Cluster Management℠

1992 ◽  
Vol 3 (4) ◽  
pp. 743-748
Author(s):  
Rebecca Katz
Keyword(s):  
Quality Improvement ◽  
Formal Structure ◽  
Management Model ◽  
Cluster Management ◽  
Leadership Potential ◽  
Licensed Practical Nurses ◽  
Task Forces ◽  
Staff Members ◽  
Job Titles ◽  
Manager Support

Cluster management℠ is a management model that fosters decentralization of management, develops leadership potential of staff, and creates ownership of unit-based goals. Unlike shared governance models, there is no formal structure created by committees and it is less threatening for managers. There are two parts to the cluster management℠ model. One is the formation of cluster groups, consisting of all staff and facilitated by a cluster leader. The cluster groups function for communication and problem-solving. The second part of the cluster management℠ model is the creation of task forces. These task forces are designed to work on short-term goals, usually in response to solving one of the unit’s goals. Sometimes the task forces are used for quality improvement or system problems. Clusters are groups of not more than five or six staff members, facilitated by a cluster leader. A cluster is made up of individuals who work the same shift. For example, people with job titles who work days would be in a cluster. There would be registered nurses, licensed practical nurses, nursing assistants, and unit clerks in the cluster. The cluster leader is chosen by the manager based on certain criteria and is trained for this specialized role. The concept of cluster management℠, criteria for choosing leaders, training for leaders, using cluster groups to solve quality improvement issues, and the learning process necessary for manager support are described

Improving Access to Integrated Behavioral Health in a Nurse-Led Federally Qualified Health Center

2021 ◽  
pp. 107839032199416
Author(s):  
Sarah Stalder ◽  
Aimee Techau ◽  
Jenny Hamilton ◽  
Carlo Caballero ◽  
Mary Weber ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Primary Care Providers ◽  
Care Team ◽  
Psychiatric Nurse ◽  
Care Providers ◽  
Team Members ◽  
Task Forces

BACKGROUND: The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice. METHOD: The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record. INTERVENTION: The four interventions that emerged from these task forces were (1) the establishment of patient tiers based on diagnosis, medications, and risk assessment; (2) the creation of process maps to engage care team members; (3) just-in-time education regarding psychiatric medication management for primary care providers; and (4) use of a registry to track patients. RESULTS: The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time. CONCLUSIONS: For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.

scholarly journals Assessing Nurses’ Knowledge of Noise in the Intensive Care Unit: An Educational Intervention Project

2021 ◽  
Author(s):  
Jennifer Fortes
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Quality Improvement ◽  
Educational Intervention ◽  
Quality Improvement Project ◽  
Minimal Risk ◽  
Improvement Project ◽  
Staff Members ◽  
Nurses Knowledge

Noise in the intensive care unit (ICU) has been studied for over thirty years, but it continues to be a significant problem and a top complaint among patients. Staff members are now reporting detrimental health effects from excessive noise. One of the significant factors of inadequate noise control in the ICU is that nurses have insufficient awareness regarding the hospital noise issue and its negative impact on health status. The level of knowledge of clinical staff on the topic of noise is not known. A quality improvement project to explore noise in the ICU could facilitate better understanding of the phenomenon and formulation of new ways to continue to reduce noise at a community hospital in Massachusetts. The purpose of this quality improvement project was to evaluate nurses’ knowledge of the potentially harmful effects of noise on patients as well as on nurses, to identify opportunities for improvement of the environment, and to conduct an educational intervention aimed at reducing noise in the intensive care unit. The methodology for this project included a pre-test, followed by an educational session, and completion of a post-test. The participants included registered nurse staff members in the Intensive Care Unit (ICU) and the Critical Care Unit (CCU). Exclusion criteria included staff members who are not registered nurses. The project posed minimal risk. No identifying or biographical data was collected, and results included analysis of aggregate data. Descriptive statistics were used to assist with analysis. Results were disseminated to the staff of the ICU and CCU, posted on a bulletin board in the critical care area, presented as a poster presentation at the Spring RIC MSN Symposium, and available as a manuscript on the RIC Digital Commons.

Early Mobility for Critically Ill Patients: Building Staff Commitment Through Appreciative Inquiry

2020 ◽  
Vol 40 (4) ◽  
pp. 66-72
Author(s):  
Michelle M. Fernald ◽  
Nicholas A. Smyrnios ◽  
Joan Vitello
Keyword(s):  
Quality Improvement ◽  
Critically Ill ◽  
Appreciative Inquiry ◽  
Critically Ill Patients ◽  
Staff Members ◽  
Before And After ◽  
Trained Facilitator ◽  
Improvement Method ◽  
And Performance ◽  
Staff Commitment

Background Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization. Objectives To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care. Methods Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members’ attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops. Results Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months. Conclusion Participation in the workshops improved the staff’s attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.

scholarly journals The St Thomas’ Hospital Emergency Department Homeless Health Initiative: improving the quality, safety and equity of healthcare provided for homeless patients attending the ED

2020 ◽  
Vol 9 (1) ◽  
pp. e000820
Author(s):  
Charles Gallaher ◽  
Simone Herrmann ◽  
Laura Hunter ◽  
Alex Wilkins
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
General Practitioner ◽  
Oral Hygiene ◽  
Hospital Emergency Department ◽  
Staff Satisfaction ◽  
Hospital Emergency ◽  
Staff Members ◽  
Health Initiative ◽  
Full Compliance

We carried out a quality improvement (QI) project (QIP), aiming to improve the quality, safety and equity of healthcare provided for homeless patients attending the emergency department (ED). We used QI methodology to identify areas for improvement, and introduced and modified interventions over four Plan, Do, Study, Act cycles. We launched a departmental ‘Homeless Health Initiative’ (HHI), the chief intervention being the provision of ‘Homeless Health Boxes’ in the ED, which contained a ‘Safe Discharge Checklist for Homeless Patients’, maps to specialist homeless general practitioner surgeries and homeless day centres, information on other inclusion health services, copies of a local rough sleepers’ magazine and oral hygiene supplies. Voluntary Homeless Link Nurses and a number of informal ‘Homeless Health Champions’ were appointed. The HHI was embedded in departmental awareness through regular presentations to staff and incorporation into the induction programme for new doctors. Staff satisfaction, in terms of how satisfied staff members were with the care they were able to provide for homeless patients in the ED on a 0–10 scale, improved modestly over the course of the QIP from median 6/10 to median 7/10. The number of staff who were severely dissatisfied with the care they were able to provide for homeless patients improved more markedly: first quartile staff satisfaction improved from 3.875/10 to 6.125/10. Staff compliance with the checklist was poor, with full compliance observed in only 15% of cases by the end of the QIP. An HHI is a cheap and worthwhile QI project, with the potential to significantly improve the quality, safety and equity of healthcare provided for homeless patients, while improving staff satisfaction concurrently. Similar initiatives should be considered in any ED which sees a significant number of homeless patients.

scholarly journals Implementation of quality improvement coaching versus physician communication training for improving human papillomavirus vaccination in primary care: a randomized implementation trial

2021 ◽  
Author(s):  
Brigid K Grabert ◽  
Rachel Kurtzman ◽  
Jennifer Heisler-MacKinnon ◽  
Jennifer Leeman ◽  
Adam Bjork ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Vaccination Coverage ◽  
Hpv Vaccination ◽  
Cluster Randomized Trial ◽  
Communication Training ◽  
Physician Communication ◽  
Health Departments ◽  
Human Papillomavirus Vaccination ◽  
Staff Members

Lay Summary Our cluster randomized trial compared two interventions that health departments commonly use to increase HPV vaccination coverage: quality improvement (QI) coaching and physician communication training. We found that QI coaching cost less and was more often adopted by primary care clinics, but communication training reached more staff members per clinic, including vaccine prescribers. Findings provide health departments with data needed to weigh the implementation strengths and challenges of QI coaching and physician communication training for increasing HPV vaccination coverage.

Norris Cotton Cancer Center (NCCC) neuro-oncology glioma tumor quality improvement project.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 137-137
Author(s):  
Evelyn Schlosser ◽  
Camilo E. Fadul ◽  
Jennifer Snide ◽  
Karen Homa
Keyword(s):  
Quality Improvement ◽  
Best Practices ◽  
Poor Performance ◽  
Individual Case ◽  
Primary Brain Tumor ◽  
Tumor Board ◽  
Cancer Center ◽  
Improvement Project ◽  
Staff Members ◽  
The Individual

137 Background: Glioma patients represent 30% of the primary brain tumor population at NCCC, and often require surgical intervention prior to medical management. In order to ensure coordinated, comprehensive and timely care, reliable referral to the neuro-oncology program is needed. Earlier quality improvement efforts identified 10 best practices designed to facilitate referral into the neuro-oncology program, though over the years these practices lapsed. A manual record review of 2010 cases revealed 43 glioma patients, of which compliance with best practices ranged from 29% to 93%, and none of the patients had all best practices when indicated. Additionally, the percentage of 9 out of the 10 best practices (excluding post-operative order sets) completed for all consecutive patients from January 2010 to May 2011 was 63%. Methods: A project was chartered by leadership and a multidisciplinary team was convened twice a month from May to October 2011. The team was organized into three groups (entry into the system, surgical, and post-op care, and continuing care) and assigned a coach with instructions to flowchart the current processes and identify factors that contributed to poor performance. The three process maps were then combined to create one system map by which the team brainstormed improvement ideas to pilot. Results: Concurrent review of the individual case-level data during the project team meetings was helpful in identifying process weaknesses as changes were being piloted. Performance of best practices improved significantly when measured several months following completion of the project; furthermore, best practices completed for consecutive patients from June 2011-May 2012 was 87%. Conclusions: The team was challenged to identify changes in process that were not dependent upon individual providers/staff members and that took advantage of a newly implemented electronic medical record. Manual chart abstraction was replaced by electronic data abstraction. Sustained measurement and reporting of performance is essential and has been incorporated into the Neuro-Oncology Tumor Board meetings on a quarterly basis.

The Importance of Leadership and Followership

2021 ◽  
pp. 69-86
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Emotional Intelligence ◽  
Transformational Leadership ◽  
Quality Improvement ◽  
Hospital Setting ◽  
Project Managers ◽  
Quality Improvement Initiative ◽  
Scientific Validity ◽  
Staff Members ◽  
For Profit ◽  
Successful Infection

Leadership in a hospital setting differs substantially from that in a for-profit corporation, regarding both mission and practice; that is evident during a quality improvement initiative. Top administrative and clinical leaders need to continually communicate the value and scientific validity of the project to staff members by all available means—including personal cheerleading. Project managers and team champions have to energize the staff with their own enthusiasm for the initiative, capitalizing on the trust and respect they have earned. What is called for is transformational leadership and substantial emotional intelligence. Leaders on all levels need to devote themselves to helping colleagues become exemplary followers. The major characteristics of the leaders of successful infection prevention projects are described.

Designing a Quality Management Model for Health Services in Iran

2020 ◽  
Author(s):  
Vajiheh Zarei ◽  
Seyyed Jamaleddin Tabibi ◽  
Mahmood Mahmoodi ◽  
Leila Riahi
Keyword(s):  
Health Care ◽  
Factor Analysis ◽  
Quality Improvement ◽  
Quality Management ◽  
Confirmatory Factor Analysis ◽  
Care Quality ◽  
Management Model ◽  
Confirmatory Factor ◽  
Quality Management Model

Introduction: Nowadays, the quality of services, especially in high volume clients, such as financial and care services, has become increasingly important. Therefore, quality of service in accordance with professional standards and customer expectations is important and a first step for it is a quality improvement. Objective: The purpose of this study was to design a quality management model for providing health care in Iran. Method: In this study, the comparative method was used to evaluate the health care quality indicators in selected countries (America-England-Japan-Malaysia-Egypt) and to compare their health care strategies. Hospital managers and people responsible for improving hospital quality in Iran have been involved in this research (377 questionnaire were analyzed). The study lasted from September 2018 to September 2019. Maxqda software was used to classify the adaptive variables. Maxqda software was used to classify the adaptive variables. LISREL software were used- Exploratory and confirmatory factor analysis- to identify the dimensions and validation of the mode . Results: Twenty-four types of health care variables were identified from 6 countries. Exploratory factor analysis and questionnaire resulted in four general criteri: Quality Assurance, Quality Planning, Quality Control and Quality Improvement. Confirmatory factor analysis also showed that the identified dimensions are valid . Conclusion: Considering that guarantee,control, planning and quality improvement have the highest impact respectively, continuous planning at the level of hospitals can lead to a significant increase in the quality of health care delivery.

scholarly journals Implementing target range oxygen in critical care: A quality improvement pilot study

2019 ◽  
pp. 175114371989278
Author(s):  
Rosie Heartshorne ◽  
Jenna Cardell ◽  
Ronan O'Driscoll ◽  
Tim Fudge ◽  
Paul Dark
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Pilot Study ◽  
Care Staff ◽  
Target Range ◽  
Baseline Survey ◽  
Staff Attitudes ◽  
Critical Care Units ◽  
Staff Members

Background Iatrogenic hyperoxaemia is common on critical care units and has been associated with increased mortality. We commenced a quality improvement pilot study to analyse the views and practice of critical care staff regarding oxygen therapy and to change practice to ensure that all patients have a prescribed target oxygen saturation range. Methods A baseline measurement of oxygen target range prescribing was undertaken alongside a survey of staff attitudes. We then commenced a programme of change, widely promoting an agreed oxygen target range prescribing policy. The analyses of target range prescribing and staff survey were repeated four to five months later. Results Thirty-three staff members completed the baseline survey, compared to 29 in the follow-up survey. There was no discernible change in staff attitudes towards oxygen target range prescribing. Fifty-four patients were included in the baseline survey and 124 patients were assessed post implementation of changes. The proportion of patients with an oxygen prescription with a target range improved from 85% to 95% (χ2 = 5.17, p = 0.02) and the proportion of patients with an appropriate prescribed target saturation range increased from 85% to 91% (χ2 = 1.4, p = 0.24). The improvement in target range prescribing was maintained at 96% 12 months later. Conclusions The introduction and promotion of a structured protocol for oxygen prescribing were associated with a sustained increase in the proportion of patients with a prescribed oxygen target range on this unit.

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