Clinical Quality Improvement Guideline Essay Example For College

Introduction

Evaluating the impact of organizational change is an evidence-based process that requires the key stakeholders to assess whether the organizational intervention improved the health outcomes of patients and thus demonstrated value and effectiveness (Schrag, 2009). Clinical practice guidelines are examples of organizational change that can vary depending on the already established guidelines as well as the objectives of a healthcare facility outlined.

Overview

An example of clinical practice guideline is the World Health Organization (WHO) – World Alliance for Patient Safety guidelines, which directs and coordinates authority within the United Nations system (Joint Commission, 2012). The guideline was established for providing the leadership role on the issues of health, developing the standards and norms, laying out the policy options created from evidence, as well as monitoring and evaluating world health care trends (WHO, 2010).

The WHO patient safety guideline that was introduced into the healthcare setting is “Towards 100% voluntary blood donation: A global framework for action.” The guideline describes the process of blood transfusion as the critical service within the system of health care, and those individuals who choose to donate their blood make a tremendous contribution to patients’ survival. Since there is an ongoing global challenge to collect enough blood from safe donors, the guideline aims to provide instructions that health facilities should follow to ensure 100% voluntary blood donation, which will lead to the elimination of paid donations in the future (WHO, 2010).

Holding Professionals to the Guideline

Different professionals in the healthcare system are held to the standard of creating an environment that promotes 100% voluntary blood donation, maintains a safe and sustainable process of donations along with the donor base, and provides quality services to volunteering donors (WHO, 2010). Nevertheless, the key target audience for the guideline includes policy-makers, planners, and managers that have a direct impact on the functioning of blood donation services within healthcare facilities.

Notably, the hospital management such as the chief executive, the director of nursing, associate medical directors, general managers, and the head of services and information are held responsible for introducing the guideline into the practice setting and ensuring that all departments work towards the achievement of the 100% voluntary blood donations in the facility. With support from the National Red Cross and Red Crescent societies, the management of a healthcare facility is encouraged to hold meetings, training sessions, planning activities, and informational campaigns that promote the culture of secure 100% voluntary blood donations.

On the lower level, nurses responsible for performing blood donation procedures are required to strictly follow the rules and guidelines on safe and high-quality services as well as educate patients on the importance and the benefits of 100% voluntary blood donations within the local community. A successful blood donor program is the one that combines the efforts of the higher and the lower-standing stakeholders who can have their influence on different levels of the healthcare organization’s performance. The dissemination of knowledge and information among departments is successfully conducted through seminars and workshops that provide valuable opportunities for facilitators and participants who share insights and experiences contributing to the success of the blood donor program (WHO, 2010).

Research for Adopting the Guideline

The research used for adopting the guideline heavily relied on the national and global statistics of blood donations. According to the American Red Cross (2017), in the United States, someone needs blood every two seconds, with around thirty-six thousand units of red blood cells needed every day. Furthermore, as cancer is one of the greatest challenges for modern health care, patients need blood (in some cases even daily) in the course of their chemotherapy treatment (American Red Cross, 2017).

The process of research is a vital tool targeted at understanding current and potential donors. Conveniently, research is neither complex nor costly; however, it requires a systematic approach. The first step is assessing the data gathered from already available records. For instance, a high discard rate usually implies that the materials targeted at educating doors are insufficient and that donor selection criteria are unclear (WHO, 2010). Research studies regarding the psychology of blood donation (Masser, White, Hyde, & Terry, 2008) and blood donor incentives (Abolghasemi, Hosseini-Divkalayi, & Seighali, 2010) are useful sources for getting insights and ideas for the guideline implementation. Apart from local research institutions, it is also important to include global research data that could be relevant in a variety of contexts.

Evidence for Defining the Guideline

Evidence used to define the guideline is related to the context of the emergency and non-emergency blood transfusions that are often key to saving the lives of patients. Field experiments have presented sufficient evidence suggesting that 100% voluntary blood donations are crucial for improving the quality of patient care and eliminating the challenges that currently exist within the clinical setting. For instance, the field experiment conducted by Goette and Stutzer (2008) showed concern that material incentives for blood donation have an undermining effect on prosocial motivation, which subsequently leads to the decrease in blood donations rather than their increase.

Therefore, the WHO (2010) guideline promotes voluntary blood donations since they positively influence prosocial motivation and contribute to society. Evidence of prosocial behavior and motivation is highly relevant in the context of 100% voluntary blood donations since the WHO (2010) guideline for patient safety is not targeted at manipulating donors’ visibility of such behavior but rather educating them on the importance of donations and providing them with relevant evidence suggesting that voluntary donation of blood could elevate the challenges many healthcare facilities face when it comes to the supply of blood. Moreover, Goette and Stutzer (2008) mentioned that monetary incentives for blood donation present risks for the safety of donors and increase the likelihood of infections.

Demographic data is another type of evidence used to define the patient safety guideline for 100% voluntary blood donations. According to the research conducted by Shaz, James, Hillyer, Schreiber, & Hillyer (2011), 98.7% of all donations come from individuals aged between 16 and 69 years, 77.7% of whom are white, 16.3% are African-American, 2.3% are Hispanic, 2.2% are Asian, and 1.6% are other donors. Moreover, donors aged between 40 and 49 donated the highest percentage of units. Demographic evidence can show the peculiarities of the local population and determine whether there is a need for placing a focus on the representatives of a particular demographic group; however, the 100% voluntary donations guideline invites as many different donors as possible.

Levels of Evidence

If to discuss the level of evidence used in the evidence-based practice quality improvement guideline, it is important to first mention that any evidence is relevant for the 100% voluntary blood donations program, ranging from evidence from authorities’ opinions to evidence from systematic reviews of a meta-analysis of the relevant randomized controlled trials (Winona State University, 2017). However, the most relevant and reliable evidence for the development of the WHO guideline was acquired from level I – level III, which included evidence from systematic reviews, well-designed randomized control trials, and controlled trials without randomization. These three levels of evidence provided enough relevant information for developing the guideline and ensuring that the interests of donors are maintained throughout the process of the program implementation.

As mentioned previously, key evidence regarding the importance of 100% voluntary donations was associated with gathering data as to the ineffectiveness of incentivized blood donations and the lack of prosocial motivation among the public. A large well-designed randomized control trial conducted by Goette and Stutzer (2008) provided an extensive background for the development of the voluntary blood donation guideline that was not associated with any kind of incentives and only promoted free donations that community members chose to undergo voluntarily.

How Professionals Followed the Guideline

While it is challenging to determine how well the guideline is followed by all professionals, it can be asserted that the 100% voluntary blood donations quality improvement program has become an effective tool for encouraging all stakeholders involved in the process to educate potential donors and establish an environment that will facilitate voluntary donations.

First, healthcare professionals were required to meet the guideline for safe blood donations with the help of strengthening the donor program. Even the most well-designed and well-integrated quality improvement program requires constant control and extensive work for bringing in new donors while maintaining close relationships with the already existing ones.

The chief executive of the healthcare facility, the director of nursing, associate medical directors, general managers, and the head of services and information all work cooperatively to comply with the patient safety guideline and promote the environment that will encourage donors to donate blood and educate them on its importance. It is crucial to mention that all healthcare professionals coordinate their resources to develop a cohesive program that in the future will achieve a safe and sufficient blood supply (WHO, 2010).

The healthcare professionals involved in the guideline follow the following action points for expanding and strengthening the 100% voluntary blood donation program:

  1. Assessment of the healthcare facility’s information needs and provision of current and relevant data and evidence targeted at illustrating the case for supporting the implementation of the guideline.
  2. Identification and collaboration with key stakeholders that have the ability to provide internal advocacy for the needs of blood donors within the healthcare organization.

If to provide an opinion on how well the professionals followed the guideline, prominent efforts were seen on the part of head of services and head of information that were engaged in the promotion of the 100% voluntary blood donations, involvement of possible donors into the conversation about the importance of blood donations for the patients in need.

It is also important to distinguish the work conducted by the director of nursing who invested time and efforts into educating nurses on how they should communicate with donors, what procedures should be followed during the process itself, which specific emergency measures should be undertaken if the situation calls for it, as well as what information should be collected for ensuring the success of the program. The chief executive of the healthcare facility was responsible for the assessment of the guideline’s implementation and identification of challenges and barriers that prevented the healthcare facility’s team from fulfilling its tasks.

Despite the fact that the adherence to the program was limited by the lack of cooperation between professionals, each stakeholder was assigned a specific role, which was followed to the best possible extent. Professionals within the system saw the 100% voluntary blood donations as a step forward to providing high-quality care and closing the gap with regards to the lack of available blood units for covering emergency situations (e.g. a patient surviving a severe car crash) and regular treatment (e.g. blood transfusions to patients undergoing chemotherapy for battling cancer). For this reason, professionals that operated within the health care environment were all focused on educating the already existing donors and potential donors on the importance and the effectiveness of the 100% voluntary blood donations for the well-being of the local community. Although some processes could have been performed better, the overall contributions of all stakeholders can be regarded as positive.

Discussion

The vision of the quality improvement program was the achievement of 100% voluntary blood donation in as many healthcare facilities around the globe as possible (WHO, 2010). The provision of the sustainable blood supply provided by non-remunerated blood donors is key to reducing the gaps that are associated with the lack of donor blood units in healthcare facilities that do not have sufficient practice guidelines that dictate the implementation of such quality improvement programs. Although the goal of reaching 100% voluntary blood supply in all healthcare facilities is rather ambitious, it is worthwhile since it could elevate the level of prosocial motivation and responsibility within local communities.

Cooperative work of the main stakeholders involved in the process of planning, training, and program implementation was crucial for reaching the established goals. In conclusion, it can be stated that the guideline helped the healthcare facility to establish a well-organized blood transfusion service coordinated on both local and national levels, providing and maintaining sufficient blood supplies when needed (WHO, 2010). The program provided rationale for collecting blood from voluntary non-remunerated donors and the subsequent phasing out of paid and replacement blood donations.

Quality testings were also in place (e.g. screening for possible transfusion infections) for ensuring the high quality of services and the reduction of unnecessary transfusions that exasperate donors’ and patients’ risks of getting infected. Lastly, the quality improvement program was successful with the help of the effective quality systems implementation, quality management, the development of standards for quality, a cohesive system of documentation, and staff training (WHO, 2010).

Lack of funding could be a significant limitation for the development and the implementation of the 100% voluntary blood donor quality improvement program; however, engaging large healthcare organizations that monitor the sufficiency of quality improvement programs can effectively eliminate this barrier. Overall, the 100% voluntary blood donations initiative is an important step towards providing patients with high quality of care and ensuring a sustainable supply of blood units that can be used for different clinical treatment purposes. By engaging the community into being proactive in their social position, healthcare facilities around the world can contribute to the elimination of issues associated with the supply of donor blood.

References

Abolghasemi, H., Hosseini-Divkalayi, N., & Seighali, F. (2010). Blood donor incentives: A step forward or backward. Asian Journal of Transfusion Science, 4(1), 9-13.

American Red Cross. (2017). Facts about blood needs.

Goette, L., & Stutzer, A. (2008). Blood donations and incentives: Evidence from a field experiment

Joint Commission. (2012). Examples of clinical practice guidelines or practice standards developed by organizations or professional societies regarding aspects of CLABSI prevention or diagnosis.

Masser, B., White, K., Hyde, M., & Terry, D. (2008). The psychology of blood donation: Current research and future directions. Transfusion Medicine Reviews, 22(3), 215-233.

Schrag, D. (2009). Evaluating the impact of organizational changes in health care delivery: Challenges in study design. Journal of Clinical Oncology, 27(11), 1744-1745.

Shaz, B., James, A., Hillyer, K., Schreiber, G., & Hillyer, C. (2011). Demographic patterns of blood donors and donations in a large metropolitan area. Journal of the National Medical Association, 103, 351-357.

WHO. (2010). Towards 100% voluntary blood donation: A global framework for action. Web.

Winona State University. (2017). Evidence based practice toolkit.

Chapters 6-12 Of A Short History Of Reconstruction

A Critical Analysis of the Book: Chapters 6-12

According to Eric Foner, the Republicans wanted most of the southern states to join their party. These Republicans used powerful blueprints in order to empower many ex-slaves in the south. This scenario led to the Radical Reconstruction. During the same period, many whites in the south renounced slavery and secession1. However, the idea of white supremacy remained in the south. The Republicans used various constitutional policies and amendments in order to abolish slavery. The Military Reconstruction also played a significant role towards the re-constitution of these southern states.

The author also examines the era from a political perspective. According to the author, Reconstruction equipped more people with voting rights. Several African Americans were appointed to different offices. Many people in the south also benefited from state-funded institutions. New laws emerged in order to empower more blacks in the south. Many African-Americans in the south also became part of Reconstruction. A new system of taxation emerged during the period. Many whites continued to oppress the poor in the south even after Reconstruction. This situation catalyzed the infamous economic depression that affected the south2.

New challenges and problems emerged during the same period. This development resulted in new ideologies. For instance, many northerners focused on the issue of labor. The northerners continued to focus on their economic positions. This fact explains why the northerners were against different policies. The concept of free labor created new tensions between the south and the north. The northerners also encountered new problems. They eventually stopped focusing on the idea of equality. Corruption and other malpractices became common throughout the period3. Many capitalists in the north imposed different economic programs.

The chapter “The Politics of Depression” identifies the issues arising from the Reconstruction Era. Many blacks had become sharecroppers towards the end of the era. The economic bubble emerging after the war resulted in one of the worst depressions. Many people lost their jobs. Many northerners withdrew their monies from the country’s economy. The Comprise of 1877 played a significant role towards ending Reconstruction4.

What Is The Author Writing About?

The above six chapters show clearly that Reconstruction was a fight between two opposing factions. According to Foner, the Republicans wanted to advance their dishonest ideals. During the same period, the Democrats fought tirelessly in order to support the needs of many citizens. The author also explains how most of the freedmen fought tirelessly for political equality. Many ex-slaves participated in Reconstruction in order to support their liberties5. Racism also played a major role towards the failure of Reconstruction. That being the case, Reconstruction became the beginning of a new struggle in the United States.

Critique of the Argument

Eric Foner has presented the best arguments and discussions. He explains how the interests of many northerners affected the success of Reconstruction. According to the author, many freedmen worked hard in order to achieve their goals. However, many whites acquired more lands in the south. This development created the ground for the economic recession that affected the country6. Many African Americans fought tirelessly in order to achieve their goals. More whites became conservative thus affecting the lives of many southerners. Eric gives a detailed analysis of the issues and developments that defined Reconstruction.

Bibliography

Bressler, Jonathan. “Reconstruction and the Transformation of Jury Nullification.” The University of Chicago Law Review 78, no. 4 (2011): 1133-1201.

Foner, Eric. A Short History of Reconstruction, 1863-1877. New York: Harper Perennial, 1990.

Footnotes

  1. Eric Foner. A Short History of Reconstruction, 1863-1877 (New York: Harper Perennial, 1990), 239.
  2. Jonathan Bressler, “Reconstruction and the Transformation of Jury Nullification,” The University of Chicago Law Review 78, no. 4 (2011): 1142.
  3. Eric Foner. A Short History of Reconstruction, 1863-1877 (New York: Harper Perennial, 1990), 249.
  4. Jonathan Bressler, “Reconstruction and the Transformation of Jury Nullification,” The University of Chicago Law Review 78, no. 4 (2011): 1153.
  5. Eric Foner. A Short History of Reconstruction, 1863-1877 (New York: Harper Perennial, 1990), 268.
  6. Jonathan Bressler, “Reconstruction and the Transformation of Jury Nullification,” The University of Chicago Law Review 78, no. 4 (2011): 1145.

The Civil Rights Movement And Reconstruction

The Civil Rights Movement

With the end of the Civil War in the United States, several groups, including the government and other non-governmental organizations, came up with many propositions to protect the rights of minorities, such as Africans and Asians, who were always under constant threats from the whites. This meant that the government was aware of the conflicts that existed in society, and it moved in to help end the issue that threatened American sovereignty and national security interest. Newly freed slaves had limited capacities both politically and socio-economically since they did not have equal opportunities, as far as participation in leadership was concerned.

Additionally, few Africans were involved in economic matters, such as trade and manufacturing of important products. In other words, many blacks had been incorporated into the country’s financial system as underdogs, with their main role being offering the much-needed labor (Houck 112). In fact, Africans and other blacks from the South American region simply offered their cheap labor, and they depended wholly on the ruling class for survival. In 1866, 1870, and 1871, a legislative act was passed with the hope of giving Africans an advantage in society, but things never changed, as they continued to serve the interests of the rich and the politically mighty in society. In 1875, an act of parliament made it illegal for any person or authority to deny blacks their rights and freedoms, such as the right to access quality health, freedom of speech, and the right to own property. In the same year, blacks were given permission to sue whoever trespassed on their property, and all the juries were expected to respect the views of Africans in courts, whereby they would grant property rights to them.

The outcome of the demonstration had a nationwide impact, as it affected the operations of the government in each state. In fact, the government had to act in order to end the conflicts that threatened the unity and the security of the nation. In 1957, the blacks forced their way when they tried to enroll in government-sponsored high schools, but the city governors in consultation with the whites blocked their move. The president had to recruit the services of the military to protect the blacks in high schools. In 1964, President Johnson Lyndon sponsored a bill that was passed in the congress, giving all blacks a chance to mingle freely in society.

The bill banned all forms of discrimination that were based on gender and race, especially in schools and in the places of work. The ideas of Morris, which claim that there was more to the civil rights movement than Dr. King’s speeches and protest marches, are valid because Dr. King simply spoke out the problems that blacks had experienced for several years (Ollhoff 67).

To some extent, the civil rights movement resolved the many problems that faced blacks in the country since several legislations were passed that gave the minorities an advantage in politics and economics. In the political arena, for instance, the Voting Rights Act of 1965 was passed, which protected the right to vote, consequently allowing many blacks to take part in the important political exercise (Uslaner 89). Economically, The Civil Rights Act of 1968 allowed blacks to engage in real estate trade, as it banned all forms of discrimination in the housing department.

Reconstruction

It is true that the reconstruction process brought about several political and economic changes since the blacks were involved in the elections, and they were allowed to own property in various parts of the country. Reconstruction demanded that the government moves in to help the minorities, who were mainly blacks and other slaves that had been seriously affected during the Civil War. The process of reconstruction had to be undertaken in two major levels, one being the political level where the congress had to come up with several laws that would help the blacks attain their goals. In this regard, the lawmakers had to draft policies that would make it illegal for any state to neglect the views of blacks whenever a policy is drafted. Therefore, each group had to be involved in governmental decision-making (Franklin, 15).

Additionally, the government had to come up with ways that would ensure former slaves and other blacks access education and other social services, such as quality healthcare. In this case, the state had to ensure that no school discriminates against a black person, as education was considered critical in the process of reconstruction. In the second level, the judiciary had to change the system of operation by issuing stern punishments to those who never respected the law. For instance, it ordered deregistration of all private organizations that never considered racial equality in their recruitment exercises. The judges ensured that all blacks enjoyed their lives in a society without any disturbance from any group.

With time, the reconstruction process ended and many blacks were subjected to injustices in the same way they were oppressed during slavery and slave trade era. It was felt that Africans had been given many privileges that they did not deserve and this put much pressure on the government to end all reconstruction policies. Furthermore, it was eminent that equality had been achieved and no group was in need of any help as far as fulfillment of individual goals and objectives were concerned. In this regard, many Africans were rendered jobless and the little political power they had accumulated was snatched from them and given to the whites who used it effectively to subjugate other minority groups and dominate them in society (McNeese 45).

The blacks were never given any opportunity to own property, neither were they employed in the civil service because certain jobs were only reserved for the whites. The government moved in too late in 1957 to come up with legislations that ensured the civil rights are provided to all Africans and other minorities. For instance, the Montgomery law demanded that all whites be given respect and it was upon each black to ensure that he or she does not enter into any form of conflict with the white person. In 1955, blacks were tired with the injustices meted unto them, with the support of the government. Rosa Parks felt that it was not right for one race to be given undue advantage socially and she proved that this was wrong when she refused to give a white man a seat in the bus, something that sparked widespread riots in the state of Alabama. Fortunately, Reverend Martin Luther King Junior was among the black travelers available in the bus and he took up the responsibility of leading the demonstrators against white domination.

Works Cited

Franklin, John. Reconstruction after the Civil War. Chicago, Ill: University of Chicago Press, 2012. Print.

Houck, Davis. Rhetoric, Religion and the Civil Rights Movement, 1954 – 1965. Waco, Tex: Baylor Univ. Press, 2006. Print.

McNeese, Tim. Reconstruction: Life after the Civil War. New York: Chelsea House Publishers, 2009. Print.

Ollhoff, Jim. The Civil Rights Movement. Edina, Minn: ABDO Pub, 2011.Print.

Uslaner, Eric. Segregation and Mistrust: Diversity, Isolation, and Social Cohesion. Cambridge: Cambridge University Press, 2012. Print.

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