Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability Essay
The University of Texas Medical Branch (UTMB) facility prides itself in being a premier institution of care. The application of evidence-based practice in several of its units has made it improve on its provision of services. However, the human aspect of the hospital has demonstrated certain weaknesses that the leadership should address. An analysis of the UTMB reveals that the ratio nurses to patients goes beyond the recommended level of 1: 6. The analysis further revealed that the high nurse to patient ratio exists due to a high turnover rate at the facility. As such, addressing the turnover rate will play an important role in ensuring that the ratio aligns with the recommendation of the American Nurses Association of 1:6. The present paper will thus focus on the implementation, evaluation and sustainability of the nurse turnover change initiative at the UTMB medical-surgical unit.
Cognizant of the role that training plays when it comes to improving a nurse’s competencies in EBP and thus empowering them to contribute to the development of EBP, here are certain strategies that can be undertaken from both an organizational level, to the larger professional level. At the organizational level, the organization can organize for opportunities where their nurses can get trained on evidence based practice. On the greater professional levels, professional bodies such as the ANA and the ANCC have developed certification program for nurses. By including components of evidence based practice in the certification exams, this ensures that nurses will prepare and apprise themselves on EBP and thus, in order to earn the certification, they will have to be competent in EBP. Alternatively, the institutions can include a whole different certification for EBP, where nurses will specifically be trained on EBP, tested on the same and thus, their competency will be proven by their certification. This will ultimately improve their ability to participate in the development and implementation of EBP.
The Need for Change
Nurse turnover has created a rapidly growing human resource issue in the contemporary healthcare sphere. Hospital managers have stated that nurse turnovers have certain consequences since it leads to the disruption of hospital service operations (Tang & Hudson, 2019). The UMTB has suffered the consequence of high nurse turnover as demonstrated by its high nurse to patient ratio at the medical-surgical unit. As a consequence of high turnover rate at the medical-surgical unit, it experiences a high risk-adjusted mortality. Moreover, the medical-surgical unit also experiences higher lengths of stay at the unit compared to other units.
The presence of high turnover rates at the medical surgical unit of UMTB has also increased the cost of care for an individual patient. Due to the extended length of stay at the unit, the amount of money spent on individual patients have increased remarkably since the medical-surgical unit started registering increased nurse turnover. Suggestive evidence shows that high turnover rate at the unit has increased its operational costs (Tucker et al., 2019). An analysis shows that cost of hiring and training new nurses for the medical-surgical unit has skyrocketed since its nurses started leaving.
The loss of nurses for the medical-surgical unit has also led to staffing problems for the unit. Consequently, the unit suffers the loss the trained and experienced nurses, an imbalanced composition of remaining and new nurses and nurse shortages (Tang & Hudson, 2019). The staffing problems have resulted in challenges in arranging work and formulating schedules for nurse managers. As a result, the situation necessitates increased overtime for remaining nurses. The resultant effects of nurse turnover cause reduced morale amongst the nurses at the unit, which negatively impacts most parameters of healthcare quality.
The driving forces for nurse turnover entails multifactorial factors in the form of economic, social and political aspects. The medical-surgical unit at UMTB suffers from factors such as absence of support from the nurse leadership. Organizational variables such as the lack of leadership play significant roles in the presence of nurse turnover (Scruth, Garcia, & Buchner, 2018). The nurse leadership at the medical-surgical unit of UMTB lacks the requisite skills to motivate the nurses hence their high turnover rates. Moreover, the high nurse-to-patient ratio results increased workload for the nurses. The overworking of nurses through strategies such as forced overtime makes them susceptible to burnout, which exacerbates the turnover rate issue.
The limited growth opportunities at the unit also leads to nurses quitting in pursuit of places where they abound for them. External factors such as the local labor economy does not favor the hospital hence the high rates of turnover. Moreover, State of Texas does not have a law guiding on the number of nurses per patients, which makes hospitals try to save money by keeping the ratio high (Cimiotti et al., 2019). Also, the presence of high competition from other healthcare players has accelerated the rate at which UMTB medical-surgical unit loses nurses. An analysis of the healthcare environment reveals that the competitors perhaps have better policies and offer more incentives, which attracts the medical-surgical nurses from UMTB.
The presence of a high turnover rate will have a direct impact of the remaining nurses and the patients. The remaining nurses have to work twofold and sometimes threefold due to understaffing. These nurses also have to persevere with forced overtime, which leads to other issues such as burnout (Scruth, Garcia, & Buchner, 2018). On the other hand, the patients suffer since the quality of services offered have reduced. The impact of nurse turnover on quality parameters has in turn negatively affected patient satisfaction with the services offered at the medical-surgical unit at UMTB.
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The proposed change for the issue of nurse turnover entails a multifactorial approach including inculcating the organizational culture during hiring, providing effective communication of organizational goals during the same period, and offering opportunities for growth through courses that improve competence. The nurse managers will take a frontline approach in the change initiative. During this period, nurse managers will need to change their approach in terms of communicating the unit’s goals, objectives and culture to the new nurses to make them feel part of the team (Hughes, 2017). Moreover, the new nurses at the facility will greatly benefit from the change initiative since they will find a new culture of doing things at the facility, which will persuade them to stay longer. The veteran nurses will also benefit from the change initiative since their workload will reduce and the facility will give them increased opportunity to grow at the facility.
The Role of Nurse Leader in the Change Initiative
Nurse leaders act as change agents to implement changes that will enhance nursing and improve the working conditions of floor nurses. In the present change initiative, the nurse leaders will play a fundamental role in implementing improved interpersonal relationships with new nurses during interviews and orientation. Moreover, the nurse leaders will ensure the formulation effective communication concerning the reorganization of the growth opportunities for existing nurses and how they align with organizational objectives (Nelson‐Brantley & Ford, 2017). In order to ensure that nurses remain with the facility for a long time, nurse leaders will explain to them the need to observe organizational culture and how the change initiative will impact the nurses going forward. In other words, nurse leaders will ensure the implementation of the various facets of the change initiative.
The Lippit’s seven step change theory will play an instrumental role in the change initiative at the UMTB medical-surgical unit. Using this theory, the present author will diagnose the issue of nurse burnout and evaluate the capability and motivation for change. Moreover, the author will assess the motivation of the change agent and available resources as well as elect progressive change objectives. Further, explaining the role of the change agent to the employees by ensuring clarity in their expectation and sustaining the change through feedback, effective communication and coordination regarding the effects of the change will occur (Burke, 2017). Lastly, the Lippit’s seven step change theory will allow the author to terminate the helping association of the change agent gradually.
Change Agents and their Roles
Change agents play crucial roles in managing the change process. As such, the identification of these change agents and clearly outlining their roles becomes an important facet of a change initiative. In the present project, the chief financial officer, as part of the management, will need to support the project. Their role will entail providing resources for the project by convincing the management of the business essence of the change initiative (Jones-Schenk, 2017). Further, a quality improvement adviser will need to participate in the project and their main role will entail convincing the administrative leadership of the impact of the project on quality parameters.
Moreover, the nurse manager will work as a change advocate for the project. The role of the nurse manager as a change advocate will entail showing commitment to the objectives of the project and then influence others to become active (Kodama & Fukahori, 2017). The author will also identify a nurse from the remaining nurses to also act as a change advocate. The role of the nurse will entail convincing other nurses of the essence of the project and communicating the leadership’s objective to them.
Application of the Change Theory to Develop Strategies
The change initiative related to the reduction of nurse turnover rates will occur based on Lewin’s Change Model. The adoption of the change model occurs due to its premise that seeks to influence organizational behavior (Shani & Noumair, 2017). The model will facilitate the acquisition of driving forces that will push the UMTB employees at the medical-surgical unit towards the desired direction by the unit’s leadership. Moreover, the theory will enable the leadership of the unit to determine the potency of the forces leading to a high nurse turnover and prescribe the requisite intervention to halt the same.
The first step of the model entails unfreezing, which encompasses altering the existing behavior so as to achieve equilibrium, conformity, and overcome resistance. During the phase, the unit leadership and change agents will undertake an examination of internal and external factors to support the need for change. Regarding internal factors, parameters such as nurse burnout, enhanced readmission rates, failing quality indicators, and high levels of mortality will convince the leadership of the need to have the change initiative and recruit change advocates from amongst them (Halter et al., 2017), Similarly, the management will need convincing using external parameters such as failing patronage, reduced patient satisfaction statistics, and failing revenues. The presence of information concerning the need for change will lead to the identification of a team that will oversee the improvement of interpersonal relationship through effective communication and other stratagem to improve change within the medical-surgical unit at UMTB.
The second phase of the change initiative based on Lewin’s model entails the change process. During this phase the change, the presence of effective communication strategies will play a significant role in institution change. The nurse leadership at the unit will adopt an informal communication strategy so as to take advantage of informal social dependencies, paths, and connections to improve interprofessional relationships between leadership and nurses at the medical-surgical unit (Zbieg, Batorski, & Żak, 2016). However, a form of formal communication known as the cascade strategy will also occur wherein nurse managers will train nurse leaders, who will in turn train the nurse advocates, who will pass the information to their peers. The unfreezing process will entail the implementation of the change initiative wherein proper interpersonal relationships starting with interviews will occur.
Overcoming Barriers to Change
The success of the change initiative will depend on the stakeholder support that will exist from the leadership and personnel of the organization. Potential barriers may include lack of support from the leadership and limited financial resources from the administration. Moreover, ineffective communication could also hamper the initiative. To address the challenges, the advocates of change initiatives will lobby for enough funding while they will use data to convince the administration of the necessity for the project (Clayton, 2019). Moreover, formulation of an effective communication strategy to communicate the objectives of the initiative to the leadership and outline the roles of various change agents will overcome the barriers. Monitoring the implementation process will allow the change team wo address unforeseen circumstances and address it in timely fashion and intelligently.
The evaluation methods of the change initiative will focus on the quality parameters and the improvement of the wellbeing of nurses. One of the most significant determinants of the success of the project will entail a reduction of the mortality rates, improved patient satisfaction, and the cost of care per patient. Moreover, other parameters such as the financial position of the unit, the rate of turnover and the nurse to patient ratio after the implementation of the initiative will also demonstrate the effectiveness of the project (Nelson‐Brantley & Ford, 2017). The evaluation of the change initiative will occur based on comparative data before the change initiative and after the implementation of the same. The analysis of the data will reveal whether the project will have succeeded or not based on individual parameters.
Strategies for Sustaining Change
To sustain change, identification of the threats to the project will become foundational and it will occur using the The National Health Service Sustainability Model. Afterwards, the UTMB will adopt the usage of tools such as such as process control boards, performance board, improvement hurdles, as well as standard work to guarantee change sustainability. Whereas process control and performance board will help the change agents to review the project to the leadership, the standard work will visually communicate to the nurses the best practices supported by the organization as a result of the change initiative (Silver et al., 2016). The improvement hurdles will assess the project through meetings between the leadership and the nurses, which facilitates the improvement of interpersonal relationships.
Overall Effectiveness of Change Plan
The mission statement of the UTMB entails the provision of highest quality patient care. The fact that reduced turnover of nurses will improve quality parameters implies that the change initiative aligns with the mission statement of the facility and its goals. The change initiatives address stakeholder concerns by ensuring that the hospital’s patronage will improve, patient satisfaction will increase and other quality parameters of the facility will also improve. As relates to the community, the improvement of services through improving the nurse to patient ratio will ensure that the people of Texas benefit from quality healthcare as promised by the facility.
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