Each quality improvement (QI) initiative is composed of systematic inputs, processes, and activities. Additionally, the QI initiative is a team process involving various stakeholders. Whether the initiative is seeking to improve wait time, diabetes care, or other important goals, a team effort can help achieve significant and lasting improvements. Without proper resources as inputs, the QI activities might not reach their optimal outcomes.
Individual members of each team are to write a three- to five-page paper that details Part 2 of your QI initiative.
In part 2 of your paper,
Identify at least three quality improvement or risk management tools or methodologies (e.g. flowchart, 6-Sigma, etc.) needed for your QI initiative.
Be sure to provide the rationales for your selected tools or methodologies.

Determine the stakeholders involved to accomplish your QI initiative.

Be sure to provide the rationales.

Examine other resources (e.g., time, financial, materials, etc.) required for your QI initiative.
Be sure to provide the rationales.
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Vanderbilt University Medical Center; Complications and Death
Quality Improvement Initiative
MHA624: Continuous Quality Improvements & Risk Management
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Complications and Death Quality Improvement Initiative
Introduction
Consistent with the high standard of services rendered, Vanderbilt University Medical
Center in Nashville is highly regarded as a leading health service provider serving a variety of
customers locally. Through this paper, we will address the issues of business entity, services and
products it offers and customers it serves. Next step will be to evaluate the rate of complications
and deaths inside the entity, which will be done by the discussion of the issues from the point of
positioning the entity on the reflex plan, patient’s safety and financial stability. Then, we will
elucidate a set of SMART goals targeted at progressive enhancement of such metrics, and after
that, we will include a review of most available policies that were devised to upgrade patient
outcomes.
Nature of Business, Services, and Customers
Vanderbilt University Medical Center is a medical center with high reputations that offers
a wide range of health services, consisting of preventive healthcare, specialized medical and
surgical services, diagnostic services, and research programs. It carries patients of a wide variety,
from patients who apply here to get routine medical care, to the patients who have complicated
medical condition that require specified medical service which are targeted for this group of
patients. VUMC is also towards patients who go in for the acceptation to clinical trials and
research studies (Wilkins et al., 2021). The hospital / medical center does not only serve for the
Nashville local population, but also patients from different counties of Tennessee, across the
state, regions and other countries that demand advanced treatment.
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Evaluation of Complication and Deaths and its Importance
The complication and mortality rates within the hospital are cardinal statistic and slightly
suggests the standard of care, the level of safety and financial health of an institution (Wilkins et
al., 2021). The portion of corresponding to the death and subsequent complications can not only
downgrade the profile status of hospital, but as well upgrade the necessary conditions of care and
safety set by the regulatory bodies like the Joint Commission Committee. In addition to the
patient’s well-being, such long-term adverse outcomes can result in respective lawsuits, loss of
reputations, and funding availability.
SMART Goals
1. Reduce Hospital-Acquired Infections (HAIs):
Specific: Set a goal of reducing the frequency of HAIs aircrafts, most of all SSIs. Aim to tip it
from 20% to 10%.
Measurable: Make sure to trace and record HAIs monthly and additionally draw a comparison
with the starting baseline data as sourced from a baseline study.
Achievable: Adopt an approach based on evidence based practice and design staff training
programs conquering infectious diseases.
Relevant: Safety and better care for patients are also means of the hospital under its vision and
mission.
Time-bound: Reduce the mortality rate by 15% for a period of 18 months.
Specific: Lower the mortality rates in high-risk operations, like cardiogenic surgeries, by 15%.
Measurable: Complete mortality rate studies for specific procedures every three months and
report them.
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Achievable: Improve retained surgical skills, preoperative assessments, and postoperative care
pathways. Create your own knowledge base and develop your vocabulary. These tools are
specifically designed for independent learners who want to deepen their understanding of
academic or specialized subjects.
Relevant: Saving patients’ lives and healing, is not just an aim of the healthcare system but also
aimed at long-term positive changes.
Time-bound: Achieve at least 15% reduction in the rate of mortality within the span of 18
months.
Analysis of Policies
Policies in a range from local, state up to and including national, including The Joint
Commission Standards, have paramount significance for inspiring quality enhancement activities
in hospitals (Leape, 2022). Such a set of policies is designed to allow for evenness up by
providing rules as well as guidelines in line with the utmost the most possible evidenced based
practice for enhanced patient and reduced complications to better inventory. An example of this
could be the National Patient Safety Goals of the Joint Commission, which establish particular
directions regarding the reduction of healthcare associated infections and preventing surgical
errors (Basson et al., 2021). This approach also complies with the SMART goals mentioned
earlier. Through adherence to these guidelines and ongoing evaluation of them and the assigned
metrics, hospitals including Vanderbilt University Medical Center can guarantee that the
treatment, safety, and care for people will grow better over time.
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Conclusion
Summing up, VUMC in Nashville caters for a mix spectrum of customers with differing
healthcare products and services. These in-house catastrophes that result in the demise of patients
symbolize poor quality procedures, flawed care plan and economic helter-skelter. The hospital’s
mission is to lower the rate of hospital-acquired infections and to maintain the very low mortality
rate for high-risk operations by setting up SMART goals. In other words, it enables the medical
center to achieve better outcomes for patients and conforms to regulatory standards. Along these
lines, application of evidence-based policies including those of The Joint Commission Standards
is paramount for the purpose of promoting runaway advancement and safe patient outcome.
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References
Basson, T., Montoya, A., Neily, J., Harmon, L., & Watts, B. V. (2021). Improving patient safety
culture: a report of a multifaceted intervention. Journal of patient safety, 17(8), e1097e1104.
Leape, L. L. (2021). Enforcing standards: the joint commission. In Making Healthcare Safe: The
Story of the Patient Safety Movement (pp. 185-202). Cham: Springer International
Publishing.
Wilkins, C. H., Williams, M., Kaur, K., & DeBaun, M. R. (2021). Academic medicine’s journey
toward racial equity must be grounded in history: Recommendations for becoming an
antiracist academic medical center. Academic Medicine, 96(11), 1507-1512.
https://journals.lww.com/academicmedicine/fulltext/2021/11000/Academic_Medicine_s_
Journey_Toward_Racial_Equity.11.aspx