Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem

Assignment

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

1. Provide an overview of the problem and the setting in which the problem or issue occurs.
2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
3. Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
4. Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
5. Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
6. Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Quality Improvement Proposal – Sample Answer

In 2016, Johns Hopkins (2017) released the findings of a study in which it found that medical errors claim the lives of more than 250,000 Americans yearly. Compared to other leading causes of mortality in the U.S., medical errors come second, just before the respiratory illnesses. The Institute of Medicine (IOM) recognizes these errors as a threat to the healthcare system, and this is why some of its recommendations emphasize on building hospitals’ capacity to prevent and address these errors. From a clinical point of view, medical errors encompass various forms of mistakes that clinicians and patients commit, either knowingly or unknowingly.

Some examples include misdiagnosis, administering wrong medications, and transfusing blood to the wrong patient. Errors due to the administration of medication affect a significant number of American patients. To minimize the incidences of these mistakes including their impact, hospitals require Quality Improvement (QI) programs. It is important to present a proposal for such a program, emphasizing its importance, and implementation and evaluation processes.

An Overview of the Problem Including the Setting In Which It Occurs

The problem occurs in outpatient setting, and it involves the lack of precaution and health literacy, and absence of adequate clinician-patient communication, leading to wrong medication and missing doses. This issue is prevalent in the selected setting primarily because of the illegible handwriting during the doctor’s prescription, causing pharmacists to misread the prescription. Additionally, the absence of support staff and high workload are contributing to cases of medical errors. The responsibilities that come with handling multiple patient cases at once can be overwhelming, resulting to burnout.

According to Kwon et al. (2021), physicians who experience burnout are more likely to commit medical errors, compared to those experiencing burnout. Lack of patient counseling is also a contributory factor for the quality issue because lack of patient’s awareness regarding the importance of adherence, tends to cause poor adherence. Furthermore, this problem is occurring in outpatient due to the use of some drugs with similar names.

The Reason Why a Quality Improvement Initiative Is Required In the Setting Including Expected Outcome

Cases of medication administration errors have various implications for patients and for clinicians, and if not addressed, they can have serious impact on the wellbeing of patients, and dent the image of practitioners. These errors put patients at risk of injuries or even death because prescribing certain medications to some patients can cause them to develop kidney complications. If a patient is suffering from a chronic kidney disorder, for instance, administering nephrotoxic medication may cause the condition to worsen. If one mistakenly uses atenolol to treat COPD, still, the patient may experience adverse complications because beta-blockers are known to worsen the condition.

Recently, the Medicare program has been penalizing providers for failing to meet the required quality standards. Therefore, there is need to ensure the providers deliver the required quality in the selected setting. Thus, the implementation of the QI will lead to decline in cases of patient injuries and deaths due to medication administration errors, by more than 50%.

How the Results of Previous Research Demonstrate Support for the Quality Improvement Initiative and Outcomes

Some of the available evidence lends support to the proposed QI including the projected outcomes. According to the cross-sectional study carried out by Wondmieneh et al. (2020), for instance, the absence of guidelines for guiding the administration of the medication, and inadequate training of the clinical staff were responsible of incidences of medication errors. For their part, Petejova and colleagues (2019) investigate the effect of nephrotoxic, and from their analysis, it is evident that that the drug can cause renal failure.

Current evidence also supports the relationship between counseling and adherence. Taibanguay et al. (2019), using a randomized-controlled trial to examine this relationship, found that educating patients had a significant chance of improving adherence. Since lack of adherence is one of the main factors that lead to medication errors, the findings by Taibanguay et al. (2019) support the projected outcomes.

Steps Necessary to implement the Quality Improvement Initiative (Include Rationale and Evidence)

The Road to Evidence-Based Practice process provides the framework that can help guide the implementation of the QI initiative. The first step will involve carrying out an assessment to determine the nature of the problem including its magnitude, and the resources that can be useful when it comes to the implementation. The second step in this process involves asking a specific clinical question. An example of such a question is; In Patients receiving outpatient services how does the use of interventions such as patient counseling and adequate staffing, compare to lack of use of these interventions, in terms of reducing adverse medication events in a span of two weeks?

After generating this question, the next step involves appraising the quality of evidence, before applying it to improve outcomes.  Finally, the results are compared against the projected outcomes.

The Mechanism of Evaluation of the Quality Improvement Initiative to determine evidence of Improvement

Evaluation of the QI is critical to gauging its impact in terms of helping address the presented concerns. Comparing the number of incidences of errors due to medication administration, for instance, can help gauge the milestones achieved in terms of lowering cases of errors. With this approach, the hospital selects two different periods, and compares the clinical outcomes in the outpatient setting for these two periods.

The other mechanism that is applicable in this scenario is testing adherence to the guidelines proposed as part of the QI. Some of these guidelines would include counseling patients, following prescription protocol, and labeling medications correctly (Cardoso et al., 2021).  High level of compliance would mean the process is success.

The Variables and Hypothesis Test to Use to Prove that the Quality Improvement Initiative was Successful

Variables and hypothesis provide the tools that can be useful in proving the success of the QI. Experimental variables are particularly useful in this case because they can help prove the relationship between two events. For the proposed QI initiative, increasing the population of the staff, and decrease in medication errors are independent and dependent variables respectively. The hypothesis provides an alternative tool for gauging how well the initiative was successful. In this case, the hypothesis would be, “Implementing a QI in which provides get training on how to prescribe medications, leads to decline in incidences of clinical errors.”

When testing this hypothesis, therefore, the focus would be determining if the proposed interventions would translate to fewer cases of medication errors. The processing of performing this test starts with stating the hypothesis, gathering relevant data, and performing meaningful test using a statistical method. By following this procedure, one can decide if the hypothesis is true.

Conclusion

In conclusion, improving quality should be a priority for hospitals that are grappling with quality-related issues such as high cases of clinical errors. This is important because these errors cause poor patient outcomes, and may increase the patient’s risk of death. Besides, hospitals may face penalties under programs such as Medicare, if they provide health care in a manner than jeopardize the patient’s safety and wellbeing. During the implementation of the QI, hospitals need to follow certain steps to improve the success of their QI initiatives.

When working on a QI program, a hospital needs to have variables, and develop hypothesis to guide it as it implements the various QI tasks. Through the interpretation of these variables, it is possible for one to know whether they are making progress.

References

Cardoso, D., Couto, F., Cardoso, A. F., Bobrowicz-Campos, E., Santos, L., Rodrigues, R., Coutinho, V., Pinto, D., Ramis, M. A., Rodrigues, M. A., & Apóstolo, J. (2021). The Effectiveness of an Evidence-Based Practice (EBP) Educational Program on Undergraduate Nursing Students’ EBP Knowledge and Skills: A Cluster Randomized Control Trial. International journal of environmental research and public health, 18(1), 293. https://doi.org/10.3390/ijerph18010293.

Johns Hopkins. (2017). Current News Releases. https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us..

Kwon, C. Y., Lee, B., Kwon, O. J., Kim, M. S., Sim, K. L., & Choi, Y. H. (2021). Emotional Labor, Burnout, Medical Error, and Turnover Intention among South Korean Nursing Staff in a University Hospital Setting. International journal of environmental research and public health, 18(19), 10111. https://doi.org/10.3390/ijerph181910111.

Petejova, N., Martinek, A., Zadrazil, J., & Teplan, V. (2019). Acute toxic kidney injury. Renal failure, 41(1), 576–594. https://doi.org/10.1080/0886022X.2019.1628780.

Taibanguay, N., Chaiamnuay, S., Asavatanabodee, P., & Narongroeknawin, P. (2019). Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient preference and adherence, 13, 119–129. https://doi.org/10.2147/PPA.S192008.

Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: a cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC nursing, 19, 4. https://doi.org/10.1186/s12912-020-0397-0.

Quality Improvement Proposal – Alternative Sample Answer

Pediatric care centers are crucial in addressing the health needs of children, but they face issues that risk plaguing the entire healthcare industry. Among these issues include care variation, communication breakdown across patients and between providers, patient discharge variations, and avoidable medical errors. The initiation of quality improvement initiatives helps to address some of these issues by devising strategies to better-face the associated challenges (Randmaa, 2016).

Following its quality improvement initiative regarding communication errors, Duke Children’s Hospital in Durham, NC was among the facilities that won the 2013 Pediatric Quality Award Winners (Children’s Hospital Association, 2020). Nurse leasers and other people who are vision bearers in hospitals are expected to lead in these quality improvement projects, which would not only help in saving the associated monetary damages, but would also add to the patient satisfaction.

Overview of the Problem and the Setting in which the Problem Occurs

Communication errors in facilities often have the impact of creating teamwork breakdowns, which results in medical errors as well as poor patient outcomes. Also, facilities with communication breakdowns often have higher costs of care as well as prolonged length of stay. Among the common causes of communication errors in healthcare is the lack of proper education among healthcare providers as well as among patients.

Whenever the patients, for instance, are unable to interpret the message of the healthcare givers, they often create a communication gap that leads to ineffective healthcare. Also, healthcare givers who do not have the right education about dealing with different patient care outcomes are likely to result in communication errors (Boling, 2020).

There are many settings for the problem to occur, but most of the time, communication errors happen where there is interaction between people in the healthcare set up. For instance, during patient discharge, the healthcare providers give various instructions to patients to enhance their wellbeing while away from the facility. If there is a communication challenge, it is likely that they cannot experience the right recovery.

Why a Quality Improvement Initiative is needed in this Area and the Expected Outcomes

A quality improvement initiative is needed in this area because this is an area of care where failure is likely to lead to numerous inefficiencies. If there is no intervention regarding communication errors, it is likely that a facility will be less capable of addressing the patient care demands. Clinicians who communicate wrongly do not have what it takes to listen, explain, and emphasize the effect of functional and biological outcomes.

Also, the fact that clinicians have thousands of patient interactions in the course of their career means that a misunderstanding about a communication error may lead to lifelong effects on their career by repeating numerous mistakes on patients.

Also, in healthcare, there are competing demands that show that communication errors leads to adverse effects on patient privacy, which has recently become a healthcare concern due to the introduction of technology and other modern means of communication. Solving communication errors helps in embracing better evidence-based practice and improving the care outcomes.

How the Results of Previous Research Demonstrate Support for the Quality Improvement Initiative and the Projected Outcomes

Omura et al. (2017) discusses about some of the implication of assertiveness communication training programs among nursing students and healthcare professionals. The research identifies communication errors as part of the reasons why there are numerous negative effects on patient safety. Healthcare providers should acquire the necessary skills to eliminate patient risk through improving the communication methods and avoiding the occurrence of communication errors (Omura et al., 2017).

There is also evidence that interventions improve assertive communication is often more efficient in some groups. Also, teamwork in healthcare is only possible with the help of the relevant communication strategies.

Grahramanian et al. (2017) explains some of the aspects of nurse-physician professional communication that helps in improving the overall quality of healthcare services. The study investigates the relationship of healthcare services from the perspective of patients with nurse-physician professional communication (Grahramanian et al., 2017). Organizational culture which helps in solving medical errors should be made to embrace non-punitive response. Also, efforts that are geared in reduction of communication errors are efficient in the implementation of relevant teamwork practices that help in improving care outcomes.

Hassan (2018) discusses some of the effects of avoiding medication errors by embracing effective communication in healthcare environments. The researchers in this study identify ineffective communication between healthcare personnel and patients as one of the primary causes of medication errors (Hassan, 2018).

Healthcare givers should only use technical language among themselves, but when relating to patients, they should appreciate that this technical language could lead in communication voids in care (Hassan, 2018). Also, constant knowledge and support among patients can help to promote effective practice in hospitals as well as improve the care outcomes.

Steps Necessary to Implement the Quality Improvement Initiative

The quality improvement initiative suggested in this task is the implementation of education on how to improve communication during daily rounds. When this technique was applied in Duke Children’s hospital, it led to numerous outcomes including a 34% increase in provider satisfaction (Children’s Hospital Association, 2020).

While rounding is a common thing to happen in facilities, most healthcare givers do not know how to do it efficiently. In many instances, communication is considered to be a native skill, and people are not taught about how exactly it should be done. As a result, there are often numerous assumptions that lead to enveloping of medical errors.

The first step in implementing this initiative is collecting all the available resources for communication improvement in healthcare. These would include possible human resources to aid in the growth of patient outcomes. Second in the implementation of this quality improvement initiative would be collection of the most recent evidence-based resources to guide in the process. Lastly, different patient and healthcare giver education platforms would be identified, with the relevant time and resource allocation to the same to ensure effective outcomes.

How the Quality Improvement Initiative Will Be Evaluated to Assess whether there is Improvement

A quarterly evaluation is always effective in ensuring that the initiative works efficiently. In the evaluation, various parameters would be checked, such as assessing the quality of communication available in the individual set ups. A standard experimental design should be applied in all the stages of the evaluation, to help check whether there is an improvement in various associated parameters (Foronda, McWilliams, & McArthur, 2016).

For instance, the assessment of whether or not the number of medical errors per a given period reduced over time would be an efficient way to check whether there is an improvement in addressing the problem of communication errors.

A hypothesis test that could prove the findings would be, ‘the number of medical errors in unit X will reduce by 20% after a continuous application of the quality improvement initiative for a period of six months.’ A suitable statistical test that could help in proving the findings would be to set up a study where the patient conditions are investigated in a certain period before running the quality improvement initiative, and trying the same study after the quality improvement initiative have been tried. Here, the researcher would be open to a wide range of variables, but those that can be assessed primarily from patient data such as the use of the number of admissions are more preferred.

Conclusion

The quality improvement proposal of implementing patient education on improving patient communication during the daily rounds is efficient as it has already been proven to have many positive results in different set ups such as Duke Children’s Hospital. This initiative aims at debunking the myth that communication is a native trait, and appreciating the need of embracing various education about how to manage communication protocols in healthcare.

Communication errors are the leading causes of medical errors and has other indirect effects such as the increase in patient admission rates and reducing the quality of healthcare. Nurse educators need to appreciate the value of education about the right communication protocols among nurses and also among patients where possible.

There is need for healthcare givers to appreciate the fact that technical language should only be applied when they are conversing amongst themselves, but when talking to patients and their families, they should employ a high level of simplicity so as to ensure effectiveness of the message. Most importantly, healthcare givers should be open to embrace quality improvement initiatives that help in improving patient care outcomes.

References

Boling, A. (2020). Interprofessional Simulaton among Healthcare Students: A Randomized Controlled Trial to Improve Communication Self-Efficacy. Retrieved from https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/73306/Boling_umkc_0134D_11535.pdf?sequence=1

Children’s Hospital Association, (2020). 4 Quality Improvement Ideas Hospitals Can Implement. Retrieved from https://www.childrenshospitals.org/improvement

Foronda, C., McWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse education in practice, 19, 36-40. Retrieved from https://doi.org/10.1016/j.nepr.2016.04.005

Ghahramanian, A., Rezaei, T., Abdullahzadeh, F., Sheikhalipour, Z., & Dianat, I. (2017). Quality of healthcare services and its relationship with patient safety culture and nurse-physician professional communication. Health promotion perspectives, 7(3), 168. Retrieved from https://doi.org/10.15171/hpp.2017.30

Hassan, I. (2018). Avoiding Medication Errors through Effective Communication in Healthcare Environment. Movement, Health & Exercise, 7(1), 113-126. Retrieved from http://dx.doi.org/10.15282/mohe.v6i2.157

Omura, M., Maguire, J., Levett-Jones, T., & Stone, T. E. (2017). The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. International journal of nursing studies, 76, 120-128. Retrieved from https://doi.org/10.1016/j.ijnurstu.2017.09.001

Randmaa, M. (2016). Communication and Patient Safety: Transfer of information between healthcare personnel in anaesthetic clinics (Doctoral dissertation, Acta Universitatis Upsaliensis). Retrieved from http://urn.kb.se/resolve?urn=urn%3Anbn%3Ase%3Auu%3Adiva-278726

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How to Identify and Implement Quality Improvement Opportunities in Healthcare: A Comprehensive Evidence-Based Guide

Healthcare organizations worldwide face mounting pressure to deliver exceptional patient care while managing costs and improving outcomes. A quality improvement opportunity in healthcare represents a systematic approach to identifying, analyzing, and addressing gaps in care delivery that can significantly impact patient safety, satisfaction, and clinical outcomes.

What Are Quality Improvement Opportunities in Healthcare?

Quality improvement opportunities in healthcare are systematic approaches to identifying and addressing gaps in patient care, safety protocols, and operational efficiency. These initiatives leverage evidence-based practice methodologies to create sustainable improvements that benefit both patients and healthcare organizations.

Quality of care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes” and forms the foundation for identifying meaningful improvement opportunities.

Current State of Healthcare Quality: Key Statistics

Understanding the current healthcare quality landscape is crucial for identifying improvement opportunities:

Source: Agency for Healthcare Research and Quality, 2024

The Evidence-Based Approach to Quality Improvement

Foundation Principles

Evidence-based quality improvement (EBQI) “aims to integrate scientific evidence and methods into the QI process while maintaining focus on team-based innovation and problem-solving within real-world settings”.

The key components include:

1. Data-Driven Decision Making: Using quantitative and qualitative data to identify improvement areas
2. Stakeholder Engagement: Involving multidisciplinary teams in the improvement process
3. Systematic Implementation: Following structured methodologies for sustainable change
4. Continuous Monitoring: Establishing metrics for ongoing assessment and adjustment

Common Quality Improvement Opportunities in Healthcare Organizations

1. Reducing Hospital Readmissions

The Problem: Hospital readmissions represent a significant quality improvement focus, with healthcare systems “striving to improve the patient experience” through readmission reduction initiatives.

Evidence-Based Solutions:

• Comprehensive discharge planning protocols
• Post-discharge follow-up systems
• Patient education programs
• Care coordination improvements

Implementation Framework:

• Assessment: Analyze readmission data by diagnosis, department, and patient demographics
• Root Cause Analysis: Identify contributing factors (medication errors, inadequate discharge instructions, lack of follow-up)
• Intervention Design: Develop targeted interventions based on evidence-based guidelines
• Implementation: Execute pilot programs with measurable outcomes
• Evaluation: Monitor 30-day readmission rates and patient satisfaction scores

2. Healthcare-Associated Infection Prevention

The Problem: Healthcare-associated infections (HAI) reduction represents a critical quality improvement area, with sources including “CLABSI, CAUTI, C. diff, MRSA, colon SSI, and hysterectomy SSI”.

Evidence-Based Interventions:

• Hand hygiene compliance programs
• Antibiotic stewardship initiatives
• Infection control protocol standardization
• Environmental cleaning enhancements

3. Patient Safety Event Reduction

Focus Areas:

• Medication error prevention
• Fall prevention programs
• Surgical site infection reduction
• Communication improvement initiatives

Step-by-Step Framework for Identifying Quality Improvement Opportunities

Phase 1: Assessment and Data Collection

1. Conduct Organization-Wide Quality Assessment

• Review patient satisfaction scores
• Analyze clinical outcome data
• Examine operational efficiency metrics
• Assess staff satisfaction and engagement

2. Benchmark Against Industry Standards

• Compare performance to national quality measures
• Identify gaps in evidence-based practice implementation
• Evaluate compliance with clinical guidelines

Phase 2: Priority Setting and Stakeholder Engagement

1. Stakeholder Identification

• Clinical staff (physicians, nurses, pharmacists)
• Administrative leadership
• Quality improvement specialists
• Patient representatives
• IT and data analytics teams

2. Priority Matrix Development

Phase 3: Evidence-Based Intervention Design

1. Literature Review Process

• Systematic review of current evidence
• Analysis of best practices from similar organizations
• Evaluation of intervention effectiveness data
• Cost-benefit analysis of proposed solutions

2. Intervention Development

• Define specific, measurable objectives
• Establish implementation timeline
• Identify required resources and training
• Develop measurement and evaluation plans

Implementation Strategies for Quality Improvement Initiatives

The PDSA Cycle in Healthcare Quality Improvement

Plan: Define the problem, establish objectives, and design interventions Do: Implement pilot programs with small-scale testing Study: Analyze results and identify lessons learned Act: Scale successful interventions organization-wide

Technology Integration for Quality Improvement

Electronic Health Records (EHR) Optimization:

• Clinical decision support systems
• Automated quality measure reporting
• Real-time performance dashboards
• Predictive analytics for risk stratification

Quality Management Software:

• Incident reporting systems
• Root cause analysis tools
• Performance monitoring platforms
• Compliance tracking systems

Measuring Success: Key Performance Indicators

Clinical Quality Metrics

Operational Quality Metrics

• Length of stay optimization
• Emergency department wait times
• Surgical case cancellation rates
• Staff turnover and satisfaction scores

Common Challenges and Solutions

Challenge 1: Staff Resistance to Change

Solutions:

• Comprehensive change management programs
• Staff education and training initiatives
• Recognition and incentive programs
• Clear communication of benefits and outcomes

Challenge 2: Resource Constraints

Solutions:

• Phased implementation approaches
• Cost-benefit analysis presentation to leadership
• Grant funding opportunities exploration
• Partnership with academic institutions

Challenge 3: Sustainability of Improvements

Solutions:

• Integration into standard operating procedures
• Ongoing monitoring and feedback systems
• Regular refresher training programs
• Continuous performance review processes

Future Trends in Healthcare Quality Improvement

Artificial Intelligence and Machine Learning

Applications:

• Predictive analytics for patient deterioration
• Automated quality measure calculation
• Real-time clinical decision support
• Population health management

Patient-Centered Care Models

Focus Areas:

• Shared decision-making processes
• Patient experience optimization
• Health literacy improvement
• Cultural competency enhancement

Conclusion

Identifying and implementing quality improvement opportunities in healthcare requires a systematic, evidence-based approach that engages stakeholders, leverages data analytics, and maintains focus on patient-centered outcomes. Evidence-based practice and decision-making have been “consistently linked to improved quality of care, patient safety, and many positive clinical outcomes”.

Healthcare organizations that successfully implement comprehensive quality improvement initiatives demonstrate improved patient outcomes, enhanced safety records, and increased operational efficiency. The key to success lies in combining rigorous evidence-based methodologies with practical implementation strategies that address real-world challenges and constraints.

By following the frameworks and strategies outlined in this guide, healthcare professionals can systematically identify, prioritize, and implement quality improvement initiatives that create lasting positive change for patients, staff, and organizations.

References and Additional Resources

1. Agency for Healthcare Research and Quality. (2024). 2024 National Healthcare Quality and Disparities Report. Retrieved from https://www.ahrq.gov/research/findings/nhqrdr/nhqdr23/index.html
2. World Health Organization. (2020). Quality of Care. Retrieved from https://www.who.int/health-topics/quality-of-care
3. Commonwealth Fund. (2024). Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System. Retrieved from https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
4. Symplr. (2024). Top 4 Quality Areas to Improve Health Outcomes in 2024. Retrieved from https://www.symplr.com/blog/top-quality-area-to-improve-health-outcomes-2024
5. National Center for Biotechnology Information. Evidence-Based Quality Improvement: A Scoping Review. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9708973/