Using Lean Six Sigma to Increase the Effectiveness of an Evidence-Based Quality Improvement Program

The global research landscape and future trends in healthcare Total Quality Management

Total Quality Management (TQM) is instrumental in augmenting the quality and efficacy of healthcare service delivery, but a comprehensive evaluation of present and evolving TQM research trends within healthcare research articles is notably absent. This study provides an insightful view into the prevailing international scenarios and upcoming research frontiers in healthcare TQM research field, utilizing bibliometric mapping through VOSviewer. Drawing data from 360 publications in the Web of Science core citation database, it delineates a steady growth in the field over the last 30 years. Research outputs span 51 countries and regions, with notable contributions from the United States, United Kingdom, Netherlands, and Italy. The top five research institutions and numerous authors predominantly hail from the United States. Key keywords in near years encompass healthcare safety, healthcare quality assurance, quality indicators, and the application of Six Sigma management principles. This exploration serves as a pivotal reference for understanding the global research landscape and future trends in healthcare TQM, particularly in guaranteeing quality and safety. Future scientific endeavors will build upon these focus areas, exploring and connecting research gaps in more specialized fields.

Cultivating an Evidence-Based Decision-Making Mindset

This is the first article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

Academic-Practice Partnership to Prevent and Manage Pressure Injuries: An Evidence-Based Quality Improvement Initiative

PURPOSE

This evidence-based quality improvement (EBQI) initiative examined the effect of an academic-practice (A-P) partnership on improvement in quality measures in an acute care setting, specifically hospital-acquired pressure injury (HAPI) prevention and management.

DESIGN

A pre-/postdescriptive design was conducted using the practice-informed active learning program to guide the project.

PARTICIPANTS AND SETTING

The EBQI initiative was conducted at a Southern Gulf-Coast university college of nursing and clinical nursing practice leaders at its affiliated 406-bed academic health center/level I trauma center, regional burn center, and comprehensive stroke center. Both institutions are located in the Southeastern United States (Mobile, Alabama).

METHODS

The A-P council used a participatory action research approach and developed a practice-informed active learning program incorporating Melnyk's evidence-based practice (EBP) steps, the Donabedian Model and the Patient-Centered Outcomes Research Institute (PCORI) Stakeholder Engagement in Question Development and Prioritization (SEED).

METHOD

Hospital-acquired pressure injuries were selected as the quality outcome to address. To identify HAPI prevention/management evidenced-based practices, the A-P council conducted an integrative literature review and developed a concept map and the Pressure Injury Prevention Gap Analysis Instrument. The gap analysis identified significant gaps between EBP and current pressure injury prevention practices, with priority ranking of gaps for action by key stakeholders.

OUTCOME

Following the practice-informed active learning program objectives, the A-P council identified 79 HAPI best EBPs organized by Donabedian domains of structure, process, and outcome and prioritized 3 gaps for action. Actions to address the HAPI gaps included: restructuring the hospital HAPI program, incorporating appropriate leadership to guide the HAPI program, modifying the HAPI reporting process, hiring specialized experts (WOC nurses) with emphasis on pressure injury prevention, establishing a standardized HAPI prevalence survey, improving electronic documentation, increasing transparency of HAPI reporting, improving HAPI accountability at the unit level, and exploring technology to enhance skin assessment. While HAPIs increased by 6.3% from 2019 (n = 104) to 2021 (n = 111), HAPI severity (Stages 3 and 4) decreased by 9.9% from 2019 (n = 14, or 13.46%) to 2021 (n = 4, or 3.6%).

IMPLICATIONS FOR PRACTICE

Our experience with this quality improvement initiative indicates that an A-P partnership can provide a model to address complex clinical problems, quality indicators, and quality improvement while advancing a culture of inquiry and scholarship and building nursing capacity.

Applying Lean Six Sigma to evidence-based practice projects

Process improvement methodology minimizes barriers to implementing new knowledge.