Process Improvement in Nursing: Ending Bad Management Plans

Process improvement (PI), continuous quality improvement (CQI), and total quality management (TQM) are a few of the seemingly endless acronyms that are used to denote the process of making things better. Process improvement in nursing is a science unto itself with no shortage of practitioners or theories boasting how to best achieve success. There is little debate on the merits of process improvement in nursing to achieve quality and, ultimately, value. Why, then, do attempts, plans, and projects intended to make improvements so often fall short of achieving their goal?  

The complete answer is lengthy and multi-faceted, but one core reason is the lack of viable knowledge translation (KT). According to the World Health Organization, KT involves moving knowledge out of the research environment and into the hands of end users. Process improvement in nursing must implement knowledge translation effectively. 

The Sequence of Events for Formal Process Improvement in Nursing 

1. A stakeholder or group defines an opportunity for improvement. 
2. The current process is measured or surveyed using data collection and/or process mapping. 
3. The findings are analyzed. 
4. A plan for achieving improvement is created. 
5. The plan is implemented. 
6. The new process is measured to see if improvement occurred. 

A workgroup can produce an excellent plan for process improvement in nursing which, if implemented, would drastically improve quality and value. If this plan is not adequately presented, or end users are not receptive, the plan will produce marginal improvement at best. A well-crafted intervention strategy and a change environment are necessary for knowledge translation to occur, thereby allowing process improvement in nursing to occur. 

What Makes A Change Environment

1. Management is fully committed to KT of the recommended process changes with time, staff, and financial resources. 
2. Staff agree that change is needed and are committed.  
3. Staff understand the reasoning behind specific changes. 
4. Change is undertaken at a realistic pace. 

Intervention Strategies that Produce the Best Results

1. Interactive educational offerings  
2. Manual and computerized reminders 
3. Audit and feedback [if possible, more than one set of measures] 
4. Marketing to staff why the change is needed and what the target result is 

Intervention Strategies that Produce Marginal Results 

1. The use of local opinion leaders [management only] 
2. The use of consensus canvassing [can be counterproductive to the plan] 
3. Patient mediated change [clinical practice feedback, patient reps, patient led training] 

Intervention Strategies that Produce Minimal to No Results

1. Educational print materials 
2. Didactic educational offerings with little or no interaction 

In conclusion, initiatives for process improvement in nursing do not always follow logical steps and often end up producing marginal results. This results in time wasted, damaged work relationships, and frustrated staff, all for little positive change. Root cause determination discovers unrealistic upper administrative mandates, which are often under-funded and poor reactions to corporate issues. Effective process improvement in nursing will require more time and energy but will increase the positive outcome and actually save time in the end. 

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