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Feb 20, 2024

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1 Building a Quality Initiative Team Windy Tanner South University NSG 4029 Leadership in a Diverse Society Dr. Evalyn Gossett January 25, 2022

2 Building a Quality Initiative Team The Cardiac Catheterization Unit recently received its quarterly quality report concerning its percutaneous cardiac intervention (PCI) program. It defines specific performance measures based on best practices and national benchmarks. A trend in data concludes that a less-than- optimal outcome has occurred for post PCI patients, resulting in contrast-induced kidney injury for our facility. After a careful review of the information, leadership requests the development of a team to review the quality of the PCI program using the quality metrics set forth by the (NCDR) National Cardiovascular Data Registry Cath PCI registry. T he registry contributes to the quality of care by providing data feedback on a wide range of performance metrics to participating facilities and aiding local and national quality improvement efforts (Moussa et al., 2013). Effective teams define the group's purpose, set specific goals to meet the objective, establish clear roles, and select the right members to accomplish the task. Teams also need to identify and provide the necessary resources to implement the plan understand the who, what, when of the activities and functions with an efficient communication platform (Murray, 2017). Identification of a nurse and physician champion to drive the purpose will aid in meeting the goals timely, assist in collaborating with selected members, and push through roadblocks. A quality improvement team is necessary to set the foundation and drive the quality improvement plan for decreasing the number of patients with a contrast-induced kidney injury post PCI. Team Development Developing a team requires leadership to identify the correct players for the project. The people necessary to successfully implement the quality improvement team are the first considerations. The key people needed to implement the quality improvement project are nursing leadership and frontline staff, laboratory staff, pharmacists, cardiologists, hospitalist physicians,

3 nurse practitioners, and information technology support. Physicians, nurse practitioners, and Pharmacists can provide valuable input into the quality initiative by evaluating patient conditions, treatments, and outcomes. Frontline and laboratory staff can attest to successes or challenges in the quality forum. Information technology supports improvements in collecting data, revising documentation tools, and reporting the information. Nursing leadership organizes the data, keeps the initiative on target, and conveys the outcomes to the senior leadership team. After identifying who needs to be at the table, communicating the problem statement and purpose of the team will be the next step. Establishing a meeting time and venue that is cohesive to the majority ensures that everyone can attend to discuss the needs, set specific goals, identify the barriers, assign tasks, and allocate resources. Today many organizations hold meetings in virtual rooms. Alternatives to the traditional work meeting encourage attendance, greater involvement, and people having the freedom to accomplish more in a shorter amount of time. This project will use the Microsoft TEAMS platform allowing for files to be shared and viewed by all working on the project. It has an excellent communication platform to keep everyone informed and updated on new developments. Once the team is established and starts collaborating on ideas, the development of the purpose statement occurs. Purpose Statement The purpose statement is to prevent or reduce the number of contrast-induced kidney injuries in the post PCI population. Understanding the problem and purpose allows reflection on each person's role on the quality improvement team. Each member has a specific skill to bring to the table, from identifying who is responsible for implementing leadership and physician staff changes. To staff knowing what best practices are already in place to monitor contrast-induced kidney injuries—following the patient through the hospitalization to understand when and where

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4 the gaps in fluid resuscitation occur—reviewing charts to establish the current practices in fluid administration post PCI. Research also provides physicians and staff with the most up-to-date information and best practices on the problem. Once data collection, monitoring, and reporting are determined, responsibility assignment occurs to specific sections. The team will need to establish the monitoring parameters of how the information presented will appear when the reviews happen and how the data distribution transpires. Work can begin on the goals and objectives. The purpose statement drives the plans for the quality improvement project. The Deeming cycle (PDCA) involves identifying the problem, purpose, or goal, defining the success metrics, and implementing a plan ( Patel & Deshpande, 2015). These activities include the Do step, in which implementation of the plan's components ensues. Next comes the check step, where monitoring outcomes occurs and the validity of the project for progress and success, or problems and areas of improvement ( Patel & Deshpande, 2015). The Act step closes the cycle, integrating the lessons learned through the process. Nurses use the PDCA cycle to achieve the goal, change methods, or reformulate the problem altogether ( Patel & Deshpande, 2015). The cycle is continuous in quality improvement. Goals The discussion of specific goals and timelines is the project's next stage. Quality programs should receive the full support of senior leadership to implement teams to review and devise education plans to improve the outcomes in PCI patients. Selecting goals using the SMART action plan to incorporate the following five characteristics to be specific, measurable, attainable, relevant, and time-based allows direction for the quality program ( Cothran and Wysocki, 2005). The quality team needs to understand the organizations' culture to quality. To accomplish this, a collection of the present culture is necessary. Identify what achievement goals

5 need to be established and take steps to close the gap (Khan, 2006). Goals can be strategic or serve as an internal source of motivation and commitment, providing guidance for action and measuring performance. Goals help define and articulate the objective and how an organization will get there by delivering direction ( Cothran and Wysocki, 2005). Roles and Relationships of Team Members A variety of skills are essential to bringing the vision reducing the number of patients with contrast-induced kidney injury post PCI. Each team member brings a particular skill set to the table to bring solutions and ideas to meet the purpose statement. Clear job descriptions define the responsibilities of the individual in the workgroup. Team members need to feel free to express opinions ideas and fully engage during the goal development phase. Early identification of possible obstacles and ways to overcome them fuels the plan's success during the implementation phase. The members who value everyone's input encourage growth and unlock a successful team's potential. When implementing the team, understanding the team members' ability to mesh well, to accomplish the goal is a consideration. C onsciously involving team members in decision-making, delegating responsibilities appropriately, and empowering members to make decisions facilitates leadership (Smith et al., 2018). Successful teams have set expectations of the team members, cultivating a climate of mutual respect during discussions, ensuring cohesion, and developing the interpersonal skills of the group (Smith et al., 2018). Smith, Fowler-Davis, Nancarrow, Ariss, and Enderby (2018) stress the importance of ensuring that work allocation is equal, coordination of tasks, and teams promote interprofessional collaboration for the team's success. Having the right people at the table that are willing to put the work into the project, complete items on time, remain open-minded about possible options allows for problems to be apparent early on and addressed before pitfalls occur. Feldman (2018)

6 states that assembling a group of individuals willing to work for the greater good can make the difference between the success and failure of any team. Leadership Leadership styles and effects on quality Transformational leadership fosters significantly more positive attitudes toward quality changes while laissez-faire and aversive leadership styles actively inhibit changes (Chen et al., 2018). Kiwanuka, Nanyonga, Sak‐Dankosky, Muwanguzi, and Kvist (2021) report a solid link between nursing leadership styles on structural and outcome measures in nursing units. When used by nurse leaders, transformational, considerate, exemplary leadership practices and trusted leadership styles guarantee a higher quality of nursing care resulting in improved outcomes ( Kiwanuka et al., 2021). Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the organization in quality initiatives (Cummings et al., 2018). Effective teams produce desired results; however, team members must demonstrate effective processes to achieve these outcomes (Lacerenza et al., 2018). Personal Leadership Skills I am very detail-oriented with a drive to understand the objectives of any project involved. Evaluating the situation and researching before formulating a problem statement or plan is a strength of mine. Sound leaders need to lean on one another and speak up when they need help. I seek input from others and use a collaborative team approach when tackling issues. I am very transparent with my team, which encourages honest feedback. Some weaknesses that I am working on include engaging more with staff on personal levels, keeping conversations on track during meetings, not letting the discussion get off-topic, and keeping items to the schedule. Staff engagement establishes well-being among the group and breaks down communication

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7 barriers. Maintaining control of meetings with the schedule and time respects others. Evaluating one's leadership skills by being objective and open to feedback allows growth and change that can result in positive outcomes. Developing nursing leadership will help ensure that future nurses have the skills to conquer the healthcare system's challenges (Cummings et al., 2021). Nurse leaders' role in affecting patient, personnel, and organizational outcomes is vital (Cummings et al., 2021). Stages of Team Development Team development does not occur overnight. There are five stages in which teams experience. Forming is the introductory phase, where everyone gets acquainted and establishes roles. The establishment of the team leader and objectives occurs in this phase. Discussion on the project occurs next in the storming stage. The storming stage is essential, and many projects die in this phase concerning disagreements and personal biases. The conflict can lead to nonproductivity. The next step is norming; it is vital for success in the team. Resolution of issues occurs in this stage through open communication. Members need to recognize each other's strengths and weaknesses and their roles. The norming step requires conscious leadership and clear, open two-way communication. Performing follows, and in this stage, everyone is functioning at its peak, on task and understands their roles. The team is working toward the one common goal and supporting each other along the way. Adjourning occurs when the mission is complete and obtaining achievement of the goal. Understanding the team-building dynamics and using these concept stages, the momentum can keep the group moving forward towards the goal and encourage teamwork along the way ( Vaida and Serban, 2021). First Meeting

8 The team's planning requires selecting the correct key people, collecting data to support the cause, planning topics, goals, and deadlines is part of successful team building. I am choosing to use the TEAMS platform as the communication foundation for the meetings. The ability to discuss verbally and via chat box option the reason for creating the team encourages everyone to participate. Screensharing and emailing the current data to support the purpose or problem statement allows members to visualize the concerns and formulate resolutions. Providing evidence-based research articles engages the members to develop an in-depth understanding of the issue. Organization of meeting times, deadlines, data collected, workflow plans, PDCA forms, and updates can be shared in one folder with the TEAMS site to stay in touch and current on the project. The leadership drives information sharing, defining roles and responsibilities, setting goals and target dates, and frequent status updates keep the quality initiative on track to meet the organization's quality goals and improve the care provided to the post PCI population. Conclusion Quality initiatives drive outcomes in organizations. The NCDR Cath PCI registry has national benchmarks to gauge s performance against other facilities of the same size or volume. Quality teams use the Plan, Do, Check, Act (PDCA) to formulate purpose statements, define goals, monitor progress, and evaluate the outcomes. Nursing leaders play a critical role in quality outcomes and set the tone for nursing units. Defining clear roles and responsibilities is established in the forming stage. After moving through team-building stages, quality teams successfully set aside personal biases. Open communication fosters growth and results in moving the project to success. Identifying a physician and nurse champion for the quality initiative will maintain engagement. The nurse leader's responsibilities include keeping timelines on target and

9 reporting the data to senior leadership. Changes occur after careful consideration and adaptation of the organizations' culture. Effective teams work diligently toward the common greater good to improve outcomes and are essential for successful group development in our personal and professional life ( Vaida and Serban, 2021).

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10 References Chen, Y., Ning, R., Yang, T., Feng, S., & Yang, C. (2018). Is transformational leadership always good for employee task performance? Examining curvilinear and moderated relationships. Frontiers of Business Research in China , 12 (1), 1-28. Cothran, H. M., & Wysocki, A. F. (2005). Developing SMART goals for your organization. EDIS , 2005 (14). Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International journal of nursing studies , 85 , 19-60. Cummings, G. G., Lee, S., Tate, K., Penconek, T., Micaroni, S. P., Paananen, T., & Chatterjee, G. E. (2021). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International journal of nursing studies , 115 , 103842. Feldman, H. R. (2018). Identifying, building, and sustaining your leadership team. Journal of Professional Nursing , 34 (2), 87-91. Khan, N. (2006). The role of culture in successful implementation of quality initiatives. In Pakistan's 10th International Convention on Quality Improvement November (pp. 27- 28). Kiwanuka, F., Nanyonga, R. C., Sak‐Dankosky, N., Muwanguzi, P. A., & Kvist, T. (2021). Nursing leadership styles and their impact on intensive care unit quality measures: An integrative review. Journal of Nursing Management , 29 (2), 133-142.

11 Lacerenza, C. N., Marlow, S. L., Tannenbaum, S. I., & Salas, E. (2018). Team development interventions: Evidence-based approaches for improving teamwork. American Psychologist , 73 (4), 517. Moussa, I., Hermann, A., Messenger, J. C., Dehmer, G. J., Weaver, W. D., Rumsfeld, J. S., & Masoudi, F. A. (2013). The NCDR CathPCI Registry: a US national perspective on care and outcomes for percutaneous coronary intervention. Heart , 99 (5), 297-303. Murray, E. (2017). Nursing leadership and management for patient safety and quality care with DavisPlus resources. F. A. Davis Company. https://digitalbookshelf.southuniversity.edu/books/9780803698024 Patel, P. M., & Deshpande, V. A. (2015). Application of plan-do-check-act cycle for quality and productivity improvement-A review. Studies , 2 (6), 23-34. Smith, T., Fowler-Davis, S., Nancarrow, S., Ariss, S. M. B., & Enderby, P. (2018). Leadership in interprofessional health and social care teams: a literature review. Leadership in Health Services . Vaida, S., & Serban, D. (2021). Group development stages. A brief comparative analysis of various models. Studia Universitatis Babes-Bolyai, Psychologia-Paedagogia , 66 (1).

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