Discussion: Quality & Sustainability Program Paper

Discussion: Quality & Sustainability Program Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Quality & Sustainability Program Paper The Quality and Sustainability Paper is a practice immersion assignment designed to be completed in three sections. This is part three of the assignment. Learners are required to provide a theoretical framework that supports the design and implementation of their evidence-based quality and/or safety program and discuss expected outcomes. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper General Guidelines: Discussion: Quality & Sustainability Program Paper Use the following information to ensure successful completion of the assignment: This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. This assignment requires that you support your position by referencing at least six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings. You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. Directions: Write a 2,000-2,500 word paper that provides the following: Discussion: Quality & Sustainability Program Paper Identify a quality, change, or safety theory you will use to support the implementation of your quality and/or safety program. Provide evidence that supports the use of this theory within the program you designed. Provide the design of your evidenced-based quality and/or safety program that can be implemented to improve quality or safety outcomes in your identified entity. Discuss expected outcomes of your implementation and how to ensure their sustainability. Support your position by referencing at least five to six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings.Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper rubric_quality_and_sustainability_part_3.xlsx evaulation_of_a_collaborative_care_model_for_hospitalized_patients.pdf training_nurses_and_resident_to_work_as_a_patient_centered_care_team_on_a_medical_ward.pdf Course Code DNP-835 Class Code DNP-835-IO10310 Criteria Content Percentage 70.0% Completed Changes and Corrected Errors to Subsequent Paper, Including Transitions for a Scholarly Paper 5.0% Identification of Quality, Change, or Safety Theory to Support Implementation of Quality or Safety Program 10.0% Design of Evidence-Based Quality or Safety Program to Implement in Proposed Health Care Entity 25.0% Expected Outcomes and Sustainability 20.0% Six to Eight Additional Scholarly Research Sources With In-Text Citations 10.0% Organization and Effectiveness 20.0% Thesis Development and Purpose 7.0% Argument Logic and Construction 8.0% Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Format 10.0% Paper Format (use of appropriate style for the major and assignment) 5.0% Research Citations (in-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) 5.0% Total Weightage 100% Assignment Title Quality and Sustainability Part Three – Implementation and Evaluation Unsatisfactory (0.00%) Learner did not attach previous paper and did not make changes as indicated. A theory is not used to support implementation of the quality and/or safety program. Discussion: Quality & Sustainability Program Paper. Program design of quality and/or safety program is not presented. The program does not utilize an evidence-based design. Expected outcomes and steps to ensure sustainability are not discussed. None of the required elements (minimum of six topic-related scholarly research sources and six in-text citations) are present. Paper lacks any discernible overall purpose or organizing claim. Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Template is not used appropriately or documentation format is rarely followed correctly. No reference page is included. No citations are used. Total Points 180.0 Less than Satisfactory (74.00%) N/A Theoretical support is discussed, but a specific theory is not identified to support implementation of the quality and/or safety program. Evidence that supports the use of this theory in the proposed program is not presented. Program design of quality and/or safety program is referenced, but a clear description of the program is missing. The program does not utilize an evidence-based design. Expected outcomes and sustainability are referenced, but no specific outcomes or steps to ensure sustainability are discussed. Not all required elements are present. One or more elements are missing and/or included sources are not scholarly research or topic-related. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Sufficient justification of claims is lacking. Argument lacks consistent unity. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper There are obvious flaws in the logic. Some sources have questionable credibility. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) and/or word choice are present. Sentence structure is correct but not varied. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Reference page is present. Citations are inconsistently used. Satisfactory (79.00%) Learner attached previous paper and has made changes as indicated. Learner needs to incorporate transitions to connect the ideas between the papers. Theoretical support is discussed that references a specific theory. It is unclear how this theory supports implementation of the quality and/or safety program. Evidence that supports the use of this theory in the proposed program is not presented. Program design of quality and/or safety program is described, but numerous details are missing. There is no substantiation that the design can be implemented. The program partially includes an evidence-based design. Expected outcomes and sustainability are discussed, but the projected outcomes lack support for claims, or the plan for sustainability lacks specific steps. All required elements are present. Scholarly research sources are topic-related, but the source and quality of one or more references is questionable. Thesis and/or main claim are apparent and appropriate to purpose. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Appropriate template is used. Formatting is correct, although some minor errors may be present. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Good (87.00%) Learner attached previous paper and has made changes as indicated. Learner needs to incorporate better transitions to connect the ideas between the papers. Theoretical support is discussed using a specific theory. The theory supports implementation of the quality and/or safety program. General evidence that supports the use of this theory in the proposed program is presented. Program design of quality and/or safety program is generally described and there is adequate substantiation that the design can be implemented. The program utilizes an evidencebased design. Expected outcomes and sustainability are discussed. Projected outcomes are supported, and general steps to ensure sustainability are presented. All required elements are present. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper Scholarly research sources are topic-related and obtained from reputable professional sources. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. Appropriate template is fully used. There are virtually no errors in formatting style. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. Excellent (100.00%) Learner attached previous paper and has made changes as indicated. Learner has includes all necessary transitions to create a scholarly paper. Theoretical support is thoroughly discussed using a specific theory. The discussion provides insight in to successfully implementing the quality and/or safety program. Strong evidence that supports the use of this theory in the proposed program is presented. Program design of quality and/or safety program is clearly described and substantiates that the design can be implemented. The program utilizes an evidence-based design. Strong evidence is provided to support the program design and implementation. Expected outcomes and sustainability are thoroughly discussed. Projected outcomes are supported with clear evidence, and very specific steps to ensure sustainability are discussed. All required elements are present. Scholarly research sources are topic-related and obtained from highly respected, professional, original sources. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Discussion: Quality & Sustainability Program Paper Thesis statement makes the purpose of the paper clear. Comments Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. Writer is clearly in command of standard, written, academic English. All format elements are correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error. Points Earned Cheryl McKay K. Lynn Wieck Evaluation of a Collaborative Care Model for Hospitalized Patients EXECUTIVE SUMMARY The current lack of collaborative care is contributing to higher mortality rates and longer hospital stays in the United States. A method for improving collaboration among health professionals for patients with congestive heart failure, the Clinical Integration Model (CIM), was implemented. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper The CIM utilized a process tool called the CareGraph® to prioritize care for the interdisciplinary team. The CareGraph was used to focus communication and treatment strategies of health professionals on the patient rather than the discipline or specific task. Hospitals who used the collaborative model demonstrated shorter lengths of stay and cost per case. CHERYL McKAY, PhD, CNS, RN, completed this work as part of her doctoral education at the University of Texas at Tyler. She is presently Nurse Executive, Healthier Populations, OrionHealth, Santa Monica, CA. K. LYNN WIECK, PhD, RN, FAAN, is Mary Coulter Dowdy Distinguished Nursing Professor, University of Texas at Tyler. 248 NTERDISCIPLINARY collaboration is an emerging mandate to decrease fragmentation of care delivery in U.S. hospitals. Higher mortality rates (Estabrooks, Midodzi, Cummings, Ricker, & Giovannetti, 2005) and longer lengths of hospital stay (Zwarenstein, Goldman, & Reeves, 2009) have been found in environments where collaboration is limited or not present. As many as 98,000 people die in hospitals each year as a result of medical errors which may be traced to lack of collaboration and disjointed care. Beyond the cost of human lives, billions of dollars are spent annually for additional care resulting from medical errors (Kohn, Corrigan, & Donaldson, 2000). The aim of this study was to determine if a care delivery model based on collaboration and coordination of care using the CareGraph® would improve patient outcomes. To provide high-quality care and meet public expectations with limited resources, collaboration has become a necessity. In a landmark study, Knaus, Draper, Wagner, and Zimmerman (1986) found that hospitals where collaboration was present reported a mortality rate 41% lower than the predicted number of deaths. Hospitals where there was little to no collaboration exceeded predicted mortality by as much as 58%. Collaborative I relationships have also been tied to reduced costs for the health care system (Zwarenstein et al., 2009). Although empirical evidence in support of collaboration in the health care environment is available in the literature, there is little evidence on how to create this environment (Tschannen, 2004). Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper The main structural elements necessary for collaboration in an acute care environment include a culture where relationships are valued, health care professionals communicate effectively, and respect is shared among all parties. A model of care delivery consistent with these cultural values and focused on patient safety is paramount. A Midwestern health care system designed an innovative model of care delivery where collaboration was purposefully woven into the structures and processes to effect positive change in patient and organizational outcomes. Called the Clinical Integration Model (CIM) (Zander, 2007), several of the health system hospitals adopted it while others chose to stay with a traditional primary care model. Comparing hospitals within the health system provides an opportunity to determine if there is a difference in survival, length of stay (LOS), and cost for patients receiving care in facilities utilizing the CIM and those receiv- NURSING ECONOMIC$/September-October 2014/Vol. 32/No. 5 ing care in facilities utilizing a primary care model. Collaboration in Health Care Collaboration, as defined by the American Nurses’ Association (ANA) (2010), is a partnership based on trust with shared power, recognition, and acceptance of separate and combined practice spheres of activity and responsibility. Collaboration also includes mutual safeguarding of the legitimate interests of each party and a commonality of goals. The key components of shared power, recognition and acceptance, and common goals are relevant to many of the definitions found in the literature (Fewster-Thuente & Velsor-Friedrich, 2008; Petri, 2010). These components are essential for a collaborative process and can be operationalized in an acute care setting. A number of factors have affected the ability of health care organizations to provide a collaborative environment including the educational system and professionalization of health care practitioners. Studying determinants of successful collaboration, San MartinRodriguez, Beaulieu, D’Amour, and Ferrada-Videla (2005) found health care practitioners develop a strong professional identification through education. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper This strong professional identification often limits knowledge of other professionals within the team and is considered a main obstacle to collaboration. The dynamics of professionalization lead to further differentiation of health care professionals (D’Amour & Oandasan, 2005) and potential conflict hindering the development of true collaborative relationships. Collaboration in health care affects patient survival and decreases adverse patient outcomes. Knaus and colleagues (1986) found hospitals where collaboration was present reported a significant decrease in mortality rates (Chi square=62.9, df 12; p<0.0001, r=0.83). Hospitals where there was little to no perceived collaboration exceeded predicted mortality. Positive collaborative relations have also been tied to a decrease in failure to rescue. Boyle (2004) evaluated unit-level characteristics and the impact on patient outcomes and found a negative correlation between collaboration and failure to rescue (r= -0.53). High levels of perceived collaboration were linked to early detection of change in clinical condition and appropriate intervention leading to a decrease in failure to rescue. Collaborative environments can positively affect health system outcomes. Ovretveit (2011) evaluated the impact of clinical coordination and collaboration and found when collaboration and coordination were present, patients experienced a shorter LOS with lower costs to the health care institution. Additionally, Zwarenstein and co-authors (2009) evaluated multiple studies to determine the impact of interprofessional collaboration and found 80% of the studies demonstrated decreased LOS and cost savings to the health care institutions. Barriers to Collaboration in Health Care The barriers to collaboration are rooted in the hierarchal and long-established structures of most health care organizations and are difficult to change. The nursephysician relationship is one example of an established hierarchal relationship that has been a barrier to true collaboration in health care facilities. Hojat and colleagues (2001) conducted a cross-cultural study evaluating nurse-physician attitudes toward collaboration and found nurses in both the United States and Mexico expressed more positive attitudes toward collaboration than their physician counterparts (p<0.01). As a possible solution, the authors recommended inter-professional education to improve nurse-physician collaboration. NURSING ECONOMIC$/September-October 2014/Vol. 32/No. 5 Empirically the link between collaboration and improved patient and system outcomes has been demonstrated, but there remains a gap in the literature on how to create a collaborative environment. This study begins to fill the gap by looking at a large scale change of care delivery based on essential collaborative structures and processes and its impact at the patient, hospital, and system levels. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper Theoretical Framework The Donabedian Model (1966) is proposed as a way of providing essential structures and processes for collaboration in the health care setting. The model was used to provide a comprehensive structure to move from inputs through the process of care delivery, and conclude with the outcomes for this study. In accordance with the Donabedian Structure, Process, Outcome Model (see Figure 1), structure refers to the environment in which care is provided. Structure encompasses the work environment, availability of equipment and supplies, and type of unit. These structural elements tend to be relatively permanent in nature and are often thought of as key determinants to quality (Donabedian, 1988). Process elements are more flexible and readily changeable. Process encompasses the things health care workers do or fail to do which shape patient outcomes (Montalvo & Dunton, 2007). Outcomes are the changes in patients’ health attributable to their care (Montalvo & Dunton, 2007). According to Donabedian (1988), changes in structures and processes of care are required to optimize patient outcomes. The Structure, Process, Outcome Model proposes the context (structure) in which the intervention (process) occurs has an influence on the outcomes. Collaboration is seen as the process that occurs within a specific context leading to the measured results or 249 Figure 1. Donabedian Structure, Process, Outcome Model (Adapted) Modified Donabedian Model for Clinical Integration Program Structure Patient diagnosis Core measure compliance Type of unit Outcomes Patient survival Length of stay Cost per case Process Clinical Integration Model or Traditional care delivery model Information exchange Clinical Integration Model Patient admitted. CareGraph completed. Top three problems and discharge goals identified. Does patient need complex care? Does patient need complex care? NO Patient progressing toward discharge goals. Patient discharged from complex care team meetings. Patient discharged from hospital with goals met. NO Continue interdisciplinary care coordination. Focus on top three problems. SOURCE: Adapted from Donabedian, 1966. outcomes. The process of collaboration not only requires health care providers to communicate effectively and trust each other, it also requires a multidisciplinary model of care delivery. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper The Donabedian Model provides a useful structure for studying processes and outcomes of care and was used to guide this study. 250 Clinical Integration Model for Interdisciplinary Collaboration This clinical effectiveness study utilized the implementation of a new approach to patient care delivery and documentation based on bringing health professionals together as partners in care called the CIM. This collaborative approach was manifested by a new method for organizing and charting activities that was integrated, consistent, and goal-directed rather than discipline-specific. The focus changed from the task to the patient as the center of care. This model of care delivery was designed with a specific goal of interweaving collaborative structures and processes into care. The NURSING ECONOMIC$/September-October 2014/Vol. 32/No. 5 Figure 2. CareGraph Example of Wound/Skin Category Admit Baseline Date Date Date 4 – Has large gaping wound that requires packing or complex dressing change taking >30 minutes >3 times/day 4 4 4 3 – Has draining wound with/without packing or complex dressing change < 3 times/day or unable to apply wound vac 3 3 3 2 – Has draining wound with/without packing or constant re-enforcement or requires wound vac 2 2 2 1 – Has reddened area with skin intact or simple dressing/open to air 1 1 1 0 – Has intact skin/wound/incision 0 0 0 Wound/Skin: (Identify focus__________________________________) drivers for change within this health system were based on an average LOS that was heading in an upwar …] Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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Discussion: Quality & Sustainability Program Paper

Discussion: Quality & Sustainability Program Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Quality & Sustainability Program Paper The Quality and Sustainability Paper is a practice immersion assignment designed to be completed in three sections. This is part three of the assignment. Learners are required to provide a theoretical framework that supports the design and implementation of their evidence-based quality and/or safety program and discuss expected outcomes. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper General Guidelines: Discussion: Quality & Sustainability Program Paper Use the following information to ensure successful completion of the assignment: This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. This assignment requires that you support your position by referencing at least six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings. You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. Directions: Write a 2,000-2,500 word paper that provides the following: Discussion: Quality & Sustainability Program Paper Identify a quality, change, or safety theory you will use to support the implementation of your quality and/or safety program. Provide evidence that supports the use of this theory within the program you designed. Provide the design of your evidenced-based quality and/or safety program that can be implemented to improve quality or safety outcomes in your identified entity. Discuss expected outcomes of your implementation and how to ensure their sustainability. Support your position by referencing at least five to six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings.Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper rubric_quality_and_sustainability_part_3.xlsx evaulation_of_a_collaborative_care_model_for_hospitalized_patients.pdf training_nurses_and_resident_to_work_as_a_patient_centered_care_team_on_a_medical_ward.pdf Course Code DNP-835 Class Code DNP-835-IO10310 Criteria Content Percentage 70.0% Completed Changes and Corrected Errors to Subsequent Paper, Including Transitions for a Scholarly Paper 5.0% Identification of Quality, Change, or Safety Theory to Support Implementation of Quality or Safety Program 10.0% Design of Evidence-Based Quality or Safety Program to Implement in Proposed Health Care Entity 25.0% Expected Outcomes and Sustainability 20.0% Six to Eight Additional Scholarly Research Sources With In-Text Citations 10.0% Organization and Effectiveness 20.0% Thesis Development and Purpose 7.0% Argument Logic and Construction 8.0% Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Format 10.0% Paper Format (use of appropriate style for the major and assignment) 5.0% Research Citations (in-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) 5.0% Total Weightage 100% Assignment Title Quality and Sustainability Part Three – Implementation and Evaluation Unsatisfactory (0.00%) Learner did not attach previous paper and did not make changes as indicated. A theory is not used to support implementation of the quality and/or safety program. Discussion: Quality & Sustainability Program Paper. Program design of quality and/or safety program is not presented. The program does not utilize an evidence-based design. Expected outcomes and steps to ensure sustainability are not discussed. None of the required elements (minimum of six topic-related scholarly research sources and six in-text citations) are present. Paper lacks any discernible overall purpose or organizing claim. Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Template is not used appropriately or documentation format is rarely followed correctly. No reference page is included. No citations are used. Total Points 180.0 Less than Satisfactory (74.00%) N/A Theoretical support is discussed, but a specific theory is not identified to support implementation of the quality and/or safety program. Evidence that supports the use of this theory in the proposed program is not presented. Program design of quality and/or safety program is referenced, but a clear description of the program is missing. The program does not utilize an evidence-based design. Expected outcomes and sustainability are referenced, but no specific outcomes or steps to ensure sustainability are discussed. Not all required elements are present. One or more elements are missing and/or included sources are not scholarly research or topic-related. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Sufficient justification of claims is lacking. Argument lacks consistent unity. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper There are obvious flaws in the logic. Some sources have questionable credibility. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) and/or word choice are present. Sentence structure is correct but not varied. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Reference page is present. Citations are inconsistently used. Satisfactory (79.00%) Learner attached previous paper and has made changes as indicated. Learner needs to incorporate transitions to connect the ideas between the papers. Theoretical support is discussed that references a specific theory. It is unclear how this theory supports implementation of the quality and/or safety program. Evidence that supports the use of this theory in the proposed program is not presented. Program design of quality and/or safety program is described, but numerous details are missing. There is no substantiation that the design can be implemented. The program partially includes an evidence-based design. Expected outcomes and sustainability are discussed, but the projected outcomes lack support for claims, or the plan for sustainability lacks specific steps. All required elements are present. Scholarly research sources are topic-related, but the source and quality of one or more references is questionable. Thesis and/or main claim are apparent and appropriate to purpose. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Appropriate template is used. Formatting is correct, although some minor errors may be present. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Good (87.00%) Learner attached previous paper and has made changes as indicated. Learner needs to incorporate better transitions to connect the ideas between the papers. Theoretical support is discussed using a specific theory. The theory supports implementation of the quality and/or safety program. General evidence that supports the use of this theory in the proposed program is presented. Program design of quality and/or safety program is generally described and there is adequate substantiation that the design can be implemented. The program utilizes an evidencebased design. Expected outcomes and sustainability are discussed. Projected outcomes are supported, and general steps to ensure sustainability are presented. All required elements are present. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper Scholarly research sources are topic-related and obtained from reputable professional sources. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. Appropriate template is fully used. There are virtually no errors in formatting style. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. Excellent (100.00%) Learner attached previous paper and has made changes as indicated. Learner has includes all necessary transitions to create a scholarly paper. Theoretical support is thoroughly discussed using a specific theory. The discussion provides insight in to successfully implementing the quality and/or safety program. Strong evidence that supports the use of this theory in the proposed program is presented. Program design of quality and/or safety program is clearly described and substantiates that the design can be implemented. The program utilizes an evidence-based design. Strong evidence is provided to support the program design and implementation. Expected outcomes and sustainability are thoroughly discussed. Projected outcomes are supported with clear evidence, and very specific steps to ensure sustainability are discussed. All required elements are present. Scholarly research sources are topic-related and obtained from highly respected, professional, original sources. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Discussion: Quality & Sustainability Program Paper Thesis statement makes the purpose of the paper clear. Comments Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. Writer is clearly in command of standard, written, academic English. All format elements are correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error. Points Earned Cheryl McKay K. Lynn Wieck Evaluation of a Collaborative Care Model for Hospitalized Patients EXECUTIVE SUMMARY The current lack of collaborative care is contributing to higher mortality rates and longer hospital stays in the United States. A method for improving collaboration among health professionals for patients with congestive heart failure, the Clinical Integration Model (CIM), was implemented. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper The CIM utilized a process tool called the CareGraph® to prioritize care for the interdisciplinary team. The CareGraph was used to focus communication and treatment strategies of health professionals on the patient rather than the discipline or specific task. Hospitals who used the collaborative model demonstrated shorter lengths of stay and cost per case. CHERYL McKAY, PhD, CNS, RN, completed this work as part of her doctoral education at the University of Texas at Tyler. She is presently Nurse Executive, Healthier Populations, OrionHealth, Santa Monica, CA. K. LYNN WIECK, PhD, RN, FAAN, is Mary Coulter Dowdy Distinguished Nursing Professor, University of Texas at Tyler. 248 NTERDISCIPLINARY collaboration is an emerging mandate to decrease fragmentation of care delivery in U.S. hospitals. Higher mortality rates (Estabrooks, Midodzi, Cummings, Ricker, & Giovannetti, 2005) and longer lengths of hospital stay (Zwarenstein, Goldman, & Reeves, 2009) have been found in environments where collaboration is limited or not present. As many as 98,000 people die in hospitals each year as a result of medical errors which may be traced to lack of collaboration and disjointed care. Beyond the cost of human lives, billions of dollars are spent annually for additional care resulting from medical errors (Kohn, Corrigan, & Donaldson, 2000). The aim of this study was to determine if a care delivery model based on collaboration and coordination of care using the CareGraph® would improve patient outcomes. To provide high-quality care and meet public expectations with limited resources, collaboration has become a necessity. In a landmark study, Knaus, Draper, Wagner, and Zimmerman (1986) found that hospitals where collaboration was present reported a mortality rate 41% lower than the predicted number of deaths. Hospitals where there was little to no collaboration exceeded predicted mortality by as much as 58%. Collaborative I relationships have also been tied to reduced costs for the health care system (Zwarenstein et al., 2009). Although empirical evidence in support of collaboration in the health care environment is available in the literature, there is little evidence on how to create this environment (Tschannen, 2004). Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper The main structural elements necessary for collaboration in an acute care environment include a culture where relationships are valued, health care professionals communicate effectively, and respect is shared among all parties. A model of care delivery consistent with these cultural values and focused on patient safety is paramount. A Midwestern health care system designed an innovative model of care delivery where collaboration was purposefully woven into the structures and processes to effect positive change in patient and organizational outcomes. Called the Clinical Integration Model (CIM) (Zander, 2007), several of the health system hospitals adopted it while others chose to stay with a traditional primary care model. Comparing hospitals within the health system provides an opportunity to determine if there is a difference in survival, length of stay (LOS), and cost for patients receiving care in facilities utilizing the CIM and those receiv- NURSING ECONOMIC$/September-October 2014/Vol. 32/No. 5 ing care in facilities utilizing a primary care model. Collaboration in Health Care Collaboration, as defined by the American Nurses’ Association (ANA) (2010), is a partnership based on trust with shared power, recognition, and acceptance of separate and combined practice spheres of activity and responsibility. Collaboration also includes mutual safeguarding of the legitimate interests of each party and a commonality of goals. The key components of shared power, recognition and acceptance, and common goals are relevant to many of the definitions found in the literature (Fewster-Thuente & Velsor-Friedrich, 2008; Petri, 2010). These components are essential for a collaborative process and can be operationalized in an acute care setting. A number of factors have affected the ability of health care organizations to provide a collaborative environment including the educational system and professionalization of health care practitioners. Studying determinants of successful collaboration, San MartinRodriguez, Beaulieu, D’Amour, and Ferrada-Videla (2005) found health care practitioners develop a strong professional identification through education. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper This strong professional identification often limits knowledge of other professionals within the team and is considered a main obstacle to collaboration. The dynamics of professionalization lead to further differentiation of health care professionals (D’Amour & Oandasan, 2005) and potential conflict hindering the development of true collaborative relationships. Collaboration in health care affects patient survival and decreases adverse patient outcomes. Knaus and colleagues (1986) found hospitals where collaboration was present reported a significant decrease in mortality rates (Chi square=62.9, df 12; p<0.0001, r=0.83). Hospitals where there was little to no perceived collaboration exceeded predicted mortality. Positive collaborative relations have also been tied to a decrease in failure to rescue. Boyle (2004) evaluated unit-level characteristics and the impact on patient outcomes and found a negative correlation between collaboration and failure to rescue (r= -0.53). High levels of perceived collaboration were linked to early detection of change in clinical condition and appropriate intervention leading to a decrease in failure to rescue. Collaborative environments can positively affect health system outcomes. Ovretveit (2011) evaluated the impact of clinical coordination and collaboration and found when collaboration and coordination were present, patients experienced a shorter LOS with lower costs to the health care institution. Additionally, Zwarenstein and co-authors (2009) evaluated multiple studies to determine the impact of interprofessional collaboration and found 80% of the studies demonstrated decreased LOS and cost savings to the health care institutions. Barriers to Collaboration in Health Care The barriers to collaboration are rooted in the hierarchal and long-established structures of most health care organizations and are difficult to change. The nursephysician relationship is one example of an established hierarchal relationship that has been a barrier to true collaboration in health care facilities. Hojat and colleagues (2001) conducted a cross-cultural study evaluating nurse-physician attitudes toward collaboration and found nurses in both the United States and Mexico expressed more positive attitudes toward collaboration than their physician counterparts (p<0.01). As a possible solution, the authors recommended inter-professional education to improve nurse-physician collaboration. NURSING ECONOMIC$/September-October 2014/Vol. 32/No. 5 Empirically the link between collaboration and improved patient and system outcomes has been demonstrated, but there remains a gap in the literature on how to create a collaborative environment. This study begins to fill the gap by looking at a large scale change of care delivery based on essential collaborative structures and processes and its impact at the patient, hospital, and system levels. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper Theoretical Framework The Donabedian Model (1966) is proposed as a way of providing essential structures and processes for collaboration in the health care setting. The model was used to provide a comprehensive structure to move from inputs through the process of care delivery, and conclude with the outcomes for this study. In accordance with the Donabedian Structure, Process, Outcome Model (see Figure 1), structure refers to the environment in which care is provided. Structure encompasses the work environment, availability of equipment and supplies, and type of unit. These structural elements tend to be relatively permanent in nature and are often thought of as key determinants to quality (Donabedian, 1988). Process elements are more flexible and readily changeable. Process encompasses the things health care workers do or fail to do which shape patient outcomes (Montalvo & Dunton, 2007). Outcomes are the changes in patients’ health attributable to their care (Montalvo & Dunton, 2007). According to Donabedian (1988), changes in structures and processes of care are required to optimize patient outcomes. The Structure, Process, Outcome Model proposes the context (structure) in which the intervention (process) occurs has an influence on the outcomes. Collaboration is seen as the process that occurs within a specific context leading to the measured results or 249 Figure 1. Donabedian Structure, Process, Outcome Model (Adapted) Modified Donabedian Model for Clinical Integration Program Structure Patient diagnosis Core measure compliance Type of unit Outcomes Patient survival Length of stay Cost per case Process Clinical Integration Model or Traditional care delivery model Information exchange Clinical Integration Model Patient admitted. CareGraph completed. Top three problems and discharge goals identified. Does patient need complex care? Does patient need complex care? NO Patient progressing toward discharge goals. Patient discharged from complex care team meetings. Patient discharged from hospital with goals met. NO Continue interdisciplinary care coordination. Focus on top three problems. SOURCE: Adapted from Donabedian, 1966. outcomes. The process of collaboration not only requires health care providers to communicate effectively and trust each other, it also requires a multidisciplinary model of care delivery. Grand Canyon UniversityDNP 835 Quality & Sustainability Program Paper The Donabedian Model provides a useful structure for studying processes and outcomes of care and was used to guide this study. 250 Clinical Integration Model for Interdisciplinary Collaboration This clinical effectiveness study utilized the implementation of a new approach to patient care delivery and documentation based on bringing health professionals together as partners in care called the CIM. This collaborative approach was manifested by a new method for organizing and charting activities that was integrated, consistent, and goal-directed rather than discipline-specific. The focus changed from the task to the patient as the center of care. This model of care delivery was designed with a specific goal of interweaving collaborative structures and processes into care. The NURSING ECONOMIC$/September-October 2014/Vol. 32/No. 5 Figure 2. CareGraph Example of Wound/Skin Category Admit Baseline Date Date Date 4 – Has large gaping wound that requires packing or complex dressing change taking >30 minutes >3 times/day 4 4 4 3 – Has draining wound with/without packing or complex dressing change < 3 times/day or unable to apply wound vac 3 3 3 2 – Has draining wound with/without packing or constant re-enforcement or requires wound vac 2 2 2 1 – Has reddened area with skin intact or simple dressing/open to air 1 1 1 0 – Has intact skin/wound/incision 0 0 0 Wound/Skin: (Identify focus__________________________________) drivers for change within this health system were based on an average LOS that was heading in an upwar …] Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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