Organizational Systems and Quality Leadership

Course of Study
This course supports the assessment for Organizational Systems and Quality Leadership. The
course covers 4 competencies and represents 3 competency units.
Introduction
Overview
Nurses serve as clinicians, managers, and mentors to shape the future of healthcare and impact
patient care outcomes in positive ways. This course will help students to be more confident and
better prepared to assume leadership roles regardless of their position in the healthcare delivery
system. This advanced leadership course focuses on the concepts of patient safety,
improvement science, balancing cost, quality and access through the triple aim, leadership and
patient/family centered care. Students will develop mastery of advanced competencies
particularly in patient safety in quality improvement science.
Watch the following video for an introduction to this course:
Note: To download this video, right-click the following link and choose “Save as…”: download
video.
Competencies
This course provides guidance to help you demonstrate the following 4 competencies:
Competency 734.3.1: Principles of Leadership
The graduate applies principles of leadership to promote high-quality healthcare in a
variety of settings through the application of sound leadership principles.
Competency 734.3.2: Interdisciplinary Collaboration
The graduate applies theoretical principles necessary for effective participation in an
interdisciplinary team.
Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
Competency 734.3.4: Healthcare Utilization and Finance
The graduate analyzes financial implications related to healthcare delivery,
reimbursement, access, and national initiatives.
Preparing for Success
The information in this section is provided to detail the resources available for you to use as you
complete this course.
Learning Resources
The learning resources listed in this section are required to complete the activities in this course.
For many resources, WGU has provided automatic access through the course. However, you
may need to manually enroll in or independently acquire other resources. Read the full
instructions provided to ensure that you have access to all of your resources in a timely manner.
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Automatically Enrolled Learning Resources
You will be automatically enrolled at the activity level for the following learning resources.
Simply click on the links provided in the activities to access the learning materials.
VitalSource E-Text
The following textbook is available to you as an e-text within this course. You will be directly
linked to the specific readings required within the activities that follow.
Cherry, B., & Jacob, S. (2014). Contemporary nursing: Issues, trends, and management
(6th ed.). St. Louis: Mosby Elsevier. ISBN: 978-0-323-101097.
Note: This e-text is available to you as part of your program tuition and fees, but you may
purchase a hard copy at your own expense through a retailer of your choice. If you choose to do
so, please use the ISBN listed to ensure that you receive the correct edition.
Elsevier Evolve Online Course
Elsevier Evolve is the online companion site to the Contemporary nursing: Issues, trends, and
management textbook. This course of study will directly link you to specific activities within
Evolve.
Cherry: Contemporary Nursing: Issues, Trends, and Management (4th ed.)
Other Learning Resources
You will use the following learning resources for this course of study.
IHI Open School Courses
If you do not have an IHI account, you will need to create one. Please review the “Working with
IHI” guide. This tutorial will guide you in creating an account and accessing the required
learning modules.
This course of study will require you to complete all the modules necessary to obtain the IHI
Basic Certificate of Completion. Once completed, you will need to save a copy to upload to
Taskstream as part of this course and as part of your Professional Portfolio (Prelicensure and
RN to BSN students only). The provided instructions will guide you through locating and
downloading the certificate of completion. While there are numerous modules, you will only
upload the single certificate that indicates you have completed all the modules. If you are a
registered nurse, you may also apply for continuing education credit for the lessons completed
in IHI.
Nursing Standards
You will be able to access Nursing Professional Standards as they apply to your program
through the WGU Library. Please access these documents at the following website:
Nursing Standards E-Reserves
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Leadership and Management
Nurses, regardless of the position they hold, are leaders when they use their knowledge and
skills in the provision of high quality patient care. In this section you will learn key concepts
related to leadership and management that are essential for the delivery of safe and effective
patient centered care. The terms “leadership” and “management” are often used
interchangeably, but they are not the same. You will be introduced to leadership and
management skills and styles that will be most helpful to you in your role as a professional
nurse.
Issues, Trends, and Management
Leadership and management are complex and also continually changing concepts. While
certain basic assumptions and ideas remain constant, many methods and practices alter and
develop as cultures change.
This topic addresses the following competency:
Competency 734.3.1: Principles of Leadership
The graduate applies principles of leadership to promote high-quality healthcare in a
variety of settings through the application of sound leadership principles.
This topic highlights the following objectives:
Prepare resources that enhance management and leadership skills.
Document the impact change theory has on the spread of new ideas in a population.
Apply strategies enabling individuals to exert leadership without occupying a formal
leadership position.
Compare and contrast types of team-building skills needed for effective interdisciplinary
coordination of patient care.
Apply strategies for persuading and supporting others to effect change.
Examine the relationship between leadership and management theories and specific
nursing leadership, including nursing activities drawn from with each theory.
Triple Aim for Populations
In this lesson, we introduce you to what’s involved in improving population health. To combat
many of the most important threats to human health, it’s not enough to improve clinical care for
only one patient at a time; we must understand the broader influence of education, the
environment, and wealth distribution on health outcomes.
Complete the following IHI Open School:
TA 101: Introduction to the Triple Aim for Populations
Nursing Leadership Management
Read the following chapter in Contemporary Nursing:
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chapter 16 Nursing Leadership and Management
Access the Evolve Contemporary Nursing online course and complete the following
module (note: the module number is not the same as the chapter number):
module 15: Nursing Leadership and Management
lessons 1–5
IHI Open School
Access IHI Open School and complete the following courses:
PFC 101: Introduction to Patient – Centered Care
L101: Introduction to Health Care Leadership
Change Theory
A change that seems practical and beneficial to you may seem unreasonable to others.
Learning to implement change by helping others adopt change can facilitate efforts to improve
throughout your organization. In this section, we will explore the concept of change theory,
based on the foundational work of psychologist Kurt Lewin and sociologist Everett Rogers. As
you review the material, consider how you might utilize these strategies to motivate
change-resistant individuals and develop new ideas more likely to spread across a population.
Complete the following IHI Open School:
QI 201: Planning for Spread: From Local Improvements to System-Wide Changes
Essentials of Collaborative Practice
As a professional nurse, being able to effectively communicate with colleagues and having the
necessary conflict resolution skills are critical for the delivery of safe patient care. In this section
you will learn about communication techniques that can prevent conflict and strategies that have
been proven effective in building trusting collaborative relationships.
This topic addresses the following competency:
Competency 734.3.2: Interdisciplinary Collaboration
The graduate applies theoretical principles necessary for effective participation in an
interdisciplinary team.
This topic highlights the following objectives:
Identify factors that may influence the communication process.
Examine the influence interdisciplinary teams have on quality improvement, safety, and
improving patient outcomes.
Examine the importance of nurses taking an active, contributing position within the
interdisciplinary team.
Apply strategies for effectively participating with interdisciplinary team members.
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Apply evidence-based strategies used to optimize communication and teamwork in
interdisciplinary teams.
Create a plan for health quality and safe patient care from the perspective of a member
of an interdisciplinary team.
Effective Communication and Conflict Resolution
Read the following chapter in Contemporary Nursing:
chapter 18 Effective Communication and Conflict Resolution
Access the Evolve Contemporary Nursing online course and complete the following
module (note: that the module number is not the same as the chapter number):
module 17: Effective Communication and Conflict Resolution
lessons 1-5
Optimizing Communication and Teamwork
How do we engage nurses at the bedside to become more creative about designing safety and
quality processes? The Robert Wood Johnson Foundation (RWJF) and the Institute for
Healthcare Improvement (IHI) did just that with the launch of Transforming Care at the Bedside
(TCAB). This national, innovative initiative was designed to improve the work environment of
medical/surgical units by implementing changes that would improve patient outcomes and staff
satisfaction. The changes focus on strategic applications of improved communication
techniques across multiple disciplines, including nurses, physicians, and other clinical and
support staff. Review the initiative at the website below:
TCAB – Transforming Care at the Bedside
Creating a Culture of Safety for Quality Patient Care
Medical errors are one of the nation’s leading causes of death and injury. Communication
regarding safety issues and errors needs to be clear and honest. Process improvement
strategies help nurses focus on resolving the problem rather than merely giving or receiving
blame.
Patient Safety First
In this section, you will watch prominent clinicians describe the errors they have made and how
those errors still haunt them today. Errors can be significant learning opportunities as they point
out measures that can be implemented to reduce the likelihood of reoccurrences.
This topic addresses the following competency:
Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
This topic highlights the following objectives:
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Document the primary types and causes of errors in organizations.
Examine behaviors nurses engage in to improve the safety of patients in their direct
care.
Describe how adverse events can be used as learning opportunities.
IHI Open School: The Mistake, Introduction to Patient Safety, and Fundamentals of
Patient Safety
Read the following chapter in Contemporary Nursing:
chapter 21 Quality Improvement and Patient Safety
IHI Open School: The Mistake, Introduction to Patient Safety, and Fundamentals of Patient
Safety
Access IHI Open School and watch the following two videos:
Learning from Medical Errors (Part 1) (8:35)
Learning from Medical Errors (Part 2) (7:57)
Note: These videos are in addition to the courses found in the IHI Basic Course.
Complete the following IHI Open School Courses on Patient Safety:
PS 101: Introduction to Patient Safety
PS 102: From Error to Harm
IHI Open School: Overcoming Barriers to Error Disclosure
Besides being deadly, medical errors can also be a source of great injury and sufferings for
patients and their families. Many barriers exist to discourage the open, honest disclosure of
errors in the healthcare settings. In this section, you will view three short videos dealing with this
important topic.
Access IHI Open School:
Watch the following 3-part series (see side panel for links to Part 2 and Part 3):
The Patient and the Anesthesiologist, Part 1: The Incident
The Patient and the Anesthesiologist, Part 2: The Connection
The Patient and the Anesthesiologist, Part 3: The Experts React
Note: These videos are in addition to the courses found in the IHI Basic Course.
Complete the following in IHI Open School:
PS 103: Human Factors and Safety
PS 104: Teamwork and Communication in a Culture of Safety
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Initiatives, Strategies and Tools to Ensure Safe, Quality Patient
Care
In this section, we will explore some initiatives such as the National Safety Patient Goals and
safety tools that are being increasingly used to provide safe care. As you review this section,
reflect on how you may use these initiatives, strategies and tools to improve your patient
outcomes.
This topic addresses the following competency:
Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
This topic highlights the following objectives:
Examine behaviors nurses engage in to improve the safety of patients in their direct
care.
Determine the tools and skills necessary for effective quality improvement activities.
National Patient Safety Goals
According to the Joint Commission, the purpose of the National Patient Safety Goals (NPSGs)
is to improve patient safety. The Goals focus on problems in health care safety and how to
solve them and have specific requirements for protecting patients.
As you review the goals, you will notice that patient safety measures indicated for each goal are
measures that you have already learned and are implementing in your respective health care
settings. You will also notice that significant focus has been placed on the most pressing patient
safety issues that all organizations are struggling to manage effectively.
Nursing Quality Indicators
Also known as Nursing Sensitive Indicators, nursing quality indicators reflect the impact that
nursing has on patient care.
Watch the following video, Nursing Sensitive Indicators [Sauls, K. (November 18, 2013], for
more information:
Note: To download this video, right-click the following link and choose “Save as…”: download
video.
The Checklist Manifesto
The implementation of a low-cost checklist can drastically improve patient outcomes by helping
to prevent patient errors.
This topic addresses the following competency:
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Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
This topic highlights the following objectives:
Examine behaviors nurses engage in to improve the safety of patients in their direct
care.
Determine the tools and skills necessary for effective quality improvement activities.
The Checklist Manifesto: How to Get Things Right
Access and view the following videos:
Note: To download this video, right-click the following link and choose “Save as…”: download
video.
Note: To download this video, right-click the following link and choose “Save as…”: download
video.
You are strongly encouraged to read this book:
Gawande, A. (2007). Better: A Surgeon’s Notes on Performance. NY: Henry Holt and
Company. ISBN-13:978-0-312-42765-8
Bundling
Recent data has shown dramatic success in improving the quality of patient care by focusing on
the implementation of an entire group or bundle of evidenced-based practices to achieve a
better outcome than when implemented individually. This new process is referred to as
“bundling” of evidence-based practices.
This topic addresses the following competency:
Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
This topic highlights the following objective:
Describe how the use of bundling practices can improve patient healthcare outcomes.
Bundling: Evidence-Based Practices
Access and read the following:
Evidence-Based Bundle Increases Adherence to Recommended Practices, Leading to
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Fewer Central Line Infections and Lower Hospital Costs
Getting to the Root Cause of Medical Errors: A Systems
Approach
It is now commonly accepted that the majority of errors result from problems in the system and
not necessarily individual behaviors. This section will focus on getting to the root of medical
errors. In this section you will learn how a system may contribute to either a safe working
environment or barriers to patient safety and quality care. You can then use systems tools and
strategies to join healthcare colleagues in the creation and building of a culture of safety.
Systems Thinking in Healthcare
Concepts of systems theory, thinking and tools are the underpinnings for our understanding of
root cause of medical errors and in the continuing efforts to prevent errors from occurring.
This topic addresses the following competency:
Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
This topic highlights the following objectives:
Apply best practices for utilizing a systems approach to prevent medical errors.
Determine the human and fiscal resource impact of medical errors on patients, families,
practitioners and the healthcare industry.
Determine the professional nurse’s role in reducing medical errors and improving
healthcare quality.
Apply a root cause analysis method to address a system problem in healthcare.
Importance of Systems Thinking in Healthcare
Access the Systems Thinking and Systems Tools website and read the following:
Systems Thinking
Systems Thinking in Organizations
Organizations as Open Systems
Five Disciplines of Systems Thinking – per Peter Senge
Some Applications of Systems Theory
Root Cause Analysis
The key to solving a problem is to first truly understand it. Often, we try to solve a problem
before completely comprehending its cause, and the focus shifts too quickly from the problem to
the solution. A root cause analysis can help you determine the issue, avoid quick fixes and
tackle chronic concerns in a system.
Access and read the following:
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Ask “Why” Five Times to Get to the Root Cause
Including patients in root cause and system failure analysis: Legal and psychological
Implications.
Click on the “View Article” button on the lower left side to access the complete article.
The Unfortunate Admission
The documents for the case study are linked in the “Documents” box. Read the case study first.
Next review the PowerPoint slides of the winning student team that conducted the root cause
analysis on the case study.
IHI Open School: Root Cause and System Analysis, Communication with Patients After
Adverse Effects, & Introduction to the Culture of Safety
Complete the following IHI Open School:
PS 105: Responding to Adverse Events
Failure Modes and Effects Analysis
The Root Cause Analysis (RCA) is a reactive process that looks back at past events to
determine their causes and initiate a plan of action to correct those causes in order to prevent a
recurrence. In contrast, the Failure Modes and Effects Analysis is a proactive process that looks
ahead to anticipate ways in which potential errors may occur and to initiate a plan of action to
prevent them before they have a chance to occur.
This topic addresses the following competency:
Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
This topic highlights the following objectives:
Apply best practices for utilizing a systems approach to prevent medical errors.
Determine the professional nurse’s role in reducing medical errors and improving
healthcare quality.
Failures Modes and Effects Analysis
Watch the following video, Failure Modes and Effects Analysis [Sauls, K. (November 18, 2013)
], for an overview of the FMEA process:
Note: To download this video, right-click the following link and choose “Save as…”: download
video.
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Review the following information from the IHI website for additional details:
“Failures Modes and Effects Analysis”
Scroll down to the documents section to download and review the “FMEA Tool”
Basic Principles of Safety, Quality Improvement and
Change
In this section, you will examine principles relevant to the provision of safe, quality care,
improvement, and change. Understanding and applying best practices gained from the national
quality and safety initiatives help to ensure a safe healthcare environment and the provision of
quality care. Quality improvement is a necessary process in any business or industry but may
be most important when dealing with people’s lives as healthcare professionals do. An
understanding of principles such as process improvement, clinical indicators, and standardized
care processes is essential for the provision of safe, timely, effective, efficient, equitable, and
patient-centered care.
Quality Improvement and Patient Safety
Quality improvement is a necessary process in any business or industry but may be most
important when dealing with people’s lives as healthcare professionals do. An understanding of
principles such as process improvement, clinical indicators, and standardized care processes is
essential for the provision of safe, timely, effective, efficient, equitable, and patient-centered
care.
This topic addresses the following competency:
Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
This topic highlights the following objective:
Determine the professional nurse’s role in ensuring patient safety and improving
healthcare quality.
Quality Improvement and Patient Safety
Review the following chapter in Contemporary Nursing:
chapter 21 Quality Improvement and Patient Safety
Access the Evolve Contemporary Nursing online course and complete the following
module (note: that the module number is not the same as the chapter number):
module 20: Quality Improvement and Patient Safety
lessons 1-5
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Complete the following IHI Open School:
QI 101: Introduction to Health Care Improvement
QI 102: How to Improve with the Model for Improvement
QI 103: Testing and Measuring Changes with PDSA Cycles
QI 104: Interpreting Data: Run Charts, Control Charts, and other Measurement Tools
QI 105: Leading Quality Improvement
Staffing and Nursing Delivery Models
The ability to provide safe patient-centered care is dependent upon many factors. As a
professional nurse, it’s important to be knowledgeable about the illness of the patients, the
amount of nursing time available, the care delivery model, care management tools, and
organizational support needed to facilitate care.
Staffing and Nursing Care Delivery
An important skill of the nurse leader is to ensure that staffing patterns are effective for safe,
patient-centered care. Patient factors that must be considered in developing staffing schedules,
staff and environmental factors, and how staffing patterns are impacted by the unit’s delivery
model are some of the issues addressed in this section.
This topic addresses the following competency:
Competency 734.3.3: Quality and Patient Safety
The graduate applies quality improvement processes intended to achieve optimal
healthcare outcomes, contributing to and supporting a culture of safety.
This topic highlights the following objectives:
Determine the impact of staffing and staff mix on patient care, staff satisfaction and the
organization’s financial status.
Determine the role of the professional nurse in considering individuals, populations, and
cost in healthcare outcomes.
Staffing and Nursing Care Delivery Models
Read the following chapter in Contemporary Nursing:
chapter 20 Staffing and Nursing Care Delivery Models
Access the Evolve Contemporary Nursing online course and complete the following
module (note: that the module number is not the same as the chapter number):
module 19: Staffing and Nursing Care Delivery Models
lessons 1-5
Healthcare Cost in America
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Healthcare cost in America is a major economic and political concern. This section will discuss
your role as a professional nurse in terms of cost containment and how health care economics
affect professional nurses.
Healthcare Delivery System: Resources and Financing
Implications
The delivery of healthcare in America differs significantly from countries around the world. This
section will compare the perspectives of healthcare providers in the United States with those in
countries in which healthcare is affordable and accessible to most of its citizens.
This topic addresses the following competency:
Competency 734.3.4: Healthcare Utilization and Finance
The graduate applies financial implications related to healthcare delivery,
reimbursement, access, and national initiatives.
This topic highlights the following objectives:
Compare and contrast U.S. healthcare cost and delivery with other comparable nations.
Analyze how national healthcare policies influence healthcare delivery in the United
States.
Healthcare Delivery System: Resources and Financing Implications
This section will examine the concepts of healthcare utilization management and healthcare
financing. It will include an overview of economic issues and trends driving changes in
healthcare delivery, how healthcare is paid for, and how these issues affect nursing. The
delivery of healthcare in America differs significantly from countries around the world. This
section will compare the perspectives of healthcare providers in the United States with those in
countries in which healthcare is affordable and accessible to most of its citizens. View the
following videos:
PBS Frontline: Sick Around the World
Select one of the five countries in the Frontline report and compare healthcare cost of your
selected country with healthcare cost in the United States. Post your comparison in your study
notes. Did the comparisons of healthcare cost and delivery around the world change or
influence your perspective about national health coverage?
Healthcare Cost and Quality
Balancing cost and quality presents many ethical concerns for professional nurses.
This topic addresses the following competency:
Competency 734.3.4: Healthcare Utilization and Finance
The graduate applies financial implications related to healthcare delivery,
reimbursement, access, and national initiatives.
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This topic highlights the following objectives:
Examine the challenges of Americans with critical illnesses lacking healthcare coverage.
Analyze the role of the professional nurse in helping patients understand their insurance
options.
Analyze policy issues that affect reimbursement for hospital-acquired infections.
Analyze how national healthcare policies influence healthcare delivery in the United
States.
Analyze the ethical implications of inefficiencies in fiscal or resource allocation.
Ethics Toolbox: Healthcare Cost and Quality
Access and read the following:
Healthcare Cost and Quality
Read the following chapter in Contemporary Nursing:
chapter 7 Paying for Healthcare in America: Rising Cost and Challenges
Access the Evolve Contemporary Nursing online course and complete the following
module (note: that the module number is not the same as the chapter number):
module 7: Paying for Healthcare in America: Rising Cost and Challenges
lessons 1-5
ATI Review for Pre-Licensure Students Preparing for NCLEX
If you are a pre-licensure student and you have already completed Professional Roles and
Values, this would be a good time to take the ATI RN Leadership Online Practice test. Access
your ATI account and see how much you have learned in this course.
Final Steps
Congratulations on completing the activities in this course! This course has prepared you to
complete the assessment associated with this course. If you have not already been directed to
complete the assessment, schedule and complete your assessment now.
Accessibility Policy
Western Governors University recognizes and fulfills its obligations under the Americans with
Disabilities Act of 1990 (ADA), the Rehabilitation Act of 1973 and similar state laws. Western
Governors University is committed to provide reasonable accommodation(s) to qualified
disabled learners in University programs and activities as is required by applicable law(s). The
Office of Student Accessibility Services serves as the principal point of contact for students
seeking accommodations and can be contacted at ADASupport@wgu.edu. Further information
on WGU’s Accessibility policy and process can be viewed in the student handbook at the
following link:
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Accessibility Policy
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Course Feedback
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