Health & Medical Question

HCM520: Quality & Performance in HealthcareHCM520: WEEK 2 Paper
Week 2 Paper: Article Annotated Bibliography
Locate and read three research articles on the topic of systems for managing quality improvement
across healthcare organizations (e.g., Six Sigma, Lean manufacturing, Malcolm Baldridge National
Quality Award [MBNQA], Benchmarking, ISO 9000). Two articles must be quantitative studies, and
the third article must be a qualitative study.

Create an annotated bibliography that summarizes the key points in each article.
Assess the application of these quality improvement systems in healthcare environments.
Reflect on how the article informs your learning or shapes your professional practices as a
Healthcare Leader.
Submission Requirements:
Your annotated bibliography should meet the following requirements:

Be 4-5 pages in length, not including the cover or reference pages.
Be formatted according to the CSU Global Writing Center Links to an external site..
Provide full APA citations for articles under review. These citations should serve as the
headings for your annotated bibliography, each followed by article summary content.
Week 2: Discussion Post ~ 300-500 words.
This week we will review the role of leadership, gathering data, and implementing quality initiatives.
For this week’s discussion you are each going to create an initial discussion board prompt and reply to
one another’s questions. Choose from the following topics to create your discussion board prompt for
this week:

Topic 1: The statistical tools used in quality measurement and improvement (e.g.,
flowcharts, cause-and-effect diagrams, Pareto charts, and run charts).
Topic 2: The changing leadership roles for providers.
Topic 3: Compare and contrast three of the various leadership styles and their effect on
healthcare outcomes.
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HCM520: Quality & Performance in Healthcare
References for Paper / Discussion Post:
American Society for Quality. (2022). W. Edwards Deming’s 14 points for total quality management.
Balanced and Company. (2018, April 2). Balanced
Honda, A. C., Bernardo, V. Z., Gerolamo, M. C., & Davis, M. M. (2018). How lean six sigma principles
improve hospital performance. Quality Management Journal, 25(2), 70–82.
Institute for Healthcare Improvement. (2022). Run chart
Lucidchart. (n.d). Flowchart symbols and notation.
Professor, B. N., & Albrecht, K. (2019). A reviewer’s guide to qualitative rigor. Journal of Public
Administration Research & Theory, 29(2), 348–363.
Qualitative Research Consultants Association. (2021). About qualitative research: several unique aspects
of qualitative research contribute to rich, insightful results.
Ray, L. (2017). The advantages of teamwork in today’s health care organizations. The Chronicle.
Robertson, E., Morgan, L., New, S., Pickering, S., Hadi, M., Collins, G., Arias, O. R., Griffin, D., & McCulloch, P.
(2015). Quality improvement in surgery is combining lean improvement methods with teamwork training: A
controlled before-after study. PLoS ONE 10(9): e0138490.
Salluh, J. I., Chiche, J. D., Reis, C. E., & Soares, M. (2018). New perspectives to improve critical care
benchmarking. Annals of Intensive Care, 8(1), 17-19.
Spath, Patrice L. (2022). Applying quality management in healthcare: a systems approach (5th ed.). Health
Administration Press. **THIS IS OUR TEXTBOOK**
Ulrich, B., & Kear, T. (2014). Patient safety and patient safety culture: Foundations of excellent health care delivery .
Nephrology Nursing Journal, 41(5), 447-457.
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HCM520: Quality & Performance in Healthcare
***Helpful Resources from this week’s readings for Paper***:
Learning Outcomes
1. Classify categories of data and differentiate between qualitative and quantitative data
collection procedures.
2. Compare performance measures and select appropriate statistical tools to track performance
3. Define the purpose of measurement and assess the validity of measurements.
4. Evaluate quality approaches and compare and contrast the systems’ effectiveness, including
exploring their compatibility with one another.
5. Investigate how quality scorecards, dashboards, and benchmarking create quality alignment.
Quality can be measured through multiple approaches that
include, but are not limited to:

Plan, Do, Study, Act Cycle (PDSA);
Malcolm Baldrige Criteria;
ISO 9000;
Lean; and
Six Sigma.
Additional concepts and definitions commonly discussed when preparing a quality improvement
program include the following.
A balanced scorecard is utilized to collect, measure, and analyze strategic management goals defined by an
organization. A value of this tool is the ability to transfer organizational performance goals from the executive
suite to individual departments as a way to measure the impact of daily operations and deliverables. It also
provides a visual representation of specific performance measures in finance, customers, internal business
processes, and employee growth. The balanced scorecard can be used to meld an organization’s mission and
vision into a specific set of objectives that can be measured and evaluated (Bain & Company, 2015).
Benchmarking is done by setting goals with an emphasis on the outcomes of other organizations’ achievements
A dashboard is a commonly used tool for reporting performance measures utilizing shapes and colors to draw
attention to specific areas of concern or in need of improvement.
Categories of Data, and Qualitative and Quantitative Data Collection Procedures
First, let’s look at quantitative and qualitative research. The focus of quantitative research is to
describe, explain, test and predict behavior, knowledge, or opinion. The quantitative paradigm and
method are distinct within the assumption of objective facts of reality, value, and neutrality. In
quantitative studies, the research purpose is theory building and testing.
Qualitative research is “designed to reveal a target audience’s range of behavior and the perceptions
that drive it with reference to specific topics or issues” (Qualitative Research Consultants Association,
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HCM520: Quality & Performance in Healthcare
2022, para. 2). Qualitative studies develop an in-depth understanding of the subjective meanings
within the human experience. Supporters of the qualitative approach seek to understand the world
through lived experiences of the participants.
Given the previously given information regarding quantitative and qualitative research methods, where would
you place the whole process of quality improvement? Would the process be more quantitative or qualitative? Is
it situational regarding the data, data collection, and methods? Would you use both quantitative and qualitative
data? If you create a study that utilizes both forms of data, you may be utilizing the mixed methodology
approach that has become popular in recent years.
Comparison of Performance Measures & Tracking:
Many useful tools are available for measuring quality. Generic tools include graphs, check sheets,
checklists, flowcharts, tables, tree diagrams (matrix, tree), and charts. According to Vanteddu and
McAllister (2014), “Healthcare improvement initiatives should address provider and patient
perspectives. Traditional healthcare-quality improvement tools focus on either perspective and fail to
capture a holistic approach’s advantages” (p. 494). In essence, there should be a unified approach.
Once you have established the understanding and use of a tool, variations can then be constructed to
fit specific circumstances.
Statistical methods and tools we will address in this module include:

Cause-and-effect diagrams,
Pareto charts, and
Run charts.
A flowchart is a visual display of the steps of a process conducted in sequential order. It is considered
a generic tool and can have many variations. Variations of flowcharts include high-level, detailed, and
deployment charts. What can be included in a flowchart?
According to Lucidchart (2018), elements commonly seen in flowcharts include any or all of the

Start/stop time, and
Process measurements.
Cause-and-effect Diagrams
A cause-and-effect diagram is also referred to as a fishbone diagram or Ishikawa Diagram. The
cause-and-effect diagram is a simple, practical tool. It identifies and categorizes possible causes
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HCM520: Quality & Performance in Healthcare
of a problem. It can be used to facilitate brainstorming sessions. It is especially useful in solving
the actual problem.
Pareto Charts
A Pareto chart is a bar graph used to measure frequency. The length of the bar represents the
frequency; the bars are arranged in order, longest from the left of the graph, clearly defining the
causes with the biggest impact. Additionally, the charts are easy to construct. You can create a Pareto
manually; however, it is usually much easier to create it in a spreadsheet program, such as Excel.
Run Charts
“A run chart, sometimes called a line graph, is a graphical representation that is typically used to
describe a single set of performance data, such as patient wait times in the ED, over time. Run Charts
are a useful graphical method of detecting any trend, pattern, or shift in a performance measure of
interest overtime” (Spath, 2022, p. 169-170).
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Annotated Bibliography
A bibliography is a list of references for works (books, articles, reports, government documents,
etc.) on a specific topic. In an annotated bibliography, each reference is followed by an annotation:
1-2 paragraphs that summarize and evaluate the source. An annotation can help a researcher
determine the value of each work on the topic and the contribution it might make to further
Keep the following tips in mind when constructing Annotated Bibliographies:

The purpose of the annotation is to summarize or describe the source, evaluate the source’s
credibility and quality, and reflect on the relevance of the source by explaining how it
connects to other sources you’ve found and where it fits into your argument overall.
When summarizing each source, consider the following characteristics of the work:
o Main purpose, idea, or argument
o The author’s intended audience
o Research methods
o Findings and conclusions
o Any special features of the work, like maps, illustrations, etc.
When evaluating the quality of the source, consider the following:
o Credibility of the author: Is the author an expert on this topic? Do they have
credentials and experience in this field and on this subject?
o Conflict of interest: Does the author have any conflicts of interest that would call the
reliability of the findings into question?
o Timeliness: How recently was the source published? For example, older works on a
rapidly changing and developing topic may be less relevant if their findings are
o Publisher: Is the publisher of the source reputable? Sources published by university
presses are generally considered scholarly.
When reflecting on the relevance of the source to your topic and project overall, consider the
o Synthesis: How does this source connect to other sources included in your annotated
bibliography? Does this source corroborate or contradict the findings in your other
o Purpose: What is the role this source will play in your larger research paper or
project? What does this source contribute? How useful is this source?
You are expected to evaluate the credibility of each source and its usefulness for
understanding your topic and for your research project overall. When needed, use in-text
citations in your annotations if you are directly quoting or paraphrasing the source material.
When summarizing the source and evaluating its credibility, the use of third person is
appropriate. When expressing your own views and discussing the relevance of the source to
your own research and argument, the use of first person is appropriate because it avoids
ambiguity and confusion in attribution.
APA outlines specific formatting requirements for annotated bibliographies.

Include a title page with your annotated bibliography.
The title of the paper should be the first line of the page after the title page. The title should
be centered and bolded, with major words capitalized.
Arrange your references in alphabetical order, like you would for a typical references page.
Below each reference entry, include an annotation as a new paragraph. The annotation
should be indented half an inch from the left margin. Do not indent the first line of the
If your annotation is more than one paragraph, then indent the first line of the second
paragraph an additional half inch.
This sample annotated bibliographywill give you an idea of what your bibliography should look
Social Media and Climate Change: Annotated Bibliography
Al-Saqaf, W., & Berglez, P. (2019). How do social media users link different types of extreme events to climate
change? A study of Twitter during 2008–2017. Journal of Extreme Events, 6(2), Article 1950002.
An annotated bibliography is a tool used in the beginning stages of a research project or paper. An
annotated bibliography contains a list of references for individual sources that you plan to utilize for
your research project. Each reference is followed by an annotation: a short explanation of the source and
an evaluation of the source’s credibility and relevance to your larger research project. Writing an
annotation provides a clearer understanding of how your sources relate to each other and how each
source fits into your larger argument. In each annotation, you should summarize the source’s argument,
supporting evidence, and key points; evaluate the credibility and reliability of the source; and reflect on
the purpose and usefulness of the source in your research project overall. When summarizing the source
and evaluating its credibility, the use of third person is appropriate. When expressing your own views
and discussing the relevance of the source to your own research and argument, the use of first person is
appropriate because it avoids ambiguity and confusion in attribution.
Diehl, T., Huber, B., Gil de Zúñiga, H., & Liu, J. (2019). Social media and beliefs about climate change: A
cross-national analysis of news use, political ideology, and trust in science. International Journal of
Public Opinion Research, Article edz040.
Diehl et al. (2019) argue that social media use is generally correlated with pro-social beliefs: “beliefs
that align with the scientific consensus on climate change” (Diehl et al., 2019, p. 2). However, the effect
of social media use on pro-social beliefs is influenced by macro-level indicators, like carbon output,
individualism, and gross domestic product per capita, as well as micro-level indicators, like political
ideology and trust in scientific institutions. For example, in countries with individualist societies and
with higher levels of carbon output per capita, survey respondents were more likely to be skeptical about
climate change. This source is academic and scholarly in nature, as indicated by the fact that the authors,
who are all faculty at universities in different countries, use survey data from 20 different countries to
perform a multilevel regression analysis. The text itself was also published by Oxford University Press
in the peer-reviewed International Journal of Public Opinion Research. This study is useful for my
research because it validates the findings of my other sources and illustrates the complex role of social
media alongside culture and politics in forming a personal opinion of climate change. For example,
Diehl et al. (2019) and Al-Saqaf and Berlez (2019) show that an individual’s country of residence will
shape their views on climate change, but Diehl et al. address cultural and economic factors while AlSaqaf and Berlez focus on exposure to extreme weather events. I will cite this source throughout my
research project to support my argument that several psychological and sociological factors play a more
influential role in shaping an individual’s views on climate change than the science itself.

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