Zenith Hospital is facing quality issues, particularly with rising postsurgical infections, exemplified by the case of Mr. Jones, who developed severe complications following surgery. The healthcare manager is seeking to implement a quality improvement program after the board approved the request, aiming to address the urgent need for better resources and processes. Key considerations for this initiative include effective communication, understanding quality problems through qualitative approaches, and the importance of proactive measures for improving patient outcomes.

1. Most healthcare organizations in the country are implementing
quality improvement programs to save lives, enhance customer
satisfaction, and reduce the cost of healthcare services. Limited
human and material resources often undermine such efforts.
Zenith Hospital in a rural community has 200 beds. Postsurgical
patients tend to contract infections at the surgical site, requiring
extended hospitalization. Mr. Jones—75 years old—was
admitted to Zenith Hospital for inguinal hernia repairs. He was
also hypertensive, with a compromised immune system. Two
days after surgery, he acquired an infection at the surgical site,
with elevated temperature, and then he developed septicemia.
His condition worsened, and he was moved to isolation in the
intensive care unit (ICU). A day after transfer to the ICU, he
went into ventricular arrhythmia and was placed on a respirator
and cardiac monitoring machine. Intravenous fluids, antibiotics,
and antipyretics could not bring the fever down, and blood
analysis continued to deteriorate.
The hospital infection control unit got involved. The team
confirmed that postsurgical infections were on the increase, but
the hospital was unable to identify the sources of infection. The
surgery unit and surgical team held meetings to understand
possible sources of infection. The team leader had earlier
reported to management that they needed to hire more surgical
nurses, arguing that nurses in the unit were overworked, had to
go on leave, and often worked long hours without break.
Mr. Jones’ family members were angry and wanted to know the
source of his infection, why he was on the respirator in
isolation, and why his temperature was not coming down.
Unfortunately, his condition continued to deteriorate. His
daughter invited the family’s legal representative to find out
what was happening to her father and to commence legal
proceedings.

2. Then, the healthcare manager received information that two
other patients were showing signs of postsurgical infection. The
healthcare manager and care providers acknowledged the
serious quality issues at Zenith Hospital, particularly in the
surgical unit. The healthcare manager wrote to the Chairman of
the Hospital Board, seeking approval to implement a quality
improvement program. The Board held an emergency meeting
and approved the manager’s request. The healthcare manager
has invited you to support the organization in this process.
Please address the following questions in your response:
What are successful approaches for gaining a shared
understanding of the problem?
How can effective communication be implemented?
What is a qualitative approach that helps in identifying the
quality problem?
What tools can provide insight into understanding the problem?
In quality improvement, what does appreciative inquiry help
do?
What is a benefit of testing solutions before implementation?
What is a challenge that is inherent in the application of the
plan, do, study, act (PDSA) method?
What are the attributes of the outcome measure?
What are the attributes of the measurement for improvement?
Why is collecting the right data important?

3. What is a component of establishing a culture of quality
improvement in healthcare organizations?
What knowledge do healthcare managers require to sustain a
quality culture?