Improvement in Healthcare
In the field of healthcare, quality improvement is a persistent and systematic effort that strives to enhance various aspects such as efficiency, effectiveness, performance, accountability, and outcomes, among other quality indicators, within healthcare services or processes. The central focus is on shaping healthcare to be safe, effective, centered around the patient, timely, efficient, and equitable (Vana et al., 2023).
Quality improvement involves the use of specific methods and tools to bring about measurable improvements within a healthcare setting. One of the approaches is through the application of the Plan-Do-Study-Act (PDSA) cycle. This cycle, developed by Dr. W. Edwards Deming, is a systematic process for gaining valuable insights for continual improvement (Vana et al., 2023). It consists of four phases: devising a plan to test a change (Plan), executing the test (Do), observing and learning from the results (Study), and determining what adjustments should be made to the test. This paper will address how the PDSA cycle can be used as a tool to improve communication among healthcare workers, ultimately leading to better patient outcomes.
In the subsequent sections, the steps of the PDSA quality improvement framework will be applied to the selected root cause of the RCA, which is ineffective communication among healthcare workers leading to compromised patient safety. The advantages and potential challenges of using the PDSA cycle in this context will also be discussed, providing a comprehensive overview of this approach.
Plan
The identified problem in the given context is the lack of effective communication among the surgeon, nurse, and anesthesiologist in the healthcare team. The 2023 study by Lee et al. supports the fact that the operating room is frequently a hotbed of strong emotions, leading to subpar teamwork, ineffective communication, and potential risks to patient safety. The root of this communication issue is the hierarchical culture and the inability of the nurse and the anesthesiologist to question the surgeon. Pattni et al., in their 2019 study, underscored the importance of acquiring the skills and knowledge necessary to voice concerns and question authority when patient safety is in danger.
The action plan involves training all the team members in the operating room on a communication tool known as the Two-Challenge Rule, which is expected to enhance team collaboration and boost patient safety. The Two-Challenge Rule tool empowers all team members to halt a process if they identify a critical safety issue. If the initial concern is not acknowledged or addressed, the team member is encouraged to voice it again. If the concern still isn’t addressed after two attempts, the team member should escalate the issue to a higher authority. This rule promotes open communication and ensures that concerns about patient safety are heard and acted upon. The objective goal is to achieve a 25% reduction in communication-related incidents in the operating room within six months.
Do
The change to be implemented will be the use of the Two-Challenge Rule in an operating room to see if using it will reduce the errors that happen in relation to communication barriers. The operating room staff will be educated on the Two-Challenge Rule and how to use it prior to collecting the data. One study that was mentioned before by Lee et al. (2023), states that team members in the operating room are more likely to speak up when the leader of the surgery (the lead surgeon) has a positive attitude during the surgery. Due to this, the education the operating room team members would receive will talk about working towards having a positive attitude to promote an environment that allows members to speak up. Data will be collected before using this rule and after to see if there is a reduction in incidents. There will be three different operating rooms evaluated after each team member receives education in 5 sessions related to the Two Challenge rule. These operating rooms will be evaluated in the 6 months prior to the education session and 6 months after the education is received to see if there is an improvement.
Study
Two different articles one by Etherington et al. (2019) and one by Garrett (2016), both talk about the Two Challenge rule and how it is effective in improving communication between members of the operating team which then helps to improve errors and patient safety. In almost 1 in 10 cases in the operating room, the patient has complications related to an error (Etherington et al., 2019). Of these errors, 50% are preventable and communication failure is the cause of most (Etherington et al., 2019). As mentioned previously, the Two Challenge rule helps communication in the operating room that could cause potential errors. Because of this, there will be a reduction in errors overall if this approach is taught and used in the operating room. Currently, there is no data to show the effectiveness of the Two Challenge rule in operating rooms. Due to this, there is no data to show if there is a reduction in errors from communication by 25% in 6 months to conclude the goal is met.
Act
Based on the data found in the Study portion, the plan for this PDSA would need to be changed or adjusted. There then would need to be another PDSA that would start. The newly revised plan could focus on teaching the Two Challenge rule and determining if there is an increase in the confidence and willingness of the team members to speak up in situations where the patient’s safety is compromised. After reviewing studies about this, it could show an increase in staff members’ ability and comfort in speaking up to the surgeon or other members during a surgery that could negatively impact the patient or cause a preventable error. Once this is determined, it could show that there is a potential for an increase in people speaking up and communicating in the operating room when a possible error occurs. This could then show a potential decrease or reduction in errors in this area. It could also create more studies in the future related to the Two Challenge rule and its relation to a reduction of errors.
Discussion
· Interpret the results. Did we achieve what we aimed for? Why/why not? Discuss any barriers, challenges, or surprises we encountered.
· : I will complete this discussion piece when everyone is done with the PDSA pieces!
Conclusion
· Summarize the main points of our paper.
· Restate the importance of the PDSA model in improving healthcare quality.
