Running head: ANALYSIS OF THE NURSING LEADERSHIP ROLE
Analysis of the Nursing Leadership Role
Danielle Williams
Ferris State University
1
ANALYSIS OF THE NURSING LEADERSHIP ROLE
2
ABSTRACT
The purpose of this paper is to review and analyze the quality improvement process for
leadership members in a council to improve delayed patient discharges. A collaborative team of
members throughout the hospital will be assembled in order to identify and breakdown the
barriers that are involved in delaying the timely discharge of its patients. Data will be collected
and reviewed by the interdisciplinary team members. The goals, methods, and strategies
involved in the quality improvement of this clinical activity council will be identified and
discussed.
ANALYSIS OF THE NURSING LEADERSHIP ROLE
3
Analysis of the Nursing Leadership Role
Healthcare organizations strive for excellence in providing the highest level of care to
improve patient outcomes and reduce unnecessary costs. Quality and safety initiatives require an
ongoing process of employee involvement, patient satisfaction, and innovation (Yoder-Wise,
2011). The quality improvement (QI) process includes identifying consumer needs, assembling
a team, collecting data, establishing outcomes, making a plan, and evaluating the plan. In order
to operate a successful quality-focused organization, quality improvement initiatives must be in
place to improve systems and processes without placing blame on individuals (Yoder-Wise,
2011).
Hospitals are facing an increasing patient demand for better quality of care. Bed
management can play a key role in affecting the way hospital departments perform; most
departments depend on efficient bed availability to be able to serve a wide variety of health
concerns (Ortiga et al. 2012). From the patient’s experience, being admitted to a bed in an acute
hospital is a major event, if they experience an extensive wait in the emergency department the
patient experience and perception of the hospital in general starts out in a very negative light
(Ortiga et al. 2012).
Delayed patient discharges can lead to increased wait times in all areas, which may lead
to decreased patient satisfaction scores, increased risk for patient injury, and greater costs to both
patients as well as hospital facilities. The demand for patient beds is sometimes greater than
capacity will allow. This leads to delays in patient admissions, transfers, and cancellations of
procedures (Maloney et al., 2007). When hospital census is full and beds are not available, loss
of revenue occurs when patients are diverted to other hospitals. These changes can cause an
ANALYSIS OF THE NURSING LEADERSHIP ROLE
4
increase in dissatisfied patients, leading to decreased patient satisfaction scores, causing a loss of
a competitive edge for the facility (Maloney et al., 2007).
Interdisciplinary Team members of Patient Discharge Committee
A committee of several different interdisciplinary team members within the hospital
setting will be assembled in order to collect data, evaluate the data collected, identify strategies
for change, and develop goals to improve the current practice of discharging patients. The
Quality Improvement leader will act as head of the council and guide team members in data
collection strategies, goals, and methods. A lead physician will identify and address factors that
can delay discharge from a physician’s standpoint and assist in evaluating feedback from other
physicians hospital wide. A manager for transport services will participate in discussing and
evaluating delays caused by peak time discharges, nurse delays, and staffing concerns. The
manager of environmental services will participate in evaluating the effectiveness of current
staffing levels and reevaluate allotted time for each patient room clean. A management member
of the physical therapy department will be involved in identifying common discharge delays
related to therapy needs. A charge nurse will provide insight into delays from the floor nurse
role in the process of patient discharge. A discharge planning manager will discuss common
barriers related to insurance, home care, and safety concerns. Collectively this team will work to
establish barriers that hinder the process of discharge for a patient from the time the physician
writes the discharge order to the time that the patient is out of the room.
Data Collection
Data will be collected by each member of the interdisciplinary team and examined during
2 hour meeting that will be held once a week for 6 months. Maloney et al., (2007) developed
ANALYSIS OF THE NURSING LEADERSHIP ROLE
5
and implemented a “Patient Tracker” electronic application based on current evidence-based
research to manage and improve the discharge process. The patient discharge committee will be
using similar techniques based on the developments of Maloney et al., (2007). The council will
implement a version of this electronic application to improve coordination and communication
between disciplinary team members by breaking down the discharge process into several steps.
A detailed flowchart will be used to separate the steps of discharge for each
interdisciplinary grouping. As the steps are broken down trends in delays and opportunities for
improvement can be easier identified (Yoder-Wise, 2011). The steps includes the times of
physician order, nurse noting the order, transport services being notified, patient leaving the
room, and room becoming clean. The patient tracker will assist in data collection by identifying
and recording common trends in delays. The program will track the time that a discharge was
entered by a physician to the time the patient was removed from the census. If a notable delay
occurs, the system will be able to identify which step of the process that was responsible and
initiate changes needed to improve upon that step. The flowchart will include boxes and
directional arrows for each individual step to clearly identify opportunity for improvement
(Yoder-Wise, 2011).
Outcomes
Outcome goals are patient-care centered and will be based on decreasing the delay of
patient discharges in each separate step of the discharge process. Comparison data will be taken
and averaged prior to the start of the QI program. The data will also be collected and averaged 6
months after intervention has been initiated to measure outcomes within the organization. The
quality of the outcomes will also be evaluated by benchmarking. The committee will compare
ANALYSIS OF THE NURSING LEADERSHIP ROLE
6
the average delay times of its own facility against that of similar institutions (Yoder-Wise, 2011).
The National Database of Nursing Quality Indicators (NDNQI) will be followed in order to track
falls causing injury, hospital acquired illnesses, and pressure ulcers which all delay the patient’s
ability to be healthy enough for discharge. The committee will also compare the areas of
concern from environmental services, transport services, and nurse staffing ratios to the national
database. This will aid in improving current practice (EBP) based on evidence based practice
from other leading facilities (Yoder-Wise, 2011).
Implementation
Archie & Boren (2009) describe patient discharge as more of a complete process than an
event that happens once. In order to smoothly get the patient moved from the hospital to the next
appropriate step, strong communication needs to occur amongst all systems involved (Archie &
Boren, 2009). Using information evaluated from eligible EBP articles, Archie & Boren (2009)
identify several aims for improvement in health care. They include “lack of inter-professional
communication, lack of executive management buy-in, lack of information sharing, lack of
adequate staffing, inequities of power, ineffective knowledge transfer, government legislation
and departmental barriers” (pg. 18).
Implementation of the changes will begin with regular standardize communication
between the interdisciplinary team members three times a week. Enhancing multidisciplinary
teamwork will help to eliminate gaps in communication. The team members that provide direct
care to the patients will complete care coordination rounds on every patient on Monday,
Wednesday, and Friday during the week. The focus will be on caring for the patient and helping
them to obtain their optimal health to prepare for discharge. Attention will be focused on
ANALYSIS OF THE NURSING LEADERSHIP ROLE
7
anticipating and planning discharge needs within the first 24 hours of admission. Health care
members involved in the care coordination rounds will include the floor nurse, discharge
planner, and a physician on the council. They will meet to identify and openly discuss barriers to
discharge. This will be done to ensure gaps in communication are not the reason the patient is
still admitted.
Aside from this meeting of direct care givers the interdisciplinary committee will be
continuing to work on improving each step of the overall process of discharge. The feedback
from the care coordination rounds will be included in the group’s discussion. Policies will
frequently be reviewed and rewritten in order to properly reflect the current best practices
(Yoder-Wise, 2011).
Evaluation
After the team has broken down the areas of concern and initiated changes based on
evidence based practice, they will continue to meet to evaluate these changes that have been
made. If the team discovers that a certain area of the discharge process continues to struggle
with delays, they will make revisions to the current plan to improve upon the system (YoderWise, 2011). This QI committee will continue to meet at less frequent intervals, evaluation will
involve comparing benchmark data and identifying and adjusting interventions to areas that
struggle. The QI for improving delays in patient discharge will focus on reducing length of stay,
optimizing hospital resources, enhancing multidisciplinary teamwork and improving patient
quality of care, while gaining gain flexibility in hospital capacity (Ortiga et al. 2012).
Conclusion
ANALYSIS OF THE NURSING LEADERSHIP ROLE
Delays in patient discharges have negative consequences for both the patient as well as
the health care facility. Reducing factors that contribute to the ongoing issues related to delayed
patient discharge requires strong leadership of the QI process. Areas in need of improvement
can be more effectively addressed by focusing on an interdisciplinary approach to the problem.
8
ANALYSIS OF THE NURSING LEADERSHIP ROLE
9
References
Archie, R. & Boren, S. (2009). 10. Opportunities for Informatics to Improve Discharge Planning:
A Systematic Review of the Literature. AMIA Annu Symp Proc. 2009; 16–20. Published
online 2009 November 14.
Maloney, C., Wolfe D., Gesteland, H., Hales, J., & Nkoy, F. (2007). A Tool for Improving
Patient Discharge Process and Hospital Communication. AMIA Annu Symp Proc.2007;
493–497. Published online 2007
Ortiga, B., Salazar, A., Jovell, A., Escarrabill, J., Marca, G., & and Corbella, X. (2012).
Standardizing admission and discharge processes to improve patient flow: A cross
sectional study. BMC Health Services Research 12:180. Retrieved from
http://www.biomedcentral.com/1472-6963/12/180
Yoder-Wise, P. (2011). Leading and managing in nursing (5th ed.). St. Louis, MO: Elsevier
Mosby.