System Change Project
SYSTEM CHANGE PROJECT
SystemsChange for Quality Improvement of Patient Safety
Hospitalfalls refer to legal, regulatory and clinical problems which arefaced in day to day running of health centers. Over time, despite theeffort to get appropriate remedies for such issues, there has beenthe failure due to lack of efficient models and technology (Hempel,Newberry, Wang, Booth, Shanman, Johnsen and Ganz, 2013). Furthermore,the Center for Medicaid and Medicare are no longer taking appropriateinitiatives to ensure all medical centers are equitably reimbursed(Weaver & Manzano, 2016). With ongoing restructuring in the USdemographic pattern whereby the number of aging people is increasingat the high rate each year, the fall prevention should be taken withof concern to prevent far-reaching consequences, as the aged peopleare vulnerable to falls.Hempel,Newberry, Wang, Booth, Shanman, Johnsen, and Ganz, (2013) noted thatin the United States mitigating cases of falls is posing asignificant challenge as most of the patients are acutely ill andonly 4.5% on average are in hospitals. As a result, healthpractitioners are facing the serious problem in the effort to makethese patients safe.
KEYWORDS:Patient safety, DNP, Quality of care,
Fallprevention is comprised of sophisticated operations and subcomponentsin the implementation of the countermeasures. As a result, itrequires sound leadership skills and participation of various expertsto ensure viable results are realized. After implementation of suchprograms, the active monitory process is necessary to ensure all theemployees conform to such strategic guidelines to bring improvementin healthcare service delivery. Manchester, Gray-Miceli, et la (2014)observed that, for the management of DNP expert to ensure successfulchange process and implementation, Kurt Lewin change process iscritical. It involves three major steps which are unfreezing,transition or moving and freezing. Since Health Safety is fundamentalin every state, it should be taken with due diligence and due care.
Accordingto Weaver and Manzano (2016), patient safety is very paramount inachieving sustainable development in healthcare delivery. The patientis defined as freedom of the patient to get rid of accidental injuryespecially during the treatment. Each year an estimate of 44,000 to96,000 deaths which are preventable are reported in the United Stateswhich otherwise could be prevented at the cost of about $38 to $50billion dollars, especially by harnessing effective method ofaddressing all issues associated with patient safety (Walker andPolancich, 2015). On the other hand, quality of care is defined asthe probability that desirable and consistent health results are tobe realized at prevailing knowledge by the health practitioners. As aresult, all the relevant stakeholders such as affected families,patients and educators should be actively involved to ensure theimprovement of the current state of the patients’ safety. Withoutsuch joint effort, only insignificant improvement can be realized.Furthermore, measurement of the trend has become a routine in most ofthe health centers so as to facilitate identifying possible areas ofimprovement of delivery of healthcare services. Walker and Polancich(2015) agree that use of more efficient techniques and technology islikely to contribute significantly increase of patients safety. Themedical practitioners with right competencies and skills shouldparticipate in ensuring the improvement process is smooth. Members ofthe Association of Advance practice nurses (APN) have prepared someguidelines which are likely to facilitate the initiative towards theimproving patients’ safety and quality care. Additionally, it isprojected that the services of ecologist will be highly needed by2025, it is anticipated that there may be the shortfall of about 15%of APNs hence leading to the possible shortage of these crucialservices to the patients (Weaver & Manzano, 2016).
Healthcareproviders should use evidence-based practices (EBP) to ensure thatpatients get the healthcare services at most affordable costs.Manchester, Gray-Miceli, Metcalf, Paolini, Napier, Coogle and Owens(2014) agree that implementation of necessary equipment andsupportive protocols are crucial to ensure all operations are carriedout successfully. On adopting new changes, there is a need to makesome adjustments to the current state to accommodate such changes.Otherwise, it can lead to straining with the effort to sustain suchchanges in the delivery of the healthcare services.
Systemschange through educatinghealthcare practitioners on evidence-based practice (EBP).
Thechange process should be carried out stepwise to avoid resistance bysome of the employees. As a result, the DNP practitioner headingchange process should ensure relevant training is offered to otherjunior DNP specialists (Hempel,Newberry, Wang, Booth, Shanman, Johnsen & Ganz, 2013).Introducing intervention in the delivery of clinical servicesincludes some activities such as continuous quality improvementtechniques, procedures, establishing the team, educating all staffson changes to be made and lastly offering leadership support.
Currently,evidence-based practice (EBP) is increasingly gaining adoption inmost of the healthcare centers. It at facilitating the adoption ofnew and improved health services by the doctors and nurses hence theadvancement of knowledge. As a result, the health practitioners aregaining argument to offer services conveniently to both existing andnew clients (Walker & Polancich, 2015). Furthermore, theirability to make clinical judgment and accuracy in decision making isenhanced by undergoing continuous professional development (CPD)program. The following steps should be followed systematically
Unfreezingphase is one of the most crucial stage in the change process. Itinvolves getting ready for the anticipated changes. The chief DNPpractitioner should take charge to inform his team the importance ofevidence based process (EBP). Ideally it encompasses creatingcondition suitable for the adoption of required changes (Walker &Polancich, 2015). After creating the awareness, if the otherpractitioners feel change is necessary, they are likely to have thezeal to embrace improved method of service delivery. The healthcaresuperintendent should provide rewarding systems to award those haveachieved organizational expectations of being steadfast in adoptingEBP.
Themanagement or change agent should offer categories of motivationprograms as without such there will be little or no empathy toembrace such anticipated changes. Pro and cons of adopting changesshould be evaluated before deciding on the possible cause of actionto take through a process known as force field analysis (Hempel,Newberry, et la, 2013).Afteranalysis, if the demerits exceed the merits, then such change shouldbe abandoned, while if the benefits exceeds the demerits appropriatecourse of action should be taken and implement accordingly.
Walkerand Polancich (2015) observed that DNP practitioner acting as changeagent should start by asking critical clinical guiding questionsfollowing PICO (T) format, which is acronym standing for the patient(P), the problem of interest or population. Secondly, prognosticfactor to be considered or intervention (I). Thirdly, intervention orcomparison (C).Forth, outcome measured (O) and lastly within a givenperiod (T). Conduct in-depth research to get all possible solutionsto the formulated questions (PICO). One should search through variousdatabases and other resources to get viable information. Keywordsconcept of searching information should be utilized. Then, evidenceappraisal should be carried out by evaluating multiple perspectivesof gathered information by determining the validity of the study,applicability, and reliability to the clients and otherpractitioners.
Changeof moving stage
Accordingto Hempel, Newberr, Wang, Booth, Shanman, Johnsen and Ganz (2013),change is process thus it should be introduced gradually to avoidresistance from some of the stakeholders who are expected to play acentral role in the implementation process. The transition is innerzeal which compels one to make the step forward towards therealization of the change. In the entire change process, this phaseis most difficult as most of the practitioners who are expected toplay a central role fear or are unsure about their ability to embracesuch proposed changes (Walker & Polancich, 2015). Since it maytake the time to understand some fundamental elements required toimplement new changes, the medics should be given ample time to learnabout the new change.
Continuoussupport is very paramount here, and it can be acquired throughcoaching, training, holding seminars and expecting mistakes. Thus oneshould be willing to accept and be willing to be corrected. Theemployees who have been bestowed the mandate to be change agentsshould lead by example by being the role model to their followers.Also, they should be willing to give freedom to their fellow membersto come up with the solutions to some of the possible improvement tothe healthcare systems aimed at improving health care safety. Soundcommunication channel should be maintained as it helps in keepingproductive trajectory towards realizing viable change and helpshealth practitioners to be focused that they do not lose sight onachieving the desired changes in the of implementing EBP efficiently(Walker & Polancich, 2015). The fourth step of evidence-basedpractice involves integrating the gathered evidence with the onesclinical practitioner`s and clients to make the most effectiveclinical decision.
Otherconsideration which is beyond the applicability threshold should beconsidered before integration. Such consideration includessocioeconomic, epidemiologicand biologicissue. After the implementation has been done the results of the EBPshould be evaluated, various questions should be addressed first. Hasthe desired been realized? If not, what is the reason behindnon-attainment? Did it arise from non-adherence to laid stipulationsand treatment plan or because the practitioners were not ready toembrace such changes? Was it as result of lack of appropriate skillsor evidence interpretation? .The last phase will involvedissemination of outcomes to the other health care practitioners.There are various methods which can be used in the dissemination ofthe outcome results they include inter- or intra-departmentalchannels, manuscript, academic journals, journal clubs, posters,conferences, lectures and through online media.
Thefreezing stage is also known as the refreezing stage. The mainactivities involved here are geared towards boosting the stabilityafter the change has been introduced in the healthcare system. Ongaining acceptance of the evidence-based process (EBP), the newhealthcare norms should be formulated to achieve strategic fit andgoals laid down by the Association of DNP. After this, allpractitioners become acquitted to the new standards and guidelines.
Therole of the DNP and expected outcomes
TheDNPs performs some functions which mostly depends on the context orjurisdiction of the operation. The primary function of the DNP is tofacilitate normalization or standardization of healthcare operationalguidelines and regulatory framework. There has been a lot ofconfusion among many practitioners concerning the role which shouldbe executed the DNP. For instance, some people believe that thefunction of DNPs is to come up with the new body of knowledge afterconducting research. According to Walker and Polancich (2015), theambiguity in the role may bring variation in the training program ifnot addressed on time, which may lead to the lack of standards anduseful guidelines in medical profession among the nurses. Advancedpractice nurses (APN) is composed of practitioners of four categorieswhich include nurse practitioners, clinical nurses’ specialists,certified registered nurses and certified nurse midwives. Nursepractitioners are always in the frontline in delivering acute care inhospitals, schools, clinics and other settings. Furthermore, theyperform other clinical activities such as treating injuries,conducting the physical examination, managing diabetes, high bloodpressure among other functions. According to American Association ofColleges of Nursing (AAACN), there are eight essentials of DNPgraduate which as follows
First,DNPs should recognize the scientific and philosophical issuesrelating and necessary complexity of basic nursing professional atthe doctorate level. Secondly, they should have the capacity torecognize the essentials for sustaining and improving the healthoutcome, healthcare, mitigating health disparities, promotingpatients’ healthcare and excellence in service delivery. Thirdly,DNPs graduate should have the capacity to recognize essentials toevaluate, manage and utilize research information to make the qualitydecision on health matters. Furthermore, DNPs should havecompetencies necessary to use technology and intelligence to improveand support healthcare systems (Walker & Polancich, 2015). Fifth,DNPs should have skills and ability to recognize the role of thenursing practitioner at such advanced level and should have influenceefficiency of healthcare, quality, and safety in the healthcareprofession. Such graduates should also have the ability to recognizefiduciary position they hold in the improvement of the healthcareprofession and should have the capacity of preparing doctoratestudents to serve in the same capacity. Lastly, they should recognizethe need for population health and clinical prevention so as toimprove the health of the nation (Walker & Polancich, 2015).
Walkerand Polancich (2015), Agree the role of the DNP is divided into thetwo broad divisions. Either as change agent and role in practice. Asseen in above discussion the role of the DNPs is purely depended onthe context or environment of operation. Though there are no standardroles, some association have put some emphasizes on variousessentials stipulated under qualification for one to qualify as DNPgraduate. Sometimes DNPs have engaged in translation and system basedimprovement this is composed of inter-professional teams andleadership geared towards mitigating the risk of causing harm to thepatients. Furthermore, Walker and Polancich (2015) noted that qualityhealthcare system improvement involves the cycle of activities withfour steps which include, planning which entails setting goals andcollecting viable data for decision making. Secondly, conducting thetest on the plan document to determine the viability of the proposedchanges to be implemented. Thirdly, conducting a study, whichinvolves screening of collected data, review the strategic decisionand decide on appropriate course action. Lastly, implementing theselected course of action. The role of DNP in practice is viewed as aperson who has competencies and skills to act and lead efforts as achange agent in the implementation of healthcare systems. On emergingissues, the DNP can work in the various position in faculty andleadership position in the Ecology environment or setting.
Inconclusion, DNP-prepared as DNP has leadership capacity to lead inchallenging healthcare environment full of dynamics. Traditionally,the role of the DNP was only constrained to clinical functions. Withthe expansion of the body of knowledge and the scope of operation thefunctions of DNP has also expanded. The DNP can now serve asconsultants, managers, and researchers. The role of the ANP has beenexpanding in according with the measures taken by the ANP to advancethe delivery of healthcare services in the practice setting.Additionally, DNPs prepared as ANP have the capacity to contributesignificantly to ontology care. In other contexts, DNPs have been toserve in different innovative roles such as organizational leaders,faculty, and entrepreneurs
Hempel,S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., &Ganz, D. A. (2013). Hospital fall prevention: a systematic review ofimplementation, components, adherence, and effectiveness. Journalof the American Geriatrics Society,61(4),483-494.
Manchester,J., Gray-Miceli, D. L., Metcalf, J. A., Paolini, C. A., Napier, A.H., Coogle, C. L., & Owens, M. G. (2014). Facilitating Lewin`schange model with collaborative evaluation in promoting evidencebased practices of health professionals. Evaluationand program planning,47,82-90.
Trepanier,S., & Hilsenbeck, J. (2014). A hospital system approach atdecreasing falls with injuries and cost. Nursingeconomics,32(3),and 135.
Walker,D. K., & Polancich, S. (2015). Doctor of Nursing Practice: TheRole of the Advanced Practice Nurse. In Seminarsin oncology nursing(Vol. 31, No. 4, pp. 263-272). WB Saunders.
Weaver,A. C., & Manzano, J. G. (2016). Quality and Safety inHospitalized Patients with Cancer. HospitalMedicine Clinics,5(3),368-378.
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