Topic: Hypoglycemia management
Draft a 6-page report on outcome measures, issues, and opportunities for the executive leadership team or functional stakeholder group.

Introduction
Note: Each assessment in this course builds on the work you completed in the previous evaluation. Therefore, you must complete the reviews in this course in the order in which they are presented.

As a nurse leader, you may be called upon to submit a detailed report to your executive leadership team and key stakeholders that describes a quality or safety problem and its effects on outcomes, fully supported by relevant and credible data.

This assessment provides an opportunity to draft such a report. You can call attention to quality and safety issues and opportunities, effectively support your position, and layout a plan for change.

This assessment is based on the executive summary you prepared in the previous evaluation.

Preparation
Your executive summary captured the attention and interest of the executive leadership team, who have asked you to provide them with a detailed report addressing outcome measures and performance issues or opportunities, including a strategy for ensuring that all aspects of patient care are measured.

Note: Remember that you can submit all or a portion of your draft report to Smarthinking for feedback before you submit the final version for this assessment. However, be mindful of the turnaround time of 24–48 hours for receiving feedback if you plan on using this free service.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

How might you engage stakeholders to help develop, implement, and sustain a vision to actually change and improve patient outcomes?
What arguments might be most effective in obtaining agreement and support?
What recommendations would you make to implement a proposed plan for change?
The following resources are required to complete the assessment.

APA Style Paper Template [DOCX]. Use this template for your report.

Requirements
Note: The requirements outlined below correspond to the grading criteria in the Outcome Measures, Issues, and Opportunities Scoring Guide. Be sure that your written analysis addresses each point, at a minimum. You may also want to read the Outcome Measures, Issues, and Opportunities Scoring Guide and Guiding Questions: Outcome Measures, Issues, and Opportunities [DOCX] to better understand how each criterion will be assessed.

Drafting the Report
Analyze organizational functions, processes, and behaviors in high-performing health care organizations or practice settings.
Determine how organizational functions, processes, and behaviors affect outcome measures associated with the systemic problem identified in your gap analysis.
Identify the quality and safety outcomes and associated measures relevant to the performance gap you intend to close. Create a spreadsheet showing the outcome measures.
Identify performance issues or opportunities associated with particular organizational functions, processes, and behaviors and the quality and safety outcomes they affect.
Outline a strategy, using a selected change model, for ensuring that all aspects of patient care are measured and that knowledge is shared with the staff.
Writing and Supporting Evidence
Write coherently and with purpose, for a specific audience, using correct grammar and mechanics.
Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.
Additional Requirements
Format your document using APA style.

Use the APA paper template linked above. Be sure to include:
A title page and reference page. An abstract is not required.
A running head on all pages.
Appropriate section headings.
Properly-formatted citations and references.
Your report should be 6 pages in length, not including the title page and reference page.
Add your Quality and Safety Outcomes spreadsheet to your report as an addendum.
Portfolio Prompt: You may choose to save your report to your ePortfolio.

Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Analyze quality and safety outcomes from an administrative and systems perspective.
Identify typical quality and safety outcomes and their associated measures.
Competency 3: Determine how specific organizational functions, policies, processes, procedures, norms, and behaviors can be used to build reliability and high-performing organizations.
Analyze organizational functions, processes, and behaviors in high-performing organizations.
Determine how organizational functions, processes, and behaviors support and affect outcome measures for an organization.
Identify performance issues or opportunities associated with particular organizational functions, processes, and behaviors and the quality and safety outcomes they affect.
Competency 4: Synthesize the various aspects of the nurse leader’s role in developing, promoting, and sustaining a culture of quality and safety.
Outline a strategy for ensuring that all aspects of patient care are measured and that knowledge is shared with the staff.
Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.
Write coherently and with purpose, for a specific audience, using correct grammar and mechanics.
Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

The paper must include the following:
1. Analyzes organizational functions, processes, and behaviors in high-performing organizations, and identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the analysis).
2. Determines how organizational functions, processes, and behaviors support and affect outcome measures for an organization, and identifies assumptions and reasons on which determination is based.
3. Identifies typical quality and safety outcomes and their associated measures, and evaluates the quality of the data.
4. Identifies performance issues or opportunities associated with particular organizational functions, processes, and behaviors and the quality and safety outcomes they affect, and identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty.
5. Outlines a strategy, using a selected change model, for ensuring that all aspects of patient care are measured and that knowledge is shared with the staff, highlighting opportunities for interprofessional collaboration.
6. Writes coherently and with purpose. Grammar and mechanics are error-free
7. Integrates relevant, credible, and convincing sources of evidence to support assertions. Sources are current, and citations and references are error-free.

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Solution

Outcome Measures, Issues, and Opportunities

Healthcare has been in a continuous evolution process due to the emergence of unique healthcare demands. To meet the various demands and needs of patients, healthcare systems and providers have implemented various policies to enhance evidence-based practices that meets care that is personalized and one informed by evidence. There are various outcome measures that have been the driving force for the radical changes experienced within the healthcare system. Some common measurable outcome measures that have been the driving force for healthcare evolution include the safety of patient care, cost of healthcare, and the improvement of patient experience. The various organizational performance issues have a direct association with outcome measures. This paper aims to analyze high performing organizations, identify the various performance issues and opportunities while highlighting how organizational functionality influences outcome measures. Lastly, the paper will define a change strategy that will ensure that all aspects of hypoglycemia management are measured.

Analysis of High-Performing Organizations

The Baldrige Criteria for Performance Excellence is one of the most suitable frameworks that are used to determine and understand the various characteristics of high-performance organizations within the healthcare system. With the use of the Baldrige Criteria for Performance Excellence, various organizations can perform a self-assessment using a set of six outlined fulfillment criteria (Kanter & Page). Besides, high performance organizations can analyze their performance using the standard concepts and values enshrined within their organizations. The core values or concepts helps to reinforce change based on the specific organizational expectations and desires. Usually, high performance organizations have a unique vision and mission which helps in defining the course of action that will enhance improved organizational performance.

Organizational vision and mission in turns gives rise to a culture of personal and organizational leaning which always focuses on organizational growth. The six-excellence matrix defined by the Baldrige Framework includes the following; strategy, operations, leadership, customers, workforce, and lastly measurement, analysis and knowledge management. The Baldrige Framework is essentially important in that it helps in identification of appropriate evaluation criteria, communication of best practices and the establishment of role model organizations. The Baldrige Framework can therefore be defined as the standard healthcare performance measure.

Organizational Culture and Outcome Measures

Organizational culture refers to a set of defined functions, processes and behaviors which govern the specific organization. Organizational culture directly influences the various outcome measures for various healthcare challenges such as management of hypoglycemia. The effective leadership for instance has a direct implication in the creation of a safety culture my effective mitigation of possible adverse healthcare outcomes. Organizational culture is directly associated with the performance of outcome measures in that an organizational culture helps in adjusting the focus on the various organizational elements where the ideas and contributions of all members and stakeholders are valued (Paradiso & Sweeney, 2019). The involvement of all stakeholders in organizational processes helps in fostering good cultural practices such as good communication skills that promote professional development. One evident way of improving organizational performance is by developing a culture of effective leadership behaviors. For instance, the establishment of a safety culture will translate to success when initiating safety and quality outcome measures.

Proper leadership skills have been attributed to improved quality and safety in that proper leadership skills helps in establishing mechanisms of investigating and reporting errors with healthcare which works as the primary step in the development of strategies aimed at reducing errors (Agency for Healthcare Research and Quality, 2019). The management of hypoglycemia for instance is one of the healthcare areas that have been associated with poor patient outcomes due to the prevalence of errors when delivering medications. Some of the outlined challenges associated with hypoglycemia management are poor site injections of medication or even overdose of medication. For instance, excessive administration of glucose when managing hypoglycemia can lead to hyperosmolar syndrome.

Quality and Safety Outcome Measures

It is obvious that you cannot improve if you cannot measure, meaning that for any improvement to be done, there must be a measurement mechanism or criteria to govern measurement. The measurement criteria are evidence based and always give a methodology that is deemed the gold standard for measuring best practices. The Agency for Health Care Research and Quality (AHRQ) is an agency within the health and human service department in the United States that uses evidence to inform practices that make the provision of healthcare more accessible, safer, equitable, higher quality and affordable (Henriksen et al., 2017). Therefore, the key responsibility of the agency is to ensure that evidence is understood and utilized. The AHRQ has outlined quality indicators that provide recommended best practices.

In line with the management of hypoglycemia, the Agency for Health Care Research and Quality can be used to determine the safety and quality outcomes. The safety and quality outcomes in the management of hypoglycemia include mortality rate, readmission rate and safety of care. The corresponding indicators for safety and quality measures include team collaboration, appropriate staff education, the use standard practices as well as the use of proper equipment and instruments. Monitoring the adherence to the outlined measures helps in quality performance improvement by generating the required feedback to the leadership and stakeholders which aids implementation of appropriate policies and practices.

In the healthcare setting, there are four main categories of quality measure that include process, outcome structural as well as balancing measures. The four are explained bellow;

Process Measures

Process measures are the corresponding compliance to implemented practices and actions aimed at achieving the requirements for quality improvement (Santana et al., 2018). For instance, the administration of glucose tablets or glucose gel for conscious patients is one of the standard processes that can be measured during quality improvement to assess adherence to hypoglycemia management standards.

Outcome Measures

Outcome measures are the health conditions of a patient after receiving healthcare attention (Santana et al., 2018). Some examples may include mortality after glucose tablet administration, pre-hospital mortality and emergency of severe adverse effects such as hyperosmolar syndrome.

Structural Measures

Structural measures refer to the capacity of an organization such as processes and systems to have the capacity to handle the healthcare issue of concern (Santana et al., 2018). Structural measures for the management of hypoglycemia may include the number of board-certified endocrinologists, number of emergency nurses and the availability of blood sugar monitoring equipment.

Balancing Measures

These are the unintended consequences of the implementation of the quality improvement projects within the healthcare organization. Some of the unintended negative consequences may include staff overload and increased medical costs while positive outcomes may include improved patient outcomes.

Performance Issues and Opportunities

Incorrect hypoglycemic management is one of the many challenges facing the healthcare sector which directly increases mortality and morbidity among hypoglycemic patients. With the increase in the prevalence of diabetes globally, there also emerging concerns over an increase in incidences of hypoglycemia which if not addressed properly can lead to poor health outcomes including mortality (Lin et al., 2020). Currently, the existing gaps in hypoglycemic management include (a) poor assessment criteria; (b) lack of adherence to standard hypoglycemic protocols; (c) missing proper interventions; (d) inadequate staff education; (e) lack of proper documentation of patient information. The combination of the above healthcare gaps in the management of hypoglycemia has impacted negatively the effective management of the condition.

A poor assessment criterion is the leading cause of mortality that is associated with hypoglycemia. A poor assessment criterion leads to false results which directly affect treatment and management plans. Besides, poor adherence to evidence based hypoglycemic protocols leads to negative patient outcomes because the treatment of hypoglycemia requires the use of evidence to infer best practices. Inadequate staff education also has negative impacts on the outcome of hypoglycemic management because the staffs such as nurses are the frontline care takers for the hypoglycemic patients. Lastly poor patient information documentation has also affected drastically proper treatment of hypoglycemia. The use of old documentation systems does not highlight comorbid conditions among hypoglycemic patients leading to poor medication prescription leading to mortality and general patient outcomes.

There are however existing opportunities that can help effective management of hypoglycemia such as the use of electronic health records in the storage of patient data. Electronic health records give promising outcomes in the management of hypoglycemia because it helps the universal storage of patient information which helps the provision of wholesome medical care. Besides, the use of electronic health records can help identify existing conditions hence proper drug prescription.

The Change Strategy

Healthcare organizations have a responsibility of identifying the possible areas where change should be effected and also provide a possible outline that defines how the expected changes will be achieved or implemented. To ensure that the change process is effectively implemented, the use of a change theory framework becomes necessary as it helps organizations to put implement the specified improvements. Failure to adopt a theoretical approach in effecting change will lead to failure of appropriate implementation of the change therefore affirming the assertion that strategy is the backbone of excellence.

One of the most appropriate change strategies applicable in healthcare that change and improve hypoglycemic management is the Lippitt’s theory and model for change. The Lippitt’s theory and model for change is similar to the nursing process hence, its effective application will enhance improved outcomes in measuring the various aspects of patient care (Asirifi et al., 2021). The model consists of seven phases which helps in simplifying the change process hence making it easy to implement and measure outcomes.

The attributes of leaders that embrace Lippitt’s change theory in effecting management include optimism, professionalism, selfish-less and team motivator. Leaders with such qualities will always lead organizations to higher heights in terms of quality of care. The application of the Lippitt’s change theory helps the incorporation of evidence-based practices which are especially important in improvement of hypoglycemic management.

Conclusion

The analysis of high-performance organizations helps in the development of specific evidence-based protocols that define and inculcate a culture of measuring excellence. Measuring excellence in an organization is important in that it helps identify specific areas that require improvement to promote high standards of care. The use of the Lippitt’s change theory can help in designing and implementing improvement strategies hence improving safety and quality outcomes associated with hypoglycemic management.

References

Agency for Healthcare Research and Quality. (2019). Leadership Role in Improving Safety retrieved from https://psnet.ahrq.gov/primer/leadership-role-improving-safety

Asirifi, M. A., Ogilvie, L., Barton, S., Bilash, O., Stobart, K., Aniteye, P., … & Aziato, L. (2021). Reflections on change theory and community-based participatory action research: Congruent, similar or different?. Journal of Nursing Education and Practice, 12(3).

Henriksen, K., Dymek, C., Harrison, M. I., Brady, P. J., & Arnold, S. B. (2017). Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on improving diagnosis: a proceedings review. Diagnosis, 4(2), 57-66.

Kanter, R. M., & Page, G. R. BAlDRIGE. Retrieved from http://www.thekinggroupconsulting.com/wp-content/uploads/Baldrige_20_20.pdf

Lin, Y. K., Fisher, S. J., & Pop‐Busui, R. (2020). Hypoglycemia unawareness and autonomic dysfunction in diabetes: lessons learned and roles of diabetes technologies. Journal of diabetes investigation, 11(6), 1388-1402.

Paradiso, L., & Sweeney, N. (2019). Just culture: It’s more than policy. Nursing management, 50(6), 38.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person‐centred care: A conceptual framework. Health Expectations, 21(2), 429-440.

Addendum