NURS 4020: Leadership and Quality Improvement – Assessment Brief

Assessment 2: Quality Improvement (QI) Change Proposal

Weighting: 40%

Word Count: 2,000 words (+/- 10%)

Submission Format: Word Document (.docx) via Turnitin

Due Date: Sunday, Week 6, by 23:59 (Local Time)

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1. Assessment Context

Healthcare organisations are dynamic environments where patient safety and quality of care depend on the continuous evaluation of practice. As a registered nurse and future leader, you are expected to not only identify gaps in clinical practice but also to lead the implementation of evidence-based solutions. This assessment simulates a real-world proposal to a hospital board or management team, requiring you to justify a specific change initiative using data, research evidence, and change management theory.

2. Task Description

You are required to develop a comprehensive Quality Improvement (QI) Project Proposal addressing a specific patient safety issue or practice gap within your current or most recent clinical setting. You must identify the problem, propose an evidence-based intervention, and outline a plan for implementation and evaluation using a recognised change management framework.

Your proposal must address the following key components:

• Problem Identification: Define a specific clinical problem (e.g., high falls rate, medication errors, poor handover communication) supported by internal data (hypothetical or real) and external prevalence data.
• Evidence Review: Synthesise current literature (last 5-7 years) to support your proposed intervention. Why is this solution the best practice?
• Theoretical Framework: Apply Kurt Lewin’s Change Management Model (Unfreeze-Change-Refreeze) or Kotter’s 8-Step Process to structure your implementation plan.
• Implementation & Evaluation: Detail the steps to implement the change (timeline, stakeholders, resources) and the metrics you will use to measure success.

3. Structure and Guidelines

Please adhere to the following structure to ensure your proposal is professional and persuasive:

Introduction (approx. 200 words)

Introduce the clinical setting and the specific safety issue. Present a clear thesis statement outlining the proposed change. Define the scope of the project and its significance to patient outcomes.

Problem Analysis and Rationale (approx. 400 words)

Provide a “root cause analysis” of the problem. Why is this happening? Support your claims with relevant statistics (e.g., “Ward X has seen a 20% increase in falls…”). Contextualise this within national safety standards (e.g., National Safety and Quality Health Service Standards or Joint Commission goals).

Review of Evidence (approx. 500 words)

Critically analyse at least five (5) peer-reviewed research articles that support your proposed solution. Do not just list studies; synthesise the findings to demonstrate that your intervention is evidence-based and likely to succeed.

Change Management Strategy (approx. 500 words)

This is the core of your assignment. detailed application of your chosen theory (Lewin or Kotter). For example, if using Lewin:

• Unfreeze: How will you create urgency and convince the team that change is necessary?
• Change: What are the specific steps of implementation? (Education sessions, new protocols, pilot testing).
• Refreeze: How will you sustain the change and prevent a drift back to old habits?

Evaluation Plan (approx. 250 words)

Determine the specific outcome measures (KPIs). How will you know the project worked? (e.g., “Reduction in fall rates by 15% within 6 months”). Discuss both process measures (staff compliance) and outcome measures (patient data).

Conclusion (approx. 150 words)

Summarise the proposal. Reiterate the benefits to the organisation, staff, and patients. Conclude with a strong statement on the value of nurse-led leadership in quality improvement.

4. Formatting and Referencing

• Font: Times New Roman or Arial, 12-point.
• Spacing: Double-spaced with 2.54cm margins.
• Referencing Style: APA 7th Edition.
• Sources: Minimum of 8-10 high-quality academic sources published between 2019 and 2026.

5. Grading Rubric / Marking Criteria

Criteria	High Distinction (85-100%)	Credit (65-74%)	Pass (50-64%)	Fail (< 50%)
Problem Definition & Rationale (20%)	Compelling articulation of the clinical problem with robust data support. Root cause analysis is insightful and deeply linked to safety standards.	Clear definition of the problem with adequate data. Root causes are identified but may lack depth.	Problem is stated but lacks specific data or clear rationale. Connection to safety standards is weak.	Fails to identify a clear clinical problem or rationale.
Evidence-Based Intervention (30%)	Sophisticated synthesis of high-quality research. The link between the evidence and the proposed solution is seamless and persuasive.	Good use of research to support the intervention. Synthesis is present but may be descriptive in parts.	Intervention is supported by some evidence, but the literature review is limited or relies on non-academic sources.	Proposed solution is not supported by evidence or relies on opinion.
Application of Change Theory (30%)	Masterful application of Lewin/Kotter. The strategy for each stage (Unfreeze/Change/Refreeze) is specific, realistic, and strategic.	Solid application of the theory. The steps are logical, though some strategies may be generic.	Theory is mentioned but applied superficially. The implementation plan lacks specific detail.	Theory is missing or incorrectly applied. No clear plan for implementation.
Evaluation & Academic Literacy (20%)	Clear, measurable KPIs defined. Writing is flawless, authoritative, and professional. APA referencing is perfect.	Evaluation plan is realistic. Writing is clear with minor errors. Referencing is mostly accurate.	Evaluation metrics are vague. Writing quality varies; frequent grammatical or referencing errors.	No evaluation plan. Poor writing quality makes the proposal unreadable.

To address the resistance anticipated during the ‘Unfreeze’ stage of Lewin’s model, the project lead will organise a series of town hall meetings to present the internal data on catheter-associated urinary tract infections (CAUTI). By transparently displaying the correlation between current catheter maintenance practices and the rising infection rates, the team aims to create cognitive dissonance, a necessary psychological driver for behavioural change (Shirey, 2020). Furthermore, identifying and recruiting ‘change champions’ from the senior nursing staff will facilitate peer-to-peer influence, ensuring that the urgency for the new sterile insertion protocol is communicated effectively across all shifts. This approach aligns with the evidence suggesting that frontline ownership of safety goals is the single most significant predictor of successful clinical practice adaptation.

References

• Cummings, G.G., Tate, K., Lee, S., Wong, C.A., Paananen, T., Micaroni, S.P.M. and Chatterjee, G.E. (2018) ‘Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review’, International Journal of Nursing Studies, 85, pp. 19–60. doi: 10.1016/j.ijnurstu.2018.04.016.
• Melnyk, B.M. and Fineout-Overholt, E. (2023) Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 5th edn. Philadelphia: Wolters Kluwer. Available at: https://shop.lww.com/Evidence-Based-Practice-in-Nursing—Healthcare/p/9781975185720 (Accessed: 25 January 2026).
• Shirey, M.R. (2020) ‘Lewin’s Theory of Planned Change as a Strategic Resource’, JONA: The Journal of Nursing Administration, 43(2), pp. 69–72. doi: 10.1097/NNA.0b013e31827f20a9.
• The Joint Commission (2024) National Patient Safety Goals Effective January 2024. Available at: https://www.jointcommission.org/standards/national-patient-safety-goals/ (Accessed: 25 January 2026).
• World Health Organization (2021) Global Patient Safety Action Plan 2021–2030: Towards eliminating avoidable harm in health care. Geneva: WHO. Available at: https://www.who.int/publications/i/item/9789240032705 (Accessed: 25 January 2026).