D158 Healthcare Improvement Project Paper

D158 Healthcare Improvement Project Paper

Implementation Approach

The D158 Healthcare Improvement Project (HIP) was designed to reduce surgical cancellations at Ortho Colorado Hospital (OCH) by improving patient communication, strengthening preadmission processes, and providing staff with targeted education. The implementation began with project-team formation and scope development, followed by structured planning, resource allocation, staff training, monitoring, and evaluation. Regular team meetings, a detailed budget, a Gantt chart, and the Nominal Group Technique (NGT) provided the structure needed to keep the project coordinated and accountable.

Project Initiation

The first step in advancing the Healthcare Improvement Project was to establish a dedicated team focused on reducing surgical cancellations. The project began with a meeting between the project manager and preceptor to define the project’s scope, objectives, and expected outcomes. The proposed scope was then presented to the broader project team for discussion, agreement, and commitment.

Establishing a shared understanding at the beginning of the project helped ensure that team members understood their responsibilities and the intended outcome. The primary objective was to reduce surgical cancellations by 5% through improved patient engagement, enhanced preadmission communication, staff education, and more consistent use of preoperative processes.

Project Planning and Resource Allocation

During the planning phase, the project team met every two weeks to identify the resources required for successful implementation. These meetings provided an opportunity to review project requirements, identify potential barriers, and coordinate responsibilities among team members.

A detailed budget was developed as an important component of the planning process. The budget used personnel pay and hours data to estimate labor requirements and allocate available resources appropriately. This approach supported financial transparency and allowed the project manager to monitor expenses throughout implementation.

Regular financial review was particularly important because the project included additional staff responsibilities, educational activities, and increased patient communication. Establishing the budget early helped the team identify resource needs before implementation began.

Consensus Building With the Nominal Group Technique

The Nominal Group Technique (NGT) was selected as the project’s primary consensus-building method. NGT is a structured decision-making approach that allows participants to contribute ideas independently before discussing and ranking them collectively. This process can help promote balanced participation and reduce the influence of dominant participants during group discussions (Arakawa & Bader, 2022).

The implementation team used four primary stages:

Using a structured consensus process encouraged participation from all team members and supported collaborative decision-making. The process ultimately resulted in team agreement regarding the HIP implementation plan.

Maintaining Project Momentum

Consistent communication was essential for maintaining project momentum. The team planned biweekly meetings to review progress, address barriers, and prepare for upcoming activities. Meeting every two weeks provided enough time for team members to implement changes and evaluate their effects while maintaining regular accountability.

The project manager scheduled meetings around the action plan and Gantt chart milestones. Meeting agendas were aligned with upcoming deadlines and project activities so that discussions remained focused on implementation.

Weekly email updates supplemented the formal meetings. These updates provided stakeholders with information about completed activities, upcoming responsibilities, project changes, and potential concerns. Combining scheduled meetings with ongoing electronic communication helped maintain engagement between formal project meetings.

Policy Review and Process Changes

Policy review was incorporated into the project as a recurring agenda item. The hospital’s exclusion criteria policy remained unchanged; however, the preadmission testing guidelines were revised to strengthen patient follow-up.

Under the revised approach, patients received weekly follow-up calls rather than relying on a single telephone contact. More frequent communication provided additional opportunities to reinforce instructions, answer questions, identify barriers, and prepare patients for their surgical experience.

Because many project-team members also represented the primary stakeholder groups, proposed policy changes could be discussed directly during project meetings. The changes were reviewed and unanimously approved by the participating team members and stakeholders.

Action Plan

The HIP action plan established five major phases: initiation, planning, implementation, control, and evaluation/closure. Each phase included specific activities, responsible individuals, and completion dates. The action plan was coordinated with the project’s Gantt chart to provide a consistent framework for monitoring progress.

The project timeline extended from January 29 through July 31, 2024. Establishing specific deadlines for each phase helped the team monitor progress and maintain accountability.

Gantt Chart Utilization

The Gantt chart functioned as a visual project-management tool for tracking activities, deadlines, responsibilities, and progress. Rather than serving as a static schedule, the chart was updated collaboratively as the project progressed.

The Gantt chart helped the project manager and team identify upcoming tasks, monitor completed activities, recognize potential delays, and coordinate project resources. It also provided a common reference point during team meetings and helped connect individual activities to the overall project timeline.

Social Determinants of Health and the Target Population

The target setting for the HIP was Ortho Colorado Hospital (OCH) in Lakewood, Colorado. The project sought to reduce surgical cancellations by 5% while addressing patient communication and access-related factors that could affect preparation for surgery.

OCH is described as a 48-bed facility with 17 preoperative/PACU bays and eight operating rooms. The facility employs 187 individuals, including approximately 175 clinical employees. Understanding the demographic and socioeconomic characteristics of the surrounding community was important because social determinants of health can influence patients’ ability to access healthcare, understand instructions, obtain medications, and complete required preoperative activities.

According to the project data, Lakewood had an estimated population of 156,149 in 2022, with a median age of 38.1 years and a median household income of $82,786. The reported demographic and socioeconomic characteristics included the following:

These characteristics provided context for developing patient education and communication strategies. Effective healthcare improvement initiatives should consider barriers beyond the clinical environment, including education, transportation, financial resources, and access to healthcare services.

Addressing Social Determinants of Health

The project incorporated several strategies to address social determinants of health (SDOH), particularly education, economic stability, community resources, and healthcare access.

Education access and quality were addressed by developing patient education materials at approximately a sixth-grade reading level. Materials were also translated into Spanish to improve accessibility for patients with different language preferences and literacy levels.

Economic stability was considered by recognizing that financial challenges can interfere with a patient’s ability to follow preoperative instructions, obtain medications, or attend appointments. Frequent patient contact provided an opportunity for nurses to identify concerns and connect patients with appropriate resources.

Neighborhood and transportation factors were also considered. Although Lakewood provides parks and public transportation, transportation-related concerns can affect patients’ ability to attend appointments and access healthcare services.

Social and community support was strengthened through awareness of community resources, including food banks and pharmacies that offer discounted medications. These resources may provide additional support for patients experiencing financial or social barriers.

Healthcare access and quality were supported through connections with community healthcare resources, including CommonSpirit Health services and organizations offering discounted or free care. These partnerships can help patients who experience difficulty accessing healthcare services.

Weekly nurse telephone calls and accessible educational materials were central to the patient-engagement strategy. These interventions were intended to improve understanding, identify concerns earlier, and help patients feel better prepared for their surgical experience.

Force Field Analysis

Force field analysis was used to identify factors that could either support or hinder implementation of the HIP. Recognizing these forces allowed the team to develop strategies for strengthening support and addressing barriers before they interfered with project activities.

Strategies for Managing Implementation Barriers

Several strategies were developed to address the restraining forces identified during the analysis.

Monthly executive updates were planned to communicate surgical cancellation metrics and maintain leadership awareness of project progress. Leadership walkthroughs were also intended to improve understanding of frontline staff experiences and operational challenges.

The project team planned to use the approved staffing resources to reduce workload and improve the capacity for patient communication. Staff members were also involved in developing educational materials, giving frontline employees an opportunity to contribute to the intervention and increasing ownership of the process.

These strategies supported a collaborative implementation environment in which staff concerns could be identified and addressed rather than overlooked.

Scope Statement

The scope of the HIP focused on improving patient engagement and preparation for surgery through increased communication and accessible educational resources. The project included multiple telephone touchpoints, patient handouts, educational booklets, and classes explaining surgical requirements, expectations, and important milestones.

The purpose of these resources was to improve patient understanding and adherence throughout the surgical preparation process. By providing consistent information before surgery, the project aimed to identify potential problems earlier and reduce preventable cancellations.

SMART Goal

The project’s SMART goal was to reduce surgical cancellations at Ortho Colorado Hospital by 5% by June 30, 2024. The intervention focused on enhanced patient communication, additional preadmission contacts, comprehensive educational materials, and targeted staff training.

The goal was specific because it addressed surgical cancellations, measurable because the desired reduction was 5%, achievable through defined interventions and staffing resources, relevant to the hospital’s identified quality concern, and time-bound by a specific completion date.

Key Performance Indicators

Key performance indicators (KPIs) were established to measure implementation progress and determine whether critical project activities were completed.

These measures provided tangible indicators of implementation. Staff competency sign-off demonstrated that personnel had received and understood the required training, while checklist compliance provided a measurable indicator of adoption of the revised preadmission process.

Communication Plan

Effective communication was necessary to coordinate the project team, maintain stakeholder awareness, and support timely completion of project activities.

The communication plan created a predictable structure for sharing project information. Regular updates also provided opportunities to identify concerns and clarify responsibilities before they affected project milestones.

Staff Training Plan

Training was planned for surgical, preadmission, preoperative, and operating room staff. The training focused on the practical changes required to support the HIP, including the use of new educational materials, compliance with preadmission checklists, and enhanced patient communication.

Training sessions were scheduled four times per week over two weeks, from May 20 through June 7, 2024. Each session lasted approximately two hours and was offered during morning and evening periods, as well as virtually through the surgeon’s clinic, to accommodate staff schedules.

Competency sign-off was required following training. Staff members were expected to complete a walkthrough and explain the purpose and goals of the project. This approach provided a method for verifying that employees understood not only the procedural changes but also the relationship between their responsibilities and the project’s goal of reducing surgical cancellations.

Conclusion

The D158 Healthcare Improvement Project used a structured quality-improvement approach to address surgical cancellations at Ortho Colorado Hospital. The implementation strategy combined team-based planning, the Nominal Group Technique, a detailed action plan, Gantt chart monitoring, force field analysis, stakeholder communication, staff training, and measurable KPIs.

A major focus of the project was improving patient preparation through more frequent preadmission communication and accessible educational resources. Addressing social determinants of health, including education, financial barriers, transportation, community support, and healthcare access, further supported a patient-centered approach.

By establishing defined responsibilities, deadlines, communication processes, and evaluation measures, the HIP created a systematic framework for implementing and monitoring changes intended to reduce surgical cancellations.

References

Arakawa, N., & Bader, L. R. (2022). Consensus development methods: Considerations for national and global frameworks and policy development. Research in Social and Administrative Pharmacy, 18(1), 2222–2229. https://doi.org/10.1016/j.sapharm.2021.06.024

D158 Healthcare Improvement Project Paper

Data USA. (n.d.). Lakewood, CO. https://datausa.io/profile/geo/lakewood-co/#demographics