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NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

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Capella University

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

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Background: Chronic Kidney Disease (CKD) is the gradual loss of renal function, leading to several poor complications. The disease influences all aspects of an individual’s life, including daily living, social and occupational roles, and psychological well-being. Long-term hemodialysis and recurrent hospitalization result in depression and stress among CKD patients. 

Aim/Objective: The goal of this Quality Improvement (QI) initiative is to analyze the dashboard data from North Texas Medical Center, where CKD patients are experiencing various poor clinical outcomes due to CKD-related stress and depression. This stress leads to poor quality of life and reduced psychological well-being, augmenting patient safety risks. Thus, the QI initiative aims to improve the quality of life and provide psychosocial support to these individuals. 

Methods: The study used the Six Sigma Model (DMAIC cycle) as the QI method to introduce psychosocial support programs in the organization. These programs include strategies like patient-to-patient mentoring, support groups, and educational interventions for effective stress management. 

Conclusion: The Six Sigma approach is proven effective for implementing QI initiatives. However, the limitations of time and complex procedures and expensive costs must be addressed promptly to avoid implementation hindrances. On the other hand, psychosocial support using peer mentoring, support groups, and patient education is an effective and evidence-based strategy to minimize stress among CKD patients. Nevertheless, successful execution requires interprofessional collaboration. This coordination is essential to ensure accountability and foster a sense of ownership, encouraging teams to make shared decisions and improve the quality of care for the patients. 

Quality Improvement (QI) Method

The DMAIC approach, an integral component of the Six Sigma initiative, is a quality improvement method used in healthcare organizations. DMAIC is an abbreviation for “define, measure, analyze, improve, and control.” This method is used in healthcare systems to improve healthcare delivery, quality of care, and patient safety (Monday, 2022). Below are presented the steps of the DMAIC approach integrated with our QI initiative. 

  • Define: The initial step is to recognize the problem and define the initiative’s brief goals, helping stakeholders establish a process map for further implementation. Depression and stress in CKD patients, for instance, is the defined problem in our initiative. 
  • Measure: Collecting data from the organization to establish baseline metrics is essential to measure pre- and post-implementation results. For example, we collected data on the current state of clinical outcomes and established desired goals to minimize stress and improve the quality of life for CKD patients. 
  • Analyze: Along with the baseline data and the current organizational environment, this step enables stakeholders to recognize the errors, practice deviations, and risk factors within the organization. For our QI initiative, we could identify the loopholes in the mental health services and psychosocial support to address them using targeted interventions. 
  • Improve: This is the crucial step in establishing and executing change strategies within the organization. The proposed strategy for North Texas Medical Center is comprehensive psychosocial support programs, including patient-to-patient mentoring, support groups, and educational sessions. 
  • Control: The final step of this cycle involves post-intervention monitoring and evaluation. This is essential to bring further improvements and ensure the plan’s sustainability. 

Challenges of QI Method

The DMAIC approach is a robust quality improvement method. However, several challenges are associated with the model. The complexity of the process and expensive costs are significant hindrances to the model’s effectiveness. According to Sony et al. (2020), the Six Sigma method is a multifarious cycle with extensive data collection, resulting in a time-consuming process. Moreover, the authors claim that applying the Six Sigma method is expensive and yields minimal benefits to the organization. Thus, it is essential to address these issues by prioritizing tasks to streamline the process and utilize technology for data analysis to combat time constraints. Additionally, to optimize resources, the stakeholders should focus on essential areas and learn the principles of the QI method to prevent unnecessary expenditure. 

Evidence to Support QI Method

The DMAIC approach is a well-recognized and commonly used QI method in the healthcare industry. It is an evidence-based method used to enhance the quality of care and bring positive patient outcomes. The two distinct studies support using the Six Sigma DMAIC approach in the healthcare sector. A peer-reviewed article presents that this methodology has resulted in several benefits within healthcare organizations, such as improving operational efficiency, reducing medical errors, lessening patient waiting times, and improving patient experiences (McDermott et al., 2022). An observational study concluded that using the DMAIC method minimized the number of medication errors by pharmacists, including errors related to purchase, distributions, inventory management, and medication administration in a trauma center (Lourdu et al., 2023). Therefore, the approach is applicable, effective, and beneficial for QI initiatives in the healthcare domain. 

Knowledge Gaps and Unknowns

However, some knowledge gaps and uncertain circumstances arise in the DMAIC approach. There lies an uncertainty related to the causes of frequent hospitalization. This requires stakeholders to thoroughly examine patients’ medical records and histories to identify comorbid situations. Additionally, the knowledge gap related to patients’ perceptions about quality of life and life stressors may require additional information to develop targeted interventions and refine strategies to minimize stress and depressive symptoms in CKD patients. Since the DMAIC approach is a circular process, complete and comprehensive knowledge is imperative to avoid interruptions in the implementation process, leading to seamless operations and effective results.

 Change Strategy Foundation

CKD patients commonly encounter depression and anxiety due to the poor consequences of the disease on an individual’s life. The statistics presented by a study reveal that these secondary health issues are 25% prevalent in CKD patients. The poor consequences include adverse health outcomes, progression towards end-stage renal disorder (ESRD), and death (Nagar et al., 2021). This high prevalence grounds the foundation of our QI initiative to introduce comprehensive psychosocial support programs. These programs have a three-pronged approach, including patient-to-patient mentoring, support groups, and educational interventions for effective stress management.

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

According to McKeaveney et al. (2021), peer mentorship helps patients gain insight from peers’ experiences, helping them mitigate their psychological and emotional symptoms using the best strategies. Additionally, support groups are essential to encourage social interaction and improve quality of life (McKeaveney et al., 2021). As part of the change strategies, educational programs addressed CKD-related knowledge gaps and enhanced patients’ coping mechanisms by instilling stress reduction techniques and lifestyle modifications (Seery & Buchanan, 2022).

 Challenges of Change Strategy

Several difficulties arise in executing comprehensive psychosocial support programs into practice. These difficulties include the stigma surrounding mental health, reluctance to adapt, and a lack of resources. To destigmatize mental health issues, the organization should start educational awareness campaigns that emphasize the value of mental health in people with chronic kidney disease (Shahwan et al., 2022). Similarly, we can foster effective interprofessional cooperation and the gradual introduction of psychosocial services to combat resistance among interprofessional teams.

This action guarantees effective task delegation, preventing staff from overburdening and encouraging participation. Furthermore, integrating services gradually motivates patients to improve quality by increasing their knowledge about the advantages of mental health support. Lastly, resource limitations can be addressed by leveraging existing resources, coordinating with external stakeholders, and implementing telehealth services to broaden the program’s scope and optimize resource utilization.

Interprofessional Team Benefits

Interprofessional collaboration and teamwork are essential for implementing successful change management within the healthcare organization, enhancing the effectiveness of the QI initiatives. An integral aspect of this collaboration is effective communication. Through clear and accessible communication lines within the teams, patients’ information is transferred without communication gaps, ensuring appropriate and holistic decision-making (Robinson, 2020). Moreover, influential teamwork guarantees that team members operate on shared goals. These objectives are imperative to provide equitable care without discrimination, improve care quality, and create healthcare accessible. Eventually, preserving patient safety and producing desired goals of the change implementation plan – improve quality of life and provide adequate psychosocial support. This analysis assumes that the interprofessional team is ready to adapt and implement new protocols and that the organization’s stakeholders are well-prepared to manage staff workload and provide fringe benefits for additional responsibilities. 

Overall Project Benefits

In conclusion, the overall benefits of the project are to reduce CKD-related depressive symptoms and stressful events for patients undergoing re-hospitalization and long-term hemodialysis treatment. This poster presentation’s professional and scholarly resources recommend comprehensive psychosocial support programs to improve quality of life scores and provide adequate psychosocial assistance. The program components include peer mentoring, support groups, and educational interventions. These programs offer multifaceted benefits to CKD patients. By integrating mental health services into care, this change implementation enhances patients’ stress coping and improves emotional well-being and adherence to treatment plans. Overall, these programs contribute to a holistic patient-centered approach, enhancing the quality of life, reducing the psychosocial burden, and promoting better long-term outcomes for CKD patients.


Lourdu, B. D., Theivasigamani, K., Harwin, A., Paulraj, K., Paul, S., & Lachmanan, A. (2023). The impact of SIX SIGMA DMAIC methodology in the effective pharmacy inventory management system in a major trauma care center–A prospective observational study. Indian Journal of Pharmacy Practice16(3). https://doi.org/10.5530/ijopp.16.3.31 

McDermott, O., Antony, J., Bhat, S., Jayaraman, R., Rosa, A., Marolla, G., & Parida, R. (2022). Lean six sigma in healthcare: A systematic literature review on challenges, organisational readiness and critical success factors. Processes10(10), 1945. https://doi.org/10.3390/pr10101945 

McKeaveney, C., Noble, H., Carswell, C., Johnston, W., & Reid, J. (2021). Psychosocial well-being of patients with kidney failure receiving haemodialysis during a pandemic: A survey. Healthcare9(8), 1087. https://doi.org/10.3390/healthcare9081087

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Monday, L. M. (2022). Define, measure, analyze, improve, control (DMAIC) methodology as a roadmap in quality improvement. Global Journal on Quality and Safety in Healthcare5(2), 44–46. https://doi.org/10.36401/JQSH-22-X2

Nagar, K., Vaidya, A., & Patel, K. (2021). Depression, anxiety and stress among the patient of chronic kidney disease at Nadiad city, A cross-sectional survey. medRxiv. https://doi.org/10.1101/2021.08.01.21261443 

Robinson, A. Z. (2020). A systematic review of structured communication among interprofessional teams. Walden University. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=9601&context=dissertations 

Seery, C., & Buchanan, S. (2022). The psychosocial needs of patients who have chronic kidney disease without kidney replacement therapy: A thematic synthesis of seven qualitative studies. Journal of Nephrology35(9), 2251–2267. https://doi.org/10.1007/s40620-022-01437-3 

Shahwan, S., Goh, C. M. J., Tan, G. T. H., Ong, W. J., Chong, S. A., & Subramaniam, M. (2022). Strategies to reduce mental illness stigma: Perspectives of people with lived experience and caregivers. International Journal of Environmental Research and Public Health19(3), 1632. https://doi.org/10.3390/ijerph19031632

Sony, M., Antony, J., Park, S., & Mutingi, M. (2020). Key criticisms of Six Sigma: A systematic literature review. IEEE Transactions on Engineering Management67(3), 950–962. https://doi.org/10.1109/TEM.2018.2889517 


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