Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability
Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability
You will utilize your change model for this assignment. Review the feedback submitted by your instructor on your previous change model assignment. Make any changes or modifications necessary for the submission of this assignment.
Evaluate the performance of your organization or department. Identify an area that would significantly benefit from initiating a change. Write a paper (1,500-1,750 words) in which you describe the particular area you propose to address through a change initiative. Include the following for your company:
Discuss the issues in this area and the current outcomes as a result of the issues.
Describe the external and/or internal driving forces, contributing issues, and the people affected.
Evaluate the stakeholders involved and discuss how they will be affected by your change initiative.
Clarify your role and responsibility as a change leader. Discuss the leadership theory (or theories) you will use to guide the change process.
Discuss the change agents you need to recruit in order to successfully implement your change. Describe the roles of these change agents.
Utilize your change model to develop strategies: (a) Explain the relevance of this model to your organization; and (b) Present the strategic aspects using your model. Be sure to clearly define the purpose of each aspect, the people involved, and the actions that need to be taken.
Identify, or predict, the potential barriers to change. Discuss possible ways to overcome these obstacles, including methods for dealing with emerging or unforeseen circumstances that could impede implementation.
Describe the evaluation methods you will use to determine the level of success of your change initiative. Discuss what metrics or measurable determinates you will use.
Propose strategies to anchor change or support continuous change.
Establish how your change plan supports the organizational mission/goal, genuinely addresses stakeholder concerns, and will serve as an equitable contribution for the community or society overall.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Benchmark Change Initiative: Reducing the Rate of Accidental Patient Falls
Organizations that want to maintain a competitive advantage over competitors are known to constantly change by embracing new practices. This is the same case with healthcare organizations. In the case of the latter, it is even more crucial to embrace change since healthcare services must be based solely on evidence-based practice or EBP (Melnyk & Fineout-Overholt, 2019). A culture of change in a healthcare setting will enable newer recommendations coming from the results of clinical inquiry to be implemented for better patient outcomes. Clinical inquiry is inspired by the questioning of common practices to find out whether they are backed by any scientific evidence. Another source of inspiration for change is the need for quality improvement (QI) when a performance indicator shows that the organization is performing poorly on that front. Some of the outcome measures that inspire change in this regard include the rate of readmissions, the rate of pressure ulcers, the rate of ventilator-associated pneumonia or VAP, the rate of catheter-associated urinary tract infections or CAUTI, the rate of patient falls, and the rate of central line-associated blood stream infections or CLABSI amongst others. The purpose of this paper is to present the implementation of a change initiative in a healthcare setting using the Rogers’ Diffusion of Innovations change model.
The Current Area in the Organization that Could Benefit from Change Initiation and the Accompanying Issues
The organization of interest in this paper monitors its performance indicators through the dashboard metrics in its certified electronic health record technology (CEHRT) system (Alotaibi & Federico, 2017; McGonigle & Mastrian, 2017). This is the same situation with almost all other healthcare organizations as they are mandated by law to have electronic medical record (EMR) systems (Sweeney, 2017). In this case, the organization’s quality improvement committee noted that the rate of accidental patient falls had been rising and was now at 3.5 falls per 1,000 patient stays. This was now a cause for concern for the committee as it was already slightly above the national benchmark which is 3.44 falls per 1,000 patient stays (Venema et al., 2019). Across the country, the reported falls rate especially among elderly patients stands at between 3.3 and 11.5 patient falls per 1,000 bed days (Bouldin et al., 2013).
According to an agency that performs industry analysis known as MarketScale (2020), there are between 0.7 and 1.0 million patients that suffer falls annually in the United States. Out of these, three to four out of ten will sustain an injury due to the fall that will add more than six days to the victim’s duration of stay in the hospital. The industry report goes on to state that falls are considered by the Centers for Medicare and Medicaid Services or CMS sentinel events that should never happen. For this reason, treatment of injuries sustained from falls is never reimbursed. This cost is borne directly by the healthcare organization. According to MarketScale (2020), “fall prevention is key to patient health and the achievement of better patient outcomes”. The no-pay policy for patient fall injuries by the CMS has been in effect since October 2008 (Fehlberg et al., 2017).
The issues that surround this area of performance or outcome measure are therefore that the organization is beginning to spend a lot of money on treating fall patients. It is also risking litigation for malpractice claims due to negligence. That is another avenue where money is going to be lost through the payment of damages. Above all, patient outcomes are getting worse because of this quality glitch. Patient satisfaction is falling and the rating of the facility by the regulatory bodies such as the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance is beginning to drop too. This is why action needs to be taken by way of instituting change in the way the situation is handled. Sound evidence-based preventive measures need to be implemented urgently if the fall rate is to be stopped from going up further.
External/ Internal Driving Forces, Contributing Factors, and the People Affected
As with many other issues in the realm of quality improvement, there are factors or forces that contribute to the situation. In this case, the external driving forces to the rising number of patient falls include the increasing number of elderly patients being admitted for pre-existing conditions such as heart disease and type II diabetes. The most probable reason for this is the fact that the Patient Protection and Affordable Care Act or ACA 2010 revived by President Biden offers incentives to payers to cover these conditions (Kominski et al., 2017). The other external factor is the longer life expectancy due to better healthcare policies that makes the number of senior citizens increase. Falls are known to affect elderly patients most, especially those aged 65 years and above (Guirguis-Blake et al., 2018).
Some of the internal driving or contributing forces/ factors on the other hand include insufficient knowledge on the part of the nurses and nurse assistants about fall risk assessment, lack of the use of technology (such as bedside alarms) in assisting to prevent falls, and nurse shortage. The people affected by this situation are the patients who are the victims, the nurses who bear the blame for the falls, the relatives of the patients who have to contend with the injuries suffered and the lengthened hospital stay, and the hospital management that have to bear the cost of treating the patient.
Stakeholders Involved and How they Will Be Affected by the Change Initiative
As already stated above, the stakeholders that will be affected are the patients themselves, their families, the nurses, and the hospital management. The change initiative will impact the patients positively in that patient outcomes will improve; such as a reduced length of hospital stay. The relatives of the patients will suffer less emotional distress since the incidents of falls will reduce and hopefully stop. The nurses will be less apprehensive and worried of victimization and will thus experience better psychological safety at the workplace. This means they will experience more job satisfaction and have less turnover intention. Lastly but not least, the management will save on treatment costs for the injured from falls, as well as the cost of damages paid due to malpractice litigation.
Role and Responsibility of the Advanced Practice Nurse as a Change Leader and the Leadership Theory to Use in Guiding the Change Process
As a change leader, the role of the advanced practice nurse is to inspire the staff to embrace and actualize the change. The responsibility is that of a team leader or project manager. They have to make sure the change initiative is completed within the specified timeframe and within the allocated budget. To do all this effectively, the best leadership theory that has been confirmed to be efficient and effective in healthcare settings is transformational leadership theory (Northouse, 2019; Sfantou et al., 2017; Turnnidge & Côté, 2016). A transformational leader is one who inspires, motivates, uplifts, and empowers their followers and subordinates. This way, they are able to feel that they are appreciated and wanted and therefore give their best to achieve organizational objectives (Asiri et al., 2016). Transformational leaders provide a safe and welcoming workplace such that the nurses will not suffer stress or burnout. Above all, they will be motivated to perform and will feel they have job security.
Change Agents Needed and Their Roles
For any change initiative there must be change agents. The first change agent needed in this case is the innovator. This is the person that will propose the need for the change. They will present the facts as they are in terms of figures and the consequences of not changing. This is the agent who carries out research on the issue. Then there is the educator. This is the change agent who will be involved with educating the staff on the need and importance of the change during the knowledge phase of Rogers’ Diffusion of Innovations model of change (Dearing & Cox, 2018). Other change agents needed are the nurse informaticist and data analysts. The nurse informaticist will bring informatics knowledge and therefore help with tracking the improvement through dashboard metrics, while the data analysts will be staff who can work with the electronic patient data to generate useful information that will guide decisions.
Utilizing the Change Model to Develop Strategies
- Relevance of the Model to the Organization
The Rogers Diffusion of Innovations model is the best suited for the organization because it has phases that begin by gaining buy-in through educating the staff and persuading them with facts to embrace the change initiative (Dearing & Cox, 2018). Its purpose is to guide the implementation of the change in a systematic and professional way. It is very relevant because without using it the organization would be risking failure of the change project.
- Strategic Aspects of the Model
The strategic aspects of the model include that it has five distinct stages each of which is important in seeing that the implementation of the initiative is successful. The stages are knowledge, persuasion, decision, implementation, and confirmation (Dearing & Cox, 2018; Pashaeypoor et al., 2016). The knowledge stage involves educating the staff on the importance of implementing the change. The persons involved here are staff that serve as volunteer educators. The persuasion stage involves convincing the sceptics that the project is important and will address quality gaps. Those involved here are all staff that are for the change including the innovators and the early adopters (Dearing & Cox, 2018; Pashaeypoor et al., 2016). The decision stage involves the team leader and other decision makers making up their minds whether to proceed with the change initiative or not. The persons involved here are the organization’s management that make the decision. The implementation stage involves actually applying the preventive strategies on patients and the organization. Everyone is involved at this stage. Finally, the confirmation stage is about making the change part of the organization’s policies in a process referred to as translation into practice. The persons involved here are the organization’s management as they decide the policies of the organization.
Barriers to Change and How to Overcome Them
There are several barriers to change in any change initiative. In this case, one of them is staff resistance due to complacency and being in a comfort zone. One of the evidence-based preventive strategies for patient falls is purposeful hourly rounds conducted by the nurses on the shift (AHRQ, 2018; Daniels, 2016). This is actually labor-intensive work that also requires higher numbers of nurses per shift and dedication. For this reason, many nurses will resist the change due to a perceived increase in the workload. The best way to overcome this barrier is to recruit more nurses and also to give them incentives such as non-productive pay. Another barrier is lack of sufficient resources such as funds for training staff. This can be overcome by carrying out a “policy brief” at the very beginning or conception stages of the idea of change (Arcury et al., 2017). This way the directors can set aside enough funds for the project if convinced even before it starts. There will also be a contingency plan and budget that will address emerging or unforeseen challenges against implementation.
Evaluation Methods and Strategies to Anchor Change
The method that will be used to evaluate whether the change process has been successful is the determination of the prevailing rate of falls after the period of implementation of the change. This will come from analysis of data and the dashboard metrics data (McGonigle & Mastrian, 2017). The rate will then be compared with the baseline rate taken before starting the implementation. A fall in the rate will indicate successful implementation. The proposed strategy that will anchor the change and also support continuous change is to make the change permanent by including it in the organization’s standard operating procedures (SOPs) and policies.
This change plan supports the organization’s mission of providing the best possible quality healthcare to all. The change also addresses the stakeholder concerns cost, disability, and job satisfaction amongst others. Lastly, the change will serve as a vehicle of social change as the society is the entity that will benefit in the end with better health outcomes.
Change in organizations is inevitable if they are to remain competitive. For healthcare organizations, change is even more important as it is the only way that quality improvement can be carried out. This paper has presented a change initiative regarding prevention of accidental patient falls using the change model that is the Rogers’ Diffusion of Innovations model.
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