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Running head: Safety Score Improvement Plan

Running head: Safety Score Improvement Plan

Safety Score Improvement Plan for TrueWill General Hospital

Nursing professionals are key players in maintaining a culture of quality care and patient safety in a health care environment. Their role in addressing specific patient safety issues will be discussed using the example of TrueWill General Hospital (TGH), a 1,500-bed multispecialty hospital in the United States. The hospital regularly reports its performance data to the Hospital

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Safety Score, a nongovernmental organization that ranks hospitals on their safety rate. 

The safety score for the orthopedic inpatient unit of TGH has alarmingly increased because of the number of patient injuries resulting from falls. The negative score can affect the image of the hospital, because patient falls are preventable hospital-acquired conditions. The nurse manager of the unit has been advised by the hospital’s patient safety office to identify the cause of the problem, determine an evidence-based safety score improvement plan, and devise measurable long-term solutions for the safety issue.  

Factors behind the Patient Safety Issue

Patient falls are one of the most reported patient safety incidents in health care practice. According to the American Nurses Association (n.d.), it is a serious problem in nursing and health care; as injuries resulting from falls can lead to permanent loss of function of certain body parts or even death. According to systems theory, adverse events such as patient falls are related to the quality of care provided by health care professionals at the front line of operations such as nursing professionals (Lawton, Carruthers, Gardner, Wright, & McEachan, 2012).

 Health care experts have relied on systems theory and systems thinking perspectives to analyze the incidence of safety issues as a nursing challenge. The theory states that problems in any part of a system, such as the nursing department in a hospital, will affect the functioning of

Comment [A1]: Yes, patient falls and how can lead to adverse effects, even death.

the hospital as a whole. Therefore, larger organizational systems should be taken into consideration while implementing changes in nursing profession to improve safety issues. 

Influence of Leadership in Changes for Safety 

Nurse leaders at TGH are an important systems factor in driving changes at the organizational and clinical level. The importance of leadership in achieving better patient outcomes or patient experiences was explored in a study of leadership practices and styles (Wong, Cummings, & Ducharme, 2013). The study showed that relational leadership styles, which focused on people and relations, improved patient outcomes because nurse leaders were able to assess patients’ needs better and coordinate staff and resources accordingly (Wong et al., 2013). 

TGH nurse leaders can use relational leadership styles to analyze the systems effect of safety issues on patients and nursing professionals. The leadership style can improve job satisfaction among nursing professionals by better managing staff and can enhance patient safety and satisfaction by providing quality care. Relational nurse leaders are also able to effectively use systems theory to analyze organizational policies and procedures that impact patients directly and affect the way nursing professionals deliver care. 

The Effects of Policies and Procedures on Safety Issues

Policies and procedures govern every aspect of nursing such as management of staff, modes of health care delivery, and fiscal and material resources. When applied to policies and procedures governing staff management, systems theory helps nurse leaders assess the competencies of their nursing professionals, plan staff schedules to prevent work overload, hire more nurses to address shortages, and introduce strategies to retain current nurses. 

The dynamic systems model, a systems-theory-based model, can help nurse leaders monitor and reassess those policies (Morath, 2011). It promotes a transparent health care system where nurses are trained to (a) provide transparent care, (b) anticipate and pullback from risky practice, (c) work with other health care professionals, (d) monitor peers, and (e) be innovative and open to new technology that tests and studies safety practices. The model requires nurse leaders to research potential safety issues and gather evidence about those issues before implementing specific changes. 

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Recommendations to Ensure Patient Safety

Introducing changes for patient safety starts with collecting information, which will ensure an evidence-based approach to solving problems. The data collected will help devise a safety improvement plan. A structured approach to organizational change is important if the plan is to be properly implemented.

The root cause analysis (RCA) is a systematic analysis of the common causes of safety issues. The RCA also devises strategies to prevent future safety incidents. Based on systems theory, the techniques of the RCA move beyond individual blame for clinical errors and examine the organizational factors that contribute to the errors (Huber, 2017; Dolansky & Moore, 2013). 

According to Dolansky and Moore, all nursing professionals must know how to conduct the RCA as it teaches them about systems theory. However, there are difficulties in obtaining information for the RCA. Teams that conduct RCAs often overlook important evidence in the care process in their hurry to complete the analysis before the stipulated 45 days set by the Joint Commission (Wocher, 2015). The lack of information can impede strategies for implementing evidence-based changes in safety. 

Comment [A3]: The model promotes…

Comment [A4]: Reference?

Competency development integrated into staff management is a proven strategy in improving patient outcomes. One evidence-based education plan that can be adapted to clinical practice is the Quality and Safety Education in Nursing (QSEN) initiative. Funded by the Robert Wood Johnson Foundation, the competencies of the QSEN integrate quality improvement and safety management into nursing education (Dolansky & Moore, 2013). 

With the QSEN’s background in systems theory, nursing professionals can apply it at the individual and organizational levels of care. The six competencies of the QSEN are as follows:

(a) patient-centered care, (b) evidence-based practice, (c) teamwork and collaboration, (d) safety, (e) quality improvement, and (f) informatics (Dolansky & Moore, 2013). Nursing professionals who develop these competencies are better able to deliver safe care and solve safety issues. 

However, there are limitations to the QSEN strategy. The QSEN is more than a decade old and has not been updated. Despite these difficulties, the QSEN competencies have become a key component of quality care and patient safety. 

Plan to Implement Safety Recommendation and Monitor Outcomes

The education department teaches staff to think like systems thinkers and develop personal mastery over the profession and system (Burke & Hellwig, 2011). The education department at TGH could integrate QSEN competencies into education programs using a framework for organizational learning called the Baldrige framework. A system of continuous quality improvement, the Baldrige framework explains seven criteria that are indicators of quality for organizational learning programs: (a) leadership; (b) strategic planning; (c) focus on patients, other customers, and markets; (d) measurement, analysis, and knowledge management;

(e) workforce focus; (f) process management; and (g) organizational performance results (Burke

& Hellwig, 2011; Huber, 2017). Educational outcomes can be monitored at two levels: (a) the

Comment [A6]: Need to elaborate a little more about accountability of staff.

systems level where organizational performance is reviewed through patient and customer satisfaction surveys, scorecards, and human resources indicators; and (b) at the departmental level through pre- and post-testing of nursing professionals, course evaluations, further training of select nursing professionals, and assessments. 

The improvement of safety standards at TGH starts with developing the competency of its nurse leaders and nursing professionals. Because nursing professionals are at the front lines of care delivery, nurse educators should tailor programs, content, and goals to suit the unique needs of the nursing profession. 


Patient safety issues such as patient falls are commonplace in a health care organization. Health care professionals must develop the foresight and strategic thinking to identify patient safety issues early and have solutions at the ready. The example of TGH shows the importance of preemptively addressing safety issues in nursing instead of letting them fester over time and affect organizational performance. TrueWill General Hospital and its leadership should take an active interest in developing nursing competencies continuously, focusing on quality and safety education. Embedding these ideas into the safety score improvement plan will create a lasting culture of quality care and patient safety. These are the standards that define the organization’s image in health care


American Nurses Association. (n.d.). Patient Falls. Retrieved from

Burke, K. M., & Hellwig, S. D. (2011). Education in high-performing hospitals: Using the Baldrige framework to demonstrate positive outcomes. The Journal of Continuing

Education in Nursing, 42(7), 299–305. https://dx.doi/10.3928/00220124-20110103-01

Dolansky, M. A., & Moore, S. M. (2013). Quality and safety education for nurses (QSEN): The key is systems thinking. OJIN: The Online Journal of Issues in Nursing, 18(3). https://dx.doi/10.3912/OJIN.Vol18No03Man01

Huber, D. L. (2017). Leadership and nursing care management (6th ed.) Philadelphia: W.B.


Lawton, R., Carruthers, S., Gardner, P., Wright, J., & McEachan, R. R. C. (2012). Identifying the latent failures underpinning medication administration errors: An exploratory study. Health Services Research, 47(4), 1437–1459.


Morath, J. (2011). Nurses create a culture of patient safety: It takes more than projects. Online journal of issues in nursing, 16(3). https://dx.doi/10.3912/OJIN.Vol16No03Man02

The Joint Commission. (2015). Root cause analysis in health care: Tools and techniques (5th ed.). Retrieved from

Tomlinson, J. (2012). Exploration of transformational and distributed leadership. Nursing

Management, 19(4), 30–34.

Wocher, J. C. (2015). The importance of a rigorous root cause analysis (RCA) for healthcare sentinel events. Japan-hospitals: The Journal of the Japan Hospital Association, 34, 23–

27. Retrieved from

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of nursing management, 21(5), 709–724. https://dx.doi/10.1111/jonm.12116

Running head: Safety Score Improvement Plan

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