NR 554 Week 2 Discussion, Leading Change

Leading Change NAME Chamberlain College of Nursing NR 554: Nurse Leader and Healthcare Policy DATE Consider an educational or healthcare organization with which you are familiar. Analyze the organization with respect to its attitude toward change. Identify a healthcare policy that has been adopted by this organization and determine the change model used throughout the change process (if any). Include the history of the change in terms of how the issue was identified, who the stakeholders were, and how the implementation and evaluation were received. Leading Change As the healthcare system is rapidly changing, healthcare organizations must change with it. Changes to organizational policies will occur within the clinical setting as it adapts to sustain evidence-based practices. One major role of the nursing profession is functioning as a change agent. Nurses must continue to look for ways to impact change within the healthcare system. At the Cleveland Clinic, the Stanley Shalom Zielony Institute for Nursing Excellence encourages nurses to have an essential role in implementing evidence-based practices (EBP) that contribute to positive patient outcomes. Frontline nurses across the Cleveland Clinic healthcare system are encouraged to become change agents by getting involved in decision-making, thus joining unit-based shared governance councils and unit-based practice councils. An evidence-based intervention that was implemented as a hospital policy and introduced by shared governance to be performed by nurses and other caregivers is purposeful rounding. Purposeful rounding consists of hourly visits to patients throughout the day. It engages the patient, family, and nurse and enhances communication between the patient, family, and staff. The change model used to implement this policy is Kurt Lewin’s Change Theory Model. Lewin change theory model is based on a 3-step process (Unfreeze-Change/Movement-Refreeze) that provides a high-level approach to change (Shirey, 2013). According to Lewin’s theory, the first stage of unfreezing involves the change agent recognizing a problem, identifying the need for change, and mobilizing others to see the need for change (Shirey, 2013). There were two problems identified by shared governance that called for a change in practice. The first was a high incidence inpatient falls and the second was low patient satisfaction scores. According to the Joint Commission, “the average increase in a hospital's operational costs for a serious fall-related injury is more than $14,000 and the patient's length of stay increases by an average of 6.3 days” (2015). Falls can be avoided when successful safety strategies are implemented. Patient satisfaction scores are becoming more important as leaders in healthcare look towards the future when Medicaid/Medicare will base a percentage of their reimbursement on patient satisfaction. The second stage, change or movement, involves looking at change as a process. Nursing leadership creating a detailed plan of action and engaged frontline nurses and ancillary staff to try out the proposed change, purposeful rounding. The leadership provided staff with evidence-based research to show data of successful purposeful rounding in other facilities. They also communicated compliance with purposeful rounding by holding staff accountable to the protocol. The final stage, refreezing, establishes the change as the new habit so that it becomes the standard operating procedure or practice. Purposeful rounding is “Putting Patients First”, the Cleveland Clinic motto. Rounding with a purpose helps manage patient expectations, provide necessary service recovery, and promotes quality care. Stakeholders involved in this change process include patients, families, nursing leadership (nursing directors, managers, and assistant nurse managers), frontline nurses, and ancillary staff (clinical technicians, nursing assistants, and medics). Auditing hourly rounds by nursing leadership help to evaluate how successful the changes were on hourly rounding. Since practicing purposeful hourly rounding HCAHPS scores in units where nurses ‘always rounded’ enter the 90th percentile and there has been an increase in patient satisfaction scores. There was also a 52% reduction in patient falls. References The Joint Commission. (2015). Preventing falls and fall-related injuries in health care facilities. Sentinel Event Alert, 55. Retrieved from Shirey, M. (2013). Lewin's Theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72. Response to Peer: The efficacy of the silicone sacral border dressing as compared to a liquid cyanoacrylate-based monomer for the prevention of pressure injury in at risk, but intact skin. Martha and Amy, I'm the skin care resource nurse for my department and I enjoyed reading your post on alternatives to skin care management. Martha, thank you for sharing the information on liquid cyanoacrylate-based monomer. I was able to review an article that utilized a pilot evaluation of the product on pedal skin fissures (Vlahovic, Hinton, Chakravarthy, & Fleck, 2010). I would like to present this information to my Clinical Nurse Specialist and see how I can go about presenting this to the hospitals wound management department. This could be an ideal product to use in the ED and CDU. I recently learned that hospitals do not have a financial incentive to use the most advanced and/or highest quality surgical dressings and topical wound care products. However, the hospital does have a financial incentive to decrease the Medicare patient's length of stay because the hospital is allowed to keep the difference between the Medicare MS-DRG payment and their actual costs. Therefore, wound care professionals should use their outcome data to educate their hospitals decision-makers why more advanced, higher quality surgical dressings and/or topical wound therapy often decreases the patient's length of stay. Amy, I was wondering if your department had access to a clinical nurse specialist, nurse educator, or nursing research department? I believe the more allies you have on your side, you will have a greater chance of buy-in. My department’s clinical nurse specialist is a huge resource and is always willing to assist nurses with researching evidence-based practices to improve patient outcomes. Reference Vlahovic, T. C., Hinton, E. A., Chakravarthy, D., & Fleck, C. A. (2010). A Review of Cyanoacrylate Liquid Skin Protectant and Its Efficacy on Pedal Fissures. The Journal of the American College of Certified Wound Specialists, 2(4), 79–85. Response to Instructor: The promise of the healthcare reform plan was designed to correct the flaws in the healthcare marketplace. While the Affordable Care Act (ACA) has made health insurance more affordable for the uninsured, premiums and cost-sharing are still too high for many Americans. Many young and healthy individuals with incomes too high for premium tax credit eligibility saw their premiums rise sharply as the ACA’s market reforms became effective and the risk pool was required to absorb those previously excluded because of the high cost of their care (Glied, Ma, & Borja, 2017). Reform of the healthcare marketplace will make needed services available to all citizens on an equitable basis. Summary Week 2 From this week’s readings, lessons, and discussion thread I’ve learned that to function as a change agent an advanced practice nurse (APN) not only challenges the status quo in health care but must also understand the world in which health care providers and organizations function. Advanced practice nurses act as agents of change to drive processes and policy and leverage technology to prove better, more affordable care for individuals and the communities they serve. For transformational change to happen, all parties must understand what benefits are available to them as a result of changing. Judgment and finger pointing are not effective weapons for the change agent. Rather, a change agent must be an active listener and a persistent messenger and provide tools, assistance, and resources to enable change to occur. Reference Glied, S., Ma, S., & Borja, A. (2017). Effect of the Affordable Care Act on Health Care Access. Retrieved from