Running head: QUALITY IMPROVEMENT

Quality Improvement Project Implementation

Shannon Richardson
Bon Secours Memorial College of Nursing

QUALITY IMPROVEMENT

Quality Improvement Project Implementation

Thepracticeofnursingissomethingthatisconstantlyevolving.Thankstoadvancesin
technologyandscience,researchhasbeenusedtofindwaystopromoteoptimalpatient
outcomes.Evidencedbasedpractice(EBP)isthemethodthathasbeenusedtoimplement
researchfindingsintonursingpractice.Throughthis,researchquestionsandtopicsare
identified,theresearcherthenconductsexperimentsaimedatansweringtheproposedquestion.
Asanursemanagerandleader,qualityimprovementprojectsareanimportanttask.To
implementaunitbasedproject,onemustincorporatevariousmethodsofleadershipand
communication.Whencorrectlydone,theleaderbecomesapersoninwhichotherscanrely.
Introduction
Hospitalacquiredinfections,alsoknownasnosocomialinfections,isatopicthatis
continuouslyresearchedwithinthemedicalfield.Accordingtoastudyreport,urinarycatheters
aretheleadingcauseofhospitalacquiredinfections,causing80percentofallhospitalacquired
infections(Tenkeetal,2014).Becausehospitalsarenotcompensatedforinfectionsthatwere
notpresentonadmission,itisimportanttocontinuetoseekimprovementsandfurtherdata
aimedatpreventinginfections.Therearevariouselementsinvolvedregardingprevention,
acquiring,andtreatingnosocomialinfections.Oneofthemostcommonandfrequently
researchednosocomialinfectionsarecatheterassociatedurinarytractinfections(CAUTIs).
Overtheyears,manyorganizationshaveimplementedtheuseandmodificationofvarious
supplies,policies,andprocedureswiththegoalofdecreasingtheincidence.Atvarious
EmergencyDepartmentswithintheBonSecoursRichmondHealthSystem,measuressuchas
oneleveltraysystems,Foleycatheterswithantimicrobialagentsimpregnatedwithinthe

QUALITY IMPROVEMENT

catheter,useofabuddysystemforinsertion,anddocumentationofinsertionareallmethodsto
monitoranddecreasetheoccurrenceofCAUTIs.
Inordertoimplementqualityimprovementprojectsaimedatreducingtheoccurrenceof
CAUTIs,leadingaccordingtotheprinciplesandbehaviorsmentionedinthebookLeadLike
Jesuswouldbethemosteffectiveway(Blanchard&Hodges,2005).Todoso,theleadermust
possessvariousskillsandtraits,andhavetheabilitytoleadbyusingleadershipdomainssuchas
thehead,heart,hands,andhabits.Theymustalsoutilizethefiveexemplaryleadershippractices
asmentionedinTheStudentLeadershipChallenge:Fivepracticesforbecominganexemplary
leader,suchasmodeltheway,challengetheprocess,inspireasharedvision,enableothersto
act,andencouragetheheart(Kouzes&Posner,2014).
FourLeadershipDomains
Head
Leadingusingtheheadinvolvesamorelogicalapproach(Blanchard&Hodges,2005).
Thiselementinvolvesbrainstormingandthinkingthroughtheissue.Theleadermustsitaside
personalbiasesandapproachtheissuewiththegoalofimprovingtheprocessforallparties
involved.Byusingthehead,theleaderisabletodeterminetheissue,andcreateaplanthatwill
helptoresolvetheissue.WhenattemptingtodecreaseCAUTIs,thiswouldinvolvefiguringout
ifthereisanissuewiththecatheterinsertionsystems,theprocess,theenvironment,inadequate
prep,orifthefailureistheresultoflackofavailableknowledgeandresources.Workingasthe
headalsoinvolvescreationandreviewofpoliciessurroundingcatheterinsertion.Asystemcan
beusedthatgathersstaffpriorknowledgerelevanttoCAUTIoccurrenceandcauses,those
commonlyatrisk,methodstoprevent,propertechnique,inserviceandtrainingfor

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catheterizationkits,andacheckoffsystemcanbeusedtoidentifywhichstaffmembershave
metthetrainingrequirementsforeachtypeofcathetersystem.
Heart
Empathyandusinganonjudgmentalapproacharetwoofthemostimportantelements
whenleadingbytheheart(Blanchard&Hodges,2005).Thenursemanagermustrefrainfrom
judgingmembersofthestaffthatareunabletoidentifyriskfactorsandpracticesthatincrease
theriskofCAUTIs.Instead,turnthesituationintoateachingmomentthatwillprovide
membersoftheteamwiththenecessaryskillsandknowledgetoaccomplishthegoal.If
someoneintheleadershiprolefailstoturnitintoateachingmomentandinsteadmakesthe
personfeelincompetent,thenthepersonisnotlikelytoreturninthefuturewhenproblemsarise.
Hands
Incorporatingthehandsasaleadershipdomainallowsonetobeginplanningnecessaryto
bringaboutchangeusingthethoughtsandideasgathered(Blanchard&Hodges,2005).The
planisthenputintoaction.Thisisthedomaininwhichthechangesareactuallyimplemented.
Thiswouldinvolvegettingotherstoactivelyparticipateinbringingaboutthedesired
improvements.IntheEmergencyDepartmentorothersunitswithinthehospital,thiswould
involveeducatingthestaffonmaterialsandresourcesavailable,wheretogoandwhotocontact
whenissuesarise,implementingnewpoliciesandprocedures,orsimplymakingcurrentpolicies
andprocedureseasilyaccessible.Informationcouldalsobegatheredfromstaffaboutcurrent
issuesinvolvingtheprocess,adequatetraining,andavailabilityofresources.Providing
informationtostaffregardingperformanceisalsohelpfulinassistingthemtoidentifyareasin

QUALITY IMPROVEMENT

whichtheymayneedimprovement.Itwouldalsobebeneficialtoseekinputfromstaffonhow
managementcanbetterservethemandmaketheunitgoalofdecreasingCAUTIsattainable.

Habits
AccordingtoLeadLikeJesus,therearefivehabitsthatJesusappliedtocombatnegative
forces(Blanchard&Hodges,2005).Solitude,prayer,studyandapplicationofscripture,
acceptingandrespondingtoGodsunconditionallove,andinvolvementinsupportive
relationshipsarethefivehabitsmentioned.Inthiscase,themostappropriateofthehabitswould
beinvolvementinsupportiverelationships.Asanursemanager,itisimportantforemployeesto
havetheabilitytotrustandrelyonleaderspresentwithintheunit.Buildingmeaningful
relationshipsamongstmembersoftheteamwillhelpimprovethemoraleoftheunit,whichalso
improvesjobsatisfaction,performance,andwillincreaseparticipation.Thisispivotalwhen
attemptingtogetotherstobuyintosharedvisionsandgoals.Todosoonaunit,opendoor
policiesandmakingtimetoaddressunitissuesareimportant.Activelisteningandinteractions
thatfostercommunicationwillallowtheunitmanagertodevelopsupportiverelationshipswith
staff.Fellowemployeeswillthenhaveenoughtrusttoassistthemanagerwithproblemsolving
andprovidingfeedbacktothenursemanageronnecessaryareasofleadershipimprovement.
ExemplaryLeadershipPractice
Modelingthewayinvolvesleadingandbehavinginamannerthatoneexpectsofothers.
Itisinclusiveoffollowingpoliciesandprocedures,beingrespectfulduringinteractionswith
colleagues,andensuringthatthoughtsareconsistentwithdesiredbehaviorsandoutcomes
(Kouzes&Posner,2014).Ontheunit,thiswouldbethenursemanagerthatattendsand

QUALITY IMPROVEMENT

participatesinunitbasedtrainingandeducation.Forexample,manyunitshaveimplementeda
buddysystemforinsertionofFoleycatheters,alongwithcompletionofaformthataccompanies
theinsertionkitsdocumentingthetimeanddateofinsertionandinitialsofthenursethatareto
beturnedin.Thenurseleaderthatmodelsthewaywouldbesuretostayontopof
documentationrequirementsandinsertionguidelinesasothermembersoftheteam.
Aleadershouldalsobecapableofchallengingtheprocess.Thisentailshavingthe
abilitytoreviewprocessesthenlookingforwaystoimprovethesystemandrunmoreefficiently
(Kouzes&Posner,2014).Thenurseleaderwoulduseinformationgatheredregardingthe
CAUTIsratesandotherpertinentdata,thenuseittotailortheeducation,resources,policies,and
procedurestofittheneedsoftheunitanddecreasetheriskofinfection.
Toinspireasharedvision,thenurseleadermustgettheentireunittobecomevestedin
theproject.Gettingothersinvolvedandhavingthembecomeactiveparticipantswillassistthe
leaderinreachingthegoals(Kouzes&Posner,2014).Inordertogetothersfullyvested,itis
importanttoalsoensurethatasaleader,theresourcesaremadeavailabletopromotethesuccess
ofothers.Asotherscontinuetobuyintothesharedmissionandgoalsofthegroup,itis
imperativetorecognizemembersoftheteamfortheircommitmentandcontributionstothe
team.Encouragingtheheartisthetermcoinedtodescribethisaction,anditallowsothersto
knowthatthereareappreciatedfortheirefforts.
ImplicationsforNursingPractice
Applyingthefourleadershipdomainsalongwiththefiveexemplaryleadershippractices
whenimplementingthebuddysystemforFoleyinsertionandutilizingaoneleveltraysystem
wouldbebeneficialtonursingpractice. Theuseoftheprinciplesfrom LeadLikeJesus will

QUALITY IMPROVEMENT

enabletonurseleadertouseallresourcesavailablewithinthemselvesandstafftomakethe
implementationofthequalityimprovementprojectmoreeffective. Byimplementingabuddy
system,itallowstheothernursetohavearesourceatbedsidetorefertoifproblemsarise.The
othernursemayalsoserveasanadditionalsetofeyestoensurethatsterilefieldismaintained,
proceduresandpoliciesarefollowedasspecified,andsupporttheothernurse.Accordingtoa
studyconductedintheUK,staffatthehospitalstudiedoftenpromotedselfsufficiencyasbeing
ofhigherimportancethanacknowledgingneedorvulnerability(Allan&Parr,2010).Thisleft
thefuturenursingworkforcefeelingliketheywereunabletoapproachstaffwithquestionsand
concerns.Workinginthebuddysystemledtoaninteractionthatsupportedtheemotionalwell
beingandcareerdevelopmentamongparticipants.
InformationisnotyetavailableregardingtheuseofsinglelevelFoleycatheterizationkits
versusbilevelkitsandthecorrelationwithCAUTIs.ThenewsinglelevelFoleykitshavebeen
introducedintheEmergencyDepartmentatmanyoftheBonSecoursRichmondhospitals.The
newkitsaresmallerthantheprevioustwolevelkitsandhavebeenreportedtobeeasiertouse
andhaveabetterlayoutthanpreviouskits.ResultsfromaUSstudyshowedthatexperienced
nursingandsurgicalstaffhadalowerincidenceofsterilefieldcontaminationwhenusingsmaller
procedurekits(Trieretal,2014).Ifdataiscollectedinadditiontoimplementationofthesingle
levelcatheterizationkits,researchersmaybeabletodeterminetheimpactofswitchingtothe
newsystem.Thedatacanthenbeusedtochangethewaythatkitsarepackagedandthetypesof
kitsthatareorderedatfacilitiesbeyondtheemergencydepartment.
Oftenwhenplanningunitbasedprojects,leadersandmanagersmayfailtolookatallthe
aspectsthatarerequiredtosuccessfulimplementchanges.UsingtheinformationinLeadLike

QUALITY IMPROVEMENT

Jesus alongwiththatof TheStudentLeadershipChallenge:Fivepracticesforbecomingan

exemplaryleaderprovidesessentialknowledgeforbecomingasuccessfulleader.Whenapplied
correctly,theleadershippracticesanddomainswillallowthenursemanagerandstafftomeet
thegoalsofthequalityimprovementproject,increasingoutcomesforboththepatientsandthe
staff.Improvedcooperationamongstaffandleaderswillresultinasharedvision,sharedgoals,
andimprovedoutcomesandsatisfaction.

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References
Allan,H.,&Parr,S.(2010).Buddieshelpfindtheway,NursingStandard.24(26).69.
Blanchard,K.H.,&Hodges,P.(2005).LeadlikeJesus:Lessonsfromthegreatestleadership
rolemodelofalltimes[Nook].
Kouzes,J.M.,&Posner,B.Z.(2014).Thestudentleadershipchallenge:Fivepracticesfor
becominganexemplaryleader(2nded.).SanFrancisco,CA:TheLeadershipChallenge.
Tenke,P.,Koves,B.,&Johansen,T.E.(2014).Anupdateonpreventionandtreatmentof
catheterassociatedurinarytractinfections.CurrentOpinioninInfectious
Diseases,27(1),102107.doi:10.1097/QCO
Trier,T.,Bello,N.,Bush,T.R.,&Bix,L.(2014).Theroleofpackagingsizeoncontamination
ratesduringsimulatedpresentationtoasterilefield.PLoSOne,9(7),e100414.
doi:10.1371/journal.pone.0100414