For my DNP project, I selected the theory of Crosby on his attention to transforming the quality culture in the field of quality management. Crosby’s theory emphasized the importance of systems knowledge and improvement, failure of inspection, and the importance of statistical quality control with four basic absolutes or concepts of a quality improvement process (Butts & Rich, 2018).
The first absolute is “the definition of quality is conformance to requirements” where management has the basic tasks of establishing the requirements (Butts & Rich, 2018). The direct practice improvement that I’m working on is the prevention of central venous catheter (CVC) infection for patients receiving hemodialysis patients. The second absolute is “the system of quality is prevention” where prevention is successful when key processes are understood (Butts & Rich, 2018). Central Line-Associated Blood Stream Infections (CLABSI) is a highly prevalent problem that only through established protocol adherence, and best practices can reduce infections.
The third absolute is that “the performance standard is zero defect” (Butts & Rich, 2018). One of the clinical measures of The End-Stage Renal Disease (ESRD) Quality Improvement Program (QIP) is zero infection.
This metric can be preventable with surveillance, proper aseptic technique, and management strategies. Mitigating risks and brainstorming solutions establish a culture of safety. The fourth absolute is “the measurement of quality is the price of nonconformance” (Butts & Rich, 2018). The Centers for Medicare & Medicaid Services (CMS) administers ESRD QIP to promote high-quality services in renal dialysis facilities and reduce payments for those who do not meet or exceed performance standards.
Quality management is a key element allowing operational performance improvement, product quality, and organizational performance (Negron, 2020). As doctoral-prepared nurses in dynamic roles, we are poised to interface and simultaneously lead within our professional sphere.
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