APA format. Use scholar authors only. All responses have be 1 paragraph each and with 2 references.

Discussion question: 1

My definition of quality is something having utmost distinction in the eyes of a consumer, and something that is desirable and sets the standard. Spath (2018) defines quality as a characteristic that goes beyond one’s expectations, depending on a person’s point of view, and can fluctuate yet has the potential to improve. Setting the highest standard of distinction when it comes to quality is a similar mindset to Philip B. Crosby, who is described as a “quality guru” due to sharing his knowledge of quality to business leaders (QP staff, 2010). Crosby established the theory of “zero defects,” meaning that a product or service should be free from blemishes or mistakes or defects from the start, every time (QP staff, 2010). Crosby explained that this does not mean a person who makes a quality product or gives a quality service should be perfect, but rather the person should provide the service as instructed every single time (QP staff, 2010).

            Crosby’s concept of zero defects can seem a bit extreme or unattainable when it comes to nursing practice, because as nurses we know that no shift is ever perfect. However, Crosby’s idea regarding the push for doing the job right the first time and every time can be helpful in the setting of home health care nursing practice, specifically with documentation. In home health care nursing, we have specific documentation requirements that are government regulations that must be followed. These governmental regulations affect how the home health care agency gets reimbursed from insurance companies. It is important that a nurse understands the questions asked within the home health care forms, so that they are answered correctly at the start of home health care. Then, at the time of discharge from home health care, when the charting and documentation is completed correctly, the way the nurse answers the questions regarding patient status will either show an improvement in outcomes, or a decline. Educating home health care nurses about the correct way to interpret and answer these questions, called the Outcome and Assessment Information Set (OASIS), allows for nurses to answer the questions correctly and provides accurate documentation on the patients abilities and limitations in the home setting (Centers for Medicare and Medicaid Services, 2020).

The “zero defects” concept of doing the home health care documentation properly the first time can not only save the agency money (proper reimbursement), but also it avoids the nurse being wasteful of her time with correcting audited charts. Nurses’ charts get audited to help the home health agency ensure regulations have been met. With further training and experience, nurses can be more efficient with their time and documentation, and Crosby believes, avoid having to fix something when it could be done correctly in the first place (QP staff, 2010).

Discussion question: 2

When discussing quality, it is of utmost importance to define what is the most crucial aspect to the consumer.  Quality can either be about the experience, the product, or both.  Quality to me is the product being free of defects, the use of quality resources, and all for the lowest price.  How this translates to quality health care is timely and accurate results, low cost, no unnecessary tests, and knowledgeable providers.  If my concern is about a warm blanket, most modern exam room, and friendliest staff, then my definition of quality is more about customer service.  Unfortunately, the quality of healthcare includes customer service, which complicates defining what quality healthcare is.

In examining the quality theorists, the philosophy of Deming seems the most practical and congruent with my definition of quality.  Deming believed that the organization’s primary aim should focus on quality, which is a factor of reducing costs and continuously improving the processes (Monnappa, 2019).  As a result, customer satisfaction will improve, staff will be happier, and costs over time will decrease.  This philosophy evolved into the Deming or PDSA cycle, which is frequently used as a method of quality improvement (Spath, 2018).  An essential feature of this model is that it is dynamic, always looking to improve, and simple to implement. 

A practice problem that I see in my work involves how various injuries are classified and how that translates into increased costs.  Currently, any patient that comes in with a fall or injury gets charted as a “trauma evaluation.”  Charting a trauma evaluation generates a higher level of care and, thus, a higher charge.  This is wasteful, and while it generates more significant revenue, it is unnecessary as it increases the costs of healthcare.  This is the current practice; a practice change would involve only charting a trauma evaluation for patients who meet strict criteria.  My definition of quality extends to this problem by reducing unnecessary costs.  Charting a trauma evaluation does not change the patient’s care, therefore eliminating this practice would help to mitigate rising healthcare costs without affecting patient care or safety.