D026 Task 1 Value-Based Care Analysis Example

Achieving Quality Outcomes Through Value-Based Care: Components, the WGU Nursing Programs Conceptual Model, and a PDSA Cycle on a Medical Unit

Student Name

Leavitt School of Health, Western Governors University

D026: Quality Outcomes in a Culture of Value-Based Nursing Care, Task 1

Course Instructor

Month Day, Year

Achieving Quality Outcomes Through Value-Based Care: Components, the WGU Nursing Programs Conceptual Model, and a PDSA Cycle on a Medical Unit

Introduction

Health care in the United States is moving, slowly and unevenly, from paying for the volume of services toward paying for the value those services produce for patients. For nurses in advanced roles, that shift changes what counts as good work: not how much care was delivered, but whether patients ended up better off and at what cost. This paper describes three components of value-based care, explains how two elements of the WGU Nursing Programs Conceptual Model can strengthen continuous quality improvement, and shows how the plan-do-study-act method improves patient outcomes, using an example from a composite 30-bed medical unit.

Three Components of Value-Based Care

The first component is outcomes that matter to patients. Porter (2010) defines value in health care as the health outcomes achieved per dollar spent, and argues that outcomes should be measured for the patient's full cycle of care for a condition, not for each separate service. In practice this means asking whether a patient with heart failure can walk to the mailbox a month after discharge, not only whether their stay was short.

The second component is cost measured across the whole episode of care. Value cannot be judged by outcomes alone; the same result achieved at lower cost is higher value. Value-based payment programs therefore look at the total cost of an episode, such as a joint replacement from surgery through 90 days of recovery, and reward organizations that reduce waste, complications and avoidable readmissions without harming results.

The third component is payment and accountability linked to quality. In value-based arrangements, part of an organization's payment depends on its performance on quality and patient experience measures, through mechanisms such as bonuses, penalties or shared savings. This links the work of nurses directly to the organization's finances: measures of patient experience, hospital-acquired conditions and readmissions are shaped largely by nursing care.

Using the WGU Nursing Programs Conceptual Model for Continuous Quality Improvement

The WGU Nursing Programs Conceptual Model describes nursing development through knowing, doing and being, and names elements that shape practice, including patient-centered care, systems-based practice and teamwork and collaboration (Western Governors University [WGU], n.d.). Two of these elements are especially useful for continuous quality improvement.

The first is systems-based practice, which asks the nurse to understand how the larger system of care affects each patient and to use system resources to improve care. An advanced professional nurse applies this element by looking past individual errors to the processes that produce them. When a medical unit's patients are frequently discharged without their follow-up appointments scheduled, a systems-based approach asks where the discharge process breaks down, who owns each step and what data would show the problem, rather than reminding nurses to try harder.

The second is teamwork and collaboration, which the model describes as effective engagement with nursing and interprofessional teams that fosters open communication, mutual respect and shared decision-making. Continuous quality improvement depends on it, because almost every process that affects outcomes crosses professional lines. The advanced professional nurse uses this element by forming improvement teams that include every role involved in the process being changed, such as unit clerks, case managers and physicians for the discharge example, and by making sure each member's view shapes the change.

A Systematic Quality Improvement Process: Plan-Do-Study-Act

The plan-do-study-act (PDSA) method improves outcomes by testing small changes quickly, learning from each test and building on what works. A team plans a change and predicts its effect, does the change on a small scale, studies the results against the prediction and acts by adopting, adapting or abandoning the change. A systematic review of PDSA in healthcare found that many published projects did not follow the method's key features, such as iterative cycles, small-scale testing and frequent data, and argued that the method works best when those features are kept (Taylor et al., 2014).

How PDSA Improved an Outcome on a Medical Unit

On the composite medical unit, only 42% of patients discharged over three months had a follow-up appointment scheduled before they left. In the first cycle, the team planned for the unit clerk to schedule follow-up appointments for patients expected to leave the next day, predicting that half would have appointments before discharge. They tested it for one week on patients of one hospitalist team. The rate for those patients rose to 61%, but the clerk reported often not knowing which patients were expected to leave. The team adapted the change.

In the second cycle, the charge nurse added a list of expected next-day discharges to the afternoon huddle and gave it to the clerk. Over two weeks, again for one hospitalist team, the rate rose to 78%. In the third cycle, the change spread to all three hospitalist teams, and the rate held at 76% over the following month. Because patients who have follow-up arranged before leaving are more likely to attend, the team began tracking 30-day return visits to the emergency department for the same patients as the outcome that matters most. The value came from small, fast tests that fixed the real barrier, information reaching the right person, rather than a large redesign launched all at once.

Why the Method Worked

Three features of the method made the difference. First, each test was small, one hospitalist team for one or two weeks, so a failed idea cost little and the team learned quickly. Second, every cycle began with a prediction, which forced the team to say what they expected and then face the gap between expectation and result; the first cycle's modest gain is what exposed the information problem. Third, the team tracked the same measure weekly on a simple run chart posted in the break room, so staff could see the effect of their work and suggest the next change. The team also watched a balancing measure, the clerk's overtime hours, to make sure the new task was not simply moving the burden from nurses to another role. It rose slightly in the first cycle and returned to baseline once the huddle list replaced the clerk's own search through the census.

Conclusion

Value-based care asks nurses to think about outcomes, total cost and accountability together. The WGU conceptual model gives advanced professional nurses two useful lenses for that work, systems-based practice and teamwork and collaboration, and the plan-do-study-act method gives them a disciplined way to test changes and keep the ones that help patients. Used together, they turn quality improvement from a project into a habit.

References

Porter, M. E. (2010). What is value in health care? New England Journal of Medicine, 363(26), 2477-2481. https://doi.org/10.1056/NEJMp1011024

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862

Western Governors University. (n.d.). Nursing programs conceptual model. WGU Community Nursing Student Handbook. https://cm.wgu.edu/t5/Nursing-Student-Handbook/Nursing-Programs-Conceptual-Model/ta-p/19