Discuss Knowledge of theoretical underpinnings of change.


Quality improvement (QI) can be defined as the effort to better patient outcomes, system

performance, and professional development (Batalden & Davidoff, 2007). The Institute of

Medicine (IOM) has challenged professionals to improve healthcare quality, with quality

described using the following six domains: safety, timeliness, effectiveness, efficiency, equity

and patient-centeredness. These quality aims provide a framework for focusing improvement

efforts. The unrelenting engagement of all providers is required to transform healthcare. APNs

are well positioned to lead quality initiatives by virtue of their advanced knowledge and

preparation. To effectively lead quality improvement requires understanding that organizations

are complex adaptive systems; dynamic, unpredictable, and are composed of moving parts.

Knowledge of theoretical underpinnings of change (theory explicating the phenomenon of

human behavioral change) is foundational to successful improvement. A wide variety of QI

models, tools, and methods are available to guide the APN in facilitating improvement.

For this assignment, select a practice improvement issue within your organizational system and

within the realm of your practice area. Using the grading rubric as a guide, develop a quality

improvement plan to address the identified issue. The purpose of this paper is to demonstrate

knowledge of the essential elements of quality improvement, with change theory as an

underpinning for the process. Students are not expected to implement the plan; however, the

process for implementation and evaluation is addressed as part of the planning process.

The paper should be carefully written in a formal style, based on primary sources, provide an

integration of ideas, and be 4-6 pages in length, excluding title page & reference list. Organized

flow, logical progression of ideas, and clarity in thought are essential. Please use headings to

separate content.

Grading Rubric

Criteria Points

Introduction paragraph (one paragraph). Introduce a practice issue appropriate for a

quality improvement project facilitated by a MSN or DNP prepared nurse. There must

be a thesis statement at the end of the paragraph that tells the reader the purpose of

paper and what will be discussed.


Briefly provide the background/context of the practice issue. Integrate at least two of

the six dimensions of quality defined by the IOM.


Discuss a theoretical underpinning of change (Lewin, Rogers, Kotter, Havelock,

Proschaska & Diclemente, Bandura) for the proposed quality initiative. Using the

selected change theory, describe the profound importance of staff engagement,

empowerment, commitment, and ownership of practice improvement



Describe how at least one improvement tool (flow chart, root cause analysis, cause and

effect diagram, FMEA, etc.) can be used to better understand the practice issue.


Please note that this paper will go through turnitin. Submit the document early to allow yourself time to revise for originality report. You should receive reports promptly.