps.
• Reform the antibiotics noes and reconsider their change in the culture results and the severity of the patient’s clinical conditions.
• Offer care of catheterization by adequately inserting the correct aseptic catheters.
• Catheterization must only be performed when it is critical because it aids in the rapid development of the infection.
• If the bladder is closed, a catheter, tubing, or towels should also be used to keep the collection bag below the bladder.
• Inform the patient about the requirement of a complete sterile barrier at the time of central venous catheter insertion.
• The skin antisepsis preparations used in the skin antisepsis process are the chlorhexidine drug skin antisepsis preparations.

Section # 2-Strategies for Implementing a Quality Improvement Project in a Hospital.

a)      Transformational Leadership

Theory-transformational Leadership is a leadership style used by leaders whose primary focus is to empower their followers to do things they would not do in normal circumstances because leaders have visions and strongly influence and encourage their followers in their jobs (Gammon et al., 2019).

Practice—The concept of continuous improvement has identified the importance of transformational leaders in delivering healthcare services in the hospital. Such behavioral changes in staff will change healthcare practices and outcomes and help achieve better healthcare goals.

Example: The hospital’s CNO can engage in transformational Leadership by holding town hall-style meetings on the floor to underscore the need for stricter infection control. These meetings can act as a forum where nurses and other healthcare workers can address their grievances and share their ideas; they can thus feel important in the establishment(Gammon et al., 2019).

Actions by Management: Senior-level workers must be encouraged to take hospital leadership courses to implement the transformational leadership style. They can also set up a reward system to recognize the people participating in the Q.I.P. and incentivize other staff to be involved.

b)      Engaging Frontline Staff

Theory: Kouzes and Posner identify frontline staff as key; liberation engages them in the entire process because they become committed and motivated to the improvement plan for success (Casey & Moscovice, 2004).

Practice: It makes the system’s loopholes insignificant or somewhat absent, and the approach is conveyed directly by the staff practically engaged in patient care.

Example: It is also advisable to form groups of nurses, doctors, and other staff to support and enhance the adoption and success of hospital-wide infection prevention and control strategies. The other approach is for such teams to conduct regular meetings to derive meanings from data and identify issues that must be addressed to resolve the identified problems.

Actions by Management: An example of an approach through which such broad engagement can be made possible is through the use of committees or working groups that the hospital managers set up for the staff to engage in Q.I. projects. They may also provide freedom since, in this case scenario, their workers can provide feedback, and they will not retaliate against their workers.

c)      Data-Driven Decision Making

Theory: Quantitative research is a method that involves using quantitative data at specific points in time to make a decision. The strategy derived from the subject has evidence-based support rather than being subjective or emotive (Weiner et al., 2005).

Practice: The most appropriate data to collect and compile with the related data include incidence rates, personnel hand hygiene observance, and patient outcomes to determine the concerning areas and the change outcomes.

Example: This type of rate digital dash may be used to keep track of infection rates per ward in certain hospitals. The hospital will then be able to track the trends in infection rates and use the periodic analysis of this data to identify any notable increases in the measure of thresholds and can take prompt action to mitigate them.

Actions by Management: For hospitals to implement decision-making approaches in the most appropriate ways, hospital management needs to install the correct electronic information to help gather process and data analysis. They can also avail themselves of services that will train their staff to best use these systems and interpret the data they produce.

d)     Continuous Education and Training

Theory: Continuous education and training also highlight the need to repeat the learning process to retain best practices, maintain compliance with best practices, and achieve goals toward quality outcomes regarding healthcare delivery (Kriegova et al., 2021).

Practice: Frequent training programs are provided to make the staff well aware of infection control methods and the current procedures for their prevention. Training can also be formal through training, workshops, and e-learning.

Example: A hospital may also include a reminder on infection control practices once every three months, such as properly performing handwashing or using the proper E. These sessions can be compulsory for all clinical and supportive professionals.

Actions by Management: Hospital management can contribute to lifelong learning through donations and training modules. They can also use the services of organizations that provide critical information for staff, like articles and best practices from academics and professionals.

e)      Lean Six Sigma

Theory: Lean Six Sigma combines lean manufacturing and Six Sigma, involving strategies to eliminate process waste (Montella et al., 2016).

Practice: The Lean Six Sigma model can be effectively applied in the health sector to reduce excess work processes, variations, and non-value-added work.

Example: A hospital would have to discover how the Lean Six Sigma concept can be used in the medication administration process to identify the causes of delays and medication errors. In this regard, processes need to be reorganized and standard operating procedures adopted to assist the hospital in improving efficiency levels and minimizing mistakes.

Actions by Management: These Lean Six Sigma tools can be used in hospitals to educate and train employees. They can also offer to form cross-functional project teams to facilitate holistic organizational processes.

f)       Patient and Family Engagement

Theory: Encouraging patients and their families to take part in care processes will increase the safety, quality, and satisfaction of the healthcare system

Practice: Q.I. in hospitals can be done by actively engaging patients and their family members in care practices and protocols included in Q.I.

Example: A hospital can implement a patient and family advisory council that meets regularly to provide information on an infection control program and feedback on changes being implemented. This council can help guide interventions to deliver patient-centered care that addresses the interests of the people under its care.

Actions by Management: Organizations may also assist patients and families in the following ways: They can incorporate strategies that foster communication and structures for involving patient families. They can also ensure that the staff is adequately trained to develop communication and relationships with patients and their families.

g)      Assessment of Effectiveness

Reduced Infection Rates

Strategy: Protecting the Organization from Pathogens: Implementing handwashing practices and promoting cleaning policies (Mishriki et al., 1990).

Effectiveness: One of the interventions is replacing the current number of HAIs at this healthcare facility with a high percentage of reducing the number of HAIs.

Example: The infection rate for a hospital, hence before initiating any Q.I. project, is 3%, for example. 5% and 1% once a project is ready to be deployed. A 5% reduction in HAIs in the first year and the subsequent average of 4% in four successive years.

Actions by Management: To increase the number of cases, organizations’ management can also regularly track hand washing and environmental disinfection. They can also provide feedback to the staff members and request to change some protocols.

Improved Compliance

Strategy: The optimal strategies involve workers in the development of policies and in continuing education to address ineffective workers’ behavior (Neiderud, 2015).

Effectiveness: More compliance can also mean that more employees in an organization comply with infection control procedures, among other policies.

Example: This failure in the Q.I. project should be addressed, and with the effective implementation of this project, the 60% compliance rate in hand hygiene should be boosted to 90%.

Actions by Management: Management can make generic inquiries and utilize the results to decide if further actions can be taken to enhance efficiency. They can also identify higher compensation through bonus activities that motivate the employees.

Enhanced Patient Safety

Strategy: Organisational Commitment Among Front Line Staff Endorsing the Use of Transformational Leadership (Pittet, 2005).

Effectiveness: Another symptom of patients’ safety in the healthcare industry can be indicated by decreased patient infections and complications.

Example: The changes in the survey findings may be positive, with evidence of better hygiene or sanitation activities.

Actions by Management: Regarding the number of safety protocols, management can use patient feedback to enhance patient safety. They can also create awareness of safety measures on the hospital premises and make it a point to carry out safety activities in all hospitals.

h)     Challenges and Solutions

The project faced several implementation challenges:

Resistance to Change

Some staff’s attitude change towards new practices took a lot of work. To continue with this meant training workers, regular communication, and change champions who would live the change and be an example for others. It is recommended that the change management process be composed of six steps concerned with combating resistance to change in terms of communication, seeking support from the top, and involving the right people.

Time Constraints

The most challenging issue was time management, as it was only sometimes possible to combine daily duties such as caring for the patients with the new Q.I. project tasks. Options such as integrating and eliminating time-consuming processes also allowed us to deal with this issue. It stresses the need to integrate Q.I. initiatives into our regular work so that the changes continue after one or two years of changes.

Resource Limitations

The scarcity of hand sanitizer devices and cleaning chemicals was an issue. Both finding new funds and the replenishment of resources that the project already involved were needed to realize this project. Using this social theory emphasizes the significance of resource distribution in establishing Q.I. endeavors.

Section-3 Strengths and Challenges for Leaderships & Quality Management

a)      Strengths for Leadership and Quality Management

In healthcare, the skills associated with Leadership and quality management are essential in implementing the Q.I. project.

Transformational Leadership can achieve change in the behavior and performance of the staff. Motivating and empowering the staff is one way transformational leaders can elicit interest and dedication toward the Q.I. project (Darling, 1992). They also establish the project’s vision and consult staff on strategic decisions, helping engage staff in the project. For example, the CNO town hall meetings can empower people with an environment of worthiness and the ability to express themselves with ideas pertinent to infection control.

Another core competency is the strategy of engaging frontline staff. The frontline staff offers realistic feedback and recommendations about the concrete issues and practical barriers and countermeasures to be considered for the Q.I. initiatives to be effective. Their participation in creating protocols also helps follow them because they feel personally involved with the processes. For example, problems arising from infection control protocols can be best addressed within multidisciplinary teams considering actual working conditions to improve their effectiveness.

Decisions to implement Q.I. initiatives are made based on gathered data that provides a factual basis for making any decision. Making evidence-based decisions with data improves the quality of business operations and learning processes. Regular data analysis is used to track progress and change interventions. For instance, recording the number of infections in real time will help identify the problems and act swiftly to prevent large-scale infections (Nwankwo & Richardson, 1996).

Informal Professional Development and Training are used to maintain the quality of service as staff are kept updated with the most effective practices and protocols (Trofino, 2000). Regular training sessions help enhance staff’s competencies, facilitating better consistency with the protocols and higher quality care. For example, refresher education every three months ensures that staff members are updated and skillful in infection control techniques.

b)     Challenges for Leadership and Quality Management

Leadership and quality management, which define Q.I. efforts, are factors that can lead to the failure of Q.I. initiatives in healthcare.

Transformational Leadership has weaknesses, such as resistance to change. Not all workers like the visionary approach of this kind of leader; hence, there will be resistance and dragging of time in adopting new procedures. Furthermore, the intense work and dedication needed from transformational leaders may result in burnout, which reduces their preparedness and inclination to keep Q.I. initiatives moving. For instance, the staff may feel challenged when a transformational leader introduces incessant changes, resulting in burnout (Latham, 2014).

Q.I. projects demand a lot of time from an employee who may be unavailable due to long working hours. Another weakness that can sometimes arise is having individual staff members have different agendas or opinions, leading to conflicts and delays. For instance, it may be difficult for nurses to attend multidisciplinary team meetings because of their working schedules or heavy workloads, which in turn may impact the development of the Q.I. process (Silva et al., 2021).

Conclusion

The ideas of leadership and quality management principles were reaffirmed in formulating and actualizing an empirical Q.I. study to address HAIs in a hospital environment. This case has also demonstrated that Q.I. projects can facilitate change in practice and enhance the healthcare quality system across the whole hospital. This paper also showed that strategic leadership and quality management approaches are essential in attaining a Q.I. project in a hospital framework, with the help of transformational Leadership, staff engagement, data analysis, education, and training. The strategies mentioned help achieve effectiveness in delivering health care services with high perceived patient satisfaction, thus underlining the importance of organization and overall approach to health care quality improvement strategies. The necessity of Leadership and quality management strategies’ advantages and limitations define the progress and implementation of Q.I. activities in healthcare organizations. Active participation of frontline staff, data use, continuing education, and patient and family-centered care are precious resources that can inspire concrete Q.I. initiatives. However, each approach also comes with the following drawbacks: the requirement of formulating a strategic plan, the availability of resources, and support from the hospital’s administration. Thus, enhancing these strengths and avoiding these challenges enables healthcare leaders to build positive change, promote patient safety, and deliver quality care.

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