NURS_ADV-526-jason.meade-2025-02-10-02-41-00

Quality Improvement & Culture of Safety

NURS_ADV-526

Spring 2025

3 Credit Hours

(3 didactic)

Prerequisites TBD

Course Details

Day and Time: [tbd]

Meeting Location: [tbd]

Instructor Contact Information

Instructor Name: [tbd]

Instructor Contact Information: [office location, phone, email] [tbd]

Instructor Office Hours: [tbd]

Course Description

Students will gain knowledge of how to facilitate patient experience, safety, and quality through the promotion of patient-centered care grounded in a culture of safety and emergency preparedness.

Course Materials

Books:

American Psychological Association. (2020). Publication Manual of the American Psychological Association (7thed.) American Psychological Association. ISBN: 978-1433832161
Knowles, S. (2024). Patient Safety Coaching: Transforming Healthcare Culture(First edition.). Springer.

Other Materials:

Course and assignment specific resources are embedded in each week’s lectures, lessons learned, and group assignments.

Agency for Healthcare Research and Quality. (2024). Plan-Do-Study-Act Worksheet, Directions, and Examples. Content last reviewed March 2024. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html

Agency for Healthcare Research and Quality. (2024). Healthcare literacy. Content last reviewed March 2024. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/health-literacy/about/index.html

Berry, J., Davis, J., Bartman, T., Hafer, C., Lieb, L., Khan, N. & Brilli, R. (2020). Improved Safety Culture and Teamwork Climate Are Associated with Decreases in Patient Harm and Hospital Mortality Across a Hospital System. Journal of Patient Safety, 16 (2), 130-136.

doi: 10.1097/PTS.0000000000000251.

Burlison, J., Quillivan, R., Kath, L., Zhou, Y., Courtney, S., Cheng, C. & Hoffman, J. (2020). A Multilevel Analysis of U.S. Hospital Patient Safety Culture Relationships with Perceptions of Voluntary Event Reporting. Journal of Patient Safety, 16 (3), 187-193.

doi: 10.1097/PTS.0000000000000336.

Institute for Healthcare Improvement. (n.d.). Workforce safety. Retrieved from www.ihi.org. https://www.ihi.org/improvement-areas/improvement-area-workforce-safety

Liepelt, S., Sundal, H., & Kirchhoff, R. (2023). Team experiences of the root cause analysis process after a sentinel event: a qualitative case study. BMC Health Services Research, 23(1), 1–1224. https://doi.org/10.1186/s12913-023-10178-3

World Health Organization (WHO), (2021). Global patient safety action plan 2021-2030. https://www.who.int/publications/i/item/9789240032705

Fees: [tba]

**Student Learning Outcomes (SLOs)**
Course Learning Outcomes (students will be able to:)	Assessment of the Learning Outcomes
Compare and contrast quality improvement concepts, models, frameworks, and initiatives for the promotion of safe patient care	Individual Lessons Learned: Lesson 3
Analyze strategies which promote safety culture, error reporting, and emergency preparedness.	Individual Lessons Learned: Lesson 1 Individual Lessons Learned: Lesson 2 Group Exercise #3
Differentiate techniques for sustained data collection, analysis, and reporting related to quality safety metrics.	Group Exercise #1
Analyze concepts of effective communication for the promotion of interdisciplinary collaboration and patient-centered quality improvement.	Group Exercise #2 Individual Lessons Learned: Lesson 4
Develop advocacy strategies for the development of healthcare policies that promote patient safety and support ethical responses to safety events.	Individual Lessons Learned: Lesson 2 Individual Lessons Learned: Lesson 5

**Course Schedule**

**[Please note that a WSU semester is 15 weeks + Thanksgiving/Spring Break. The schedule below does not include the break.]**
Dates	Lesson Topic	Assignment	Assessment
Week 1	Introduction to Quality Improvement & the Culture of Safety	Review Course Expectations and Assignments Groups for three group exercises will be assigned.	Synchronous Class via Zoom Group Contract is in Canvas Group Contract is Due Sunday of Week 2 by 1159pst
Week 2	Quality Improvement Concepts	Read: CMS Quality Measurement and Quality Improvement, (2024). https://www.cms.gov/Medicare/Quality -Initiatives-Patient-Assessment-Instrument s/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Quality%20improvement%20is% 20the%20framework,%2C%20healthcare%20systems%2 C%20and%20organizations. CMS National Quality Strategy, (2024). https://www.cms.gov/ files/document/quality-motion-cms-national-quality-strategy.pdf Lecture in Canvas Compare and contrast quality improvement concepts, models, frameworks, and initiatives for the promotion of safe patient care *Standardizing processes and structure to reduce variation to deliver safe and effective care. Utilize continuous change methodology, PDSA (Plan, Do, Study, Act). Lean, Six-Sigma, Rapid Small-Scall Change Process. Quality Improvement https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/quality-improvement	*Lessons Learned 1* *Smart Goals* Supported by the John Hopkins Nursing Center of Inquiry, write SMART Goals to improve patient safety in your area of practice (250-300 words). Follow the format from the website for SMART. For example: Improve patient identification, reduce patient injury, enhance patient-centered communication. Ask yourself: 1.What are you trying to accomplish? How will you know whether a change is an improvement? What changes can you make that will result in improvement? The proposal should be substantive, succinct and precise with appropriate professional language. Use in-text citations and references in the correct APA style. Due Sunday of Week 4 by 1159pst.
Week 3	Improvement Frameworks	Read: NAHQ: Healthcare Quality Competency Framework. (2024). https://nahq.org/why-nahq/healthcare-quality-competency-framework/ Lecture in Canvas Explain key frameworks and their distinct features: Large-Scale: Lean Methodology and Six Sigma. Rapid Small-Scale Model for Improvement. Hamilton, S., Jennings, A., & Forster, A. J. (2020). Development and evaluation of a quality improvement framework for healthcare. International Journal for Quality in Health Care, 32(7), 456–463. https://doi.org/10.1093/intqhc/mzaa075	Synchronous Class via Zoom Class review of student’s Areas of practice SMART GOALS Opportunities for organizational quality improvement OFI Patient and Staff Safety Structure of student’s organizational Quality and Patient Safety Division
Week 4	Culture of Safety	Read: Knowles (2024): Chapters 1-3 Lecture in Canvas Analyze strategies which promote safety culture, error reporting, and emergency preparedness. *Policies, Adverse Events, Transparency, High-Reliability Organizations, Patient-Centered Care, Safety Checklist, Training, a “Just Culture” and Collaboration. Prohibit employee retaliation, Whistleblower protection. World Health Organization (WHO), (2019). Medication Safety in Polypharmacy. https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.11	*Lessons Learned 2* *Harm related to Polypharmacy* Supported by the WHO Medication Safety in Polypharmacy Initiative, identify opportunities for medication-related harm related to polypharmacy in your area of practice (250-300 words). In your area of practice or organization: Identify barriers or challenges to the adoption of strategies designed to reduce medication related errors. Propose a focus group to identify strategies for effective medication harm reduction in your area of practice. Identify role members? What mechanisms are essential to patient safety relative to medication administration? Ask yourself: What changes can you make that will result in improvement? Describe in detail the responses supported by evidence in-text citations. The proposal should be substantive, succinct and precise with appropriate professional language. Use in-text citations and references in the correct APA style. (250-300). Due Sunday of Week 6 @ 1159pst
Week 5	Quality Safety Metrics Mitigation Strategies to Reduce Risk and Improve patient outcomes and satisfaction	Read: Knowles (2022): Chapter 9 Governance, Organizational Planning, Workforce planning, and Resource utilization. Lecture in Canvas Identify organizational improvement opportunities impacting patient and staff safety. *Patient Satisfaction Scores, Readmission Rates, Medication Errors, Staff Turnover, Clinical Effectiveness Indicators (Wounds, Infections, Fall Rates).	*Lessons Learned 3* Real World Scenario and Proposed Mitigation Strategies. Describe a real-world scenario in your area of practice in which the limitation of resources impacts the optimization of care and patient outcomes. Share ideas, supported by peer-reviewed evidence to reduce barriers and challenges to your area of practice constraints. Describe in detail the responses supported by evidence in-text citations. The proposal should be substantive, succinct and precise with appropriate professional language. Use in-text citations and references in the correct APA style. (250-300). Due Sunday of Week 7 @1159 pst
Week 6	Group Exercise #1 Quality Improvement Case Study Patient Satisfaction Indicators	Quality Improvement: Patient Satisfaction Indicators Analyze case study based on publicly available data from hospital or clinic. Create action plan to address unmet patient satisfaction benchmarks. Action plans to demonstrate understanding of what drives patient satisfaction and integrate concepts of effective communication and interdisciplinary collaboration. Group Exercise Work Sheets provided to guide the development of this presentation are in Canvas (Group Exercise #1: QI Patient Satisfaction Benchmarks) Details under Assignments and Assessments. Refer to Group Exercise Grading Rubric*	Dedicated Group Exercise 1 Work Sessions Due Sunday of Week 8 by 1159pst
Week 7	Data Collection	Read: Knowles (2024): Chapter 8 & 9. Lecture in Canvas Differentiate techniques for sustained data collection, analysis, and reporting related to quality safety metrics *Organization specific quality dashboards: KPIs Key Performance Indicators, NDNQI, National Database of Nursing Quality Indicators, Hospital Safety Scores, Leapfrog Scores, The Joint Commission Accreditation Standards.	Synchronous Class via Zoom Be prepared to review either a hospital where you practice or your community hospital. Live Review: https://www.hospitalsafetygrade.org/ MMWR monthly reports (CDC) https://www.cdc.gov/mmwr/index2024.html
Week 8	Effective Communication Interdisciplinary Collaboration	Read: Knowles (2024): Chapter 3 &4. Appendix Lecture in Canvas Analyze concepts of effective communication for the promotion of interdisciplinary collaboration and patient-centered quality improvement *Inspire, Communication, Collaborate, Emotional Intelligence, Active Listening, Conflict Resolution, Transformational Leadership, Mentoring, and Problem Solving	*Lessons Learned 4* *Effective Communication* Communication, in particular ineffective communication, is a known cultural stressor in healthcare. For several decades, the Joint Commission has reported that inadequate and disrespectful communication accounts for a high percentage of adverse events. Outline communication strategies for sharing information with providers, staff, and patients, as well as mechanism for conflict resolution and problem-solving. How effective are the strategies? Is there a communication champion in your area of practice? A member of administration or leadership? A provider? A patient advocate? A team? What attributes are evident in the individual or team’s style of communication? How do you demonstrate active listening with staff and patients? The proposal should be substantive, succinct and precise with appropriate professional language. Use in-text citations and references in the correct APA style. (250-300). Due by Sunday of Week 10 by 1159pst
Week 9	Group Exercise #2 Interprofessional Communication	Interprofessional Communication Utilize a real-life scenario, to develop an interdisciplinary communication plan including concepts of effective communication skills: active listening, SBAR Communication, conflict resolution, and cultural competence. Create and outline dialogue, and a script for role-playing techniques & team-building exercises. Group Exercise Work Sheets provided to guide the development of this presentation are in Canvas (Group Exercise #2: Interprofessional Communication) Details under Assignments and Assessments. Refer to Group Exercise Grading Rubric*	Dedicated Group Exercise 2 Work Session Due by Sunday of Week 11 by 1159pst
Week 10	Error Reporting and Risk Mitigation	Read: Knowles (2024): Chapter 1-3 Appendix 3.1 Survey of Factors Contributing to Adverse Events. Appendix 3.2 Incident Reporting Form. Lecture in Canvas Analyze strategies which promote safety culture, error reporting, and emergency preparedness Policies for documenting potential hazards, safety issues, near misses, and incidents. Reporting Patient Safety Events. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. https://psnet.ahrq.gov/primer/reporting-patient-safety-events Ramírez, E., Martín, A., Villán, Y., Lorente, M., Ojeda, J., Moro, M., Vara, C., Avenza, M., Domingo, M. J., Alonso, P., Asensio, M. J., Blázquez, J. A., Hernández, R., Frías, J., Frank, A., & SINOIRES Working Group (2018). Effectiveness and limitations of an incident-reporting system analyzed by local clinical safety leaders in a tertiary hospital: Prospective evaluation through real-time observations of patient safety incidents. Medicine*, 97(38), e12509. https://doi.org/10.1097/MD.0000000000012509 https://pmc.ncbi.nlm.nih.gov/articles/PMC6160204/pdf/medi-97-e12509.pdf	*Lessons Learned 5* *Adverse Events, Sentinel Events* As noted in this week’s readings and resources, there are common barriers to incident-reporting systems. Some noted are: 1. Limited access to technology, 2. Staff uncertain whose responsibility it is to report, 3. Time constraints to completing the form, 4. Concern about the accountability of the documentation. In your area of practice or organization: 1. Identify barriers or challenges to the adoption of strategies designed to increase safety event incidents, near misses, and sentinel events. Ask yourself: 1. What changes can you make that will result in improvement? 2. Propose the development of a focus group to address safety issues. 3. Who will you invite to participate on the focus group? 4. Why did you select these roles? The proposal should be substantive, succinct and precise with appropriate professional language. Use in-text citations and references in the correct APA style. (250-300 words). Due by Sunday of Week 12 by 1159pst
Week 11	Patient Centered Care	Read: Knowles (2024): Chapter 5,7, & 9 Appendix 9.4 Strategies to Develop a Patient Safety Culture Lecture in Canvas Care principles of dignity, compassion, respect, coordination, and personalization. *Global Action of Patient Safety” World Health Organization (WHO) Developing a “Patient Safety Culture is the result of competent, engaged leaders, the buy-in of key stakeholders, empowered staff, and highly enabled teams with highly-reliable technology and tools.” Global Patient Safety Action Plan 2021-2030: Towards eliminating avoidable harm in health care https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan	N/A
Week 12	Group Exercise #3 Quadruple Aim Nursing Grand Rounds Group Power Point Presentation	In this assignment, a group of peers have been selected to present an overview of the Quadruple Aim, a framework to optimize healthcare system performance at the upcoming Nursing Grand Rounds. Discuss the following elements: Define, describe, and history of this framework. What did the Triple Aim evolve into the Quadruple Aim? Include the components of the culture of health, social determinants of health, health equity, and population health. Propose strategies to the nurse audience to successfully integrate well-being into their practice. Include team building, self-care, staff safety, gratitude, and joy in work. Describe in detail the responses supported by evidence in-text citations. Details under Assignments and Assessments. Refer to Group Exercise Grading Rubric*	Dedicated Group Exercise 3 Work Sessions Live Group Presentation Week 14 & 15 Synchronous ZOOM Class Due by Sunday of Week 14 @ 1159pst
Week 13	Debriefing, Coaching, Constructive Feedback	Read: Knowles (2024). Chapter 4 & 9. Appendix 3.3 Learning from Observation (Feedback and Coaching Sessions) Appendix 3.4 Feedback on being “Present” Lecture in Canvas Coaching, debriefing, and constructive feedback are strategies to effectively and efficiently promote team-building, patient and staff satisfaction, increased knowledge, skills, and behaviors, as well as resourceful leadersip. Hu, S., Välimäki, M., Liu, S. et al. Coaching to develop leadership of healthcare managers: a mixed-methods systematic review. BMC Med Educ 24, 1083 (2024). https://doi.org/10.1186/s12909-024-06081-y https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-06081-y#Abs1	N/A
Week 14	Safety Event Policies	Read: Knowles (2024). Chapter 9. Lecture in Canvas Develop advocacy strategies for the development of healthcare policies that promote patient safety and support ethical responses to safety events *Establish evidence-based strategies and interventions in alignment with the National Patient Safety Goals NPSG: Accurate patient identification, Medication Reconciliation, Effective alarm systems, Encourage and support staff to speak up and seek perspective. National Patient Safety Goals https://www.jointcommission.org/standards/national-patient-safety-goals/	Synchronous Class Via Zoom Live Group Exercise #3 Presentations
Week 15	Staff Safety Emergency Preparedness	Read: Knowles (2024): Chapter 5, 6, & 7. Lecture in Canvas Strategies for managing difficult situations in healthcare including patients, families, staff, providers, and community: active listening, empathy, effective communication, establish trust. Staff training: resilience, de-escalation, self-care, team building, consensus decision-making, & leadership coaching.	Synchronous Class Via Zoom Live Group Exercise #3 Presentations End of Course Student Reflection

Expectations for Student Effort

Students are expected to spend the following on course work (at a minimum):

Didactic [F2F Video Conference or Directed Online Learning]

15 hours of faculty-directed instruction per credit hour.

Graduate Courses

For each hour of lecture equivalent, students should expect to have a minimum of two hours of work outside class.

Grading

Assignment Breakdown
Type of Assignment (tests, papers, etc.)	Points	Percent of Overall Grade
Attendance & Participation	10	10
Individual Lessons Learned	30	30
Group Exercise Case Studies	60	60

Grading Schema
Grade	Percent	Grade	Percent
A	95-100	C	73-75
A-	90-94	C-	70-72
B+	86-89	D+	66-69
B	83-85	D	60-65
B-	80-82	F	0-59
C+	76-79

*Minimum passing final grade for a required nursing course is C (73%). If you receive a course grade of C- (≤72%) or lower, you will need to repeat the course.

Grade Rounding Policy

A grade is rounded up if the percentage grade is >0.5 (e.g., 93.55 is rounded to a 94) or is rounded down if the percentage grade is <0.5 (e.g., 93.43 is rounded to a 93).

Alternative Grades

Incomplete, X, or Z may be awarded based on WSU Policy at https://registrar.wsu.edu/grades-and-gpa/.

Attendance and Make-Up Policy

Policy

Students are expected to attend all scheduled classes and 1:1 sessions (with course instructor, mentor, peers, etc.), no matter the modality (in person, asynchronous/synchronous VC, etc.), unless arrangements are made ahead of time.

Students are expected to come to class prepared to listen (or to present) and to ask questions that add to their knowledge and to the knowledge of others. This includes students actively sharing what they are learning in the readings and discussion boards.

Absence Makeup

Makeups are dependent on circumstances and/or prior notice only. It is the student's responsibility to ask for any missing assignments or makeup work due to an excused absence from class.

PRIOR TO MISSING A SCHEDULED CLASS/SESSION, and using their student WSU email account, the student is to email the course instructor to negotiate how the missed session is to be made up.
More than one unexcused absence will result in a 5% deduction to the student’s overall course grade (i.e., final grade for the course).
Extreme violations of this policy will result in a Performance Improvement Plan (PIP) being filed with the Center for Student Excellence.

Late Assignments

Late Assignment Policy

All course work (including, but not limited to assignments, class activities, and discussion boards) must be submitted no later than the due date specified in this syllabus unless prior arrangements are made with the faculty and a new due date is established.

All assignments (LMS postings, individual, group, presentation/written, etc.) submitted after the deadline AND without prior notification to or arrangements with the faculty, will be subjected to a penalty.

Assignment Due Date Extension Procedure

PRIOR TO THE ASSIGNMENT DUE DATE, and using their student WSU email account, the student is to email the course instructor to negotiate a different due date.
If the student does not negotiate a different due date, depending on the circumstances, the course faculty will impose a penalty such as:
- an assignment score = zero.
- a loss of 5 percentage points (for the assignment) for each day (24 hours) past the deadline.
Extreme violations of this policy will result in a Performance Improvement Plan (PIP) being filed with the Center for Student Excellence.

Academic Integrity Statement

Students and faculty share in the responsibility of upholding and protecting academic honesty standards within the University. At Washington State University, all cases of academic dishonesty or academic misconduct, including cases of plagiarism, will be handled according to the process in WAC 504-26-415.

Through the academic integrity violation process (see https://www.handbook.wsu.edu/academic-integrity-process/), the reported student will receive notice of the concerning information and will be given an opportunity to respond. The Standards of Conduct for Students covers cheating, plagiarism, or other forms of academic dishonesty including but not limited to the following:

unauthorized collaboration on assignments;
facilitation of dishonesty including not challenging academic integrity violations by others;
obtaining unauthorized knowledge of course assignments or exam materials;
unauthorized multiple submissions of the same work for different course assignments;
sabotage of another student’s work;
knowingly furnishing false information or data to any University official, faculty, or staff; and
forgery, alteration, or misuse of any University document, record, or form of personal identification.

For a complete definition of academic dishonesty, see WAC 504-26-415 at https://apps.leg.wa.gov/WAC/default.aspx?cite=504-26-010.

Given the accessibility of electronic information, further discussion of commonly observed examples of plagiarism is warranted.

Examples may include:

copying material (e.g., copy and paste) from any source without proper citation;
copying homework solutions from online sources such as CHEGG, Bartleby, StackExchange, and solutions manuals; or
using an essay for hire service or copying material from another student.

When submitting group projects, any example of plagiarism may result in the entire group facing disciplinary action. It is appropriate to ask professors for further clarification of proper protocol. In addition to increasing the availability of information, technology also provided enhanced methods for identifying copied work. Plagiarizing another’s work denies learning opportunities and does not advance one’s academic pursuits.

If a graduate student becomes aware of any incidents of academic dishonesty, the graduate student should report the incident to the appropriate faculty member. The faculty member is then responsible for contacting the reported student and for notifying the Center for Community Standards. Sanctions imposed by the faculty member may include failure of the assignment, test, or entire course. Sanctions may also lead to loss of one’s assistantship (see Chapter 9.G) and/or dismissal from the graduate program.

The Center for Community Standards will assign additional educational outcomes to a student found responsible for an academic integrity violation. For more information about possible outcomes from the community standards process, please visit https://handbook.wsu.edu/violations-and-possible-sanctions/. If a student is uncomfortable reporting another student to a faculty member, other resources include the ombudsman, the Graduate School, and the Center for Community Standards.

Artificial Intelligence (AI) Policy

WSU Executive Policy 8 prohibits the inclusion of legally protected or regulated data (e.g., proprietary, personally identifiable information, HIPAA, FERPA) in queries provided to generative AI platforms like ChatGPT. The appropriate use of AI in this course includes the use of the platform and tools, such as AI-based tools to improve spelling and grammar like Grammarly, use of AI tools such as TurnitIn to test for plagiarism before turning in an assignment or by the professor after an assignment is received, and use of platforms such as ChatGPT for outlining an assignment. You may not use ChatGPT for more than 10% of the content of ANY assignment. Use of AI for >10% of an assignment unless it is specifically authorized in the instructions for that assignment will result in an automatic zero for that assignment and potential referral to the Center for Community Standards.