Discussion: Using Improvement Science Models to Promote Quality and Safety
…while all changes do not lead to improvement, all improvement requires change.
—United States Agency for International Development
Improvement science models bring together research and evidence-based practice to identify the most effective ways to promote quality and safety in health care. As a central tenet of quality improvement, attention must be paid to the processes that contribute to outcomes.
In this Discussion, you examine quality improvement models and evaluate how they could be applied to address specific issues within health care organizations.
To prepare:
Review the improvement models presented in the Learning Resources.
Evaluate each of the models and select two on which to focus for this Discussion.
Consider how each of the two models could be utilized in a health care organization to promote quality and safety. Think about the following:
How does the model bring together research and evidence-based practice to facilitate quality improvement?
How does the model contribute to a culture of quality and safety?
How does it address changes in process?
Reflect on the quality improvement issue and the health care setting that you are addressing for your Course Project. Of the two models that you have selected, determine which one you, as a nurse leader-manager, would use to address this issue. Also consider how this would relate to one or more of the IOM’s six aims for quality and safety.
Post your analysis of how the two improvement models that you selected could foster a culture of quality and patient safety and facilitate changes in process that promote positive outcomes. Explain how you would use one of these models to address the quality improvement issue in the organization that you have selected for your Course Project, and how doing so would relate to one or more of the IOM’s six aims for improving quality and safety.
Read a selection of your colleagues’ responses.
Respond to at least two of your colleagues on two different days using one or more of the following approaches:
Offer additional strategies for using your colleague’s selected model to address the IOM’s six aims for quality.
Share insights for engaging frontline staff using your colleague’s selected improvement model.
Compare the steps in the improvement model that you selected with your colleague’s.
Suggest an alternative model for your colleague to utilize in his or her identified health care organization.
Required Readings
Hickey, J. V., & Brosnan, C. A. (2012). Evaluation of health care quality in advanced practice nursing. New York, NY: Springer Publishing Company.
Review Chapter 6, “Evaluating Health Care Information Systems and Patient Care Technology” (pp. 113–133) (assigned in Week 6)
This chapter examines federally mandated use of health information technology to improve health care and care delivery. In addition, technology competencies are discussed along with strategies for evaluating health information technologies in coordination with nurse informaticists.
Chapter 7, “Evaluation of Patient Care Standards, Guidelines, and Protocols” (pp. 135–158) (assigned in Week 4)
How can you know if an organization is delivering the best possible care? This chapter explores evaluation methods for patient care and discusses methods used to evaluate innovations that can lead to practice changes.
Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations. Burlington, MA: Jones & Bartlett Learning.
Chapter 7, “Understanding Quality and Performance” (pp. 133–160)
Chapter 9, “Closing the Gaps” (pp. 179–194)
Altmann, T. K. (2007). An evaluation of the seminal work of Patricia Benner: Theory or philosophy? Contemporary Nurse: A Journal for the Australian Nursing Profession, 25(1/2), 114–123.
Retrieved from the Walden Library databases.
Altmann summarizes the foundational work of Benner’s novice to expert theory, reviews critiques, and outlines how Benner’s concepts are important in nursing.
Dixon-Woods, M., Bosk, C. L., Aveling, E. L., Goeschel, C. A., & Pronovost, P. J. (2011). Explaining Michigan: Developing an ex post theory of a quality improvement program. The Milbank Quarterly, 89(2), 167–205.
Retrieved from the Walden Library databases.
This article discusses evidenced-based practice and how it relates to quality improvement in healthcare.
Ernst, M. M., Wooldridge, J. L., Conway, E., Dressman, K., Weiland, J., Tucker, K., & Seid, M. (2010). Using quality improvement science to implement a multidisciplinary behavioral intervention targeting pediatric inpatient airway clearance. Journal of Pediatric Psychology, 35(1), 14–24.
Retrieved from the Walden Library databases.
Researchers applied a Plan-Do-Study-Act (PDSA) quality improvement model in completing an evidenced based study of pediatric patients with cystic fibrosis.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Retrieved from the Walden Library databases.
Review as needed (assigned in a previous week). This report outlines the Institute of Medicine’s (IOM’s) six aims to improve the quality of health care.
Maguad, B. A. (2011). Deming’s ‘profound knowledge’: Implications for higher education. Education, 131(4), 768–774.
Retrieved from the Walden Library databases.
The author of this article describes Deming’s System of Profound Knowledge as it relates to higher education.
Murphree, P., Vath, R. R., & Daigle, L. (2011). Sustaining Lean Six Sigma projects in health care. Physician Executive, 37(1), 44–48.
Retrieved from the Walden Library databases.
Lean Six Sigma is a quality improvement model that is frequently used in health care. The authors of this article provide strategies for monitoring improvement projects in order to sustain improved quality outcomes.
Polk, J. D. (2011). Lean Six Sigma, innovation, and the change acceleration process can work together. Physician Executive, 37(1), 38–42.
Retrieved from the Walden Library databases.
Dr. Polk describes both the Lean process and the Six Sigma process and explains how health care organizations combine these two improvement models to promote quality outcomes.
Improvement Science Research Network. (n.d.). What is improvement science? Retrieved March 13, 2013, from
As indicated in this resource, improvement science focuses on research about what improvement strategies are most effective for promoting health care quality and safety.
Institute for Healthcare Improvement. (2012a). How to improve. Retrieved from
The Institute for Healthcare Improvement outlines each step in the Plan-Do-Study-Act (PDSA) model as described in The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Click on the links to read each section.
Nursing Theories. (2011). From novice to expert: Patricia E. Benner. Retrieved from
This website presents an overview of the basic elements of Benner’s Novice to Expert Theory.
U.S. Department of Health & Human Services Agency for Healthcare Research and Quality. (2012). AHRQ health care innovations exchange. Retrieved from
The Innovations Exchange was established to help health care providers “solve problems, improve health care quality, and reduce disparities.” This website presents evidence-based innovations and QualityTools along with articles and up-to-date research findings.
United States Agency for International Development. (n.d.). The science of improvement. Retrieved March 13, 2013, from
The USAID organization provides a concise overview of improvement science and its application to improving health care quality.
Required Media
Laureate Education (Producer). (2013a). Improvement science defined. Retrieved from
Note: The approximate length of this media piece is 3 minutes.
In this media segment, Dr. Kenneth Rempher discusses improvement science and how it relates to three main areas of nursing practice: nursing research, evidence-based practice, and performance improvement.

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