Quality Improvement Project to Help Patients Sleep Better
Introduction
Despite a gradual improvement of the healthcare system in the United Kingdom, the country still experiences poor nursing indicators, which are attributed to the quality of care provided to the patients. Studies indicate the prevalence of high rates of hospital-acquired infections and poor patient satisfaction an indication of the need for enhanced quality of care for overall patient safety and high rates of productivity in the hospital settings. It is therefore crucial for the healthcare workers and stakeholders within the sector to collaborate and put measures such as critical thinking and decision-making, effective leadership, and pooling of resources and personnel in place to facilitate an improvement of care delivery and overall patient recovery process. This essay will describe the implementation of a quality improvement project providing a detailed explanation of the leadership approach that would steer the implementation of a successful quality improvement project. The essay will provide a practical example of the steps that would be involved in the quality improvement project aimed at helping patients sleep better in the hospital environment.
The Institute of Medicine (IOM) defines healthcare quality as the extent to which the healthcare services provided are likely to yield the desired health outcomes and at the same time are consistent with the professional knowledge (Busse et al., 2022). The Institute of Health emphasized the need for healthcare outcomes to reflect patient satisfaction and the quality of life measures. Nursing literature indicates that some of the issues that indicate the quality of care include but are not limited to clinical skill, health-related communication, rapport, effective communication, empathy, courtesy, and enough time for care (Hannawa et al., 2021). Based on the nursing literature it is therefore conclusive to assert that the quality of healthcare is determined by processes of care, which are directly facilitated by the hospital staff such as the nurses and clinicians as well as the patient outcomes. Quality of healthcare is therefore likely to be determined by the timely provision of patient care, the mode of communication, the involvement of the patient and the family in the decision-making, and overall demonstration of competency during the provision of care (Farr & Cressey, 2015). For example, healthcare practitioners should ensure that they provide quality and safe care guided by evidence-based guidelines and principles. Patient outcomes that would indicate a high quality of care include issues like high levels of patient satisfaction, high levels of happiness, and overall positive feedback about their interactions with the healthcare practitioners during the process of care.
The domain of healthcare quality, therefore, is determined by a myriad of processes and activities within the healthcare settings, all of which culminate in the process of care delivery (Al-Jabri et al., 2021; Dixon, 2021). Hospitalized patients are at a heightened risk of experiencing poor health outcomes attributed to the processes of care and the overall hospital environment. More so, the hospital settings expose patients to medical errors which is a prevalent phenomenon in the settings resulting in poor healthcare outcomes, increased risk of more hospitalization days, health complications, utilization of more hospital resources, and an increased cost of care on the patient. According to Allen-Duck et al. (2017), patient safety is the foundation upon which quality of care is built. Therefore, the ability and initiative of the healthcare practitioner to minimize harm and complications during the healthcare delivery process is a critical aspect of healthcare quality. The healthcare practitioners must be in a position to create a safe and conducive environment that minimizes chances of infection or any healthcare event that would interfere with patient safety.
Many strategies that have been designed to improve healthcare quality include inputs such as technology, the employment of highly trained healthcare personnel, the use of approved pharmaceutical supplies, and operational facilities (Hanefield et al., 2017). The above strategies have been designed with the ultimate goal of supporting the provision of healthcare services that align with the clinical guidelines (Islam & Li, 2019). Nursing studies have emphasized the need for the healthcare sector stakeholders to adopt quality improvement strategies that revolve around patient-centered models of care delivery. It is important to acknowledge that the provision of poor-quality healthcare services can be a barrier to access to universal healthcare coverage and access healthcare services. It is therefore important to acknowledge that the perception of quality of care among the patients could act as a driver of care utilization. The healthcare practitioners, therefore, need to be sensitized and reminded about the need for providing high-quality care to the patients.
Quality improvement entails a process whose goal is to improve the quality of care as well as patient safety. Quality improvement, therefore, seeks to improve the standardization of the hospital processes to improve the patient’s health outcomes. Quality improvement is actualized after evaluation of the patient outcomes and decision-making aimed at improving the standards and process of care in the hospital settings. The process of quality improvement involves three steps namely establishing standards for the desired quality of care, measuring the quality, and improving the quality. It is however vital to acknowledge that the process of quality improvement requires the involvement of leadership to steer forward the process, and resource pooling.
Marquis and Huston (2017) define leadership as a management skill, which focuses on establishing a mission, strategy, and vision as well as providing motivation to the employees. Through effective healthcare leadership, the leaders get the opportunity to influence the juniors positively through mentorship, sensitizing, inclusive decision-making, open communication, and guiding the employees’ perceptions and activities directing them towards the desired goals and objectives. In the healthcare setting, the patient is central to decisions and activities carried out with the goal of improving quality and implementing the proposed changes that would support the intended and proposed change.
This paper will address a quality improvement project on improving the patient’s sleep in the wards. The quality improvement project was inspired by the patient’s feedback.
Quality Improvement Project to Help the Patients Sleep Better
Sleep is an essential basic activity in human daily life, which affects people mentally and physically (Delaney et al., 2018; Auckley et al., 2022). Poor sleep patterns which may be caused by a change in the environment such as due to hospitalization, illness, change of sleep time, or stress have been seen to affect the sleep-wake cycle resulting in sleep deprivation, somnolence, and weakening of the immune system (Kulpatcharapong et al., 2020). Other poor outcomes include an increase in cardiovascular events, cognitive function impairment, an increased risk of falling, and even bone fracture among elderly patients (Uy, 2021; Miller et al., 2019). It is therefore of paramount importance to ensure that patients receive adequate and quality sleep to facilitate a smooth recovery process and ensure both the physical and mental well-being of the patients during hospitalization (Gilsenan, 2017). Despite efforts from the nurses to design and modify the nursing processes to improve the patients’ sleep experience, the hospital environment has been seen to affect the patient’s sleep patterns, which communicates the need for a quality improvement project to improve the patient’s sleeping patterns and hospitalization experience.
The chosen quality improvement project aims at improving the sleep patterns among the hospitalized patients by adopting strategies like reducing noise in the wards from hospital equipment such as IV pumps, reducing the amount of noise and disruptions from hospital staff at night, and improving hospital lighting systems (Tan et al., 2019; Norton 2015). The above strategies are likely to ensure that the patients receive adequate sleep as well as high-quality sleep free from disruptions. The implementation of this project will ensure that the patients will sleep peacefully throughout the night and wake up refreshed the following morning (DuBose & Hadi, 2016; Kirsten, 2021). More so, nursing literature has associated better sleeping patterns with positive health outcomes among the patients, which therefore would translate to a reduced length of hospital stay, a reduction in hospital cost, and overall satisfaction with the hospitalization experience among the patients (Arora & Stewart, 2018; Ritmala-Castren et al., 2021).
The quality improvement project can use various frameworks such as the Lean thinking method, the six-sigma methodology, the model of improvement, and the theory of constraints. The lean thinking method is a framework, which provides an opportunity for creating the desired value with minimal resources as well as less waste. It uses principles such as optimizing the whole, eliminating waste, creating knowledge, building quality, deferring commitment, responding to people, and delivering fast through managing the flow. Six sigma is a methodology, which provides the tools and techniques that are able to define and evaluate each step of a process. The framework increases the performance as well as decreases processes in variation. The theory of constraints is a theory, which identifies the limiting factor in achieving the desired goal and objectives. The goal of the goal is to improve the constraint until it no longer limits the achievement of the set goal. The model of improvement provides a framework, which develops, tests, and implements changes resulting in improvements.
This quality improvement project on improving the patients’ sleep will utilize the three-stage model for improvement. The model provides a methodological approach to conceptualize the need for change and the actions that would need to be adopted to ensure that the desired change is achieved. The three steps of the model are the identification of what one needs to accomplish, and determining whether the change is necessary, while the last step is the identification of the required changes. The last stage of the model will require the utilization of the four-step approach-entailing plan, do, study, and act (PDSA). During the first step of planning, the change agents usually identify the opportunities for change. The second step of doing entails the execution of the proposed change. At this step, the leadership of the change process usually steers the change team and documents any notable observations and problems noted for future improvements. The third step of studying entails the analysis of the obtained data to determine whether the initiated change process resulted in any difference. The fourth step of acting entails the assessment of whether or not the introduced change resulted in the achievement of the desired goals or not.
Change models that can be used to implement the proposed change include but are not limited to Kotter’s change model and Lewin’s Model. Kotter’s change model emphasizes the need to create a favorable environment for change implementation (Mahmood et al., 2018). Kurt Lewin’s change model has three steps unfreezing, movement, and refreezing (Marquis and Huston, 2017). The first step of unfreezing requires that the change agent persuade the team members about the intended change and the desired results that need to be achieved. The leader at this step must assess the motivation of the employees and provide mentorship. The second step of movement entails the implementation of the new and proposed practices while the third step of refreezing entails making the proposed change practice the status quo of the organization.
Kotter’s model of change entails eight steps: creating urgency, forming a coalition, creating a vision for change, communicating the vision, removing the obstacles, creating short-term wins, building on the change, and anchoring the changes to incorporate culture. Based on the proposed change on improving the patient’s sleeping patterns, the urgency that would need to be created would entail sensitizing the nurses on the negative outcomes associated with poor sleep patterns. The healthcare professionals would be taken for nursing seminars and workshops, which would stimulate discussions on the topic. The discussions would enable the nurses to understand the urgency of the issue in line with the standards of practice and their roles and responsibilities are defined by their job descriptions. The poor sleeping patterns have not only been linked with the hospital environment factors but also nursing processes. The nurses will therefore engage in constructive dialogues on how they can create a conducive and favorable environment that would support good sleep among the hospitalized patients. The nurses will therefore be committed and work towards reducing noise from the IV pumps and their nurse-to-nurse conversations in the wards.
The second phase entails the formation of a coalition, which would involve having a powerful team with enough power to spearhead the change process (Pollack & Pollack, 2015). The third and the fourth phases of Kotter’s change model can be combined. The two steps entail creating and communicating a vision for the proposed change. The vision about the need for the patient’s to sleep better will be communicated to the nursing staff during staff meetings or even day-to-day interactions along the corridors of the hospital or even in the nurse stations. The vision will be communicated through actions that will demonstrate my commitment to ensuring patients sleep better. For example, I will ensure optimal lighting and focus on reducing the noise. I will therefore need to show commitment and consistency with the vision to demonstrate the need to make the proposed change a status quo to experience the desired outcomes. The fifth step would entail the removal of the obstacles that could impede the adoption of the proposed change. Change is likely to be faced with barriers that would range from organizational culture and employee characteristics (Small et al., 2016). They include negative perceptions about the change among the nurses. I would therefore need to put measures in place to counter the barriers. Some of the measures that would work include open communication, and the introduction of reward systems.
The three last steps of Kotter’s model for change involve setting short-term goals and wins, building on the change, and anchoring the changes into the organizational culture. Building on the change ensures the team is charged with creating the momentum sets and making the modifications necessary as well as putting efforts to achieve the set objectives (Baloh & Ward, 2018). The eighth step entails making the proposed change to the status quo with the aim being retaining the team members that would ensure that the change is maintained and sustained in the organization.
Leadership Approach for the Quality Improvement Project
Besides the use of Kotter’s Change model, choosing a practical leadership approach to steer the change process would be essential in ensuring that the change team supports the team while at the same time ensuring that the change is sustained and made the status quo. Therefore, effective leadership will be applied in each of Kotter’s change model steps. Some of the principles of leadership that will be used to ensure professionalism and success of the entire process would include inclusive decision-making, and critical thinking. Emotional intelligence and high levels of integrity. It is important to note that I will involve co-production in the quality improvement process. In healthcare, co-production refers to the process of engaging the healthcare service users as active partners in the healthcare provision process (Vennik et al., 2016). The process of co-production is a quality improvement process that should take place between the staff and the patients fostering collaboration and positive health outcomes among the patients (Fusco et al., 2020; Batalden et al., 2015). Therefore, by applying co-production, I will implement the changes in the hospital settings, improving patient outcomes, and satisfaction and promoting collaboration with the other healthcare practitioners involved directly with the care of the hospitalized patients.
I will use situational leadership where leaders adapt to the flexible and dynamic characteristics of the healthcare settings (Skog et al., 2012; Andrigue et al., 2016). The leadership style would be suitable because, in the clinical environment, the leader needs to focus on the presenting problem and subsequently adopt strategies that would ensure successful adoption and sustainability (Rabarison et al., 2013). I will therefore be able to focus on the problem at hand about poor patient sleep experiences and organize workshops and seminars targeting the nurses and enabling them to prioritize patients’ sleep to promote their recovery as well as their physical and mental well-being. The nurses need to have an in-depth understanding of the need to provide a quiet environment free from disruptions, which have been noted in the past to interfere with patients’ quality and length of sleep.
Evaluation of the quality improvement project would be necessary to ensure that it was successfully implemented and at the same time that the previously mentioned strategies mentioned were adopted. It is vital to acknowledge that the success of the project can only be determined by the change in the nursing environment as well as patients’ positive reports confirming that they are getting adequate and quality sleep in the hospital environment. The nurses will be required to minimize noise when walking around the hallways of the wards and noise coming from the IV pumps.
Conclusion
Sleep is a physiological process where if patients experience sleep deprivation may experience poor organ functioning and poor health outcomes. Sleep supports healing and recovery which communicates the need for the healthcare practitioners to ensure that the patient’s sleep conditions are conducive and adequate. The quality improvement project would therefore ensure that nurses and their leaders support better sleep practices among the patients. A situational leadership approach would ensure that the change team steers the change process ahead by ensuring the pooling of both resources and personnel. The change team management would need to ensure that the nurses have access to seminars and workshops to sensitize them about the need for proper sleeping patterns while at the same time ensuring that they take charge in every step of Kotter’s change model. This project aligns with the NMC code themes of practicing effectively, prioritizing people, and preserving patient safety. The change is aimed t ensure that the patients receive the best care and their feedback is prioritized while ensuring that the nurses practice effectively and align with the codes of practice lastly, through the implantation of the proposed change, the patients’ safety will be preserved.
References
Al-Jabri, F., Kvist, T., Sund, R. and Turunen, H., 2021. Quality of care and patient safety at healthcare institutions in Oman: quantitative study of the perspectives of patients and healthcare professionals. BMC health services research, 21(1), pp.1-8.
Allen‐Duck, A., Robinson, J.C. and Stewart, M.W., 2017, October. Healthcare quality: a concept analysis. In Nursing forum (Vol. 52, No. 4, pp. 377-386).
Andrigue, K.C.K., Trindade, L.L., Amestoy, S.C. and Beck, C.L.C., 2016. Situational leadership style adopted by nurses in the hospital field. Rev Eletr Enferm., 18, p.e1191.
Auckley, D., Benca, R. and Eichler, A., 2018. Poor sleep in the hospital: Contributing factors and interventions. UpToDate. Retrieved, April, 3, p.2020.
Baloh, J., Zhu, X. and Ward, M.M., 2018. Implementing team huddles in small rural hospitals: How does the Kotter model of change apply?. Journal of nursing management, 26(5), pp.571-578.
Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L. and Hartung, H., 2016. Coproduction of healthcare service. BMJ quality & safety, 25(7), pp.509-517.
Busse, R., Panteli, D. and Quentin, W., 2019. An introduction to healthcare quality: defining and explaining its role in health systems. Improving healthcare quality in Europe, p.1.
Delaney, L. J., Currie, M. J., Huang, H. C. C., Lopez, V., & Van Haren, F. (2018). “They can rest at home”: an observational study of patients’ quality of sleep in an Australian hospital. BMC health services research, 18(1), 1-9.
Dixon, J., 2021. Improving the quality of care in health systems: towards better strategies. Israel Journal of Health Policy Research, 10(1), pp.1-5.
DuBose, J.R. and Hadi, K., 2016. Improving inpatient environments to support patient sleep. International Journal for Quality in Health Care, 28(5), pp.540-553.
Farr, M. and Cressey, P., 2015. Understanding staff perspectives of quality in practice in healthcare. BMC health services research, 15(1), pp.1-11.
Fusco, F., Marsilio, M. and Guglielmetti, C., 2020. Co-production in health policy and management: a comprehensive bibliometric review. BMC health services research, 20(1), pp.1-16.
Gilsenan, I., 2017. How to promote patients’ sleep in hospital. Nursing Standard, 31(28).
Hanefeld, J., Powell-Jackson, T. and Balabanova, D., 2017. Understanding and measuring quality of care: dealing with complexity. Bulletin of the World Health Organization, 95(5), p.368.
Hannawa, A.F., Wu, A.W., Kolyada, A., Potemkina, A. and Donaldson, L.J., 2022. The aspects of healthcare quality that are important to health professionals and patients: A qualitative study. Patient Education and Counseling, 105(6), pp.1561-1570.
Islam, M. and Li, Y.C., 2019. Quality improvement in healthcare: the need for valid, reliable and efficient methods and indicators. International Journal for Quality in Health Care, 31(7), pp.495-496.
Kulpatcharapong, S., Chewcharat, P., Ruxrungtham, K., Gonlachanvit, S., Patcharatrakul, T., Chaitusaney, B., Muntham, D., Reutrakul, S. and Chirakalwasan, N., 2020. Sleep quality of hospitalized patients, contributing factors, and prevalence of associated disorders. Sleep disorders, 2020.
Mahmood, T., 2018. What models of change can be used to implement change in postgraduate medical education?. Advances in medical education and practice, 9, p.175.
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing. Philadelphia, Wolters Kluwer.
Miller, M.A., Renn, B.N., Chu, F. and Torrence, N., 2019. Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions. General hospital psychiatry, 59, pp.58-66.
Norton, C., Flood, D., Brittin, A. and Miles, J., 2015. Improving sleep for patients in acute hospitals. Nursing Standard (2014+), 29(28), p.35.
Pollack, J. and Pollack, R., 2015. Using Kotter’s eight stage process to manage an organisational change program: Presentation and practice. Systemic practice and action research, 28(1), pp.51-66.
Rabarison, K., Ingram, R.C. and Holsinger Jr, J.W., 2013. Application of situational leadership to the national voluntary public health accreditation process. Frontiers in Public Health, 1, p.26.
Ritmala‐Castren, M., Salanterä, S., Holm, A., Heino, M., Lundgrén‐Laine, H. and Koivunen, M., 2022. Sleep improvement intervention and its effect on patients’ sleep on the ward. Journal of Clinical Nursing, 31(1-2), pp.275-282.
Skog, A., Peyre, S.E., Pozner, C.N., Thorndike, M., Hicks, G. and Dellaripa, P.F., 2012. Assessing physician leadership styles: application of the situational leadership model to transitions in patient acuity. Teaching and learning in medicine, 24(3), pp.225-230.
Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C. and David, D., 2016. Using Kotter’s change model for implementing bedside handoff: a quality improvement project. Journal of nursing care quality, 31(4), pp.304-309.
Stewart, N.H. and Arora, V.M., 2018. Sleep in hospitalized older adults. Sleep medicine clinics, 13(1), pp.127-135.
Tan, X., van Egmond, L., Partinen, M., Lange, T. and Benedict, C., 2019. A narrative review of interventions for improving sleep and reducing circadian disruption in medical inpatients. Sleep medicine, 59, pp.42-50.
Uy, C.K., 2021. Improving Sleep for Hospitalized Patients. AJN The American Journal of Nursing, 121(3), p.13.
Vennik, F.D., Van de Bovenkamp, H.M., Putters, K. and Grit, K.J., 2016. Co-production in healthcare: rhetoric and practice. International Review of Administrative Sciences, 82(1), pp.150-168.