Running head: QUALITY IMPROVEMENT PROJECT

Quality Improvement Project

Allegrah C. Nguyen
I pledge
Bon Secours Memorial College of Nursing
NUR 4114
Dr. Ellcessor
March 29, 2016

QUALITY IMPROVEMENT PROJECT

Quality Improvement Project

Quality improvement projects on hospital units are used to identify a potential problem
generate ways to improve it and evaluate the end result. While completing my clinical immersion
hours on a medical-surgical unit, I talked with the nurse manager about several quality
improvement (QI) projects she was trying to implement on her floor. The one that was most
intriguing was moving interdisciplinary rounds (IDRs) to the bedside. By having multiple
members of the patients health care team at the bedside, it will improve patient involvement in
their plan of care, as well as keep everyone up to date on their progress.
The purpose of the paper is to implement the QI project by placing myself in the nurse
manager role. I will implement the QI project, by using four domains of leadership (heart, head,
hands and habits), as outlined by Blanchard and Hodges (2008) in Lead Like Jesus textbook. I
will also use the five practices of exemplary leadership (model the way, inspire a shared vision,
challenge the process, enable others to act and encourage the heart), as outlined by Kouzes and
Posner (2003) in Student Leadership Practices Workbook. Afterwards I will assess how it affects
nursing practice on the med-surg unit, and evaluate patient outcomes.
Four Domains of Leadership
Heart
The first step of the four domains of leadership starts in the heart. As a leader I know that
God is all knowing and always watching. I lead not to self-serve, but to serve others. As a leader,
I want to cherish Gods ways and always remember to self-reflect so that I am always on the
right path. I will welcome constructive criticism, and precede in faith one step at a time. It is with
my love and understanding of Gods work that I will inspire a community of trust and respect

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(Blanchard & Hodges, 2008). By being unselfish, my staff will be able to look up to me and be
inspired by the vision I have in utilizing the QI project. Regardless of my title as a nurse
manager, my job as a nurse is to always put the patient first, so by having interdisciplinary
rounds at the bedside it could systematically create a cohesive team approach to patient centered
care.
Head
Next is the head of a servant leadership. As a leader, I make choices based on my core
values. I lead by building relationships based on respect and integrity, provide quality and
compassionate care, practice stewardship and have a desire for creativity and innovations. As a
nurse manager, I will embrace the values that I have as a nurse, by always practicing within my
core values. Above all, I am a patient advocate and their one true ally while they are in the
hospital. By consistently providing holistic care and healing their mind, body and spirit I will be
able to demonstrate the importance of patient advocacy at the bedside. By sticking to my core
values, I will be able to demonstrate that positive outcomes can occur when working with a team
both on the unit and with those involved in IDRs. It is by creating a mutual and trustworthy bond
with all parties involved that will be most effective.
Hands
As a servant leader, I do not want to be viewed as a superior but as a mentor. I want to be
a positive role model, and be someone that can lead by example. I am only as strong as my team
members and want us to collectively work hand in hand towards a common goal. I will be their
cheerleader, counselor, and coach but will need them to take an initiative to actively be involved
as well. Performance evaluations will be conducted to not discriminate against an individual, but

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to see what can be done differently. Evaluations will also be a way to discuss successes, met
goals, and areas of improvement. By doing so I hope that it will unify the team, and keep us on
target. The evaluations will also remind us of our core values as healthcare providers at Bon
Secours. We are the people of Bon Secours, and we will provide help to those in need while on
holy ground. Regardless of the position that we hold at Bon Secours, we have to work together
towards a common goal, and provide compassionate, holistic care to all of our patients. I believe
that in order to ease the mind of confusion, anxiety and stress, we need to collaborate more with
the patients on their daily goals and outcomes. As healthcare providers, we need to collectively
use a team approach during all aspects of care. It is only then, that we are able to focus on
promoting a healthy body and spirit.
Habits
Habits are formed in order for me to lead the way God wants me. In order to do so I need
to make sure to always provide myself with solitude, prayer, application of scripture, accepting
Gods unconditional love and involvement with supportive relationships. It is through this that I
can rid myself of any negativity. I have to remember to take time for myself to destress through
physical activity, and to remember to take care of my mind, body, spirit so that I can continue to
care for others. As a leader, I want to always practice what I preach and to guide others to follow
these five key habits, so that they can continue living a happy and prosperous life. I know that
implementing a new task, such as having IDRs at the bedside can create some turbulence, but it
is up to the individual to look past their negatively and use a clear mind to see how much good it
can create for the patient. As healthcare professions, specifically nurses it is there job to always
advocate for their patients and in order to do so a nurse needs to find solidarity within.

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Five Practices of Exemplary Leadership

Model the Way
As a leader, I will need to model the way and show healthcare providers that moving the
interdisciplinary rounds to the bedside will have more positive benefits than risks. I will need to
start implementing this in small baby steps to keep from overwhelming the staff. In order to
begin doing this, I will begin by emphasizing the importance of having the patients primary
nurse be present for the IDR. Nurses are often the liaisons between patient and doctor, and for
the patient to have the best outcome possible the nurse should be there to advocate. Nurses that
were present when IDRs began felt valued and were accurately able to collaborate and mediate
between physicians and patients (Seigel, Whalan, Burgess, Joyner, Purdy, Saunders & Willis,
2014).
In order to ensure nurse participation, designating times so that each nurse can be
available for IDR rounds on all of their patients would work. For instance, if a nurse has four
patients, I would suggest giving her about five minutes per patient in order to give report to the
other members on the IDR team, and then collectively they can come up with daily goals and
discharge planning. It will also allow them to interact with their patients, and answer any
questions or concerns they may have. If the patient requires more than the allotted five minutes,
the provider will take note and come back after the remaining IDRs are completed. As the nurse
manager, I will be available on the unit to help out while that nurse is rounding.
Inspire a Shared Vision
In order to inspire a shared vision, I will reach out to my staff and show them how IDRs
at the bedside will benefit the patient. I will reach out to them on a personal level and ask them to

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put themselves in the patients shoes. I know that my staff has seen, been or taken care of
someone in the hospital who was confused about their plan of care. I have personally felt
frustrated when trying to keep pertinent information consistent for a loved one.
By having the interdisciplinary rounds at bedside, families have reported consistent
medication information, discussed care plans, had doctors and staff listen carefully, and feel
more like a team player in their recovery (Kuo, Sisterhen, Sigrest, Biazo, Aitken & Smith, 2012).
Outcomes like the one mentioned above, shows the importance of IDRs at the bedside. By being
able to see all of the key healthcare members involved with the patients care at one time,
families are able to feel more in control and are able to accurately retain pertinent information.
Challenge the Process
Challenging the process can be summed up in two words. Risk-taker. As a leader I will
have to push myself and my team to the limit to be nothing less than great. In order to grow, my
team will have to take risks and adjust their schedule in order to meet certain outcomes. There
are definitely obstacles that I can foresee already, for instance nurse attendance, patient privacy
in a semi-private room, talking to patients and not about them, avoiding the use of medical
jargon and staying within the five minute time frame. However, I am confident that the innovated
nurses I have on staff that will strategize ways to improve on this.
Enable Others to Act
In order to enable others to act, I will encourage effective communication and
collaboration from all parties involved. I will lead by example and demonstrate that relationships
that are built on mutual trust and respect. In order for objectives to be met, everyone involved
needs to feel comfortable and confident in achieving the tasks at hand. By emphasizing safe and

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effective patient centered care through open communication; it will decrease errors and negative
health outcomes, including death. There has also been a correlation with patient outcomes,
adverse events and length of stay (Mercedes, Fairman, Hogan, Thomas & Slyer, 2015).
By having the healthcare workers and patient together in the same room, it will decrease
confusion and allow the patient and their families to ask questions. By everyone being on board
and on the same page, it will decrease frustration and redirect energy towards accomplishing the
patients goal.
Encourage the Heart
As a leader that encourages the heart, recognition needs to be awarded to every member
involved, no matter the level of accomplishment. Nursing is not an easy profession, and for
nurses to implement something that will have such an effect on their patients outcome, it needs
to be recognized. In efforts to keep nurses satisfied and improve on interdisciplinary
relationships, it is crucial that IDR at bedside with nurses continues. Studies have found that
collaborative interdisciplinary relationships were one of the most important predictors of job
satisfaction amongst nurses (Gausvik, Lautar, Miller, Pallerla & Schlaudecker, 2015). Nurses do
not need to feel like heroes because they are heroes. Nurses need to be encouraged, and shown
appreciation for their hard work so they do not feel devalued or burnt out.
Professional Practice Implications
On the medical surgical unit that it would be implemented it on, it will be beneficial
because a lot of the patients there have either been admitted with a new diagnosis, or have had an
exacerbation of symptoms that have left them completely incapacitated. I have seen far too many
families in utter dismay at the severity of an illness, and confused on what information is

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pertinent enough to share. I have also seen the families react in frustration, because they feel like
they have just been given information overload, and do not know where to begin.
By having the interdisciplinary rounds at the bedside, it will further transition care to one
that is more patient centered that keeps everyone on the same page. It is not only beneficial to the
patient, but to healthcare team as well. By implementing the IDRs, it will allow the health care
team and patient to work together to coordinate care, establish daily goals and plan for discharge.
The patients outcomes, adverse effects and length of stay will be dependent on the effectiveness
of the teams cooperation and communication (Mercedes, Fairman, Hogan, Thomas & Slyer,
2015). By moving the rounds to the bedside, it will give patients and their family an opportunity
to ask questions and to accurately obtain critical information.
It is also beneficial to the healthcare team, because by allowing time for all the healthcare
workers to discuss the patients care it will improve staffs perceptions of care quality and
increase the sense of teamwork. It will allow all aspects of the team to understand the plan of
care, and expand communication amongst team members. Furthermore, through the mutual trust
and understanding of the team members involved, it will improve the patients outcomes, safety
and job satisfaction (Gausvik et al., 2015).
Evaluation Outcomes
In order to accurately evaluate the outcomes of implementing IDR at the bedside, it is
imperative to ask the patient how it has affected them. As a nurse manager, I believe that it is in
my units best interest to make sure that the patients needs were met above all else. I would
evaluate this, after the end of the IDRs by going to the patients rooms and giving them a verbal
or written survey to fill out. It would ask questions such as: Have we addressed their concerns?

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Answered their questions? Are their goals something that can be accomplished during their
hospital stay? At discharge? After discharge? Were there any concerns that were not mentioned
during rounds? Is there anything that can be improved to make IDRs more beneficial to you?
Afterwards, I would collect the surveys and organize a consensus of what was written. I would
then present it during a staff meeting or during morning huddle (depending on time) and see
what the staffs feedback was and what we can do to ease the process. In order for the quality
improvement project to be effective, it has to be tested and retested until it becomes effective,
efficient and somewhat second nature. Patient outcomes have always been the top priority of a
healthcare team, however meeting the outcomes is through delivering patient centered care.
Through effective collaboration and communication, and moving the interdisciplinary rounds to
the bedside it could greatly improve the patient centered care approach.

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References
Aragona, E., Ponce-Rios, J., Garg, P., Aquino, J., Winer, J. C., & Schainker, E. (2016). A Quality
Improvement Project to Increase Nurse Attendance on Pediatric Family Centered
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Blanchard, K., & Hodges, P. (2008). Lead like Jesus. Thomas Nelson Inc.
Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing
communication on interdisciplinary acute care teams improves perceptions of safety,
efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal
of multidisciplinary healthcare, 8, 33.
Kouzes, J.M., & Posner, B.Z. (2003). The Leadership Practices Inventory (LPI): Participants
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Kuo, D. Z., Sisterhen, L. L., Sigrest, T. E., Biazo, J. M., Aitken, M. E., & Smith, C. E. (2012).
Family experiences and pediatric health services use associated with family-centered
rounds. Pediatrics, 130(2), 299-305.
Mercedes, A., Fairman, P., Hogan, L., Thomas, R., & Slyer, J. T. (2015). The effectiveness of
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satisfaction of patients and staff: a systematic review protocol. The JBI Database of
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Seigel, J., Whalen, L., Burgess, E., Joyner Jr, B. L., Purdy, A., Saunders, R., ... & Willis, T. S.
(2014). Successful implementation of standardized multidisciplinary bedside rounds,
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