Assume that you are a Quality Officer who is responsible for one of the state’s largest healthcare organizations. You have been told that the quality of patient care has decreased, and you have been assigned a project that is geared toward increasing quality of care for the patients. Your Chief Executive Officer has requested a six to eight-page summary of your recommended initiatives.

Note: You may create and /or make all necessary assumptions needed for the completion of this assignment.

Write a 6-8 page paper in which you:

1. Analyze three (3) quality initiatives for your organization.
2. Determine the supporting factors that would aid in the reduction of healthcare cost in your organization without reducing quality of care for the patients.
3. Differentiate between quality in a free market healthcare system and in single payer government system with three (3) examples for each.
4. Specify three (3) common law quality initiatives that are still found in 21st century healthcare organizations.
5. Defend your position on the importance of healthcare quality for your organization. Provide support with at least three (3) examples that illustrate your position.
6. Assemble a plan to protect patient information that complies with all legal requirements.
7. Use at least three (3) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.

Your assignment must follow these formatting requirements:

• Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
• Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

• Describe the evolution of hospitals and sources of law.
• Examine tort law and the criminal aspects of health care.
• Analyze the impact of healthcare financing and health insurance on healthcare access, quality, and cost.
• Determine the factors that affect healthcare quality in healthcare organizations.
• Examine information management and health care records and how the legal reporting requirements impact health care. 
• Assess the legal implications of ethical decisions that impact consent for treatment, right-to-die, and patient rights and responsibilities.
• Use technology and information resources to research issues in healthcare policy, law, and ethics.
• Write clearly and concisely about healthcare policy and law using proper writing mechanics.

Planning and implementing change can be quite challenging, especially in a complex health care environment. No matter what kind of change is undertaken, there are likely to be some obstacles. Yet, wise leader-managers, and those with whom they work, recognize that change is necessary and revitalizing; they see that planned change can not only contribute to organizational sustainability but also promote high-quality care and positively impact patient outcomes. These leader-managers harness a larger vision and engage in forethought and analysis to minimize and address barriers to planned change.

Based on what you have learned about the change process and strategic planning, what barriers do you think may arise related to the change you are proposing through your Course Project? How would you cultivate stakeholder involvement and promote team building for your planned change?

As you think about these questions, consider the following statement: “The system will evolve based on changes in the behavior of the people in the system” (Nesse, Kutcher, Wood, & Rummans, 2010, p. 27).

Do you agree? Why or why not? How does this relate to the specifics of your strategic plan?

To prepare:

Review the information presented in the Learning Resources, including Dr. Carol Huston’s comments on addressing barriers to implementing a strategic plan change. Consider insights related to change theory, common barriers to change, and strategies for addressing these barriers that relate to the implementation of your proposed change.

Identify specific barriers you are likely to encounter with your proposed change, including resistance to change. Evaluate strategies that may be used to minimize or address these barriers.

Think about the value of stakeholder involvement in planned change, as well as the specifics of stakeholder participation in your strategic plan to champion the change. Who should be involved in strategic planning and at what point? How could they serve as change champions?

Post an explanation of strategies you would use to minimize or address barriers, including resistance to change, related to your strategic plan. Explain how you would promote stakeholder involvement for your proposed change, and encourage them to become change champions.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Provide feedback on their strategies for addressing barriers to change.

Suggest additional strategies for addressing barriers or resistance.

Offer additional insights for identifying appropriate stakeholders.

Suggest additional stakeholders or change champions to be involved.

Required Readings

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Chapter 8, “Planned Change” (pp. 162–180)

(Note: You may have read this in a previous course.)

Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

Review Chapter 7, “The Three Key Elements of the Strategic Planning Process: A Vision That Guides Nursing’s Future Action”

“The Architect, Change Agent, and Communicator: Three Crucial Roles in Strategic Planning” section (pp. 135–136)

Chapter 9, “Understanding Change Theory: Strategic Planning Change Agents” (pp. 171–194)

Chapter 10, “Communicating the Strategic Plan” (pp. 195–212)

Chapter 11, “Eight Cautionary Tales of Strategic Planning” (pp. 215–226)

Chapter 9 examines change theories and how these theories can be applied in strategic planning. Chapter 10 explores the importance of communication throughout the strategic planning process and how strong communication and reduce barriers to change. Chapter 11 provides examples from the field of strategic planning efforts.

Gerrish, K., McDonnell, A., Nolan, M., Guillaume, L., Kirshbaum, M., & Tod, A. (2011). The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. Journal of Advanced Nursing, 67(9), 2004–2014.

Retrieved from the Walden Library databases.

This article describes some of the barriers to change (in this case, implementing evidence-based practices) that nurses encounter and examines knowledge brokering to facilitate change.

McMurray, A., Chaboyer W., Wallis, M., & Fetherston, C. (2010). Implementing bedside handover: Strategies for change management. Journal of Clinical Nursing, 19(17/18), 2580–2589.

Retrieved from the Walden Library databases.

This article examines a change in nursing handover practices to analyze change management with attention to individuals’ attitudes, motivations, and concerns. See Figure 2 for example of unfreezing, moving, and freezing.

Nesse, R. E., Kutcher, G., Wood, D., & Rummans, T. (2010). Framing change for high-value healthcare systems. Journal for Healthcare Quality, 32(1), 23–28.

Retrieved from the Walden Library databases.

The authors address factors that impede change and discuss change management principles, including the value of team investment for facilitating change.

Required Media

Laureate Education (Producer). (2013c). Challenges of implementation [Video file]. Retrieved from https://class.waldenu.edu

Note:  The approximate length of this media piece is 3 minutes.

Dr. Carol Huston discusses some of the challenges faced when implementing a strategic plan and strategies for addressing those challenges.

Resource: Week Two individual assignment, Quality Dimensions and Measures Table

Research inpatient and ambulatory or ancillary health care organizations.

Inpatient health care organizations:

• Hospitals

Ambulatory or ancillary health care organizations:

• Dialysis clinic
• Laser eye clinic
• Pharmacy

As a team, select one inpatient health care organization and one ambulatory or ancillary health care organization.

Create a 12- to 15-slide Microsoft® PowerPoint® presentation (the title and reference slides do not count toward the total slide count) with detailed speaker notes in which you compare each organization and their quality management performance as an organization.

Include the following in your presentation:

• Describe each of the health care organizations selected.
• Explain how to develop improvement capability for organizational performance.
  • What resources are needed to develop improvement capability?
  • Identify metrics used by each organization to measure each of the six dimensions of high quality discussed in the Week Two Quality Dimensions and Measures Table assignment.
  • Describe similarities and differences between the metrics of each organization.
  • How do these metrics help develop improvement capability for each organization?
  • What quality improvement tools are available to help develop improvement capability?
• Explain transformational improvement in relation to organizational performance.
  • What transformational model(s) can be used to assist with transformational improvement in relation to organizational performance?

Cite at least 3 peer-reviewed, scholarly, or similar references and your textbook to support your information.

Format your presentation according to APA guidelines.

Click the Assignment Files tab to submit your presentation.

As addressed this week, middle range theories are frequently used as a framework for exploring nursing practice problems. In addition, theories from other sciences, such as sociology and environmental science, have relevance for nursing practice. For the next few weeks you will explore the use of interdisciplinary theories in nursing.

This Assignment asks you to evaluate two middle range or interdisciplinary theories and apply those theories to a clinical practice problem. You will also create a hypothesis based upon each theory for an evidence-based practice project to resolve a clinical problem.

Note: This Assignment will serve as your Major Assessment for this course.

To prepare:

• Review strategies for evaluating theory presented by Fawcett and Garity in this week’s Learning Resources (see under list of Required Readings and attached pdf file)
• Select a clinical practice problem that can be addressed through an evidence-based practice project. Note: You may continue to use the same practice problem you have been addressing in earlier Discussions and in Week 7 Assignment 1.
• Consider the middle range theories presented this week, and determine if one of those theories could provide a framework for exploring your clinical practice problem. If one or two middle range theories seem appropriate, begin evaluating the theory from the context of your practice problem.
• Formulate a preliminary clinical/practice research question that addresses your practice problem. If appropriate, you may use the same research question you formulated for Assignment #4.

Write a 10- to 12-page paper (including references) in APA format and a minimum of 8 references or more, using material presented in the list of required readings to consider interdisciplinary theories that may be appropriate for exploring your practice problem and research question (refer to the sample paper attached as “Assignment example”). Include the level one headings as numbered below:

1)       Introduction with a purpose statement (e.g. The purpose of this paper is…)

2)       Briefly describe your selected clinical practice problem.

3)       Summarize the two selected theories. Both may be middle range theories or interdisciplinary theories, or you may select one from each category.

4)       Evaluate both theories using the evaluation criteria provided in the Learning Resources.

5)       Determine which theory is most appropriate for addressing your clinical practice problem. Summarize why you selected the theory. Using the propositions of that theory, refine your clinical / practice research question.

6)       conclusion

MY PRACTICE PROBLEM IS AS FOLLOWED:

P: Patients suffering from Type 2 Diabetes Mellitus

I:  Who are involved in diabetic self-care programs

C: Compared to those who do not participate in self-care programs

O: Are more likely to achieve improved glycemic control

THE THEORIES USED FOR THIS MODEL ARE:

Dorothea Orem Self-Care Theory and The Self-Efficacity in nursing Theory by Lenz & Shortridge-Baggett, or the Health Promotion Model by Pender, Murdaugh & Parson (Pick 2)

Required Readings

McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.

• Chapter 10, “Introduction to Middle Range Nursing Theories”

 Chapter 10 begins the exploration of middle range theories and discusses their development, refinement, and use in research.

• Chapter 11, “Overview of Selected Middle Range Nursing Theories”

 Chapter 11 continues the examination of middle range theories and provides an in-depth examination of a select set of theories

·         Chapter 15, “Theories from the Biomedical Sciences”

Chapter 15 highlights some of the most commonly used theories and principles from the biomedical sciences and illustrates how they are applied to studies conducted by nurses and in nursing practice.

·         Chapter 16, “Theories, Models, and Frameworks from Administration and Management”

Chapter 16 presents leadership and management theories utilized in advanced nursing practice.

·         Chapter 18, “Application of Theory in Nursing Practice”

Chapter 18 examines the relationship between theory and nursing practice. It discusses how evidence-based practice provides an opportunity to utilize research and theory to improve patient outcomes, health care, and nursing practice.

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

• Chapter 6, “Objectives, Questions, Variables, and Hypotheses”

 Chapter 6 guides nurses through the process of identifying research objectives, developing research questions, and creating research hypotheses.

·         Review Chapter 2, “Evolution of Research in Building Evidence-Based Nursing Practice”

·         Chapter 19, “Evidence Synthesis and Strategies for Evidence-Based Practice”

This section of Chapter 19 examines the implementation of the best research evidence to practice.

Fawcett, J., & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating Research for Evidence-Based Nursing. Philadelphia, Pennsylvania: F. A. Davis.

 Note: You will access this article from the Walden Library databases.

 This book chapter evaluates the use and significance of middle-range theories in nursing research and clinical practice.

DeSanto-Madeya, S., & Fawcett, J. (2009). Toward Understanding and Measuring Adaptation Level in the Context of the Roy Adaptation Model. Nursing Science Quarterly, 22(4), 355–359.

 Note: You will access this article from the Walden Library databases.

 This article describes how the Roy Adaptation Model (RAM) is used to guide nursing practice, research, and education in many different countries.

Jacelon, C., Furman, E., Rea, A., Macdonald, B., & Donoghue, L. (2011). Creating a professional practice model for postacute care: Adapting the Chronic Care Model for long-term care. Journal of Gerontological Nursing, 37(3), 53–60.

 Note: You will access this article from the Walden Library databases.

 This article addresses the need to redesign health care delivery to better meet the needs of individuals with chronic illness and health problems.

Murrock, C. J., & Higgins, P. A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65 (10), 2249–2257. doi:10.1111/j.1365-2648.2009.05108.x

 Note: You will access this article from the Walden Library databases.

 This article discusses the development of a middle-range nursing theory on the effects of music on physical activity and improved health outcomes.

Amella, E. J., & Aselage, M. B. (2010). An evolutionary analysis of mealtime difficulties in older adults with dementia. Journal of Clinical Nursing, 19(1/2), 33–41. doi:10.1111/j.1365-2702.2009.02969.x

 Note: You will access this article from the Walden Library databases.

 This article presents findings from a meta-analysis of 48 research studies that examined mealtime difficulties in older adults with dementia.

Frazier, L., Wung, S., Sparks, E., & Eastwood, C. (2009). Cardiovascular nursing on human genomics: What do cardiovascular nurses need to know about congestive heart failure? Progress in Cardiovascular Nursing, 24(3), 80–85.

 Note: You will access this article from the Walden Library databases.

 This article discusses current genetics research on the main causes of heart failure.

Mahon, S. M. (2009). Cancer Genomics: Cancer genomics: Advocating for competent care for families. Clinical Journal of Oncology Nursing, 13(4), 373–3 76.

 Note: You will access this article from the Walden Library databases.

 This article advocates for nurses to stay abreast of the rapid changes in cancer prevention research and its application to clinical practice.

Mayer, K. H., Venkatesh, K. K. (2010). Antiretroviral therapy as HIV prevention: Status and prospects. American Journal of Public Health, 100(10), 1867–1 876. doi: 10.2105/AJPH.2009.184796

 Note: You will access this article from the Walden Library databases.

 This article provides an in-depth examination of potential HIV transmission prevention.

Pestka, E. L., Burbank, K. F., & Junglen, L. M. (2010). Improving nursing practice with genomics. Nursing Management, 41(3), 40–44. doi: 10.1097/01.NUMA.0000369499.99852.c3

 Note: You will access this article from the Walden Library databases.

 This article provides an overview of genomics and how nurses can apply it in practice.

Yao, L., & Algase, D. (2008). Emotional intervention strategies for dementia-related behavior: A theory synthesis. The Journal of Neuroscience Nursing, 40(2), 106–115.

 Note: You will access this article from the Walden Library databases.

 This article discusses a new model that was developed from empirical and theoretical evidence to examine intervention strategies for patients with dementia.

Fineout-Overholt, E., Williamson, K., Gallagher-Ford, L., Melnyk, B., & Stillwell, S. (2011). Following the evidence: Planning for sustainable change. The American Journal Of Nursing, 111(1), 54–60.

This article outlines the efforts made as a result of evidence-based practice to develop rapid response teams and reduce unplanned ICU admissions.

Kleinpell, R. (2010). Evidence-based review and discussion points. American Journal of Critical Care, 19(6), 530–531.

This report provides a review of an evidence-based study conducted on patients with aneurismal subarachnoid hemorrhage and analyzes the validity and quality of the research.

Koh, H. (2010). A 2020 vision for healthy people. The New England Journal Of Medicine, 362(18), 1653–1656.

 This article identifies emerging public health priorities and helps to align health-promotion resources, strategies, and research.

Moore, Z. (2010). Bridging the theory-practice gap in pressure ulcer prevention. British Journal of Nursing, 19(15), S15–S18.

This article discusses the largely preventable problem of pressure ulcers and the importance of nurses being well-informed of current prevention strategies.

Musker, K. (2011). Nursing theory-based independent nursing practice: A personal experience of closing the theory-practice gap. Advances In Nursing Science, 34(1), 67–77.

This article discusses how personal and professional knowledge can be used in concert with health theories to positively influence nursing practice.

Roby, D., Kominski, G., & Pourat, N. (2008). Assessing the barriers to engaging challenging populations in disease management programs: The Medicaid experience. Disease Management & Health Outcomes, 16(6), 421–428.

This article explores the barriers associated with chronic illness care and other factors faced by disease management programs for Medicaid populations.

Sobczak, J. (2009). Managing high-acuity-depressed adults in primary care. Journal of the American Academy of Nurse Practitioners, 21(7), 362–370. doi: 10.1111/j.1745-7599.2009.00422.x

This article discusses a method found which positively impacts patient outcomes used with highly-acuity-depressed patients.

Thorne, S. (2009). The role of qualitative research within an evidence-based context: Can metasynthesis be the answer? International Journal of Nursing Studies, 46(4), 569–575. doi: 10.1016/j.ijnurstu.2008.05.001

The article explores the use of qualitative research methodology with the current evidence-based practice movement.

Optional Resources

McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.

Calzone, K. A., Cashion, A., Feetham, S., Jenkins, J., Prows, C. A., Williams, J. K., & Wung, S. (2010). Nurses transforming health care using genetics and genomics. Nursing Outlook, 58(1), 26–35. doi: 10.1016/j.outlook.2009.05.001

McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.