Assignment 1: Initial Analysis for Program Planning

Needs Assessment

“As a concept, need is not only difficult to define but, once defined, difficult to measure” (Kettner, Moroney, & Martin, 2017, p. 63). Likewise, it can be challenging to define and measure assets—yet it is equally important to do so during this phase of program planning. This week's Learning Resources provide foundational information and guidance for conducting needs assessments, which entails discerning needs that must be addressed in light of the assets that are present.

As you return to Assignment 1, the attention turns to conducting a needs assessment for the problem you have identified. What data collection strategies could be most useful? What issues would likely be encountered? How would you address them?

To prepare for this week's section of Assignment 1:

• Continue      (from the Discussion) to:
  • Identify       a viable approach for conducting a needs assessment for your problem.
  • Identify       method(s) of data collection.
  • Assess       potential challenges and propose alternatives/solutions.

The full Assignment 1 is due by day 4 (Thursday 12/20/18) of this week. Instructions have been provided in previous weeks to help you prepare.

By Day 4

To complete:

Write a 3- to 5-page paper, in APA format with at least 7 scholarly references in which you address the following level 1 and 2 header:

Also include an introduction and a conclusion as per APA guidelines.

1) Identification of a Problem and a Population

• Identify      a problem and a target population.
       (Note: Your problem      should be clearly developed and related to a health-promotion and      disease-prevention issue of national significance. You should select a      target population so that your program can be designed to create maximum      yet realistic impact at the aggregate level.)

2) Using a Theory or Model

• Analyze      a theory or model that is relevant to your selected problem. Explain why      this is the most appropriate model for you to use with this problem.

3) Literature Review (provide at least 4 scholarly articles less than 5 years old) )

• Assess      the literature as it relates to your problem. Use evidence from the      literature to support your response to the following question: Why is it important to assist this      population to resolve the selected problem?

4) Needs Assessment

• Describe      an appropriate approach to conducting a needs assessment for your problem.
• Identify      method(s) of data collection.
• Assess      potential challenges and propose alternatives/solutions.

Required Readings

Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

Chapter 1, “Assessment for Developing Programs and Interventions: The Big Picture”

Chapter 1 notes the importance of looking not just at needs but also the assets associated with the target population and environment; that is, assessing what needs to be addressed given the assets that are present.

This report offers a guide for the use of the logic model in program planning and outcome-oriented evaluation for nonprofit projects.

Chapter 3, “Data Collection Strategies for Needs Assessments and Evaluations”

In Chapter 3, the authors examine data collection, a key element of needs assessments. They also indicate that it is wise to plan ahead and consider data collection strategies for evaluation at the same time.

• Chapter 2, “Paint a Picture of Your Target Population:      Assessing Assets and Problems” 

This chapter presents valuable information for identifying your target population during program planning. Note: Some of the information in this chapter extends into needs assessment, which will be addressed in Week 4.

Chapter 6, "The Importance and Use of Theories in Health Education and Health Promotion"

The authors describe various theories, noting that theories are not universally applicable to every program.

Kettner, P. M., Moroney, R. M., & Martin, L. L. (2017). Designing and managing programs: An effectiveness-based approach (5th ed.). Thousand Oaks, CA: Sage.

• Review Chapter 1, “Contemporary Issues in Social      Services Program Planning and Administration” (See attached file).
• Review Chapter 3, “Understanding Social      Problems” (See attached file).

Review these chapters as needed to help you identify a health care-related problem for program planning and evaluation. For instance, you may find the problem analysis information on page 13 and pages 38–39 beneficial.

Chapter 2, "The Contribution of Theory to Program Planning"

This chapter examines the application of theory in program planning.

Chapter 4, “Needs Assessment: Theoretical Considerations”

Chapter 5, “Needs Assessment: Approaches to Measurement”

These two chapters provide foundational information as well as guidance for conducting a needs assessment as part of program planning.

Adams, J. & Kaplow, R. (2013). A sitter reduction program in an acute health care system. Nursing Economics$, 31(2), 83–89.

Pinto, B.M., Waldemore, M., & Rosen, R. (2015). A community-based partnership to promote exercise among cancer survivors: Lessons learned. International Journal Behavioral Medicine, 22, 328–335 doi 10.1007/s12529-014-9395-5 

Tompa, E., deBoer, H., Macdonald, S., Alarngir, H., Koehoorn, M., & Guzman, J. (2016). Stakeholders’ perspectives about and priorities for economic evaluation of health and safety programs in healthcare. Workplace Health and Safety, 64(4), 163–174 DOI: 10.1177/2165079915620201.

Leading Health Indicators. (n.d.). Retrieved March 22, 2017, from https://www.healthypeople.gov/2020/Leading-Health-Indicators 

National Database of Nursing Quality Indicators. (n.d.). Retrieved March 22, 2017, from http://www.pressganey.com/solutions/clinical-quality/nursing-quality 

U.S. Department of Health and Human Services. (2010). Healthy People 2020. (n.d.). Retrieved March 22, 2017, from https://www.healthypeople.gov/sites/default/files/HP2020_brochure_with_LHI_508_FNL.pdf 

IOM Future of Nursing Report. (n.d.). Retrieved March 22, 2017, from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/IOM-Future-of-Nursing-Report-1

Berhane, A., Biadgilign, S., Berhane, A., & Memiah, P. (2015). Male involvement in family planning program in Northern Ethiopia: An application of the Transtheoretical model. Patient Education and Counseling 98, 469–475

Kroelinger, C.D., Rankin, K. M., Chamgers, D.A., Diez Roux, A.V., Huges, K., & Grigorescu, V. (2014). Using the principles of complex systems thinking and implementation sceice to enhance maternal and child health program planning and delivery. Maternal Child Health Journal, 18, 1560–1564. doi 10.1007/s10995-014-1586-9

Silverman, B., Champney, J., Steber, S., & Zubritsky, C. (2015). Collaborating for consensus: Considerations for convening Coalition stakeholders to promote a gender-based approach to addressing the health needs of sex workers. Evaluation and Program Planning 51,17–26 doi.org/10.1016/j.evalprogplan.2014.12.002

Smith, T.L., Barlow, P.b., Peters, J.M., & Skolits, G.J. (2015). Demystifying reflective practice: Using the DATA model to enhance evaluators’ professional activities. Evaluation and Program Planning, 52, 142–147.

Burrows, T., Hutchesson, M., Chai, L,K., Rollow, M., Skinner, G., & Collins, C. (2015). Nutrition interventions for prevention and management of childhood obesity: What do parents want from an eHealth program? Nutrients, 7, 10469–10479 doi:10.3390/nu7125546

Derguy, C., Michel, G., M’Bailara, K., Roux, S., & Bouvard, M. (2015). Assessing needs in parents of children with autism spectrum disorder: A crucial preliminary step to target relevant issues for support programs. Journal of Intellectual & Developmental Disability, 40(2), 156–166 doi.org/10.3109/13668250.2015.1023707

Millard, T., McDonald, K., Elliott, J., Slavin, S., Rowell, S., & Girdler, S. (2014). Informing the development of an online self-management program for men living with HIV: a needs assessment. BMC Public Health, 14, 1209 doi:10.1186/1471-2458-14-1209

Springer, A. E. & Evans, A.E. (2016). Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners. Health Promotion Perspectives, 6(3), 111–118 doi: 10.15171/hpp.2016.19

Required Media

Laureate Education (Producer). (2011). Design and evaluation of programs and projects [Video file}. Baltimore, MD: Author.

• “Defining a      Population Health Problem” (featuring Dr. Melissa Willmarth, Dr. Debora Dole,      and Dr. Donna Shambley-Ebron)

You may view this course video by clicking the link or on the course DVD, which contains the same content. Once you've opened the link, click on the appropriate media piece.

In these videos, Dr. Melissa Willmarth, Dr. Debora Dole, and Dr. Donna Shambley-Ebron provide insights related to defining health care-related problems.

Laureate Education (Producer). (2011). Design and evaluation of programs and projects [Video file]. Baltimore, MD: Author.

“Needs Assessment” (featuring Dr. Rebecca Lee, Shiniche Thomas, and Dr. Donna Shambley-Ebron)

You may view this course video by clicking the link or on the course DVD, which contains the same content. Once you've opened the link, click on the appropriate media piece.

In this week's videos, Dr. Rebecca Lee and Dr. Donna Shambley-Ebron discuss needs assessments. Then, Dr. Rebecca Lee demonstrates a windshield assessment along with Seven Hills community resident Shiniche Thomas.

Optional Resources

Algera, M., Francke, A. L., Kerkstra, A., & Van der Zee, J. (2004). Integrative literature reviews and meta-analyses: Home care needs of patients with long-term conditions: Literature review. Journal of Advanced Nursing, 46(4), 417–429.

This article compares literature in the field to determine a profile for people with long-term health care conditions who utilize home care services.

Madden, S. G., Loeb, S. J., & Smith, C. A. (2008). An integrative literature review of lifestyle interventions for the prevention of type II diabetes mellitus. Journal of Clinical Nursing, 17(17), 2243–2256.

This article is an example of an integrative literature review that identifies aspects of nursing programs aimed at prevention of type II diabetes, effectiveness of such programs, and compliance with lifestyle changes after such programs.

Hulton, L. J. (2007). An evaluation of a school-based teenage pregnancy prevention program using a logic model framework. Journal of School Nursing, 23(2), 104–110.

This article describes the use of the logic model to develop, implement, and evaluate a nursing intervention in a school setting.

Johnson, S. S., Driskell, M., Johnson, J. L., Prochaska, J. M., Zwick, W., & Prochaska, J. O. (2006). Efficacy of a transtheoretical model-based expert system for antihypertensive adherence. Disease Management, 9(5), 291–301.

This article introduces the use of the transtheoretical model and stages of change as applied to interventions aimed at medication adherence for patients with hypertension.

Rogers, L. Q., Shah, P., Dunnington, G., Greive, A., Shanmugham, A., Dawson, B., & Courneya, K. S. (2005). Social cognitive theory and physical activity during breast cancer treatment. Oncology Nursing Forum, 32(4), 807–815.

The social cognitive theory is utilized to examine associations with physical activity in breast cancer patients. This article posits that the social cognitive theory can be used as a mediator for intervention evaluation with this population.

W. K. Kellogg Foundation. (2004). Using logic models to bring together planning, evaluation, and action: Logic model development guide. Battle Creek, MI: W. K. Kellogg Foundation. Retrieved from http://www.wkkf.org/resource-directory/resource/2006/02/wk-kellogg-foundation-logic-model-development-guide.

DQ 1

Comment 1

An internal method for dissemination of my EBP project results would be scheduling a short meeting with nurse managers of the unit to discuss the findings through questionnaires and interviews. External may be to schedule meeting which includes the nurse managers and staffing personnel. The importance of including all these persons in one meeting would be to provide a connect with the data and information that is discussed daily with regard to staffing and the hiring of nurses to fill vacant positions. Providing visual displays of the research that provides a clear picture showing the impact of nurse turnover and the orientation process. This meeting would be a platform for discussion and information that involves staffing, hiring and retention of staff and the impact on the unit/facility. According to  the  Agency for Healthcare Research and Quality (AHRQ) (2014),  all dissemination should have a purpose and promote the project development. This can be accomplished by raising awareness, informing and educating, engaging and involving, and promotion of the results.

Staffing levels and nurse retention is in the news daily and involving the community in discussions would offer clarification. Yes, the community is aware of the shortage, but do they know what avenues of change are taking place in the facility that hopefully will affect their healthcare now and in the future.

Strategies of communication for each group focuses on the delivery of information. Internal information transfer is effective through conversation and visual evidence. External needs to be concise and factful with a clear plan of implementation that is also visual. Time constraints for both groups is evident so many short meetings for the internal dissemination would benefit both staff and the managers/leaders of the nursing unit. The external group would also have time limitations so being concise and thorough with a limited time frame is a challenge.

Comment 2

An important part in delivering “high-quality patient care is nursing implementation of evidence-based practice (EBP); institutional leadership, such as nurse managers (NMs), plays an integral role in the implementation of EBP on nursing units” (Kueny, Shever, Lehan, & Titler, 2015, p.1). Thus, one internal method would be meeting with the NM of the unit to discuss my research findings regarding the implementation of acuity based tools specific for the unit to adjust staffing appropriately to improve patient outcomes, improve quality of care and decrease nurse burnout. Addressing the importance of measuring acuity, provide different tools that measure acuity and how to implement the use of these tools with proper education and directions. NMs are an important part of driving change, they can lead EBP projects, provide resources and educational activities to promote change and schedule workshops to assist nurses with the changes.  According to Kueny et. al (2015), “NMs have the potential to remove some of the autonomy in decision making for EBP recommendations” (p. 37). NM’s can help with culture of expectations, empowering their nurses to implement EBP to improve patient outcomes and improve nurse burnout.

An external method would be contacting a professional nursing organization, such as the American Psychiatric Nurses Association (APNA). Contacting the APNA via the internet would provide me with feedback on the next steps I need to take. Becoming a member of APNA or joining a committee, would allow me to take action addressing the importance of using acuity based tools in measuring safe staffing levels to improve patient outcomes and improve quality care. There is a lack of studies or research regarding staffing inpatient geriatric psychiatric units. The APNA (2015), encourages nurse researchers to study both populations, in order to establish specific nurse-to-patient ratios for inpatient psychiatric units and to foster the development of innovative, effective, recovery-oriented and safe-staffing models. Thus, it would be beneficial to address these populations, providing evidence that implementation of acuity based tools for safe staffing levels has improved patient outcomes.

Strategies for communication would be different for internal methods versus external methods. Internal methods require a more personal approach, addressing the problem, reviewing evidence for solutions to the problem with the NM, outlining the project, asking for feedback, projected costs involved to implement EBP, time constraints, and required nursing education on implementing acuity based tools for the unit. Promoting nursing feedback and shared governance in the decision making process and areas that need to be addressed in regards to safe staffing and equitable nurse workloads. External methods require a less formal approach, writing to APNA, would require addressing the problem, providing a solution with evidence based research, evaluating nursing practice, quality of care, improving nurse’s mental health, minimizing nurse burnout, reducing health care cost, and improving patient outcomes.

DQ 2

Comment 1

An important challenge to any evidence-based practice project evaluation is whether it was effective. I came across an article discussing the use of a premortem plan to identify outcomes and their success. In the healthcare arena we have all heard of postmortems where we discuss what happens after a sentinel event or adverse patient outcome. A premortem addresses the anticipated failures of the project before implementation. By doing this we can develop strategies that would aid in successful implementation according to Ginex (2018).

Since my project relates to staff retention and turnover on the night shift, seeing staff be successful using mentor/mentee programs after the original orientation period would offer proof the program change is working. Evaluating the cost of orientation and the cost of loosing qualified staff due to inadequate or ineffective orientation would also provide positive feedback and data. Follow up interviews with staff who have left or changed shifts would offer information related to differences in shift orientations. Also, the number of staff participating in mentor/mentee program would show the level of acceptance and commitment to the project change.

Comment 2

One way that I would evaluate whether my project made a difference in practice would be to implement some of my findings, such as talking with the DON and supervisor of my facility about scheduling equal nurse-to-patient ratios. I currently work on a sub-acute unit of my facility and there are about 6 patients that have pressure ulcers and all of them are at risk for pressure ulcer development. I have worked at the facility for a year and some pressure ulcers have developed while those residents were in the facility. All of the resident require total care and to ensure that they are changed and turned in a timely manner, there must be an appropriate staff-to-patient ratio. This means that each nurse should not have more than 7 patients because, they also only have on CNA. Each CNA has up to 14 patients, so they heavily rely on the assistance of the nurses. If the nurses feel overworked, then it shows in their patient care and the residents are at more risk for pressure ulcer development. According to Hartmann, Mills, Pimentel, Palmer, Allen, Zhao, and Snow (2018), positive interactions between the staff and patients contributes to better quality care and better patient outcomes.

I would also talk with the wound care nurse, DON, and supervisor to provide in-services to teach the staff how to implement the wound care orders properly. The wound care nurse only works from 0800-1630 and although he tries to change the dressings every day, the orders also include changing the dressing PRN if they become soiled. Many of the wounds are located on the sacrum region. All of the residents are incontinent of bowel and bladder and require total care. Orders constantly change depending on the status of the wound and there have been times when the dressing gets soiled and requires changing. I often work the even shift and there are times where I do not see the wound care nurse. I and my coworkers that work the evening and night shift have needed to change the dressing based on the order in the MAR. there have been times in which the directions of the order were unclear and/or we did not have the correct supplies. The wound care nurse only works during the week, so if we do run out of supplies, we do not have access to the storage unit that has them or the facility has run out. When there is a change in an order, it would be very helpful if the wound care nurse holds in-services to show the nurses how to perform the dressing change and make sure that at least half of the nurses from the evening and night shift know how to change it as well, so they can help their co-workers if needed. Knowing how to properly change the dressings improves wound healing and prevent worsening of the wound.

Comment 1

Development of an evidence-based practice project must include the direct and indirect impact that will be encountered through implementation. Staff retention of newly hired nurses specific to the night shift is the focus of my project and its impact on the nurses, facility and community that is served. According to published reports, a supportive work environment, especially between managers and employees, creates a strong deterrent to nurses leaving an organization by improving perception of organizational support, employee engagement, team cohesion, and connection to the mission of the health-care setting (Kurnat-Thoma, Ganger, Peterson, & Channell, 2017).

Financial aspect – staffing cost/turnover cost

Hospital staffing turnover is projected to 5% to 5.8% of total hospital annual operating budget and is largely driven by the loss and necessary replacement of qualified nurses according to  Waldman, J., Kelly, F., Arora, S., Smith, H. (2010).

Proposal direct impact – hospital revenue/staffing costs,

Proposal indirect impact – patient outcomes, positive healing environment perception by staff/patients

Quality Aspect – High turnover in any industry can be a concern, especially those that are customer-centric. Industries that deal with people’s health are in an even more precarious position. Institutions with high attrition must consider how a “revolving door” of care providers affects the quality of care an institution is able to provide, and the satisfaction of patients with their overall experience according to Arena (2018).

Proposal direct impact –

Separation Costs – Continued benefits, temporary labor, overtime to existing employees

• Recruitment Costs – Job description, posting on job boards, screening candidates, interviewing candidates, assessing candidates

• Onboarding Costs – Orientation and training of new hire

Proposal indirect impact –

Loss of productivity

• Lack of staff while positions are being filled

• Increased pressure on existing staff to cover and pick up the extra work often leading to burnout

• Patients receiving less attention

• Pressure on current staff to train and then gel with the new employees

• Lack and lag of knowledge with new employees concerning institutional practices, workplace norms, team behaviors, and patient knowledge, familiarity, and care experience

Clinical aspect – unit cohesiveness/patient care

Many nurses leave their positions because of negative experiences with heavy or unrealistic workloads and due to feeling unheard and undervalued. Clinical nurses' sense of disempowerment can be related to lack of leadership interventions. Clinical nurses may feel that managers are insensitive to their staffing needs, don't support employee well-being, and don't invest enough in staff education or clinical advancement according to Linnen and Rowley (February 2014).

Proposal direct impact – nurses will see themselves as stewards for their unit. “Nurses are leaders by virtue of their responsibilities; for them, empowerment isn't a privilege, but a professional necessity” (Linnen and Rowley, 2014).

Proposal indirect impact –

-          Nurse advancement

-          Staff participation in policy and governance

-          Leadership support

-          Adequate staff and resources

-          Nurse/physician relations

Comment 2

My mentor is a wound care nurse and my proposal is about quality improvement and how it affects pressure ulcers. After discussing with my mentor, we discussed that a financial aspect for developing an evidence-based practice project would be a reduction in billing for treatment, such as special ointments, creams, and dressings that are billed to the patient, patient’s payer source, and facility. A quality aspect would be an improvement of the quality of care. Evidence-based practice would prevent the development of pressure ulcers and/or improve the healing of current pressure ulcers. A clinical care aspect would be understanding who the target population is and what type of facility they are in.

My proposal would directly impact all of these aspects because treating these types of wounds can be very costly to not only the patient or patient’s payer, but also the facility. The facility usually has a house supply of basic dressings and wound care supplies, such as calcium alginate with and without silver, different types of dressings, collagen, etc. Over time, this can become very costly because dressing changes need to be done on a daily basis and as needed. To improve healing and prevent wound development, evidence-based studies have proven that turning patients at least every two and keeping them clean and dry significantly decreases the development of pressure ulcers. The use of preventive materials (types of mattresses, positioning devices, etc.), characteristics of the residents (personal preference of preventive materials, presence of existing ulcers, and positioning), protocols based on four themes (observation of the skin, frequency of repositioning and postures, use of support surfaces, and elevation of heels also helps as well (Beeckman, Clays, Van Hecke, et al., 2013).

Comment 3 6DQ1

Proposed solution to address issue of staff retention – Implementation of Mentor/Mentee partnership program that addresses the perception of job expectations from the viewpoint of new staff. How this idea relates to how the unit runs and aid in transforming perception to reality in the workplace.  Solicitation of nurse’s feedback regarding orientation/mentoring process, satisfaction with job description, and reasons for job change or shift changes if any in past year.

How this proposal has changed since I began – My proposal has changed to include adding a more inclusive program to orient and mentor newly hired staff that includes a broader spectrum of resources. Leadership, peer, and instruction involvement in a process that develops confidence, and well-being in nurses and that provides follow through that lasts through a full year of mentorship.

What led to current perspective and direction – Seeing the frustration in nursing staff that are left on the unit to fill in the empty spots where new nurses have left or changed shifts due to feelings of lack of support and comradery. Building an orientation program that respects the individual needs of nurses and that places nurses in a position to be confident and feel supported throughout their orientation. Also, to understand what is expected in the job that they have been hired for and that they will have a source or resource that will be available for continued feedback.

Comment 4

My proposed solution would be to increase quality improvement for the residents in Windsor Rosewood Care Center and decrease the incidence of pressure ulcers. Implementation would be based on evidence-based practices, such as turning at-risk patients at least every two hours, keep them clean and dry, and make sure they are getting enough nutrition, and for those that have diabetes, help manage it better. Based on my research, there are many ways to increase quality improvement in nursing homes. One article used a pay-for-performance plan by performing regular inspections and assessments based on a Minimum Data Set and Online Survey, Certification, and Reporting data. It provided information about how clinical weights, staffing ratios, and inspection deficiencies impact clinical outcomes (Konetzka, Skira, & Werner, 2018). Another article by Hartmann, Mills, Pimentel, Palmer, Allen, Zhao…& Snow (2018), provided valuable information about how patient-staff interaction plays a significant role in clinical outcomes. Nurses are constantly in contact with their patients and how they interact with one another can have a positive or negative on patient outcomes. Medication can only go so far, but caring for the well-being and meeting the needs of their patients emotionally can help them get better, and/or ease their suffering and pain. I have also learned that efforts need to be made on all organizational levels and all health care professionals must work with one another.

My proposed solution has changed in that I was focused quality improvement as a whole, such as wounds, falls, and diseases (pneumonia, catheter-associated infections, and respiratory illnesses). After writing what my PICOT question was on one of the threads, the instructor suggested that I need to be more specific. I decided to write a solution about wound care and falls because my mentor is a wound care nurse and many of the residents are at risk for falls. Then this past week, I decided that I should focus on just pressure wounds because many of the residents are at great risk and it continues to be a very big problem. There is also a lot of valuable information that I have learned from scholarly articles and implement the ideas into my own nursing practice.

  

4-Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system. The level of evidence are as follows:

Level I
 Experimental study, randomized controlled trial (RCT)
Systematic review of RCTs, with or without meta-analysis

Level II
 Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.

Level III
 Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematic review, with or without meta-analysis

Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
    Includes:
         - Clinical practice guidelines
         - Consensus panels

Level V
 Based on experiential and non-research evidence.
    Includes:
      - Literature reviews
      - Quality improvement, program or financial evaluation
      - Case reports
      - Opinion of nationally recognized expert(s) based on experiential evidence.

According to U.S Department of Health and Human services, Evidence Classification Scheme for a Diagnostic Measure include:

Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a 'gold standard' for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy

Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by 'gold standard') compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy

Class III: Evidence provided by a retrospective study where either person with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation

Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls).

References

Agency for Healthcare Research and Quality. (n.d.). Agency for healthcare research and quality: a profile. Retrieved December 3, 2018, from https://www.ahrq.gov/cpi/about/profile/index.html

Winona State University. (2018). Evidence based practice toolkit. Retrieved December 3, 2018, from https://libguides.winona.edu/ebptoolkit

 

 
 

5-Evidence based medicine uses evidence to make clinical decisions. There is a hierarchal system for classification of evidence. This hierarchy is known as the levels of evidence. Physicians are encouraged to find the highest level of evidence to answer clinical questions (Barnes, Rohrich, & Chung, 2012, p. 305). The higher the level the more strength the evidence has. Randomized controlled trials (RCT’s) are the strongest research designs for treatment or intervention studies because they exert the most control over the methods and the results are considered more trustworthy (Thomas, 2017). It is important to note that a high level of evidence for a treatment study may not be the highest level of evidence for a study for prognosis. The strongest levels of evidence are at the top of the hierarchy. Some examples put concepts into  practice from the different levels of evidence that may include practice alerts for revising current policies and instituting new practices.

• Meta-Analysis  A      systematic review that uses quantitative methods to summarize the results.
• Systematic      Review         An article in which the authors have systematically searched for,      appraised, and summarized all the medical literature for a specific topic.
• Critically      Appraised Topic          Authors of critically-appraised topics evaluate and synthesize multiple      research studies.
• Critically      Appraised Articles  Authors of      critically-appraised individual articles evaluate and synopsize individual      research studies.
• Randomized      Controlled Trials  RCT's include a randomized      group of patients in an experimental group and a control group. These      groups are followed up for the variables/outcomes of interest.
• Cohort      Study       Identifies two groups (cohorts) of patients, one which did receive the      exposure of interest, and one which did not, and following these cohorts      forward for the outcome of interest.
• Case-Control      Study       Involves identifying patients who have the outcome of interest (cases) and      control patients without the same outcome and looking to see if they had the      exposure of interest.
• Background      Information / Expert Opinion   Handbooks,      encyclopedias, and textbooks often provide a good foundation or      introduction and often include generalized information about a      condition.  While background information presents a convenient      summary, often it takes about three years for this type of literature to      be published.
• Animal      Research / Lab Studies  Information begins at the      bottom of the pyramid: this is where ideas and laboratory
       research takes place. Ideas turn into therapies and diagnostic tools,      which then are tested with lab models and

References

Barnes, P. B., Rohrich, R. J., & Chung, K. C. (2012, July 1). The Levels of Evidence and their role in Evidence-Based Medicine. Plastic Reconstructive Surgery, 128(1), 305-310. https://doi.org/doi:  [10.1097/PRS.0b013e318219c171]

Thomas, C. J. (2017, May 23). What Does “Levels of Evidence” Mean in Evidence-Based Practice? Nursing Education Expert. Retrieved from https://nursingeducationexpert.com/levels-of-evidence/

 

6-In attempting to prove the accuracy of a case study or other
investigation, various levels of evidence are utilized in associating well
reputed and accurate sources and data collection methods (Petrisor & Bhandari,
2007). These evaluations grade the overall validity of the study, and help to
show whether or not the evidence is accurate in its findings (Petrisor &
Bhandari, 2007). These levels of evidence are generally seen on seven levels,
with the first being the most valid and the seventh being the least valid. The
first level is gathered through a systematic review of randomized control
trials (RCT), and due to the wide range of its data is the most accurate and
can be used as a basis for broad changes in practice methods (Burns, Rohlich
& Chung, 2011). The second level is gathered through a single RCT that
could be applied to a wide range of practice changes, such as determining intervention
method effectiveness (Darrell W. Krueger Library, 2018). The third level of
evidence is similar to the second, but the participants to groups are not
assigned randomly. This form of evidence can be used in detecting extraneous
variables in a study by examining a particular factor (DWKL, 2018).

           The fourth
level of evidence consists of cohort and case-control studies which compare two
different outcomes between similar studies retrospectively, such as those with
and without a disease to determine outcomes. The fifth and sixth levels relate
to descriptive and non-quantitative studies, with the fifth level examining
numerous studies, and the sixth only examines one (DWKL, 2018). These studies
can be used to describe personal experiences. The final level of evidence is
based off of expert opinions, which are worth exploring for new ideas, but not
scientifically valid (DWKL, 2018).

References

Burns, P. B., Rohrich, R. J., &
Chung, K. C. (2011). The levels of evidence and their role in
evidence-based medicine. Evidence-based Medicine Toolkit, 128(1),
94-96. doi:10.1002/9780470750605.ch15

Darrell W. Krueger Library. (2018, September 18). Evidence based
practice toolkit. Retrieved from
https://libguides.winona.edu/c.php?g=11614&p=61584

Petrisor, B. A., & Bhandari, M. (2007). The
hierarchy of evidence: Levels and grades of recommendation. Retrieved from
www.unm.edu/~unmvclib/cascade/handouts/PICOTpyramidofevidence.pdf

    

Change Leadership: Risk Management, Safety, and Environment

Youngberg (2011) conveys the transformation needed for effective  health care quality, risk management, and regulatory compliance on  behalf of health care leaders following the release of IOM reports (p.  293). The author stresses the importance of learning from other  industries, constructing high reliability organizations (p. 294),  developing trust and transparency (p. 296), promoting justice and  accountability (p.298), and committing to a culture of safety (p. 300);  additionally, Youngberg emphasizes the new principles for high  reliability-high performing health care organizations (p. 302).

In your initial post to this discussion:

• Describe how transformational leaders can initiate change that  involves one or more of the concepts discussed in this unit's readings.
• Provide additional insights relating to leadership within the changing environment of the health care industry.
• Include a minimum of two peer-reviewed, current journal articles in your discussion of insights.

In your initial post, include APA-formatted in-text citations and accompanying, congruent APA-formatted references.

Response Guidelines

Respond to the posts of other learners according to the Faculty  Expectations Response Guidelines. If possible, respond to one learner  who has a perspective, background, or goals that are similar to yours,  and to one learner whose perspective, background, or goals are  different. Peer responses should be substantive, and need to include one  peer-reviewed source that aligns with the discussion thread. You may  feel free to add an additional source that is new or provides a  completely different perspective. "I agree" and "Thanks for sharing your  insights" are examples of responses that do not contribute content for  enhanced learning, and are not acceptable. The goal is quality,  substantive feedback that demonstrates higher-order critical thinking  and evaluation of peers' initial posts.

Reference

Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones and Bartlett.

Resources

• Discussion Participation Scoring Guide.
• APA Style and Format.
• Capella Library.
• How Do I Find Peer-Reviewed Articles?.

    

Scorecard Analysis: Process Improvement Report

To prepare to complete this assignment, review the following  materials from the study activity in Unit 8, which are also linked in  the Resources:

• Kaplan and Norton's 1992 article, "The Balanced Scorecard: Measures that Drive Performance," from Harvard Business Review. This Kaplan and Norton framework is a valuable resource for this assignment.
• Gunduz and Simsek's 2007 article, "A Strategic Safety Management  Framework Through Balanced Scorecard and Quality Function Deployment,"  from Canadian Journal of Civil Engineering. Note that Kaplan and Norton's 1992 balanced scorecard framework is depicted in Figure 2 of this article.
• Koumpouros' 2013 article, "Balanced Scorecard: Application in the General Panarcadian Hospital of Tripolis, Greece," from International Journal of Health Care Quality Assurance.
• Behrouzi, Shaharoun, and Ma'aram's 2014 article, "Applications of  the Balanced Scorecard for Strategic Management and Performance  Measurement in the Health Sector," from Australian Health Review.
• The updates addressed in Kaplan and Norton's 1996 article, "Linking the Balanced Scorecard to Strategy," from California Management Review.
• Norton's 2011 article, "Strategy Execution Needs a System," which provides a brief retrospective on updates and lessons learned.

The goal of this assignment is to generate recommendations for  process improvement and organizational fitness. You will make your  recommendations for the organization you selected in Unit 7 for the  balanced scorecard PowerPoint presentation and which you presented in  the Unit 8 assignment. Apply the concepts of balanced scorecards to  create your recommendations.

To complete the assignment, write a paper in which you:

1. Describe the selected organization, including its vision and mission.
2. Analyze the company using any adaptation of the Kaplan and Norton  balanced scorecard framework that fits your selected organization. Use  the materials listed at the beginning of this assignment.
3. Communicate vision, strategy, objectives, measures, targets, and  initiatives for each of the following four elements through a  macro-level discussion:      
   • Financial performance measures.
   • Internal business processes.
   • Learning and growth.
   • Customer satisfaction.
4. Convey the organization's values through an ethical, organizational, and directional strategy.
5. Synthesize evidence-based and best practices into recommendations for monitoring and improving discussions.
6. Generate one recommendation for each of the following:      
   • Process improvements.
   • Quality improvements.
   • Organizational efficiency.
   • Learning.        
     • In y our  recommendations, use specific language and include  evidence-based concepts from peer-reviewed literature, including a  minimum of four outside peer-reviewed sources.
7. Communicate information and ideas clearly, accurately, and concisely, including reference citations and using correct grammar.

Assignment Requirements

• Written communication: Written communication is free from errors that detract from the overall message.
• APA formatting: Resources and citations are formatted according to APA style and formatting guidelines. Use APA format for:      
  • Cover page.
  • Abstract.
  • Table of contents, including list of figures and tables.
  • Headings and subheadings.
  • Reference list.
• Number of resources: A minimum of six resources.  The Norton and Kaplan articles, "The Balanced Scorecard: Measures that  Drive Performance" and "Linking the Balanced Scorecard to Strategy,"  will serve as two resources.
• Length of paper: 10–12 typed double-spaced pages.
• Font and font size: Arial, 10 point.

Note: Your instructor may also use the Writing  Feedback Tool to provide feedback on your writing. In the tool, click  the linked resources for helpful writing information.

Portfolio Prompt: You are required to save this learning activity to your ePortfolio.

Resources

• Scorecard Analysis: Process Improvement Report Scoring Guide.
• A Strategic Safety Management Framework Through Balanced Scorecard and Quality Function Deployment.
• APA Style and Format.
• Applications of the Balanced Scorecard for Strategic Management and Performance Measurement in the Health Sector.
• Balanced Scorecard: Application in the General Panarcadian Hospital of Tripolis, Greece.
• Capella Library.
• Capella Writing Center.
• How Do I Find Peer-Reviewed Articles?.
• ePortfolio.
• Linking the Balanced Scorecard to Strategy.
• Strategy Execution Needs a System.
• The Balanced Scorecard: Measures that Drive Performance.
• Writing Feedback Tool.