Benchmark – Evidence-Based Practice Project Proposal Organizational Culture and Readiness NUR 590

benchmark - evidence-based practice project proposal organizational culture and readiness nur 590

NUR 590 Benchmark – Evidence-Based Practice Project Proposal: Organizational Culture and Readiness

A Sample Answer For the Assignment: Benchmark – Evidence-Based Practice Project Proposal Organizational Culture and Readiness NUR 590

Organizational Culture and Readiness

The evidence-based practice process entails various steps which have to be followed for the success of the project. One such stage is the implementation phase, which is arguably the most important stage. Implementing such a change in an organization requires that the change implementers assess the organization’s culture and readiness for change (Ost et al.,2020). Such an assessment is key in making the necessary adjustments that would enhance the chances of the project’s success.

The assessment of an organization’s culture can be accomplished using various tools, which can be picked depending on the need at hand. Therefore, the purpose of this assignment is to present the findings of the assessment of the organization’s culture and readiness for the implementation of the proposed intervention.

The Organization’s Culture and The Degree It Supports Change

A positive organizational culture supports the implementation of change. As such, it is key to assessing the organization and how it supports change (Cleary‐Holdforth et al.,2021). The organization’s leaders have shown indications of offering support to initiatives such as the EBP process with a major focus on improving the organization’s performance and patient outcomes. In addition, the organization targets to gain magnet status hence supporting change initiatives.

The organization’s mission and aim is to provide exemplary and excellent patient care services at affordable cost by employing the latest strategies of care. The organization also urges staff and other employees to offer support for the mission and vision and embrace positive change within the organization. As part of the organization’s focus, interprofessional teams and collaborations are encouraged to improve patient outcomes. As such, the organization’s culture supports EBP and is ready for change.

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The Selected Organizational Readiness Tools and Summary of Results

The selected tool is the organizational culture and readiness for the System-Wide Integration of the EBP survey tool, which has been shown to be effective in assessing an organization’s capacity to cope and adapt to potential changes (Melnyk et al.,2022). The tool was key in exploring the leaders’ and staff’s understanding of the potential change of using the new CAUTI bundle. From the survey conducted, important results were revealed.

Around 91% of the employees indicated that they support the proposed change, an indication that only a minority were not supporting the initiative. The majority of the organization’s leaders were also ready to support change, as up to 80% of the leaders showed a willingness to support the proposed change. The majority of the leaders and staff support the proposed change; hence the organization’s culture would support and sustain the proposed change.

Even though the culture supports the proposed change, it is worth noting that there are potential barriers

benchmark - evidence-based practice project proposal organizational culture and readiness nur 590
Benchmark – Evidence-Based Practice Project Proposal Organizational Culture and Readiness NUR 590

and weaknesses that may derail implementation. For example, lack of support by minority leaders as staff can be a major drawback. The assessment will also be key in exploring the staff knowledge in using the proposed CAUTI bundle, which will then help to formulate strategies for improving their knowledge. The leaders supporting the initiative will play an important role in availing the required resources and supporting the project through making effective decisions and formulating change champions who can then help on driving the change initiative as appropriate.

Suggestions for Health Care process and Systems For Improvement

The use of a CAUTI bundle has been proposed to help solve the practice gap identified at the facility. Hence one of the strategies is to collaborate with healthcare organizations that are already using the CAUTI bundle. Such collaborations will help the organization improve outcomes (Luckenbaugh & Auffenberg, 2018). Interprofessional collaboration within the organization will also be key for improvement and in helping in the successful implementation of the project as well as its sustenance.

Strategies To Facilitate The Readiness

Improving readiness can be key in change implementation. The current patient care initiative has not been effective in improving patient outcomes, which calls for change implementation. Such statistics on increased rates of CAUTI will be used to let the staff know why it will be key to accept the change (Advani & Fakih, 2019). Education will also be used as a way of preparing the staff for the impending change.

The Project’s Key Stakeholders and Team Members

Identifying stakeholders and team members is important for the success of the project. The implication is that such stakeholders and team members should be identified in time. The stakeholders include physicians, nurses, unit leaders, nurse managers, patients, and their families (Melnyk et al.,2022). As part of the project, every stakeholder has a significant role to play.

The Information and Communication Technologies Needed For Implementation

Information communication technology is important in the implementation process. One of the tools to be used is electronic health records. Electronic health records will be used to obtain existing data and to collect the required data (Melnyk et al.,2022). The collected data will be analyzed to help determine the effectiveness of implementing the CAUTI care bundle.

Conclusion

The nature of an organization’s culture impacts how an EBP can be implemented in the organization. Hence it is important to assess the culture. The assessment carried out showed that the organization’s culture supports EBP. It also revealed that the staff and the leaders are ready for change

References

Advani, S. D., & Fakih, M. G. (2019). The evolution of catheter-associated urinary tract infection (CAUTI): is it time for more inclusive metrics?. Infection Control & Hospital Epidemiology40(6), 681-685. Doi: doi:10.1017/ice.2019.43

Cleary‐Holdforth, J., O’Mathúna, D., & Fineout‐Overholt, E. (2021). Evidence‐based practice beliefs, implementation, and organizational culture and readiness for EBP among nurses, midwives, educators, and students in the Republic of Ireland. Worldviews on Evidence‐Based Nursing18(6), 379-388. https://doi.org/10.1111/wvn.12543

Luckenbaugh, A. N., & Auffenberg, G. B. (2018). Leveraging the clinical collaborative model to drive value improvement. Current Opinion in Urology28(4), 348-353. https://doi.org/10.1097/01.numa.0000372027.22111.c5

Melnyk, B. M., Hsieh, A. P., & Mu, J. (2022). Psychometric properties of the Organizational Culture and Readiness Scale for System‐Wide Integration of Evidence‐Based Practice. Worldviews on Evidence‐Based Nursing19(5), 380-387. https://doi.org/10.1111/wvn.12603

Ost, K., Blalock, C., Fagan, M., Sweeney, K. M., & Miller-Hoover, S. R. (2020). Aligning organizational culture and infrastructure to support evidence-based practice. Critical Care Nurse40(3), 59–63. https://doi.org/10.4037/ccn2020963

Assessment Description

For one to successfully execute organizational change within their workplace, the change agent must assess the organization’s culture and readiness for change. In 750-1,000 words, analyze the culture and level of readiness of the organization for which your evidence-based practice project is proposed. You will use the assessment of the organization’s culture and readiness in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Include the following:

  1. Describe the organization’s culture and explain to what degree the culture supports change. Consider organizational and leadership structure, mission and values, interprofessional collaboration/team engagement, communication, perception of the organization by employees, etc.

Organizational Culture and Readiness

Implementing change initiatives in the care environment is key to improving patient outcomes, the delivery of healthcare services, and improving the staff working conditions. The successful implementation of such initiatives needs an appropriate organizational culture with the right resources and framework in place. Therefore, it is important to perform an assessment that can reveal the organization’s readiness for the project’s implementation (Ost et al.,2020).

Such an assessment requires a valid tool that can be important in assessing the organization’s culture for readiness in implementing EBP. As such, the purpose of this assignment is to assess the organizational culture and its readiness for EBP implementation. The assessment was performed using a validated tool; thus, such findings are discussed in the next sections.

The Organization’s Culture and The Degree It Supports Change

As discussed earlier, the implementation of change initiatives is important in improving patient outcomes. However, a successful implementation is enhanced by a positive organizational culture that supports EBP by providing a conducive environment and eliminating potential barriers (Hayirli et al.,2021).

The proposed changes should also align with the organization’s vision, values, and mission. The organization leaders at the current institution are supportive and are ready to support EBP implementation to help the organization grow and offer exemplary patient care services. The pursuit of magnet status has set the organization on the path of supporting EBP initiatives.

The organization’s mission is to offer improved and equitable patient care to everyone, especially the underserved population. The leaders have shown the urge to support this mission by supporting EBP initiatives and eliminating a potential barrier to achieving quality and safe patient care. The organization also has, for a long time, been supporting interprofessional teams to work together and offer acceptable levels of patient care to patients and reduce adverse events such as patient falls. Therefore the level of readiness of the organization can be considered as high.

  1. Select an organizational readiness tool and assess the level or readiness for change within your organization. Identify the readiness tool and summarize the survey results. Discuss the degree to which the culture will support and sustain an evidence-based practice change. Consider strengths and weaknesses, potential barriers, stakeholder support, timing of the proposal, and resources. Provide rationale.

The Organizational Readiness Tool and a Summary of The Assessment Results

Assessment tools can be used to effectively assess the organization’s readiness. Therefore, the organizational culture and readiness for the System-Wide Integration of the EBP survey tool were used in the assessment (Patton et al.,2022). The tool has been shown to be effective in an organization’s readiness assessment. Therefore, it was used to assess the organization’s ability to promote EBP and the assessment of the understanding of the staff and leaders on the proposed change of using automated fall detectors to control or reduce patient falls.

The survey carried out revealed important results in terms of how ready the organization was in reference to the proposed solution. From the results, it was noted that up to 87% of the employees support the proposed initiative. The implication is that the majority of the employees are ready for the change and are positive that change would be vital in improving the quality of patient care services in the organization.

Up to 73% of the organization’s leadership also supported the proposed initiatives. Therefore, again, a majority of the leaders are certain that the proposed solution would positively impact the organization. As such, the fact that the majority of the individuals in the organization support change, the culture would support and sustain the proposed EBP change (Patton et al.,2022).

It is evident from the assessment that the culture in place would support the EBP implementation. However, there are other aspects, such as strengths and weaknesses, potential barriers, stakeholder support, and resources, that should be explored. Among the potential challenges is a lack of support from the leaders and employees who are negative about the change.

Through the assessment, it will be possible to have an idea of the weakness and strengths of nurses’ skills related to the use of automated fall detectors. It is also important to note that management support will be key to the success of the implementation. The leaders will play a critical role in decision-making and creating a team of champions to drive the change forwards as appropriate.

  1. Discuss what health care process and systems you would recommend for improving quality, safety, and cost-effectiveness for the organization.
  2. Propose strategies to better facilitate the readiness of the organization.
  3. Identify the stakeholders and team members for the project. Include what their duties will be in the evidence-based practice project proposal.
  4. Explain what information and communication technologies are needed for the implementation and how they will be integrated in the setting by the internal stakeholders. Explain how these will help improve nursing practice and care delivery for individuals and populations for your intervention.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

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Topic 2 DQ 1

Compare two organizational readiness tools. Identify the tool you selected and explain why it is most appropriate for assessing your organization.

“The ability of non-governmental organizations, government agencies, and corporations to deliver and support the availability and use of interventions for improved global public health depends on their readiness to do so” (Dearing, 2018). The COVID-19 pandemic proved that my organization as well as many healthcare organizations were not and are not ready for such public health crisis.

What my organization experienced (the chaos and dysfunction) makes me question our organization readiness and whether we are even ready to implement my change proposal to increase more nurses. I say this because, when the pandemic began the organization was already cutting essential resources in the name of cost savings without properly conducting a cost benefit analysis. Our organization was short of qualified registered nurses and they refused to hire more nurses because they did not want to allocate the funds to do so even though they had enough money to hire more nurses.

When it comes to presenting my idea, I foresee a backlash from upper management when it comes to allocating the funds to hire more nurses. A strategy I would propose comes from the TeamSTEPPS assessment tool. One of the steps would involve conducting a “briefing for senior leaders and key stakeholders about the TeamSTEPPS program, including its purpose and goals, what’s required from an organizational perspective, and what’s required of them to make the initiative a success; making sure they are aware of what will be needed for your organization to gain the benefits from TeamSTEPPS and allow them to make an informed decision” (Agency for Healthcare Research and Qualty, 2016). There is an abundance of current research that supports having strong nurse staffing levels and my goal is to produce the data to directly links staffing levels to patient care outcomes.

References:

Dearing, J. (2018). Organizational Readiness Tools for Global Health Intervention: A Review. Frontiers in Public Health. (6):58. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840160/

Agency for Healthcare Research and Quality (AHRQ). (2016). Tips and Suggestions for Enhancing Organizational Readiness. Retrieved from https://www.ahrq.gov/teamstepps/readiness/abouttips.htm

Organizational readiness can be used to learn the degree of motivation within candidates or potential organizations when implementing a process, determining particular capabilities, assisting in improving organizational capacities, and help to bring more value to their clients (Dearing, 2018). 

The Organizational Readiness to Change Assessment (ORCA) is an assessment tool that determines the strength and evidence provided for the intended change ro innovation, quality of the organization’s process to support change, and the organization’s capacity to facilitate and carry out change (The National Collaborating Centre for Methods and Tools, 2017). This tool helps to assess an organization’s strengths and weaknesses to support and implement evidence based practice changes.

Organizational Readiness for Implementing Change (ORIC) is a readiness tool used to assess and measure the organization’s readiness for implementation and change in a healthcare setting. Not only can this tool assess the organization’s willingness to initiate a change it also observes and determines the organization’s commitment (Storkholm, 2014). For my organization I would use the ORCA too.

While the ORIC can determine the organizations commitment, it focuses mainly on individuals and not the entire healthcare setting as a whole. In comparison, the ORCA can determine an organization’s strengths and weaknesses beyond the individuals initiating the change, but rather as a healthcare institution as a whole. An organization may have committed individuals but if they do not have proper funding, resources, management, supplies, equipment etc, the change will not be effective or beneficial for staff or patients.

 References

Dearing, J. W. (2018). Organizational readiness tools for global health intervention: a review. Frontiers in public health6, 56.

The National Collaborating Centre for Methods and Tools. (2017). Organizational Readiness to Change Assessment (ORCA) tool | Resource Details | National Collaborating Centre for Methods and Tools. Nccmt.ca. https://www.nccmt.ca/knowledge-repositories/search/187

Storkholm, M.H., Mazzocato, P., Tessma, M.K. et al. Assessing the reliability and validity of the Danish version of Organizational Readiness for Implementing Change (ORIC). Implementation Sci 13, 78 (2018). https://doi.org/10.1186/s13012-018-0769-y

Health organizations significantly influence the success of change projects implemented to improve outcomes. Factors such organizational culture, leadership, and management dictate the approaches that interprofessional teams adopt for the success of a change initiative. Nurses and other healthcare providers play a crucial role in assisting their organizations to embrace interventions that will drive excellence in service provision. Therefore, this paper examines the organizational aspects that will influence the implementation of the proposed change.

Organization’s Culture

Culture characterizes the way organizations and their stakeholders undertake tasks. One of the aspects of the practice site is teamwork. Healthcare providers utilize teams in getting organizational tasks done. The leadership and management advocate for interprofessional collaboration to achieve optimum outcomes. The other feature of the organization’s culture is open communication. The leadership and management encourage two-way flow of information. The staff must be informed of any changes and have the freedom to express their views of concern to the management and leadership.

The organization also has a culture of patient safety. It empowers its staff to be competent in the delivery of evidence-based care that aligns with the needs and expectations of their populations. The organization also supports quality improvement projects that align with its mission and vision (Halm, 2019). Based on these, the organizational culture supports change. It has the flexibility that is needed for the implementation of continuous improvement initiatives in the organization.

Organizational Readiness Tool

The Organizational Readiness to Change Assessment (ORCA) tool was selected to assess the organization’s readiness for change. The tool assesses the organizational readiness to support evidence-based practices in the provision of patient care in the clinical settings. The tool focuses on the strength of the proposed change, quality of the organization’s context to support change, and its capacity in facilitating the change. The ORCA tool revealed that the organization is ready to implement change.

The tool revealed that the proposed initiative is appropriate in addressing the crucial organizational needs. The tool also identified that the organizational culture both from clinical management or leadership and staff members support the change. The leadership utilizes formal methods such as teambuilding to achieve the desired outcomes in change initiatives. The organization also supports open communication, which is crucial for organizational success. There is also ready leadership and management support for the proposed change (Santos, 2021). Based on these outcomes, the organization appears ready to support and sustain the proposed change.

Some of the strengths identified from the tool include the existence of teamwork, supportive leadership and management, knowledgeable staff, and organization’s mission that supports change. Some of the identified weaknesses include overlap of team member roles in the change process and lack of clarity in clinical champion roles such as the individuals responsible for project’s success.

Among the potential barriers are staff resistance and inadequate institutional support (Karrer et al., 2020). The organization will provide resources such as finances and materials needed for project implementation. Stakeholder support will be obtained through lobbying for the change, increasing staff participation, and training them on the implementation process.

Healthcare Process and Systems

One of the recommended healthcare systems that should be adopted to improve safety, quality, and cost-effectiveness in the organization is barcode system of medication administration. Barcode system will benefit the organization by reducing the rate and risk of medication errors (Hutton et al., 2021). The other system is telehealth, which can help the organization to reduce its costs by delivering virtual care to patients suffering from chronic illnesses.

A needed change in the organization’s process is the adoption of models of quality improvement. Accordingly, the organization should incorporate models such as the lead or six sigma into its approaches to service provision. These models will increase the organization’s awareness of the effectiveness of its strategies and build on best practices in service provision.

Facilitating Readiness

One of the strategies that will be adopted to facilitate readiness for change will be training. Training opportunities will be offered to equip the adopters of the change with the competencies they need for them to successfully implement the change (Speroni et al., 2020). The other strategy is increasing stakeholder involvement. Increased stakeholder involvement will minimize the potentials of resistance to change from the adopters.

It will also encourage change ownership, hence, sustainable outcomes. The last strategy will be encouraging open communication (Mrayyan, 2020). Open communication will enable the stakeholders learn more about the change and offer insights on how the change outcomes can be achieved efficiently.

Stakeholders and Team Members

The stakeholders for the change will comprise nurses, nurse leaders and nurse managers. Nurses will be directly affected by the proposed change. Their involvement will be crucial to ensure that the change aligns with their expectations, knowledge, and skills. Nurse leaders and managers will facilitate the change process.

They will lobby for adequate institutional support for the change. They will also ensure that the change is utilized correctly and consistently in the organization. The implementation of the proposed change will require simple information and communication technologies. Data will be capture in Microsoft Excel. Presentations during training and project implementation will be done using a projector.

Conclusion

In summary, the organizational culture supports the proposed change. The selected tool demonstrated the readiness of the organization for change. Process and system changes are needed to improve performance in the organization. Evidence-based strategies will be adopted to facilitate readiness for change.

The two organizational readiness tools identified are the Organizational Capacity Assessment (OCA) Tool by the United Nations Development Programme (UNDP) and the Capacity Development Results Framework (CDRF) by World Bank Institute (WBI) (Dearing, 2018). As the title suggests, the organizational capacity assessment is designed to assess the overall capacity of an organization in five main areas: governance, organizational management, program management, human resources management, and financial management (United Nations Development Programme (UNDP), 2008).

On the other hand, CDFR is a readiness assessment methodology that is commonly applied in design, implementation, monitoring, management, and evaluation of development programs (Otoo, Agapitova, & Behrens, 2009). Like the OCA tool, the CDRF can be used as a step-by-step approach for planning, implementing, and evaluating development projects

While the two identified organizational readiness tools attempt to evaluate the capacity of the organization in planning and implementation of development programs, the OCA tool has been selected as the most appropriate tool for the organization. This tool is the best because it looks into all the main areas of the organization: leadership, program management, and human resources.

References

Dearing, J. (2018). Organizational Readiness Tools for Global Health Intervention: A Review. Frontiers in Public Health, 6(56), 1-6. https://doi.org/10.3389/fpubh.2018.00056.

Otoo, S., Agapitova, N., & Behrens, J. (2009). The capacity development results framework : a strategic and results-oriented approach to learning for capacity development (English). Retrieved from World Bank Group: http://documents.worldbank.org/curated/en/482971468188374127/The-capacity-development-results-framework-a-strategic-and-results-oriented-approach-to-learning-for-capacity-development

United Nations Development Programme (UNDP). (2008). UNDG Capacity Assessment Methodology. Retrieved from UNDP: https://unsdg.un.org/sites/default/files/UNDG-Capacity-Assessment-User-Guide-Feb-2008-FINAL.doc

PICOT question (P) Among adult patients (65 and over), Does the (I) implementation of hourly rounding (C) compared to the use of call light (O) decrease the incidence of falls in a long-term care facility (T) in a period of 6 months? 

Falls are one of the leading causes of morbidity and mortality among geriatric populations. Falls are predisposed to injury, loss of freedom, reduced mobility, hospitalization, nursing home placement, and early death. According to CDC (2021), One out of five falls causes a serious injury such as broken bones or a head injury. These accidents lead to higher medical expenses, advances in mortality, and preventable suffering, but they can be minimized by research, preparation, and reporting. 

It is becoming more prevalent as the population ages that falls are a hot topic in healthcare facilities. A fall that negatively affects people over 65 years of age’s quality of life and functionality is considered an emerging issue requiring urgent attention. A nurse is an integral part of the health care system, and nursing education and awareness help prevent various problems. Nursing intervention reduces the higher incidence of falls. Long-term care facilities have successfully reduced falls by implementing fall prevention programs following best practices. My proposed intervention is the implementation of hourly rounds using 4 P’s (pain, position, prompted voiding, and placement) to reduce the rate of falls among the elderly population living in a long-term care facility. Hourly rounding is a structured approach to patient care that involves regularly checking on patients to address their needs and concerns proactively. This approach has been shown to be effective in reducing falls by ensuring that patient’s needs are met promptly, and potential fall risks are identified and addressed early. Researchers at the Baltimore Medical Center found that when hourly rounding was introduced for three weeks, call light use declined by 52%, no falls were reported, and pressure ulcer rates declined by 56% (Medina & Merozier, 2020). 

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