NUR-514 Implementing Change With an Interprofessional Approach Presentation
Introduction
- Change is important for organizational success
- Promotes adaptability
- Ensures innovation
- Develops culture of excellence
Change is an important aspect for health organizations. Health organizations embrace change as a way of ensuring that they respond to the actual and potential needs in their environment. Change also ensures that the organization adopts interventions that will ensure sustainability and success in its markets. Organizations that embrace change on a regular basis are adaptive in nature. The organizations have mechanisms that ensure that they respond positively to both the anticipated and unforeseen events. Employees in organizations that are receptive of change are innovative in nature. They understand the need for the adoption of new practices that promote quality and efficiency in the provision of healthcare services. Therefore, the continuous adoption of change is critical, as it develops culture of excellence in health organizations.
Background
- Change was implementation of barcode medication administration technology
- Technology used for medication administration
- Nurse expected to use it in practice
- Prevents medication errors (Xie et al., 2019)
The change that was being implemented in our organization is the implementation of barcode medication administration technology.
The barcode medication administration technology is used in the medication administration to minimize errors. Nurses are required to counter-check the prescribed medications for the patients prior to administering them. The nurses achieve it by using the technology to confirm the patient’s identity, medical diagnosis, any significant histories, and prescribed medications. The technology also assists the nurses in determining the dose, route of administration, strengths and time prior to medication administration. The aim of the adoption of the technology was to prevent medication administration errors in practice.
Rationale
- Rising rates of medication administration errors
- To promote safety and quality in care
- To enhance efficiency
- Minimize the cost of care
The need for the adoption of the barcode technology for medication administration was attributed to a number of reasons. Firstly, the rate of medication administration errors in the hospital was rising significantly. An assessment of health organizations that had the lowest rates of medication administration errors showed them to use health technologies in addressing the issue. As a result, the use of barcode medication administration technology was considered for use in the institution. The other reason for the implementation of the barcode medication administration technology was to promote quality and safety in healthcare. The use of the technology was anticipated to minimize the risk of errors in the administration of medications. The minimization of errors was therefore considered a predictor of quality and safety of care in the institution. The technology was also adopted with the aim of enhancing efficiency in the institution. The technology was anticipated to ease the burden of medication administration and minimize wastages in the institution. Through it, the cost of care was anticipated to reduce significantly.
Goals
- To minimize the risk and rate of medication administration errors
- To reduce the cost of care
- To reduce resource misuse
- Improve safety, quality and efficiency of care
- Create culture of patient safety and quality in care
The goals of the change that was being adopted were varied. One of them was minimization and reduction of the risk and rate of medication administration errors. The use of the technology was anticipated to increase the level of situational awareness among nurses and their level of transparency in the administration of medications to patients. The adoption of the technology was also expected to reduce the cost of care incurred by patients and the institution. an i
Internal Inter-professional Stakeholders
- Nurses
- Pharmacists
- Quality assurance personnel
- IT technicians
The internal inter-professional stakeholders that should have been involved in the implementation of the above change in the organization were varied. One of them should have been the nurses. Nurses were the primary implementers of the change. As a result, they should have been involved in all the processes of implementing the change for its success. Nurses should have been trained in the whole process of implementing the project. The successful use of the technology depends on the active collaboration between the physicians, nurses and pharmacists. There was therefore the need to incorporate the pharmacists and physicians into the implementation of the change. The pharmacists and physicians should have been trained on the use of the technology to strengthen safety and quality in the provision of care. The other stakeholder is quality assurance personnel. The quality assurance personnel would have been tasked with the role of determining the safety, credibility, efficiency, and need for the barcode medication administration technology. The IT technicians should have been involved in ensuring that they provide the technical support and maintenance of the system.
External Inter-professional Stakeholders
- Trainers of trainees
- Experts from best performing institutions
- Technology vendor
The successful implementation of the project requires the involvement of a number of external stakeholders. The first one is trainers of trainees. External trainers of trainers should have been involved in ensuring that the internal stakeholders have the required knowledge and skills for implementing the change. The trainers of trainees should have ensured that the users of the technology have the needed competencies for the successful implementation of change. The second external stakeholder is experts from institutions that have demonstrated excellent results following the use of the technology. The experts would have provided critical insights into the requirements of successful use of the technology in practice. The last external stakeholder is representatives from the company selling the technology. The representatives would have provided the technical support in the use of the barcode medication administration in the institution.
Change Theory
- Rogers’ innovation diffusion theory
- Provides insights into process of adoption of change
- Enables tracking of improvements
- Allows adaptability and flexibility in adoption of change (Senior et al., 2020)
The theory of innovation diffusion by Rogers would be appropriate for the successful implementation of the change. The theory provides insights into the process of implementation of a change in an organization. According to the theory, the rate of adoption of a change among the organizational stakeholders vary significantly. An organization has different categories of adopters of a change that include innovators, early adopters, early majority, late majority, and laggards. The managers and leaders of the organizations should therefore embrace interventions that aim at addressing the needs of the above categories of staffs in an organization. The innovation diffusion theory by Rogers also provides insights into the mechanisms for tracking improvements in the implementation of change. For example, the leaders of the change initiative understand the mechanisms of determining whether the needs of each step of the model have been met to enable the continuous implementation of change in practice. Through the model, organizations and stakeholders demonstrate flexibility and adaptability in implementing change.
Health care organizations apply different strategies to improve health outcomes. Practice change improves health outcomes by addressing performance gaps and introducing new processes (Busetto et al., 2018). However, change does not always occur as planned, which can have far-reaching impacts on financial assets and workplace relationships. Therefore, the purpose of this presentation is to describe a situation where change did not go as planned in the workplace and the steps that should have been taken to implement change successfully. Central discussion areas include a background of the situation, the nurse’s role as a change agent, and stakeholders essential in change management. Other areas include a presentation of change theory, impacts of unsuccessful change, and factors to drive upcoming organizational change.
The situation where change did not occur as planned involved the introduction of a zero-tolerance policy in the organization in response to increased cases of bullying. As Mrayyan (2018) stated, zero tolerance towards workplace violence encourages nurses not to endure violence and report it immediately after they encounter it. The law also severely punishes those who commit violent acts like bullying against health care providers. Like other practice change activities, the nursing staff was supposed to be adequately prepared for policy change to embrace it fully. Unfortunately, the management introduced the policy abruptly, which reduced the staff’s commitment to implementing it fully. Hence, it did not achieve the outcomes as projected.
Health care professionals should work in safe care environments to deliver quality patient care. According to Al-Ghabeesh and Qattom (2019), bullying is damaging to the health and productivity of nurses since it impairs their emotional health and increases their desire to quit their occupations. Therefore, zero tolerance towards bullying is a practical intervention for optimizing employee productivity and protecting nurses from the adverse effects of workplace incivility. Homayuni et al. (2021) found that bullying is associated with depression and distress in nurses, which hampers interprofessional collaboration and their ability to provide quality care. A zero-tolerance policy protects the staff from such health dangers and ensures civil conduct among employees as they work to achieve a common goal.
Nurse leaders should introduce and guide while looking forward to achieving multi-dimensional impacts. Practice change achieved by implementing zero-tolerance policies can help to promote ethical conduct among nurses, which is characterized by behaviors that prevent harm and ensuring that employees are responsible for their actions. From a social dimension, nursing practice is conducted in social environments with diverse practitioners. Preventing behaviors that hamper teamwork and cooperation is instrumental in building healthy relationships among diverse teams. Mrayyan (2018) stressed the importance of a zero-tolerance policy in preventing costly medical errors. Preventing such errors also minimizes legal issues stemming from patient harm and improves the organization’s reputation and relationship with partners.
The advanced registered nurse’s role as a change agent is critical for the progressive improvement of patient care outcomes. According to Rafferty (2018), nurses and nurse leaders are directly involved in patient care, and their influence, skills, and guidance are valuable in change implementation. Skills utilization is demonstrated by continuous assessment of practice gaps and introduction of interventions for enhancing performance. Nurse leaders also use their knowledge and skills to promote evidence-based innovation and lead behavior change practices like zero-tolerance policies, motivation programs, and infection control. Other roles include designing and delivering health policy as nurses and patient advocates and mentoring nurses to embrace change to reduce resistance toward new practices.
Stakeholders play a critical role in change implementation. The type, direction, and success of organizational change depend on stakeholder engagement, participation, and support (Jasinska, 2020). One of the key stakeholders involved in change efforts is the caregivers, including nurses and physicians. They are directly involved in change efforts since many practice changes cannot be conducted without them. The organization’s management plays a crucial role in supporting change through resources and preparing the organization for change. Other stakeholders with varying roles include patients, partners and suppliers, political and legal representatives, and accreditation agencies. These stakeholders should be adequately informed about organizational practices to determine whether the organization promotes care quality and patient safety as professionally obliged.
Kurt Lewin’s change management model is highly appropriate for change implementation in a dynamic health care environment. Its basic concepts include driving forces that push change in the desired direction, restraining forces that counter change efforts, and a state of equilibrium. As Hussain et al. (2018) explained, practice change occurs progressively in three basic steps: unfreezing, changing, and refreezing. Unfreezing is primarily about preparing the nursing staff and other stakeholders to understand and embrace change to counter possible resistance. The changing phase involves transitioning to new behaviors and work routines, while refreezing involves sustaining the new status to achieve lasting effects.
Change leaders apply different change models for different reasons. Besides guiding change management in a simple and straightforward process, Lewin’s change theory aims to understand and demonstrate why change occurs (Hussain et al., 2018). Accordingly, change leaders can justify the change and visualize the outcomes. Lewin’s theory also accounts for uncertainties and resistance to change. In most instances, resistance to change occurs when the nursing staff and other stakeholders are not engaged in the change process. To overcome resistance, Lewin’s theory stresses the need for clear and convincing communication and education about the need for the change during the unfreezing phase (Deborah, 2018). Above all, the phased change management helps change leaders to introduce and implement organizational change procedurally.
Organizational change has profound impacts on care quality and work processes. Hence, the change management strategies applied should be centered on achieving change without adverse impacts on behaviors, social relationships, and finances. Due to its straightforward nature and simplicity, Lewis change management model ensures that change is implemented without ethical misconduct or negative impacts on workplace behaviors. The simple process is also economical since it does not include many steps that can be tiring or consume massive resources. Change management through positive behavior change also protects patients, health care professionals, and other populations. Doing so protects the organization from possible reputational damage, which can be politically, ethically, and legally costly.
Advanced registered nurses should be aware of change implementation barriers before initiating practice change. After identifying the change and potential impacts, I would develop a comprehensive implementation plan to share with the management and the nursing staff. Next, I would communicate the change to nurses and all stakeholders since lack of it was the main reason for the initial change failure in the facility. Communication is crucial in the unfreezing phase of change management since it helps stakeholders to understand the change and its importance (Deborah, 2018). The next step would be actively engaging stakeholders to implement the change before its evaluation to determine whether it achieved the desired effects.
Change implementation is usually a lengthy, laborious, and resource-intensive process. It requires preparation, continuous communication, and engagement of stakeholders. Unsuccessful change implies potential misuse of the organization’s resources such as zero tolerance policy handouts and finances used communication and other crucial processes. Since the goal of the change process is to prevent bullying, failure to achieve this goal would increase nurses’ exposure to workplace bullying. Al-Ghabeesh and Qattom (2019) found that bullying lowers nurses productivity since it is psychologically harming, and the same would be witnessed in the organization. Other potential outcomes include increased risk to patient care and disappointment with the change process.
Nurse leaders should never give up with organizational change. Consequently, they should have a backup plan if change is unsuccessful. The most effective intervention to address the current scenario if change does not succeed is a collaborative process and impact assessment. In this case, nurses, nurse leaders, and the management would collaborate to assess why practice change failed and practical remedies. The role of the collaborative assessment would be helping the change team to address implementation barriers before reintroducing the change. Such barriers include communication problems, a resistance culture, and a lack of stakeholder support (Busetto et al., 2018). As the implementation progresses, the change team should seek continuous feedback from stakeholders while monitoring reactions and impacts. Such an impact would help to fix any issue hampering the process timely and conveniently.
Successful organizational change is achieved through a combination of factors. Besides stakeholder engagement and communication as mentioned earlier, employee growth and development will play a crucial role in driving upcoming organizational change. Largely, employee growth and development will equip employees with the skills, knowledge, and attitudes necessary for continuous quality improvement in health practice. Organizations ready for change must foster innovation through nurse leaders who seek new ways to transform and influence higher care quality through new care delivery models (Snow, 2019; Mutonyi et al., 2021) Accordingly, the advanced registered nurse must be at the center of innovation and transformation through continuous assessment of performance gaps and fostering a culture of change in the organization.
As demonstrated in this presentation, the primary goal of practice change is to optimize health outcomes. As a result, nurse leaders and other health care professionals in advanced practice should continually assess performance gaps, promote innovation, and lead behavior-change practices. Since practice change should be systematic and procedural, the advanced registered nurse should initiate change using theoretical guidelines. Kurt Lewin’s change management theory can be applied to introduce change in the organization to achieve the best results. It stresses preparation for change and sustaining it, which are critical to successful change. Additional drivers of change in the organization include the management investing in innovation and employee growth and development programs.
References
- Al-Ghabeesh, S. H., & Qattom, H. (2019). Workplace bullying and its preventive measures and productivity among emergency department nurses. Israel Journal of Health Policy Research, 8(1), 1-9. https://doi.org/10.1186/s12913-019-4268-x
- Busetto, L., Luijkx, K., Calciolari, S., Ortiz, L. G. G., & Vrijhoef, H. J. M. (2018). Barriers and facilitators to workforce changes in integrated care. International Journal of Integrated Care, 18(2), 1-13. http://doi.org/10.5334/ijic.3587
- Deborah, O. K. (2018). Lewin’s theory of change: Applicability of its principles in a contemporary organization. Journal of Strategic Management, 2(5), 1-11. https://stratfordjournals.org/journals/index.php/journal-of-strategic-management/article/download/229/274
- Homayuni, A., Hosseini, Z., Aghamolaei, T., & Shahini, S. (2021). Which nurses are victims of bullying: the role of negative affect, core self-evaluations, role conflict and bullying in the nursing staff. BMC Nursing, 20(1), 1-9. https://doi.org/10.1186/s12912-021-00578-3
- Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: a critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002
- Al-Ghabeesh, S. H., & Qattom, H. (2019). Workplace bullying and its preventive measures and productivity among emergency department nurses. Israel Journal of Health Policy Research, 8(1), 1-9. https://doi.org/10.1186/s12913-019-4268-x
- Busetto, L., Luijkx, K., Calciolari, S., Ortiz, L. G. G., & Vrijhoef, H. J. M. (2018). Barriers and facilitators to workforce changes in integrated care. International Journal of Integrated Care, 18(2), 1-13. http://doi.org/10.5334/ijic.3587
- Deborah, O. K. (2018). Lewin’s theory of change: Applicability of its principles in a contemporary organization. Journal of Strategic Management, 2(5), 1-11. https://stratfordjournals.org/journals/index.php/journal-of-strategic-management/article/download/229/274
- Homayuni, A., Hosseini, Z., Aghamolaei, T., & Shahini, S. (2021). Which nurses are victims of bullying: the role of negative affect, core self-evaluations, role conflict and bullying in the nursing staff. BMC Nursing, 20(1), 1-9. https://doi.org/10.1186/s12912-021-00578-3
- Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: a critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002