Running head: SUMMARY OF NEED FOR QUALITY IMPROVEMENT PROGRAM AT

TRINITY 1
HOME HEALTH CARE

Summary of Need for Quality Improvement Program at Trinity Home Health Care
PS 3003 Project Design Course
Renee Kelley
Arkansas Tech University
Running head: SUMMARY OF NEED FOR QUALITY IMPROVEMENT PROGRAM AT
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HOME HEALTH CARE

Introduction
For my project, I performed a needs assessment at a home healthcare agency based upon initial

informal surveys indicating an unacceptably high level of communication-related errors and related

patient/caregiver complaints. A formal survey was completed, and a four-part recommended plan of

action was presented to an agency stakeholder.

Background

Communications-related errors have been a long-standing and well documented problem

for all healthcare organizations. However, it has been particularly difficult to make

improvements in the home healthcare sector because when field nurses are providing care in

patients homes, they are not being directly supervised, and they also are not co-located with the

patients case managers and attending physicians. The case managers are intermediaries who

relay information between the field nurses and the physicians, and there is a lot of opportunity

for miscommunication to occur. The field nurses also have to cope with frequent interruptions

and distractions that occur in the home environment and this can adversely impact concentration

and attention to detail.

Initial informal surveys with staff members at a healthcare agency in Louisiana indicated

that, despite the recent implementation of new cloud-based delivery mode software, there were

still an unacceptably high number of communication-related errors and patient/caregiver

complaints.

Purpose of Project

The purpose of the project was to work with the agencys stakeholders in conducting a

needs assessment to determine whether the implementation of a quality improvement program

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HOME HEALTH CARE

would be a useful approach to decreasing complaints associated with communications-related

errors.

Problem Identified

The agency was averaging between five to ten complaints per month. According to state

regulations, just three valid complaints in a one-year period can result in a downgrade from

full to provisional licensing status (Louisiana Department of Health and Hospitals, 2001).

Additionally, unless the error rate was reduced, the agency would not be providing the best

possible care to their patients, and they were at risk of losing business to competitors.

Research Methods and Procedures

A twenty-four item Likert-scale questionnaire targeting all of the agencys nursing staff

was created and pre-tested.

Analysis and Findings

Thirty-one out of fifty-seven questionnaires were completed, returned, and were useable.

Eleven participants included written comments.

Recommended Action Plan

Phase I: based on an analysis of the data obtained, a recommended action plan was

presented to a representative stakeholder in February 2017. Four recommendations were made.

The first recommendation was for the case managers to begin using spreadsheets no later than

March 20, 2017 to better track items needing attention throughout the day.
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The second recommendation was for all field nurses to start using standard checklists no

later than March 13, 2017.

The third recommendation was for the agency to purchase training videos on time

management skills, concentration enhancement, and interruption management no later than July

1, 2017. Employees are to be paid for the time spent watching the videos.

The agencys owners and supervisors were to implement reliability-enhancing work

practices (REWPs) in accordance with a high reliability organization (HRO) program model

(Berwick, 2005; Grennan, 2013; McAlearney et al., 2013; Vogus & Iacobucci, 2016) no later

than October 1, 2017.

Phase II of the action plan involves designing methods to evaluate the effectiveness of

each of the four measures. A cost-benefit analysis was also included.

References

Berwick, D. (2005). Creating High Reliability Organizations, Healthcare Performance

Improvement, 142(2), 121-125.
Grennan, M. (2013). Quality Improvement and Patient Safety in the Age of Reform:
Preconditions for Success, Physician Executive, 39(4), 28-37.
Louisiana Department of Health and Hospitals (2001). Louisiana Home Health State
Regulations, Louisiana Register, 27(12), 2238-2253.
McAlearney, A. et al. (2013). Implementing High-Performance Work Practices in Healthcare
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Organizations: Qualitative and Conceptual Evidence, Journal of Healthcare

Management, 58(6), 446-462.

Vogus, T. & Iacobucci, D. (2016). Creating Highly Reliable Health Care: How Reliably-
Enhancing Work Practices Affect Patient Safety in Hospitals, ILR Review, 69(4), 911-

938.