NUR 514. Week 3 presentation

S - The Marketplace to Buy and Sell your Study Material NUR 514. Week 3 presentation Implementing Change With an Interprofessional Approach Presentation As an advanced registered nurse, you will serve as a leader within your organization. Part of this role will entail being a change agent, and spurring positive change on behalf of patients, colleagues, and the industry. Consider a situation you experienced previously where change did not go as planned in your health care organization. Create a 10-15-slide PowerPoint presentation in which you will assess the situation and the steps that should have been taken to successfully implement change. 1. Describe the background of the situation, including the rationale for and goal(s) of the change. Introduction. Change occurs continuously around us and the key concerns in Health care management is the management of change. Planned change in nursing practice is necessary for many reasons, but it can be challenging to implement. Managing change is about handling the complexity of the process. It is about evaluating, planning and implementing operations, tactics and strategies and making sure that the change is worthwhile and relevant (Gorbunoff, & Kummeth, 2017). Leaders do more than organize, direct, delegate, and have vision; they use interpersonal skills to help others achieve their highest potential. Before embarking on change, nurse leaders may first consider their strengths and weaknesses in terms of their leadership skills, because these can greatly affect the outcome of a change project. It is important that nurse leaders identify an appropriate change theory or model to provide a framework for implementing, managing and evaluating change. Reason for organizational change. Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material Effective change has been characterized as unfreezing old behaviors, introducing new ones, and re-freezing them. The strongest predictors that would ensure the change was accepted would be assessing how ready the organization is for the pending change. (Ruest, Leonard, Thomas, Desrosiers, & Guay, 2019). Change can be helpful or harmful to an individual or an organization so by understanding organizational readiness, the change will be positive (Ruest, Leonard, Thomas, Desrosiers, & Guay, 2019). One can cause change, accept change, reject or fight change, or try to ignore change. The outcome from all of these actions is likely to be different but properly managed change can benefit the individual and the organization. Understanding and using a change theory framework can help nurse leaders increase the likelihood of success. Nurse Practitioners (NPs) can utilize their leadership capabilities to critically challenge health care systems and act as a role model for others (Rawlings, 2018). background of the situation Hospice care is designed to provide comprehensive, interdisciplinary, team-based palliative care, in the patient’s home, who have been identified with a short prognosis. Hospice care is appropriate when patients and their families decide to forgo curative therapies in order to focus on maximizing comfort and quality of life, when curative treatments are no longer beneficial. By helping patients get the care they need, palliative and hospice care can reduce health care spending for America's sickest and most costly patient populations, by avoiding unnecessary emergency department and hospital stays (Meier, 2011). Studies have also shown that patients with a serious illness and their families receive poor-quality medical care, characterized by untreated symptoms, unmet psychosocial and personal care needs, low patient and family satisfaction and caregiver burnout. Background – On call/ admission nurse for hospice care. The on-call nurse was to deal with any calls that came into the organization after hours. This would include patient/family calls, pending admissions and patient visits. Having worked with two different hospice companies in two different cities, the companies were different, but the problem was the same. One company was a start up hospice company in a large city with over a hundred other hospice companies, and so the competition was fierce. The other hospice company was well established with over 150 patients but was the only hospice company on the mountain, with the nearest big city being three hours away. The issue both companies had was the desire to grow but not have adequate staffing in place, prior to the desired growth. The startup company ( Company A) wanted 10-20 patients in place before hiring another registered nurse and the established company Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material ( Company B) wanted the on-call nurse to do three nurses’ jobs and would not bring in another nurse until the numbers exceeded 200 patients. rationale for and goal(s) of the change. Nurse leaders that first consider their strengths and weaknesses in terms of their leadership skills, will ensure a positive outcome to the change project. Leaders have an enormous role to play in influencing their team to progress in the right direction, and shortcomings in their characteristics can lead to problems among followers (Rawlings, 2018). Leadership, effective communication and teamworking are among the most important elements for planned change. The role of leaders is multifaceted as they provide inspiration, vision and support to everyone involved. Leaders should be seen as team players with the same goals as the rest of their team, rather than a stereotypical organizational leader (Rawlings, 2018). Change can sometimes result in loss and some members may react with resistance, but the goal would be ultimate acceptance (Gorbunoff & Kummeth, 2017). A nurse leader would need to be direct and clarify what was going on and attempt to resolve any issues by negotiation or compromise (DeNisco & Barker, 2016). The goal for change was to have nurses in place prior to the expansion of the hospice company A and B, so that patient care would not suffer, and the current nurses would not be overloaded and overstressed without the help needed. Having adequate admission or on-call nurses in place would allow for patients and families to receive the time needed for hospice care explanations, relieving of death and dying fears and encourage them to ask questions . People have the fear of the unknown and by relieving those fears, people are more comfortable discussing dying and end-of-life wishes. 2. Identify the key interprofessional stakeholders (both internal and external) that should be involved in change efforts. Failure rates are associated to a number of different factors such as lack of vision and commitment from senior management, ill-conceived implementation plans and processes in the organization (Gottlieb, 2017). Employees want to understand why change is happening and how they will be affected. Layoffs or other organizational changes can lead to paranoia, confusion, anger and insecurities under the auspices of change. Bringing about change takes time and requires the commitment of time on the Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material part of the manager. The manager must be clear about what is important and develop responses and proactive actions accordingly (DeNisco & Barker, 2016). key interprofessional stakeholders involved in change efforts Key interprofessional stakeholders would be the marketers, the on-call nurse, the case manager, the nurse manager and the referral source . The referral source would be the external stakeholder and many times that is the emergency department within a hospital. The on-call nurse, admission nurse, nurse leader and hospice marketer would be the internal source. The external source would be the hospital emergency department nurse, the hospital social worker or discharge planner. Their job would be to refer a potential hospice patient to a hospice and ensure the patient received the needed care for end of life and comfort care. The marketers would travel to the local hospitals and look for potential hospice patients or have liaisons with hospital discharge planners or social workers who would refer patients needing hospice care. Their job is to bring in the new patients for hospice care and they receive bonuses for reaching and exceeding their marketing goals. They don’t want to hear that there is no available nurse to do a patient assessment for a potential hospice admission. As they are the first hospice employee that the potential hospice patient and family would see, they need to be well educated in palliative and hospice care. Giving the family hospice information and allowing them to make the decision to investigate hospice care is important and the marketer needs to be able to present this information correctly. The on-call nurse or the case manager would need to be available to do the patient assessment and admit the patient if hospice appropriate. The issue occurs when the on- call nurse or case manager is busy with other issues and not available to do the assessment. Most hospices want an assessment done within 15-30 minutes of the referral due to the high competition from other hospices. The on-call nurse or case manager would need to be educated in palliative and hospice care and be able to explain the benefits to the patient and family in ways that they would be able to comprehend. They would be expected to acquire the knowledge, skills and competencies to become an effective hospice employee (Gottlieb, 2017). Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material 3. Discuss an appropriate change theory or model that could be used to achieve results. Change theory used to achieve results. Five phases of change need to be addressed to ensure a successful organizational change. These five phases are 1) motivating change, 2) creating vision, 3) developing political support, 4) managing the transition and 5) sustaining momentum (McNamara, n.d.). Motivating change would ensure the nurse leader creates a readiness for change within the organization and develop approaches to overcome resistance to the change. Nurse leaders need to articulate a clear vision that describes what goal will be accomplished and it should convey the benefits to the employees, and the company. Developing political support is important as this step tends to be forgotten. Politics in organizations is about power and power is important among members of any organization when attempting to do their jobs. By developing a network of leaders at various levels who interact and support each other will guide the change effort. Managing the transition is the next phase and this occurs when the organization makes the actual transition from the current state to the desired future state. During this phase there is the need for strong, clear, ongoing communications about the status of the change. Sustaining momentum is the final phase and it appears to be the most difficult phase in managing change. Change efforts can encounter obstacles such as strong resistance from members of the organization or unexpected changes in the environment outside the organization. Support from top leadership is critically and employee performance management would be needed to ensure all actions were being done correctly and with high quality (McNamara, n.d.). Lewin’s model is one of the most popular approaches and would be appropriate for the needed change. In 1947 Kurt Lewin proposed a three-step model for managing change. The steps are “1. Unfreezing: Challenging the status quo to gain support that a change is needed 2. Freezing: Making a change 3. Refreezing: Solidifying the change into the culture” (DeNisco & Barker, 2016, P. 109). The five phases of change would be implemented within Lewin’s Change Management Model. Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material Lewin’s Change Management Model would be used to create the needed change in the hospice organizations. Lewin used an analogy of changing the shape of a block of ice to explain his “unfreeze, freeze and refreeze” model (DeNisco & Barker, 2016). The unfreezing step would gain the support for the needed change and take a look at how things are currently done. Here the motivating change, creating a vision, and developing political support would be utilized (McNamara, n.d.). Analyzing every step and human interaction for potential improvements would be used doing this step of the model (DeNisco & Barker, 2016). Unfreezing would also apply to the company’s perception of the upcoming change and the natural resistance to it. Forcing sudden change only breeds resentment, so ensuring the team is ready for the new elements when deployed is important. By discussing with the team what is wrong with the current process, why it needs to change, what changes are being suggested, and what benefits those changes will bring, will help to convince them of the need to change. The core issues that are causing conflict need to be addressed as the core issues are triggers that bring forth feelings of conflict (Weberg, Mangold, Porter- O'Grady, & Malloch, 2019). Communication would be the way to ensure all core issues were addressed and would allow for the team to voice their concerns and acceptance of the pending change. This will also encourage them to stick to the new implemented process. Making the changes is the next needed step of the model which is the freezing stage. Managing the transition would be incorporated into Lewin’s model. During this phase the emphasis would be on communication, feedback on progress, teamwork and motivation. If the manager strives to ensure the change meets the staff’s motivational needs, this would likely increase the job satisfaction which would improve co-operation and performance (Gorbunoff, & Kummeth, 2017). Communication, support, and education would be vital to limit as many difficulties in the transition process. By ensuring problems are addressed as soon as they arise would make the changing process run smoothly. Refreezing the changes is the final step and sustaining momentum would be an important factor (McNamara, n.d.). Once the changes have been deployed, measured, and tweaked according to feedback, then it is important to “refreeze” the new status quo. This is vital to any change management model as it will be pointless if old habits resurface (Weberg, Mangold, Porter- O'Grady, & Malloch, 2019). 4. Outline how you would initiate the change. Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material How change would be initiated A good nurse leader is someone that can lead in such a way as to be able to plan, budget, design, staff, supervise and monitor and evaluate a program keeping the employees and themselves moving in a forward motion. Traits like personality, strength, honesty and most of all a positive vision are strong attributes of a good nurse leader (Weberg, Mangold, Porter- O'Grady, & Malloch, 2019). Having a vision to improve the organization would be needed and having the ability to communicate that vision to the employees and have them work towards that vision would create positive change. Measuring and monitoring outcomes of the change process is essential for recognizing whether or not the change process has fulfilled its purposes. It is important for nurse leaders to record and focus on the emerging problems due to change so that those situations are not repeated (Gorbunoff, & Kummeth, 2017). The change needed would be to ensure adequate staffing levels were in place prior to expanding the number of hospice patients. Many companies tend to look at the financial implication of having staff and not the adequate patient numbers. Starting a new company requires a large amount of money to be present and expenses will be large initially. The downfall many new owners make is trying to save money and not have a large outlay. Not having adequate nursing staff will cause the business to fail. Hospitals are not going to refer patients to a new hospice if they are unable to do the admission and care for patient and their families. Having the staff available when the referral comes in, will show the referral source that the hospice has the staff and they are able to provide the needed care. A hospice that is established but allows for their staff to be overworked, again will fail to expand. If the staff have too much work and too many patients to care for, they will not be available to do assessments within a timely manner, and the referral sources will cease to refer. The change I would implement in a new startup hospice or an established hospice, would be to ensure a nurse was available solely for assessments and admissions. That would require a nurse to be available during the week and another nurse to be available after hours and weekends. Having a nurse exclusively do assessment and admissions, would allow for them to be available within a timely manner, give the patient and the family the needed time to ask questions and have their fears/ concerned addressed and gives the nurse the time they would need to do a full assessment correctly. Downloaded by: Distribution of this document is illegal Want to earn $103 per month?