NURS 732 Week 6 Quality Improvement Plan Part I Example

Quality Improvement Plan Part I: Problem, Team, Aim and Evidence for Raising Blood Pressure Control From 58% to 70% in a Community Health Center

Problem Statement

Riverbend Community Health Center, a federally qualified health center with roughly 9,000 patients in a mid-sized city, cares for 1,412 adults with a diagnosis of hypertension. In the most recent reporting year, the final reading on file was under 140/90 for 58% of them, a rate that has not changed meaningfully in three years. Control varies by care team and by patient group, which suggests that the problem lies partly in processes the center can change.

The problem this plan addresses is that more than four in ten adults with hypertension at the center do not have their blood pressure controlled, with lower control among patients who prefer Spanish and those without insurance.

Significance

Uncontrolled hypertension is among the most preventable drivers of cardiovascular and kidney disease, including the strokes and heart attacks that disable patients in their fifties and sixties. The 2025 national blood pressure guideline recommends accurate office measurement, the use of home blood pressure monitoring to confirm and manage hypertension, and team-based care to reach treatment goals (Jones et al., 2025). Every patient brought into control lowers that patient's risk of a cardiovascular event, and in a population of 1,412, a twelve-point rise in control represents about 170 more people with lower risk.

The problem also matters for equity. The gap of nine points between patients who prefer Spanish and the center's average, and of nine points for uninsured patients, means the center's outcomes are unequal across the groups it exists to serve. Finally, the problem matters for the organization. Federally qualified health centers report hypertension control annually as a clinical quality measure, and the center's board has made improving it a strategic priority.

Setting and Team

Riverbend operates one main clinic with four care teams, each including a physician or nurse practitioner, a registered nurse and two medical assistants, supported by a clinical pharmacist, two community health workers and a behavioral health consultant. The center uses an electronic health record with a population health module and a patient portal.

The improvement team was chartered by the medical director with the following members and roles.

Current Process in Brief

A brief walk through a typical hypertension visit shows where the gaps may lie. A medical assistant rooms the patient within seven scheduled minutes, takes a single blood pressure with whatever cuff is in the room and enters it in the record. The provider reviews the reading during a fifteen-minute visit that often covers several problems, and medication changes depend on whether the reading appears high that day. No one is assigned to follow up on high readings between visits, and home readings enter the record only when patients bring them. Part II will map this process in detail, but even this sketch suggests three likely targets: how the reading is taken, what happens after a high reading and how patients' own data reach the team.

Sollecito and Johnson (2013) emphasize that improvement teams need people who know the process, people with authority to change it and people who will be affected by it. This team includes all three, and its patient advisor ensures that changes are tested against patients' lives as well as the clinic's measures.

Scope

The plan covers adults between 18 and 85 whose problem list includes hypertension and who had at least one visit at the main clinic in the past year. It excludes patients receiving dialysis, those in hospice care and those who are pregnant, consistent with common definitions of the control measure, because their blood pressure goals and care pathways differ. The plan addresses processes inside the center and its outreach to patients; it does not attempt to change pharmacy benefits or community food access, though the community health workers will connect patients to existing resources. Keeping the scope to processes the team controls makes the twelve-month aim realistic.

Aim Statement

Within twelve months, Riverbend Community Health Center will raise blood pressure control, defined as a final reading on file under 140/90 among adults with hypertension, from 58% to 70%, and will reduce the gap in control between patients who prefer Spanish and all patients from nine points to four points or less.

The aim is specific in naming the population and threshold, measurable through the registry, achievable given the improvement seen in comparable programs, relevant to the center's mission and strategic plan, and time-bound. The equity component was added at the patient advisor's suggestion, so that the center does not raise its average while leaving its most affected patients behind.

Review of the Evidence

Team-Based Care

Evidence supports organizing hypertension care around teams. Across the systematic reviews gathered by Halcomb et al. (2026), team-based hypertension care in primary care tended to lower blood pressure whatever the mix of professions, and programs with more elements did better, though no single model emerged as best. The center already has the professions such teams require; the plan will focus on how they work together.

Accurate Measurement

Improvement depends on measuring blood pressure correctly. When one academic department pushed its 61 clinics to recheck any first reading at or above 140/90, rechecks climbed by twenty percentage points, control improved by four points, and in a median of 38% of rechecked visits the patient turned out to be controlled after all (Murphy et al., 2026). Measurement technique, cuff size and repeat readings will therefore be early targets.

Home Monitoring

Home readings provide a fuller picture than single clinic readings and support patients' own management, but they reach patients unevenly. Luna et al. (2026) report that roughly a quarter of hypertensive patients in one urban safety-net network had any home value in the chart, and that the share differed by housing status and by clinic. The plan will include a cuff-lending program and several ways for patients to report readings.

Sustaining Improvement

Improvement efforts in primary care often fail to last. Tiso et al. (2026) traced the end of a Lean and safety program at a family medicine center to weak readiness, thin ownership among stakeholders and governance split across too many bodies. The team's charter, executive sponsor and frontline leads are intended to address those risks from the start. An aim without ownership is a wish; the charter exists so that every part of the aim has a name beside it.

Stakeholders and Communication

Beyond the team, the plan affects every provider, nurse and medical assistant at the center, the front desk staff who schedule follow-up visits and the patients themselves. The team will present the aim and baseline data at the all-staff meeting in the first month, post the monthly control rate on the run chart in each team room and share results with the board's quality committee each quarter. Patients will learn about the cuff-lending program and text messaging through providers, posters in Spanish and English and the community health workers. Each care team will be invited to propose one change idea in the first two months, so that the plan draws on the whole staff rather than the improvement team alone.

Framework

The plan follows the Model for Improvement described by Langley et al. (2009). The model begins by asking a team to agree on its goal, on how success will be recognized in the data and on which changes to try, and it then puts each change through small plan-do-study-act tests before spreading it. The aim statement settles the goal. Part II will define outcome, process and balancing measures as the evidence of improvement, and will analyze causes to select the changes worth testing. The model fits the center because it supports small, rapid tests that can be run within a busy clinic without stopping care.

Ethical Considerations and Christian Worldview

The plan is a quality improvement project, not research, and it will follow the center's policy for improvement work, using de-identified aggregate data for reporting. Patients will not be denied any standard care, and participation in home monitoring and text messaging will be voluntary, with privacy protections for messages. Ethically, the equity aim reflects the principle of justice, which asks that the benefits of improvement reach those with the most need. Jesus described the good shepherd who leaves the ninety-nine to seek the one sheep that is lost (English Standard Version Bible, 2001/2016, Luke 15:4-7). In a population measure, it is easy to celebrate the average; the equity aim keeps the team looking for the patients the average hides.

Conclusion

Part I has established that 58% of adults with hypertension at Riverbend are at goal, and that control is lowest for Spanish-speaking and uninsured patients. An interprofessional team with a patient advisor has been chartered, with an aim of reaching 70% control and narrowing the equity gap within twelve months. Evidence on team-based care, measurement accuracy, home monitoring and sustainability will shape the changes, and the Model for Improvement provides the framework. Part II will analyze the causes of poor control and define the measures and changes the team will test.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Halcomb, E., Kuzmins, K., de Tourettes, E., & Stephen, C. (2026). Team-based hypertension management in primary care: A synthesis of systematic reviews. Heart, Lung and Circulation. Advance online publication. https://doi.org/10.1016/j.hlc.2026.05.020

Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., Carter, J., Cohen, J. B., Collins, K. J., Commodore-Mensah, Y., Davis, L. L., Egan, B., Khan, S. S., Lloyd-Jones, D. M., Melnyk, B. M., . . . Williamson, J. D. (2025). 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension, 82(10). https://doi.org/10.1161/HYP.0000000000000249

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Luna, I., Karumanchi, R., Grewal, J. S., Zhang, N. S., Rodriguez, J. A., Pletcher, M. J., Sarkar, U., & Khoong, E. C. (2026). Factors associated with evidence of self-measured blood pressure adoption in an urban safety-net health system. The Journal of Clinical Hypertension, 28(6), Article e70318. https://doi.org/10.1111/jch.70318

Murphy, K., Hood, C. J., Dirisala, K., Voit, J., Vigen, R., Bowen, M. E., & Bajaj, P. (2026). Impact of a centralized quality improvement initiative on repeat blood pressure measurement at an academic medical center. The Joint Commission Journal on Quality and Patient Safety. Advance online publication. https://doi.org/10.1016/j.jcjq.2026.08.008

Sollecito, W. A., & Johnson, J. K. (Eds.). (2013). McLaughlin and Kaluzny's continuous quality improvement in health care (4th ed.). Jones & Bartlett Learning.

Tiso, A., Pozzan, C., Pamich, C., & Verbano, C. (2026). Barriers to Lean & Safety Management implementation in primary care settings: Insights from an unsuccessful case. Risk Management and Healthcare Policy, 19, Article 610926. https://doi.org/10.2147/RMHP.S610926