Write a 4-6 page policy proposal and practice guidelines for improving quality and performance associated with the benchmark metric underperformance you advocated for improving in Assessment 1.

Write a 4-6 page policy proposal and practice guidelines for improving quality and performance associated with the benchmark metric underperformance you advocated for improving in Assessment 1.
Introduction
In advocating for institutional policy changes related to local, state, or federal health care laws or policies, health leaders must be able to develop and present clear and well-written policy and practice guideline proposals that will enable a team, a unit, or an organization as a whole to resolve relevant performance issues and bring about improvements in the quality and safety of health care. This assessment offers you an opportunity to take the lead in proposing such changes.
As a master’s-level health care practitioner, you have a valuable viewpoint and voice on policy development, both inside and outside your care setting. Developing policy for internal purposes can be a valuable process toward quality and safety improvement, as well as ensuring compliance with various health care regulatory pressures. This assessment offers you an opportunity to take the lead in proposing such changes.
Instructions
Propose an organizational policy and practice guidelines that you believe will lead to an improvement in quality and performance associated with the benchmark underperformance you advocated for improving in Assessment 1. Be precise, professional, and persuasive in demonstrating the merit of your proposed actions.
Requirements
The policy proposal requirements outlined below correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, be sure to note the requirements for document format and length and for supporting evidence.
Explain the need for creating a policy and practice guidelines to address a shortfall in meeting a benchmark metric prescribed by local, state, or federal health care policies or laws.
What is the current benchmark for the organization and the numeric score for the underperformance?
How is the benchmark underperformance potentially affecting the provision of quality care or the operations of the organization?
What are the potential repercussions of not making any changes?

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What evidence supports your conclusions?
Summarize your proposed organizational policy and practice guidelines.
Identify applicable local, state, or federal health care policy or law that prescribes relevant performance benchmarks that your policy proposal addresses.
Keep your audience in mind when creating this summary.
Analyze the potential effects of environmental factors on your recommended practice guidelines.
What regulatory considerations could affect your recommended guidelines?
What resources could affect your recommended guidelines (staffing, financial, and logistical considerations, or support services)?
Explain ethical, evidence-based practice guidelines to improve targeted benchmark performance and the impact the proposed changes will have on the targeted group.
What does the evidence-based literature suggest are potential strategies to improve performance for your targeted benchmark?
How would these strategies ensure performance improvement or compliance with applicable local, state, or federal health care policy or law?
How can you ensure that these strategies are ethical and culturally inclusive in their application?
What is the direct impact of these changes on the stakeholders’ work setting and job requirements?

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Explain why particular stakeholders and groups must be involved in further development and implementation of your proposed policy and practice guidelines.
Why is it important to engage these stakeholders and groups?
How can their participation produce a stronger policy and facilitate its implementation?
Present strategies for collaborating with the stakeholder group to implement your proposed policy and practice guidelines.
What role will the stakeholder group play in implementing your proposal?
Why is the stakeholder group and their collaboration important for successful implementation?
Organize content so ideas flow logically with smooth transitions.
Proofread your proposal, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your proposal.
Use paraphrasing and summarization to represent ideas from external sources.
Be sure to apply correct APA formatting to source citations and references.
Policy Proposal Format and Length
It may be helpful to use a template or format for your proposal that is used in your current organization. The risk management or quality department could be a good resource for finding an appropriate template or format. If you are not currently in practice, or your organization does not have these resources, many appropriate templates are freely available on the Internet.
Your policy should be succinct (about one paragraph). Overall, your proposal should be 4–6 pages in length.
Supporting Evidence
Cite 3–5 references to relevant research, case studies, or best practices to support your analysis and recommendations.
Portfolio Prompt: You may choose to save your policy proposal to your ePortfolio.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
Competency 1: Analyze relevant health care laws, policies, and regulations; their application; and their effects on organizations, interprofessional teams, and professional practice.
Explain and interpret for stakeholders the need for creating a policy and practice guidelines to address a shortfall in meeting a benchmark metric prescribed by local, state, or federal health care policies or laws.
Competency 2: Lead the development and implementation of ethical and culturally sensitive policies that improve health outcomes for individuals, organizations, and populations.
Summarize a proposed organizational policy or practice change guideline and analyze the potential effects of environmental factors on recommended practice guidelines.
Competency 3: Evaluate relevant indicators of performance, such as benchmarks, research, and best practices, to inform health care laws and policies for patients, organizations, and populations.
Explain how ethical, evidence-based practice guidelines to improve targeted benchmark performance will impact a stakeholder group needed for successful implementation of the policy or practice change.
Competency 4: Develop strategies to work collaboratively with policy makers, stakeholders, and colleagues to address environmental (governmental and regulatory) forces.
Explain why particular stakeholders and groups must be involved in further development and implementation of a proposed policy or practice change to improve quality and outcomes.
Present strategies for collaborating with a stakeholder group to implement a proposed policy and practice guidelines.
Competency 5: Produce clear, coherent, and professional written work, in accordance with Capella’s writing standards.
Organize content so ideas flow logically with smooth transitions.
Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.

Policy Proposal

Brittany Leese

Capella University

Health Care Law and Policy

June 202

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Policy Proposal

Mercy Medical Centers is one of the region’s top choices for the highest quality health

care. While being ranked in the top, there is always room for improvement to better serve the

community. The diabetic patient population that chooses care at Mercy Medical Center are not

receiving the highest quality of care, based on national benchmarks. Throughout this paper there

will be discussion on the need for a change in policy and practice guidelines. The environmental

factors on implementation and the need for key stakeholders to be involved to have successful

implementation will also be reviewed.

Need for Policy and

Practice Guidelines

Diabetes is the leading cause of morbidity and mortality in the United States and the use

of preventative screenings limits complications and can improve health outcomes (Marino et al.,

2020). There is a standard national benchmark set forth to determine what is appropriate for the

diabetic population to be receiving a foot examination on at least and annual basis, this goal is 8

percent (NHQDR Web Site – National Diabetes Benchmark Details, n.d). The screenings

completed at Mercy Medical Center were on average of 58 percent completion for the years

2019 and 2020, this is significantly below an acceptable level of care provided to the diabetic

population in which it serves. Mercy Medical Center claims to provide top quality care, but there

is an obvious disconnect in need of addressing to provide better care for their patients.

The diabetic population often suffers from peripheral neuropathy and peripheral artery

disease, both of which affect the sensations felt in the distal extremities (Buschkoetter, 2019).

This increases the risk of unknown injuries or wounds sustained to the foot and becomes the

starting point for long-term complications for the patient. Due to the poor blood flow, it often

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takes the wounds on a diabetic foot a significantly longer time to heal, or some that never heal

and remain a chronic worry for the patient. It is reported that one third of the financial burdens of

caring for diabetic patient is related to the cost of caring for foot wounds, ulcers, and amputations

(Kurkela et al., 2022). Not only is this significant from a financial standpoint, but the quality of

life of those affected by diabetic foot complications or amputation is affected. It has been

determined that the completion of a comprehensive foot exam to evaluate for wounds, as well as

sensation, has been deemed beneficial for reducing the occurrence of diabetic wounds and ulcers

and should be an adopted practice by healthcare providers (Buschkoetter, 2019).

Policy and Practice Guidelines for Diabetic Foot Examinations

Policy Statement

Diabetic foot examinations are imperative to the care of the diabetic patient population.

This policy is intended to guide healthcare providers in ensuring completion of a foot

examination, including physical appearance and sensation, is completed annually during routine

visits. The practice guidelines will provide recommendations on how to best complete routine

foot examinations, as well as how to provide education to patients to complete self-exams at

home.

Scope

This policy applies to the healthcare providers, that includes and is not limited to:

medical doctor, doctor of osteopathic medicine, nurse practitioner, physician assistant and

nursing staff. All included are responsible and capable of completion of a foot examination on an

annual basis or more frequently for higher-risk patients, as well as providing patient education

for self-care at home.

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Practice Guidelines

It is at the guidance of the American Diabetes Association (ADA), there are some

guidelines already recommended for caring for the diabetic patient in regards to their foot exams.

The expectation is that each time a patient is evaluated in the office, regardless of the reason of

visit, the patients’ feet should be inspected for deformities or wounds, sensation, and vascular

blood flow (Syed, 2021). By completing this basic assessment, the healthcare provider will be

able to identify any existing foot wounds, or the risk of development of wounds. The diabetic

patients who have other comorbidities that make them high-risk, such as dialysis, smoking, or

previous history of a diabetic wound, will need to be monitored more closely and referral to a

foot specialist is recommended, as a multidisciplinary approach is best practice for this patient

population (Syed, 2021).

The recommendation by the ADA is that general preventative foot self-care education

should be provided to all diabetic patients during their visits (Syed, 2021). There were more

specific guidelines established by the International Working Group of the Diabetic Foot that will

be incorporated into the practice guidelines. It will be the duty of the healthcare provider

evaluating the diabetic patient to ensure to educate the patient on preventative care for their feet,

between visits. Topics to be discussed with the patients who are at risk for foot wounds are to

include: protect the feet by not going barefoot, inspect the inside of the shoe prior to application,

perform a daily evaluation of the foot surface and between the toes, washing the feet daily and

ensuring to dry thoroughly, cut toenails straight across-if unable to perform, seek professional

assistance with cutting nails, and encourage the patient to notify healthcare team if an

abnormality is found immediately to have it evaluated and treated (Bus et al., 2020). These items

can be discussed with the patient, family members, or caregivers that assist with activities of

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daily living during each visit and also could be provided to them in a handout form to reference

while at home, to continue self-care practices. It is not enough to review the self-care

examination with the patient, family member, or caregiver, it is also necessary to stress the

importance of completing it to prevent debilitating side effects from foot wound development

(Retinopathy, Neuropathy, and Foot Care: Standards of Medical Care in Diabetes—2022, 2021).

Effects of Environmental Factors

In the state of Minnesota, where Mercy Medical Center is, 390,00 patients were

diagnosed with diabetes, with an estimated 24,000 new cases each year (Diabetes in Minnesota –

Minnesota Department of Health, 2022). The sheer volume alone of those affected by diabetes is

concerning for a potential environmental fact that can hinder successful implementation of the

change in practice. To allow for enough time to for the healthcare provider to evaluate the

patient’s foot and also provide education to them about self-care, in a manner that they

comprehend, can consume a significant amount of time allotted for the visit. The other area of

concern is, are there physically enough healthcare providers available to manage that volume of

diabetic patients. There has been a shortage in the healthcare workforce since the COVID-19

pandemic due to burnout and retirement, and the recruitment to recover from the loss in

healthcare workers has become a concern as well (Health Worker Shortage Forces States to

Scramble, 2022). With the volume of patients increasing and the healthcare workers available to

care for them being at a mismatched level, it is worrisome that the ability to provide patients the

care they deserve will continue to suffer. In order to best manage the shortage of healthcare

workers, it is imperative that the education of self-care for foot examinations and preventative

care is necessary to prevent diabetic complications (Portela et al., 2022). The preventative visits

that are occurring will still need to have the comprehensive foot exam completed on an annual

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basis, but the patient’s taking responsibility for their own care will assist them in reducing

potential foot wounds.

Stakeholder Involvement in Implementation

The successful implementation of this change in practice will fall into the hands of the

key stakeholders. Those stakeholders are the medical doctors, doctors of osteopathic medicine,

physician assistants, nurse practitioners, and the nursing staff. They are the responsible parties

for completing the comprehensive annual foot examinations. The healthcare providers mentioned

above are also educators for the patients, to teach patients the knowledge of caring for

themselves at home by performing self-examinations daily (Bus et al., 2020). This information

should also be provided to the patients in a simple handout format so the patients can refer to it at

home, when completing their daily foot exam, until it becomes a learned habit. Should there be

difficulties with completion of the examinations by the healthcare providers, or patients that are

more high-risk cases, they should be referring the patient to a foot specialist to ensure the patient

is receiving the proper examination (Syed, 2021). The ultimate goal is to be providing the

diabetic patients the basic preventative care they deserve, while also encouraging them to be self-

empowered to care for themselves with their chronic condition.

Conclusion

In order to ensure that quality care is being provided to diabetic patients, national

benchmarks have been established to set the standards of care. The patients at Mercy Medical

Center have not been receiving the care they are deserving of and to better serve them, there is a

change in practice being implemented. The healthcare providers will be performing annual foot

examinations on every diabetic patient that they see and they will be providing the patient with

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the necessary education to perform a self-examination at home, between visits. It is recognized

that the healthcare work force is in shortage, but it is not justification to not provide the

necessary care to the diabetic population, but rather all the more reason to encourage self-

examinations performed by the patients. It is with high hopes that by changing the practice

guidelines there will be increased quality of care and decreased foot wounds in the patients cared

for by Mercy Medical Center.

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References

Bus, S. A., Lavery, L. A., Monteiro‐Soares, M., Rasmussen, A., Raspovic, A., Sacco, I. C., &

Netten, J. J. (2020). Guidelines on the prevention of foot ulcers in persons with diabetes

(IWGDF 2019 update). Diabetes/Metabolism Research and Reviews, 36(S1).

https://doi.org/10.1002/dmrr.326

Buschkoetter, K. L. M. (2019). Implementation of a comprehensive diabetic foot exam protocol

in rural primary care. Online Journal of Rural Nursing and Health Care, 19(1), 43–63.

https://doi.org/10.14574/ojrnhc.v19i1.560

Diabetes in minnesota – minnesota department of health. (2022, February). Minnesota

Department of Health. Retrieved June 1, 2022, from

https://www.health.state.mn.us/diseases/diabetes/data/diabetesfacts.html

Health worker shortage forces states to scramble. (2022, March 25). The Pew Charitable Trusts.

Retrieved June 1, 2022, from https://www.pewtrusts.org/en/research-and-

analysis/blogs/stateline/2022/03/25/health-worker-shortage-forces-states-to-scramble

Kurkela, O., Nevalainen, J., Arffman, M., Lahtela, J., & Forma, L. (2022). Foot-related diabetes

complications: Care pathways, patient profiles and costs. BMC Health Services Research,

22(1). https://doi.org/10.1186/s12913-022-07853-2

Marino, M., Angier, H., Springer, R., Valenzuela, S., Hoopes, M., O’Malley, J., Suchocki, A.,

Heintzman, J., DeVoe, J., & Huguet, N. (2020). The affordable care act: Effects of

insurance on diabetes biomarkers. Diabetes Care, 43(9), 2074–2081.

https://doi.org/10.2337/dc19-1571

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Portela, R. D. A., Silva, J. R. S., Nunes, F. B. B. D. F., Lopes, M. L. H., Batista, R. F. L., & Silva,

A. C. O. (2022). Diabetes mellitus type 2: factors related to adherence to self-care.

Revista Brasileira de Enfermagem, 75(4). https://doi.org/10.1590/0034-7167-2021-0260

Retinopathy, neuropathy, and foot care: Standards of medical care in diabetes—2022. (2021,

December 16). American Diabetes Association. Retrieved June 1, 2022, from

https://diabetesjournals.org/care/article/45/Supplement_1/S185/138917/12-Retinopathy-

Neuropathy-and-Foot-Care-Standards?searchresult=1

Syed, S. J., MD. (2021, October 16). Bullous disease of diabetes (bullosis diabeticorum)

guidelines: Guidelines summary. Medscape. Retrieved June 1, 2022, from

https://emedicine.medscape.com/article/1062235-guidelines#g1

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Running head: DASHBOARD METRICS EVALUATION 1

Dashboard Metrics Evaluation

Name

Institutional Affiliation

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DASHBOARD METRICS EVALUATION 2

Dashboard Metrics Evaluation

The healthcare sector is dependent on precise and timely data that helps in safeguarding

patients’ safety and adhering to various rules and regulations in facilitating continuous

improvements. Many healthcare facilities, surgical centers, and emergency service providers

have diverse needs and complex organizational structures and processes, which requires

healthcare professionals to have an adequate understanding of several sets of data. The quality

and effectiveness of medical services translate to the level of patient experience and satisfaction.

As such, healthcare facilities need to understand metrics on patient experience to measure how

they are performing and establishing effective strategies for continuous improvement (Stadler et

al., 2016). For the past few years, I have been working at Tift Regional Medical Centre in

Georgia in the ambulatory surgical suite. Patient experience has been core to the facility’s

success, but assessing the patient experience data would help establish how the unit is

performing.

The following is the data accessed from Tift Regional Medical Center with approval from

the facility’s manager for educational purposes. The data follow HIPPA regulations to safeguard

patients’ privacy and confidentiality. No instance will the data provide personal information or

reveal the patient’s identities.

Measure
Type

Measure Time
Frame

Current
Period

Target Variance Previous
Quarter

Variance

Patient

Experienc
e

Cleanliness and
quietness of the
facility

2020-02 88.5% 92.0% -3.5% 86.0% 2.5%

Patient
Experienc
e

Communicatio
n about
medicines

2020-02 93.4% 95.0% -1.6% 90.0% 3.4%

Patient
Experienc
e

Communicatio
n with Doctors

2020-02 90.0% 93.0% -3.0% 92.0% -2.0%

Patient Communicatio 2020-02 92.6% 90% 2.4% 89.0% 3.6%

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DASHBOARD METRICS EVALUATION 3

Experienc
e

n with Nurses

Patient
Experienc
e

Discharge
Information

2020-02 92.0% 93.0% -1.0% 90.0% 2.0%

Patient
Experienc
e

Pain
Management

2020-02 89.0% 92.0% -3.0% 90.0% -1.0%

Patient
Experienc
e

Responsiveness
of hospital’s
staff

2020-02 87.6% 90.0% -2.4% 88.0% -1.0%

Evaluation of the Dashboard Metrics

From the data obtained from the healthcare facility, it is clear that they are

underperformances in critical measures, which have been predominant since the last quarter. For

instance, communication with doctors, pain management, and the hospital’s responsiveness

necessitates the implementation of evidence-based practices for safeguarding patient safety,

especially in the ambulatory surgical suite. As indicated by the Agency for Healthcare Quality

and Research (AHRQ), improving patient experience is essential in enhancing clinical processes

and outcomes (Kuluski et al., 2017). In most cases, the adoption of effective practices at practice

and individual provider level correlates with caring processes for prevention and disease

management.

In the case of doctors’ communication, healthcare professionals must allow the exchange

of information, which is a prerequisite for high-quality care. In the healthcare sector, nurses and

doctors collaborate in hospital settings, performing distinct tasks for the effective delivery of

healthcare services. As indicated by Wang et al. (2018), effective nurse-doctor communication

has a significant impact on patient outcomes, which is reflected by patient satisfaction, reduced

length of stay, and reduced rate of adverse events. On the other hand, ineffective communication

is detrimental to patient and healthcare facilities, compromising patient safety, and increasing

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DASHBOARD METRICS EVALUATION 4

healthcare expenditure. More importantly, the Joint Commission reports that communication

failure, especially in surgical units, causes approximately 75% of sentinel events in healthcare.

Pain management after surgery is essential for supporting the patient’s recovery process.

At Tift Regional Medical Center, pain management is a priority goal that needed to be achieved

in the current quarter to prevent increasing complications such as pneumonia and blood clots.

Some of the pain reported by most patients include muscle pain and movement pain after the

surgery. As indicated by the American Society of Anesthesiologists, poor pain management in the

perioperative environment leads to unprecedented complications and prolonged rehabilitation

(Chou et al., 2016). For instance, the patients who reported pain after surgery in the previous

quarter were 80%, with 70% of them measuring it as moderate, severe, or even extreme.

Therefore, establishing effective pain management strategies would help reduce anxiety and

emotional distress that undermines overall well-being and restrict the recovery process.

Analysis of Challenges in Achieving Acceptable Performance

Achieving the appropriate rate of doctors’ communication is an essential component that

promotes the effectiveness of interprofessional teams. Currently, the value of interprofessional

collaboration is highly achieved through effective communication, which allows the adequate

performance of roles and responsibilities, work cooperatively, and make informative decisions

for improving patient safety (Harman & Verghese, 2019). Reflecting on the data provided, there

are two main reasons for communication failure among the doctors. The first one is that the

doctors were recently recruited, and they had inadequate experience working in a high-tension

environment. As such, the new professionals lacked confidence in consulting other professionals

on critical processes.

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DASHBOARD METRICS EVALUATION 5

Secondly, there was enough evidence indicating that the doctors had an inadequate

understanding of patient medical records. This resulted in a breakdown of communication

between doctors and patients, leading to low satisfaction. When it comes to pain management,

healthcare professionals had inadequate skills in managing patients’ pain, especially when

deciding the best medication to issue to patients (Kumah, 2017). Moreover, the healthcare

facility has no clear protocols to be followed, especially when patients exhibit extreme pain after

surgery. Given the caliber of Tift Regional Medical Center, patients should receive the best pain

management care to achieve the desired outcomes.

Benchmark Underperformance that has the Potential for Greatly Improving the Overall

Quality

The dynamism of the healthcare environment requires healthcare professionals to adopt

effective strategies for enhancing communication. In most cases, the interprofessional

collaboration between physicians and other healthcare professionals increases the collective

awareness of other’s knowledge and skills, leading to the continuous improvement of healthcare

services. As such, addressing communication among doctors at Tift Regional Medical Center

would help create a holistic environment for enhancing the patient experience. However, the

success in attaining the desired outcomes requires the healthcare facility to invest in continuous

training of healthcare professionals on the importance of communication and patient engagement

(Mazurenko et al., 2017).

Ethical Action to Address Benchmark Underperformance.

Some of the evidence-based strategies that can enhance communication at Tift Regional

Medical Center include team training and using electronic SBAR communication tools. As

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DASHBOARD METRICS EVALUATION 6

indicated by Wang et al., (2018), professionals’ training improves communication skills, with

more emphasis on respect and trust in role performance and responsibilities. Moreover,

enhancing communication in a high-tension environment necessitates equipping professionals

with knowledge and understanding of surgical units’ safety. With a perfect understanding of

critical components in the SBAR tool, physicians have adequate knowledge and skills oh how to

establish effective care management, leading to increased patient satisfaction. However, it is

essential to note that the SBAR tool is less effective in promoting face-to-face communication.

Conclusion

In the current healthcare environment, communication is essential in promoting

collaboration between professionals and patients. Enhancing patient satisfaction and experience,

healthcare facilities need to strategize on how to equip their workforce with communication

skills to realize desired goals. More importantly, effective communication is associated with

lower medical malpractice and improvement in healthcare processes.

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DASHBOARD METRICS EVALUATION 7

References

Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T.,

Carter, T., Cassidy, C. L., Chittenden, E. H., & Degenhardt, E. (2016). Management of

postoperative pain: A clinical practice guideline from the American pain society, the

American Society of Regional Anesthesia and Pain Medicine, and the American Society

of Anesthesiologists’ committee on regional anesthesia, executive committee, and

administrative council. The Journal of Pain, 17(2), 131–157.

Harman, S., & Verghese, A. (2019). Protecting the sanctity of the patient-physician relationship.

JAMA, 322(20), 1957–1958. Retrieved from https://doi.org/10.1001/jama.2019.17965

Kuluski, K., Nelson, M. L., Tracy, C. S., Alloway, C. A., Shorrock, C., Shearkhani, S., & Upshur,

R. E. G. (2017). Experience of care as a critical component of health system performance

measurement: Recommendations for moving forward. Healthc Pap, 17(2), 8–20.

Kumah, E. (2017). Patient experience and satisfaction with a healthcare system: Connecting the

dots. International Journal of Healthcare Management.

Mazurenko, O., Collum, T., Ferdinand, A., & Menachemi, N. (2017). Predictors of hospital

patient satisfaction as measured by HCAHPS: A systematic review. Journal of

Healthcare Management, 62(4), 272–283.

Stadler, J. G., Donlon, K., Siewert, J. D., Franken, T., & Lewis, N. E. (2016). Improving the

efficiency and ease of healthcare analysis through use of data visualization dashboards.

Big Data, 4(2), 129–135.

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DASHBOARD METRICS EVALUATION 8

Wang, Y.-Y., Wan, Q.-Q., Lin, F., Zhou, W.-J., & Shang, S.-M. (2018). Interventions to improve

communication between nurses and physicians in the intensive care unit: An integrative

literature review. International Journal of Nursing Sciences, 5(1), 81–88. Retrieved from

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