Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability Essay
Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability Essay
The promotion of quality, efficiency, and safety are important in nursing practice. Nurses implement evidence-based practice interventions to achieve these outcomes. They also explore issues in their setting to identify ways of promoting optimum outcomes. Internal and external factors drive change in healthcare organizations. Effective organizational performance requires that nurses adopt responsive interventions to both actual and potential needs in their markets. Therefore, this paper explores a proposed change to address an identified practice issue.
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Issues and Current Outcomes
The identified practice issue in my organization is falls among elderly patients. The last quarter of the year saw an increase in the rate of falls among elderly patients in the organization. A patient fall has been defined as the unplanned descent to the floor with or without patient injury. Statistics show that falls in the United States range between 700000 and 1000000 yearly. The risk of falls in elderly patients is high due to factors such as multiple medications, confusion, and gait issues. Falls have adverse effects on the health of elderly patients. Accordingly, it may cause fractures, internal bleeding, or lacerations. It also predisposes patients to fear subsequent falls in the future. Fatal falls may lead to deaths due to multiple organ involvement. Falls also increase the hospital stay. The affected patients may require intensive, specialized care to promote recovery, leading to high costs of patient care (Alshammari et al., 2018). Falls also affect an organization’s performance since the Centers for Medicare & Medicaid Services do not reimburse institutions that experience specific traumatic injuries. Based on the above, falls among elderly patients should be prevented to promote their health and wellbeing.
External and/or Internal Driving Forces
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Falls among elderly patients are attributed to several internal driving forces. One of them is caring for elderly patients in unfamiliar environments to them. Caring for confused elderly patients in unfamiliar environments predisposes them to falls. The other internal factor contributing to the issue is the nursing shortage. Prevention of patient falls requires close patient monitoring by the nurses. However, nursing shortage increases the ratio of patients to nurses. The consequence includes delays in the identification of those at risk and the implementation of timely preventive strategies. The medications prescribed for elderly patients also contribute to patient falls. Accordingly, medications that include anti-anxiety drugs, tricyclic antidepressants, and diphenhydramine increase the risk of falls in elderly patients. Most elderly patients are also prescribed multiple drugs, which predispose them to falls due to their associated side effects. The other internal factor contributing to falls among elderly patients is organizational culture. Organizations should establish a culture that prioritizes safety, quality, and efficiency in the process of patient care. Lack of culture of patient safety increases the risk of laxity in the implementation of continuous quality improvement interventions, hence, falls (Ang et al., 2018). External factors such as existing comorbid conditions among elderly patients may also play a role in falls.
Prevention of falls among elderly patients requires the involvement of several stakeholders. They include nurses, physicians, nurse leaders, managers, and quality improvement personnel. The proposed change initiative entails the implementation of hourly rounds to reduce the risk and prevent falls among elderly patients. The proposed change initiative will affect the stakeholders in some ways. One of them is improving patient-centeredness. Healthcare providers will be forced to adopt patient-centered interventions that prioritize patients’ actual needs. Patient-centeredness will minimize the risk of safety and quality issues in practice. The change initiative will also transform the current practices utilized for patient care. Healthcare providers will be challenged to explore evidence-based interventions that can be utilized to enhance patient safety(Mathieson et al., 2019). Consequently, optimum patient outcomes will be achieved in the institution.
Role and Responsibility
My roles and responsibility as a change leader will be varied. One of them will be resource allocation and monitoring of its utilization. I will allocate the required resources for the project and ensure its efficient utilization for optimum outcomes. I will ensure waste minimization and the elimination of redundancies to ensure efficiency. The other role will be assigning stakeholders roles. I will ensure the stakeholders understand their roles in the change initiative and assist in undertaking them in a manner that aligns with the project expectations. My other role will be implementing anticipatory strategies to minimize resistance to change. I will adopt interventions such as open communication and active stakeholder involvement to ensure optimum adoption of the change initiative (Adams et al., 2019). I will utilize transformational leadership theory to guide the change process. The theory recognizes the importance of active employee participation in change initiatives and open communication. It also strengthens the utilization of interventions that include rewarding performance, the delegation of duties, and role modeling in the implementation of change (Boamah et al., 2018).
Change agents are individuals that have the power or competencies to coordinate and facilitate the realization of change effort outcomes. The change agents that will be required for the change initiative will include nurse leaders, managers, and nurses’ representatives. Nurse leaders will guide the staff in implementing interventions that underpin the goals of the change initiative. They will act as role models in the implementation of best practices to promote safety in the process of patient care in the organization. Nurse Managers will work with the nursing staff in implementing change strategies. They will also provide feedback about the effectiveness of the change implementation process. They will also guide the nursing staff in adopting efficient and effective strategies to ensure the success of the change initiative. The nurses’ representatives will also ensure the implementation of the change initiative aligns with the developed plan(Sharma et al., 2018). They will guide the other nurses in ensuring the optimum realization of change initiative outcomes.
The developed change model comprises steps that include implementation, evaluation, presentation, and transformation of change. Each of the steps comprises different strategies that will be utilized in the change initiative. The evaluation for change will entail strategies that include assessing organizational readiness for change, defining change, and assessing strategy, shared values, identifying and choosing change agents. The activities in this step will provide the basis for the change. They will inform the need and relevance of the change in addressing the organization’s actual, prioritized needs. The strategic aspects in the implementation of change will include seeking approval for the change, educating stakeholders, adapting systems to change, soliciting feedback from adopters, and data collection to determine change effectiveness(Fiorio et al., 2018). The initiatives in this stage will inform the changes and improvements made to enhance initiative outcomes.
The strategic aspects in the presentation of change will include communicating change to the team, describing its benefits, identifying and removing barriers, obtaining feedback, and predicting the change effect. Once successful, change will be sustained using interventions that include continuous performance tracking, regular communication, rewarding performance, and setting new goals to drive excellence. The developed model is appropriate, as it recognizes the systematic process of change implementation and adoption of anticipatory measures to minimize barriers to the change process. Individuals, including nurses, nurses’ representatives, nurse leaders, and managers will be involved in each of the above steps of the change model(Mathieson et al., 2019). They will assess, plan, implement, monitor, and evaluate the effectiveness of the adopted interventions.
One of the potential barriers to the proposed change initiative is lack of or inadequate institutional support. The successful implementation of the initiative will require optimum institutional support in the form of human resources, material, and financial support. Lack or inadequate support will affect change outcomes. Mitigation strategies such as aligning the aims of change with the organizational mission and vision will be adopted to address this barrier. The other potential barrier is resistance from the staff. The staff may resist adopting change strategies due to a lack of knowledge or their minimal involvement in the change. Interventions that include training, open communication, and active involvement will be adopted to address this barrier. The other barrier may be inadequate resources. The allocated resources may be inadequate in addressing the entire project needs(Adams et al., 2019). Strategies such as developing budgetary needs and ensuring efficiency in resource utilization will be adopted to address the barrier.
The evaluation methods that will be used to determine project success will focus on outcome and process measures. Outcome measures will entail the determination of whether the change outcomes were achieved or not. The outcome metrics of focus will include rates of falls among elderly patients, changes in hospital stay among these patients, costs incurred in care, and mortalities due to falls. Process measures will evaluate the effectiveness of the interventions that were utilized in the implementation of change. The metrics of focus will include the examination of the effectiveness of interventions used for resource utilization, stakeholder involvement, leadership styles, and communication approaches. It will also entail the changes in the existing organizational systems and processes to ensure optimum change outcomes(Fiorio et al., 2018). Examples of process and system metrics will include the introduction of new organizational policies to ensure safety in the process of patient care.
Strategies to Anchor Change
Some strategies will be considered to ensure continuous change. One of them is providing implementers regular feedback about the success of the implementation process. Regular feedback will inform improvement interventions for the change. The other intervention is rewarding performance. Staff will be rewarded for their role in ensuring sustained improvement in quality improvement initiatives for preventing falls among elderly patients. The last strategy will be incorporating change initiatives into the organizational culture(Mathieson et al., 2019). The aim will be to ensure the interventions become part of the organizational routines.
How it Supports Organizational Mission/Goal
The change initiative supports the organizational goal of ensuring safety in patient care. The reduction and prevention of falls among elderly patients will contribute to safety in the care process. It also supports the organizational mission of providing patient-centered care. The proposed change initiative ensures patient-centeredness in the implementation of interventions to prevent falls. Therefore, the change should be implemented to enhance organizational success in achieving its objectives.
Overall, falls among elderly patients are associated with negative outcomes, including injuries, extended hospital stay, high cost of care, and mortalities. The proposed change initiative entails the implementation of hourly rounds to identify and prevent falls in this population. Stakeholder support is important in ensuring the realization of the project outcomes. Therefore, it is anticipated that the project will enhance the realization of the organizational mission and vision of safety in the patient care process.
Adams, A., Hollingsworth, A., & Osman, A. (2019).The Implementation of a Cultural Change Toolkit to Reduce Nursing Burnout and Mitigate Nurse Turnover in the Emergency Department.Journal of Emergency Nursing, 45(4), 452–456. https://doi.org/10.1016/j.jen.2019.03.004
Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F. K., Aldakhil, A. A., &Abdulfattah, F. W. (2018). Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh.Journal of Family & Community Medicine, 25(1), 29–34. https://doi.org/10.4103/jfcm.JFCM_48_17
Ang, H. T., Lim, K. K., Kwan, Y. H., Tan, P. S., Yap, K. Z., Banu, Z., Tan, C. S., Fong, W., Thumboo, J., Ostbye, T., & Low, L. L. (2018). A Systematic Review and Meta-Analyses of the Association Between Anti-Hypertensive Classes and the Risk of Falls Among Older Adults. Drugs & Aging, 35(7), 625–635. https://doi.org/10.1007/s40266-018-0561-3
Boamah, S. A., Spence Laschinger, H. K., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes.Nursing Outlook, 66(2), 180–189. https://doi.org/10.1016/j.outlook.2017.10.004
Fiorio, C. V., Gorli, M., &Verzillo, S. (2018).Evaluating organizational change in health care: The patient-centered hospital model.BMC Health Services Research, 18(1), 95. https://doi.org/10.1186/s12913-018-2877-4
Mathieson, A., Grande, G., &Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20. https://doi.org/10.1017/S1463423618000488
Sharma, N., Herrnschmidt, J., Claes, V., Bachnick, S., De Geest, S., Simon, M., & Group, the M.-S. (2018). Organizational readiness for implementing change in acute care hospitals: An analysis of a cross-sectional, multicentre study. Journal of Advanced Nursing, 74(12), 2798–2808. https://doi.org/10.1111/jan.13801
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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 measureable 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.