Nursing leadership and Management

 Attached below is a copy of the rubric and instruction for this paper. In this paper My change project for this assignment is staffing ratios in hospital. Follow instruction and connect how better staffing ratios for nurse can lead to positive outcome.


Donabedian Model Framework 

Figure 1: Donabedian Model Framework 

Source: Donabedian (2005)

The Donabedian Model Framework is essential for improvement projects to have an outcome, process, structure, and balancing measures (Donabedian, 2005). The outcome reflects on the impact of change on a patient while the process demonstrates on systems and processes involved to achieve the desired outcome. The structure demonstrates on input measures such as staff to patient ratios. Balancing measures reflect on the consequences of the change.                                                                         


Plan for change Using the PDSA cycle

Figure 2: PDSA cycle

Figure 3: Implementing the PDSA cycle (Source:

A Plan, Do, Study, Act (PDSA) cycle is used to test the changes experienced on a small scale and building on what has been learned from the test cycles in a structured way before the changes are implemented (Improving Health and Health Care Worldwide, n.d.). The author states that the process enables the hospital stakeholders to ensure that the change is safe and less disruptive for staff and the patients.

The first step in the PDSA circle is to Plan. The hospital needs to define the objective, questions, and predictions. Data collection through the questionnaire can answer the necessary questions for the change to be tested or implemented. The second step is Do. The data is collected and analyzed before carrying out the change. Study is the third step. The collected information before and after the change is analyzed and compared to predictions. The fourth step is the Act. In this step, the next circle is planned for, or full implementation takes place.

Aims Statements from the health care provider

To improve staffing ratios for nurses for a positive outcome. This will be achieved by;

  • Developing a formal plan for staffing nurses.
  • Collecting data on underlying courses to reduce turn over.
  • Consulting the staff nurses on a safe nurse to patient ratios.

In order to know if the change is an improvement, the outcomes need to be measured, such as the provision of better care. Other positive results are reduced waiting time, improved care services and treatment, and less time to undergo transfer or discharge. The change will be measured using HCAHPS Scores.  

Figure 4: HCAHPS Score of Staffing outcome



Donabedian, A (2005) Evaluating the Quality of Medical Care, The Milbank Quarterly, 83(4):691-729

(n.d.). Improving Health and Health Care Worldwide | IHI – Institute for Healthcare Improvement.