week 41.2 NR532



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Roussel, Thomas, and Harris (2017) report that a microsystem analysis includes five P’s of purpose, populations, processes, patterns, and providers. A comprehensive analysis using a standardized approach to high light opportunities for improvement. Our purpose is to find the cause of the increase in malpractice claims and improve patient outcomes. The population is patients with operative procedures using Davinci robotics. The process is the Davinci robotic procedure. Next, patterns to narrow the search to understand cause and the providers are the nursing staff working in the OR. Jones, Polancich, Steaban, Feistritzer, and Poe believe quality and patient safety requires efforts from all nursing leadership. The nurse executive (CNO) is paramount to the team and drives the vision of nursing to deliver safe, quality, efficient, patient-centered care (2017, p.186). The leadership skills of CNO are necessary to achieve high-quality patient care and excellent clinical outcomes (Jones, Polancich, Steaban, Feistritzer, & Poe). The CNO establishes the direction and identifies goals to provide the foundation for strategic planning.

The first action as a leadership team is to determine if all the claims revolve around the same type of issues by gathering data on the claims. I will meet with the quality team and nursing leaders to identify the issues. Once we study the data then we will determine how to proceed. Does it appear to be a process issue or a person issue? Is there a lack of knowledge? From the data, we find a trend with procedures done by Davinci robotic surgeries. The clinical nurse leader will observe a Davinci surgery to examine the workflow process to determine areas of opportunity. The process is mapped out in detail to determine areas of concern. It was found that Davinci procedures are now being performed with new equipment. The data is further examined to determine a pattern. Is the data related to a process, structural, or outcomes-based to decide what needs to be improved? We must decide if there is a flaw in the procedure or equipment. Finally, we look at the staff and their experience, education, and familiarity with the procedure and equipment. Is there a knowledge-based error? We know from our previous reports that staffing has been a concern and there are many new RNs working in the OR. We look at the roles of all staff associated with the procedure including the providers. The data shows that many newer nurses may be unfamiliar with the use of the new equipment, so we have an area of opportunity to educate and train the staff. The education plan, communication plan, and timeline will be developed and shared. This communication will explain the plans for the change and allow for additional input if necessary. Physicians and key stakeholders will also need to be informed about the change in advance of implementation. This gives time for additional training of physicians and ancillary staff. Listening to the feedback from teams is important. As the changes are implemented, staff will have feedback on what is working and what is not so daily huddles will be needed with staff. Feedback will be monitored, and changes made as needed to improve patient outcomes. Effective communication and enhancing team culture are especially important in strategic planning. As part of our commitment to our community, we want to provide safe high-quality patient-centered care so we will strive to decrease malpractice claims.



Jones, P., Polancich, S., Steaban, R., Feistritzer, N., & Poe, T. (2017). Transformational leadership: The chief nursing officer role in leading quality and patient safety. Journal for Healthcare Quality: Official Publication of The National Association for Healthcare Quality, 39(3), 186–190. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1097/JHQ.0000000000000090 (Links to an external site.)

Roussel, L., Thomas, P. L., & Harris, J. L. (2016). Management and leadership for nurse administrators (7th ed.). Burlington, MA: Jones & Bartlett Learning.

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