In this course, you develop a comprehensive Course Project: Promoting Health Care

Quality. To initiate this project, this week you examine the systems and structures of an

organization with which you are familiar.

Organizational Systems and Structures, Part 1

Section 1: Organizational Systems and Structures Evaluation

When a problem related to health care quality and patient safety arises, there can be an

inclination to focus on a specific event rather than to examine the larger context

surrounding it. Analyzing the systems and structures within an organization provides a

foundation for generating a fuller understanding of how and why the event occurred and

for developing strategies to address the underlying issues. Perhaps more importantly,

such an analysis can be used to proactively identify potential challenges and improve

organizational systems and structures in order to promote positive outcomes.

In the first section of your Course Project, you analyze the systems and structures of a

health care organization with which you are familiar.

To prepare:

Identify a health care organization with which you are familiar; one that you will be

able to sufficiently analyze to complete the full scope of the Course Project. (Refer to

the Course Project Overview as needed.)

Select two or more of the following frameworks:

· Learning organizations

· Complex adaptive systems (CAS)

· Clinical microsystems

· Good to great

· The 5 Ps

With these frameworks in mind, analyze the systems and structures of the

organization. Be sure to research and consider:

· Mission, vision, and values

· Strategic plan, goals, and objectives, if possible

· Key operational processes and patterns

· Information technology use

· Organizational priorities and investments, as indicated by financial data

Week 4: Organizational Systems and Structures, Part 2

Section 1: Organizational Systems and Structures Evaluation

As you continue your evaluation of a health care organization, it is essential to pay

attention to culture. Organizational culture provides the context in which all interactions

and processes occur and is therefore central to any effort to enact change.

To prepare:

Continue to analyze your selected organization, as indicated in Week 3 (Section 1 of

the Course Project).

Continue to analyze essential elements of organizational culture and evaluate the

influence of culture on the ability to achieve goals within your selected organization.

To complete:

Write a 3- to 5-page paper in which you:

· Provide a description of the organization that you selected

· Present your analysis of the organization with attention to:

· Its mission, vision, values

· Strategic plan, goals, and objectives

· Key operational processes and patterns

· Information technology use

· Organizational priorities and investments, as indicated by financial data

· The essential elements of the organization’s culture

· The influence of culture on meeting organizational goals

Section 2: Quality Improvement Issue

To help you move forward with your Course Project, this week you identify a quality

issue that you would like to address and submit a description of this issue for Instructor

feedback.

Your proposed issue should reflect a genuine need for improvement within your

selected health care organization. Through your Course Project, you will analyze this 

issue and propose strategies to improve outcome(s), including the redesign of a related

process.

To prepare:

· Review the six quality improvement aims from the Institute of Medicine (IOM)

· Safe: Avoiding harm to patients from the care that is intended to help them.

· Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).

· Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

· Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care.

· Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy.

· Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

· Conduct a search of the literature to help you identify a specific issue that warrants attention and action to promote quality improvement.

· Consider what you have surmised thus far through your analysis of the organization

that you selected. What have you noticed that could help you identify a quality related need for improvement? For instance:

· What has captured your attention in meetings, reports, and/or daily activities?

· Have you noticed discrepancies between activities in the organization and

recommendations in the research literature, quality standards, and/or the

organization’s stated policies and procedures?

· If so, what do you think could be the reason(s) for variations or gaps between

what you have observed and what is recommended?

Identify a quality improvement issue that you would like to investigate for this project.

Note: Review the Course Project Overview/full instructions, located in the Week 3

Learning Resources, as needed to identify a quality improvement issue that is viable for

completing the full scope of this project. Once you receive a response from your

Instructor on the quality improvement issue that you submit, be sure to integrate his or

her feedback before moving forward with Section 3 of your Course Project.

To complete:

Write a brief description of the quality improvement issue that you would like to address

for your Course Project.

 It's important I meet the competencies…!

Overview 

  

Create a 15-minute oral presentation (3–4 pages) that examines the moral and ethical issues related to triaging patients in an emergency room.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:  

• Competency 1: Explain the effect of health care policies, legislation, and legal issues on health care delivery and patient outcomes.       
  • Explain the health care policies that can affect emergency care.
  • Recommend evidence-based decision-making strategies nurses can use during triage.
• Competency 3: Apply professional nursing ethical standards and principles to the decision-making process.       
  • Describe the moral and ethical challenges nurses can face when following hospital policies and protocols.
  • Explain how health care disparities impact treatment decisions.
• Competency 4: Communicate in a manner that is consistent with expectations of nursing professionals.       
  • Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
  • Correctly format citations and references using APA style.

Assessment Instructions 

  

Your supervisor has asked you to do a 15-minute oral presentation at a staff meeting about a recent issue that occurred at another hospital in town. Following an industrial accident, two patients arrived at the emergency room of that hospital at the same time, presenting with very similar inhalation injuries. The hospital received a great deal of negative press due to how the patients were triaged in the ER. Your supervisor would like you to use the specifics of this case to review triage procedures and best practices at your facility. Here are the details:

• One is a 32-year-old firefighter, Frank Jeffers, who is presenting with respiratory difficulties that he obtained while evacuating victims of an industrial accident. He is a married homeowner and father of two young boys. He has lived in the community all his life. He has full and comprehensive health insurance through his employer.
• The other is Brent Damascus, a 58-year-old man. Brent is presenting with respiratory difficulties with the same intensity as Mr. Jeffers above. He is well known at the hospital emergency room, as he is a frequent visitor with various complaints, including asthma, headaches, and tremors. He is homeless, unemployed, and uninsured. He stays many nights at the YMCA and eats lunch at the soup kitchen. He has lived in the community for over 10 years and has been arrested several times for petty theft.

Preparation

Search the Capella library and the Internet for scholarly and professional peer-reviewed articles on best practices in triage nursing. You will need at least three articles to use as support for your work on this assessment.

Directions

Create a 15-minute presentation (3–4 pages) that examines the moral and ethical issues that occurred when triaging these two patients and the best practices for managing this in the future.

Divide your draft into a number of talking points that you can summarize neatly. Keep in mind that an oral presentation requires slightly different language than an essay. The aim is to communicate your message so keep sentences simple and focus on the key points you want to deliver. Address the following in your presentation:

• Explain the health care policies and protocols that are in place that direct triage care in an emergency situation.
• Explain how health care disparities impact treatment decisions.
• Identify the health care policies that are in place that direct care for uninsured individuals. Is there a difference in how these individuals are triaged?
• Describe the moral and ethical challenges nurses can face when following hospital policies and protocols. Is there a conflict when a severely injured person is also uninsured?
• Recommend evidence-based strategies that should be applied for managing the care of uninsured and indigent population.

Additional Requirements

Your presentation should meet the following requirements:

• Written communication: Written communication should be free of errors that detract from the overall message.
• References: Include a reference section with a minimum of three references; a majority of these should be peer-reviewed sources. All resources should have been published within the last 5 years.
• APA format: Resources and citations should be formatted according to current APA style and formatting.
• Length: 3–4 typed, double-spaced pages, excluding title page and reference page. Use Microsoft Word to complete the assessment.
• Font and font size: Times New Roman, 12-point.

  

Discussion: Assessing the Ears, Nose, and Throat

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.

In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case. 

Case 1: Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

Case 2: Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn't take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.

Case 3: Focused Ear Exam
Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past two days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he's been spending his summer, James responds that he's been spending a lot of time in the pool.

To prepare:

With regard to the case study you were assigned:

· Review this week's Learning Resources and consider the insights they provide.

· Consider what history would be necessary to collect from the patient.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?

· Identify at least 5 possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying the number of the case study you were assigned.

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each. 

 Write a 3–5 page executive summary that examines an organization's diversity policies and practices. 

 

To prepare for this assessment, use the Internet to study the impact of health system's power structure on nursing, leadership, diversity related to empowerment in nursing and patient outcomes, and recruitment of a diverse workforce. You may also wish to look for examples of an executive summary on the Internet.

• Identify a type of health care facility and examine the Web site and available public information to review the organization of the nursing department, nursing recruitment, and any information about the diversity of the system's workforce and leadership.
  • You may use the health care setting in which you currently work or have worked in the past.
  • Describe the type of organization and region. Example: a major Midwestern teaching hospital or a rehabilitation hospital on the East Coast. **Central Florida Region**
    • Do not report the name of the facility.

Deliverable: Executive Summary of Organizational Diversity

Read the following scenario:

Scenario:
The city in which you work has undergone a significant population shift within the last 10 years, due to increased employment, education opportunities, and an influx of immigrants and refugees. To put the population shift in perspective, the local school district enrollment report states that nearly 100 languages are spoken in the schools, up from 32 languages in the last census. Senior leadership has asked you to examine all types of multiculturalism and diversitywithin your health care organization.
To do this, you will need to use a systems perspective to examine the relationship between a diverse workforce and patient outcomes; identify gaps between best practices and the organization's diversity policies, and make a recommendation for organizational change.

In the executive summary:

• Analyze the impact of a diverse workforce on patient outcomes.
  • In what ways or situations might multiculturalism and diversity impact health care delivery or patient outcomes?
  • How is diversity defined in the organization?
• Analyze how the health care system integrates diversity and multiculturalism into its practices.
  • Is the makeup of the organization's leadership representative of the patient and employee populations? Is this important? What would you change?
  • Explain how multiculturalism and diversity can impact health care delivery or patient outcomes.
• Analyze current recruitment and retention policies to identify gaps between best practices and current policies.
• Assess the level of integration and importance of multiculturalism and diversity in a health care organization.
  • Are all types of diversity recognized and included?
  • Provide support for your position by including 2 or 3 examples of the integration of multiculturalism and diversity into the organization.
• Recommend evidence-based changes to the organizational structure and systems leadership that empower a diverse workforce.
  • What changes would you champion as a health care leader to make the system more responsive to patients and the organization's workforce?

Make your document easy to scan for readers by:

• Using subheadings to organize content.
• Using bullet points and phrases for main points, in addition to short, succinct paragraphs.
• Including a visual, such as a graph, table, or chart.

Additional Requirements

• Written communication: Written communication should be free of errors that distract from the overall message.
• APA formatting: Resources and in-text citations should be formatted according to current APA style and formatting.
• Font and font size: Times New Roman, 12 point, double-spaced.
• Length: Summary report should be 3–5 pages.
• Number of resources: Use a minimum of three peer-reviewed resources.
• Attached is an example of a high graded paper to use as a reference. 

 Write a 4–6 page impact report to senior leadership that identifies a nursing-related challenge, analyzes how it affects the organization from a nursing perspective, and details the new position.

Each organization has a unique structure that impacts the behavior of the organization. In health care organizations, this impact is on the ability of the organization to deliver quality patient care. Nursing is an essential component of any health care organization, and nursing leaders must understand the role of nursing and nursing leadership within the total organization. Understanding basic organizational structure, mission, vision, philosophy, and values will better prepare nurse leaders to improve quality and patient outcomes.

 

Use the Suggested Resources for this assessment to study systems theory, SWOT analysis, and shared governance teams, as background for an Impact Report to Senior Leadership. The report includes a SWOT analysis. The SWOT Analysis Template is linked in attachment

• Study a facility in your area (Central Florida) and examine its Web site and any available public documents to aid you in completing this assessment. You may wish to examine an organization where you work, where you have worked in the past, or where you did your clinical work.
• Do not name the organization in your report; instead, identify the type of facility and location. Example: A rehabilitation center in a midsize Midwestern city.

Use the following scenario as the basis for your report:

Scenario
The unit-based Shared Governance Council of the organization where you work has identified a major nursing-related challenge (patient/staff safety, confidentiality, management/staff conflict, poor patient satisfaction survey scores, or nursing staff shortages) within your health care organization.
In an unusual move, your system administrator is considering creating a new nurse leadership position that would have the responsibility and authority to address this specific issue. As a member of the shared governance council's subcommittee, you have been asked to write the committee's final report.

Deliverable: Impact Report to Senior Leadership

Write a 4–6 page impact report to senior leadership that identifies the challenge, analyzes how it affects the organization from a nursing perspective, and details the new position.

Example paper of expectations attached to use as example. ******

• Use systems thinking and leadership theory as tools to approach this problem.

**Construct the report with the following headings:**

The Nursing Challenge:

• Identify the nursing challenge and its impact from a nursing perspective. Choose from:
  • Patient/staff safety, confidentiality, management/staff conflict, poor patient-satisfaction survey scores, or nursing staff shortages.

The System/Organization:

• Explain how the nursing challenge creates a gap or conflict between the organization's statements and practice.
  • Identify the organization type—that is, specialty hospital, teaching hospital, major health care system, et cetera, and summarize the organizational structure, its mission, vision, and philosophy statements.
  • Use systems theory and systems thinking to explain the gap or conflict.

SWOT Analysis:

Use the SWOT Analysis Template linked in Required Resources and include the SWOT analysis table in your paper. *Table is in attachment*

• Identify organizational factors that impact the situation using a SWOT analysis.
  • For example, a budget cut may cause short staffing, which relates directly to the problem.
• What factors within the system may facilitate a solution for this problem?

The Position:

• Assess how the new nurse leader position will have power and influence and impact patient outcomes.
• How will this position affect change within the organization?
• Identify key leadership skills, knowledge, or abilities required for the position.

Additional Requirements

• Written communication: Written communication should be free of errors that detract from the overall message.
• APA formatting: Resources and in-text citations should be formatted according to current APA style and formatting.
• Length: The report should be 4–6 pages in content length. Include a separate title page and a separate reference page.
• Font and font size: Times New Roman, 12 point, double-spaced.
• Number of resources: Use a minimum of three peer-reviewed resources.