Running head: LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis Paper

Valrey Llewlaka
Christian Merz
Carol Rajala
Steve Rich
Jane Schunn

Ferris State University

LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis: Carol Rajala

The purpose of this paper is to analyze a clinical activity for quality improvement in the
workplace. All nurses can participate in the quality improvement process with the goal of
preventing errors and improving patient satisfaction. Much like the nursing process, quality
improvement is defined as a structured series of steps intended to plan, implement, and evaluate
changes in the healthcare environment (Yoder-Wise, 2014, p. 395). The purpose of quality
management and quality improvement is for healthcare agencies to provide customers with the
highest quality, safest, most efficient, and cost-effective care possible (Yoder-Wise, 2014,
p.390). Yoder-Wise (2014) continues, The goal of an organization committed to quality care is
a comprehensive, systematic approach that prevents errors or identifies and corrects errors so that
adverse events are decreased and safety and quality outcomes are maximized (p. 390).
Clinical Need: Carol Rajala
A clinical need was identified for analysis. Current research recommends that
arteriovenous fistulas (AVF) should be washed with soap and water before using an alcohol
preparation or equivalent prior to cannulation. Robson (2013) writes, Especially in outpatient
dialysis centers where clients are ambulatory, before cannulation the client should wash his or
her access with an antibacterial soap or scrub and water. After the access has been cleaned with
soap and water, the clinician should assess the access and clean the skin with an alcoholic CHG
solution or 70% isopropyl alcohol, with or without 10% povidone iodine (p. 408-9). However,
it has been observed in the outpatient dialysis clinic that this step is frequently missed. Infection
rates are relatively low for AVFs but risks still exists. Robson (2013) writes, Although AV
fistulae unequivocally pose the lowest risk of infection to the client with kidney disease, they can

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still cause infection (p. 408). AVFs are considered the first choice for hemodialysis access and
have been proven to have the lowest infection rates (Robson, 2013, p. 408).
Interdisciplinary Team: Valrey Llewlaka
In order to assure that adequate, comprehensive, and practical solutions are achieved, a
committee of stakeholders, or a cross section of [those] who are involved with the problem
(Yoder-Wise, 2014, p. 395) will be incorporated into the quality improvement process. Nurses
will be included in the team as they are in a unique position to improve patient safety because of
their inherent proximity to patients (Friesen, Farquhar, & Hughes, n. d.). Kohn, Corrigan, and
Donaldson (1999) indicate that the involvement of consumers is an important aspect of patient
safety [and that they] should communicate concerns (p. 11). Quality improvement goals can
best be accomplished through establishing committees that include consumers and providers of
care who are involved with the topic being evaluated.
For this paper, the following quality improvement interdisciplinary team has been
identified:

Nurse Representative: this nurse will be chosen based on daily interaction with
patients receiving dialysis services and the knowledge of the identified clinical need.

Patient Representative: this patient will be chosen based on being a consumer of the
dialysis services provided.

Patient Family Member: this member will be chosen from among the families of the
patients who receive dialysis services.

Dialysis Administrator: this member will be involved due to being in a position where
he or she will have the authority to act on the recommendations proposed by the
committee.

LEADERSHIP STRATEGY ANALYSIS

Nurse Educator: this member will be involved due to being in a position where he or
she can propose recommendations for implementation of staff and patient education.

The suggestions proposed by this committee will be combined with clinical data in order
to achieve a comprehensive overview of the identified clinical need.
Data Collection: Valrey Llewlaka and Jane Schunn
The qualitative data obtained by the interdisciplinary team will be evaluated, and results
will be compared to the clinical, quantitative data obtained from departmental charts and files, as
described below. The insight and understanding (Nieswiadomy, 2012) provided by the
interdisciplinary team will offer an opportunity to proceed with greater understanding of patient
needs while also addressing staff concerns. Clinical data collection will be conducted by quality
improvement personnel who will audit charts of dialysis patients who had their dialysis fistulas
washed using clean procedure and those using aseptic technique. The quality team will use a
histogram to monitor if the rate of infection was increased or decreased in each method. A
histogram is a bar chart that shows the frequency of events (Yoder-Wise, 2014). Once the data
has been collected, the process of benchmarking will be completed. In benchmarking, a
widespread search is conducted to identify the best performance against which to measures
others (Yoder-Wise, 2014). If one method is better, was it significant to change the current
practice?
Outcomes: Jane Schunn
Quality improvement refers to an ongoing process of innovation, prevention of error and
staff development that is used by institutions that adopt the quality management philosophy
(Yoder-Wise, 2014). Infection related hospitalizations contribute substantially to excess
morbidity and mortality in patients with end stage renal disease, and infection is the second

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leading cause of death in this population (Dalrymple & Alan, 2014). Our goal is to decrease the
rate of infection by using the best evidenced based practice for cleaning fistulas, thereby
decreasing the morbidity and mortality of patients with end stage renal disease.
Implementation Strategies: Christian Merz
Evidence based practice (EBP) has flourished among the profession in nursing.
According to Straus, Richardson, Glasziou and Haynes, (2005) EDP is the integration of the
best research evidence with clinical expertise and the patients unique values and circumstances
in making decisions about the care of individual patients (Yoder-wise, 2011, p. 416). Nurses
value patient outcomes and continue to use EBP to deliver quality care.
The interdisciplinary team will use several approaches to collect data and implement the
identified protocol to decrease infection when accessing AVF sites. According to Yoder-Wise
(2011) evidence is best evaluated with a systematic process (p.423). The interdisciplinary
team will utilize the acronym of PICO to identify the problem. The acronym stands for patient or
population, intervention, comparison, outcome, and time to achieve the outcome (Nieswiadomy,
2012). Researchers use this format to identify problems and simplify areas of concern to
investigate. The PICO question will assist the team to identify precipitating factors and risks for
infection. Communication and informational meetings will take place to review EBP research
and collected data, in order to improve patient outcomes by decreasing infection among dialysis
patients. Benchmarks will be analyzed and EBP research will be bridged to develop new
policies and protocols. All major decisions regarding the policies will be made by consensus.
The interdisciplinary team will estimate potential costs that may be required to implement a new
process.

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Staff education will be required to implement a change once the policy has been
developed by the interdisciplinary team. This will include in-services and education programs to
increase successes with the process. Written material will be provided to staff members and will
include data that supports the policy change. Visual reminders will be posted within the working
facility to emphasize the new process. The interdisciplinary team will provide leadership and
support for staff members to initiate the change. The team will also be required to research
additional information if requested by staff members.
Evaluation: Christian Merz and Steve Rich
Managing change in the clinical setting is a complex process that involves evaluating,
planning, and implementation. Once a change has occurred it is important to monitor the results.
Monitoring the infection rate should occur often at first and then diminish off. If infections
occur after accessing an AVF site, it will be required for staff to document the event through a
reporting system. The reporting system will track and monitor the rate of acquired infections.
The interdisciplinary team will exam all reports and measured outcomes by auditing charts as
necessary. If the new process is not producing desired outcomes, or other problems come up, the
group will have to reevaluate the protocol and determine how they should proceed.
Conclusion: Steve Rich
Quality improvement is an important part of the healthcare field. To improve healthcare,
it is important to follow recommendations of new research and evidence-based practice.
Research shows that washing fistulas with soap and water before using alcohol decreases the risk
for infection when accessing the fistula. When dialysis facilities decide it is time to update their
policy about cleaning fistulas before access, it can be a very stressful situation without a plan.
First the facility needs to develop an interdisciplinary team to develop a plan and manage the

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process. A key part of the quality improvement process is implementation of the protocol, where
the plan is fulfilled and executed. Education of staff may also be necessary to the
implementation process. Throughout this period it is important to evaluate the process and
effectiveness of the new protocol. This is the time when the interdisciplinary team would
determine if the change of the process was effective or if it needed to be modified. The change
to improve the quality of patient care should be a never-ending process that the healthcare team
should participate in.

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References
Dalrymple, L. S., & Alan S., G. (n. d.). Patients with chronic kidney disease. Retrieved from
cjasn.asnjournals.org/content/3/5/1487.short
Friesen, M. A., Farquhar, M. B., Hughes, R.G. (n.d.). The nurses role in promoting a culture of
patient safety. American Nurses Association Continuing Education and Center for
American Nurses. Retrieved from
http://ana.nursingworld.org/mods/archive/mod780/cerolefull.htm
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Ed.). (1999). To err is human: Building a
safer health system. National Academy Press: Washington, D.C. Retrieved from
http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-HealthSystem.aspx
Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed.). Upper Saddle River,
New Jersey: Pearson Education, Inc.
Robson, J. (2013). A review of hemodialysis vascular access devices: improving client outcomes
through evidence-based practice. The Art and Science of Infusion Nursing. 36 (6). doi:
10.1097/NAN.0000000000000012.
Yoder-Wise, P. S. (2011). Leading & managing in nursing (5th ed). St. Louis, MO: Saunders.