Sustainability and Measurement

I originally posted this on the Week 11 page on Thursday, but for some reason it is “awaiting Moderation” so I am reposting here.

Measurability and Sustainability

My DNP project seeks to transform the obstetric triage and admissions process at Ben Taub General Hospital into one that is safe, highly reliable, patient centered, and cost effective. The scope of the project is dependent on the institution, but above all, I hope to change the culture of the obstetric intake area to one of respect, not only for patients and families, but also for residents, nurses, and others.

In order to make any changes sustainable, I must be able to show that the changes benefit the hospital financially, as well as key stakeholders such as patients and staff (Fraser, 2007). I must also engage the leadership of the organization, and align the project with the priorities of the hospital, because sustainable projects have full support of an organizations leadership (Bodenheimer, 2007).

One way to measure the improvement that would include measuring the cost-effectiveness of the project is a balanced score card. Because Ben Taub is a not-for-profit community hospital, the framework would include customers & stakeholders, employee organization capacity, internal business processes, and financial elements, all coming from the strategy of improvement for obstetric triage and admissions (Rohm, H., n.d.).To develop the performance measures, the improvement team can search the literature for evidenced-based performance measures, and select relevant measures for each of the four areas of the balanced scorecard framework (Safdari et al., 2014). In order to prioritize the measures, we can create a Pareto chart, which will help us identify the interventions likely to have the most impact, as well as survey key stakeholders (Fraser, 2007; Safdari et al, 2014).

Ensuring that the project is aligned with the organizations values and mission makes it more likely that the improvement will be adopted (Greenhalgh et al., 2004). The mission of the Harris Heath System, of which Ben Taube General Hospital is a part, is: “We improve our community’s health by delivering high-quality healthcare to Harris County residents and by training the next generation of health professionals” (Harris Health System, n.d.) My DNP project goals easily align with this mission, but emphasizing the alignment could serve to further engage the leadership, which is key to the projects sustainability (Bodenheimer, 2007).


Bodenheimer,T. (2007). The science of spread: How innovations in healthcare become the norm. Oakland, California: California Healthcare Foundation. Retrieved from

Fraser, S. (2007). Undressing the elephant: Why good practice doesn’t spread in healthcare. Raleigh, NC: Lulu.

Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematice review and recommendations. The Milbank Quarterly, 82(4), 581-629. Retrieved from

Harris Health System (n.d.) Mission, vision & values. Retrieved from

Rohm, H. (n.d.) A balancing act. Perform: Performance Measurement in Action. 2(2), 1-8. Retrieved from

Safdari, R., Ghazisaeedi, M., Mirzaee, M., Farzi, J., & Goodini, A. (2014). Development of balanced key performance indicators for emergency departments strategic dashboardsfollowing analytic hierarchical process. 33(4), 328-34. doi: 10.1097/HCM.0000000000000033.

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7 Responses to Sustainability and Measurement

  1. I guess, each change, when related to the business process, can be hard and absurd for some people. Still, if you are in charge and you are sure it would bring a significant improvement, you should always go for it

  2. Thanks for providing this wonderful article.

  3. Thomas White says:

    I liked the way you easily explain those things. I guess I will also bookmark it for myself. Also, thank you a lot for the references, I went on reading for the half of the night. I guess, each change, when related to the business process, can be hard and absurd for some people. Still, if you are in charge and you are sure it would bring a significant improvement, you should always go for it. What is more important, is not only relying on your intuition but measuring the progress. I loved that you have it all under control, did your research, planned it, doing it. Each person, even when being student only, knows the importance of this process. In theory. Thank you for showing that in practice.

  4. I simply want to mention I am beginner to blogging and certainly enjoyed your page. Almost certainly I’m likely to bookmark your blog post . You certainly have
    excellent writings. Thank you for sharing with us your website.

  5. Olga Turner says:

    Dear Erin,
    I think your project a nd aim definitely aligns with the mission and value statement of your hospital. I think that is very important when speaking about changing the culture in a particular area. I think the one thing that is important to think about is something we were recently reading and learning more about: sustainability. I notice that with things like getting ready for TheJoint Comission, or seeking Magnet status, that a lot of time, effort, incentives, and changes are made. Then after the fact, things return to the status quo. So maintaining these initiatives, processes and culture is very important. I know this was something we were asked to consider in another blog. I would be interested to know what your plans for sustainability might be.

    • Erin Sing Biscone says:


      My plans for sustaining the project are to make sure that the projects goals and outcomes are aligned with the mission and vision of the hospital and also to engage the leadership of the hospital. I will also include the nurse educator, if possible. We recently made a change so that mothers and babies are together throughout their stay. The babies used to go to the nursery for a few hours after they were born. There was resistance, and also many little details to work out, like who would bathe the babies and where and who would put the little alarm tags on them, if they didn’t go to the nursery. However, these were overcome, and now everyone is supportive of the change.


  6. Eve H Byrd MSN/MPH says:

    Erin, It sounds like you are well on your way in creating a sustainable project. Getting buy in from hospital leadership and knowing what is most important to them as far as the bottom line and where they will lend their help will be interesting. Relationship, relationship. Compromise, compromise. I say:)

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