D158 JAM 1 TASK 1 LAM1: Task 1: Healthcare Improvement Project Implementation Plan

DJ158 JAM 1 Task 1

               The most vital step in a project cycle is the implementation phase since it ensures that every conceptualized idea is translated into reality to achieve the goals and objectives. Central to the implementation is a strategic plan for executing the proposed health improvement project (Leeman et al., 2017).

               While the primary focus is on implementing the project successfully, various aspects have to be considered, such as the socioeconomic data on the selected population that is to be impacted by the proposed health improvement project. Such a step helps in comprehensive analysis to determine opportunities and risks.

                Analysis forces for and against the project is critical in determining the strategies to overcome the forces against the project for success. Therefore, the purpose of this assignment is to explore a strategic plan for the execution of the STRIDE Early Mobility program.

Meetings and Organizational Policies

                 Having meetings are an essential part of any project implementation and management efforts. Therefore, it is prudent to have a timely plan describing how the project meetings would be organized and led (Radujković & Sjekavica, 2017).

                   It is vital to organize and lead meetings, so the leader is more than a moderator or a time monitor and avoids the pitfalls of wanting to make everyone see things from the leader’s point of view, dictating outcomes or direction (Radujković & Sjekavica, 2017). So the meetings will be organized by following various strategies such as formulating relevant objectives for each meeting and translating them into a practical plan through agenda formulation. 

                   The other strategy is to communicate timeously to the team and encourage them to participate in the meeting when the time comes and create an enabling environment that encourages everyone to participate (Lock, 2017) fully and actively. Again, it is essential to communicate the meeting results and accept and incorporate feedback from members to enhance the meeting process.

                  One of the methods to reach consensus during the meetings is facilitating an open discussion and ensuring that every team member participates (Straus, 2017). This step will ensure that everyone’s input is brought on board regarding a particular agenda, reaching the consensus more quickly. When members feel consulted and involved, they are more likely to welcome and accept the decision made regarding the agenda.

           It is vital to find out if the organization has some existing policies that can affect the implementation of the project.  Some of such policies can create a considerable hindrance; hence, it is vital to find more about them to make informed decisions. One of the methods I will use is to request the organization’s policy document from the nurse manager. I would then read the document with a legal expert to help in understanding every clause that could impact the implementation process of the proposed project.

Action Plan Development 

                  The action plan is one of the critical documents in project management and implementation as it gives a clear roadmap on the actions to undertake and strategies to use to ensure that the implementation process is a success and that the goals are achieved (Teixeira & Junior, 2019).

An action plan is in the appendix section (Appendix H).

                     The action plan contains various items such as action item owner role, five action items, the phase in which the item, and the target due date.

Gathering the input related to the development of the action plan is critical in ensuring that the correct input forms part of the action plan.

                    One of the strategies I plan to use is a survey (Zwikael et al., 2018). The survey will have a self-administered questionnaire with questions dealing with various aspects of the forming part of the survey. Through the survey, meaningful and relevant input from the members who will attend to the survey questions. The survey is easy to administer and saves time. It is important to use the right strategy in describing the key steps. Identification of the owner’s role and title was accomplished through a detailed literature search on relevant project implementation and management. In addition, the five high action items, identification of the action phase and the target dates were determined through a collaboration with nurse manager and nurse leader, both who have vast experience in implementing quality improvement and evidence-based practice projects.

SDOH and Target Population

                   Knowing and describing the target population is critical in further aligning the proposed intervention for the health improvement project. Therefore, this section describes the target population’s sociodemographic characteristics and social determinants of health and how the proposed project would affect them.

                  The program targets older individuals living with dementia. This group of people usually faces an enhanced risk of falling. Indeed, persons living with dementia have a twice chance and rates of falling when compared with individuals with the proper cognitive functionality (Peek et al., 2020). Due to their condition, these individuals need much social support to have better outcomes and ensure that they come with the incapacitating nature of the condition. 

                    There are various social determinants of health for elderly individuals living with dementia. One of them is a social support network. These individuals experience the adverse impact of this chronic condition and therefore need social support from different networks. 

                     Belonging to social support groups leads to better health outcomes for this population. Socioeconomic status is another determinant of health (Young et al. 2020). Better economic wellbeing is associated with better health outcomes as the patients can afford care and related services.

                     Neighborhood and physical environment is another social determinant of health for this group. A supportive neighborhood ensures that they have better health outcomes. When the physical environment is modified to reduce falls, these patients have higher chances of better patient outcomes.

                       Education is another determinant. Individuals with low levels of education tend to have limited knowledge on various aspects such appropriate access to care, self-care activities and relatively less finance to seek medical attention and payment of bills. Therefore, such individuals could have worse health outcomes.

                       The other social determinants related to health and healthcare is health coverage. Some of these patients lack health insurance, and when a patient lacks health insurance, they have considerably lower chances of having a primary care provider, hence impacting negatively on their health outcomes (Northwood et al., 2018). The other determinant is quality of care. Patients living with dementia need a high quality of care for better health outcomes as the condition is disabling mentally. As such, when patients lack access to high quality care, then they have poorer outcomes. Health coverage and quality of care are two of the most important SDOH that address health and healthcare related to patients with dementia. As earlier indicated, these patients are also susceptible to falls due to their condition, however, if they have higher quality of care and better health coverage, then their chances of falling is greatly reduced.

                    The proposed intervention entails a physical activity program. The program entails the initiative of a walking program among patients living with dementia who risk falling. The STRIDE Early Mobility program can improve the health outcomes among the identified target population by reducing falls. When the incidences of falls, these patients have a reduced risk of overstaying in the hospitals. The implication is reduced healthcare spending and decreased exposure to healthcare-acquired infections. 

Force Field Analysis 

                    The force field analysis allows identifying the forces which are likely to drive the implementation of the proposed intervention forward and the possible forces that are likely to oppose the implementation process (Rosenbaum et al., 2018).

A detailed force field analysis table has been included in appendix I.

                     In analyzing the force field table, three positive or driving forces and three hostile or restraining forces. The positive or driving forces identified include positive organizational support, effective communication, and a strong commitment from the leadership team.

                      On the other hand, the three identified hostile or restraining forces include possible resistance to the change implementation, inadequate resources, and lack of stakeholder engagement. The positive forces will help plan for the implementation of the proposed project.

                     Positive organizational support means that the implementation process is likely smoother since the organization supports the project (Rosenbaum et al., 2018). Therefore, the focus will lead to other organizational factors likely to hinder the implementation process.

                    Effective communication as a driving force means that the implementation process will as the team members will be able to pass vital information related to the project more effectively to support the implementation process.

                   The leadership team is also committed to the change hence such a force will be critical in the implementation process. The implication is that little or no supervision will be needed while implementing the project.

 The existence of the opposing forces is also likely to influence the implementation phase. For example, change resistance can derail the whole implementation process (Rosenbaum et al., 2018).

                     So as part of the implementation plan, strategies will be used to overcome possible resistance, such as increased involvement of every member and to send out communications in time (Hodgson, N., & Gitlin, 2021). The possible existence of inadequate resources means that appropriate plans to procure the needed resources in time. On the other hand, lack of stakeholder engagement implies that strategies will as part of the plan to increase stakeholder engagement. 

                     The force field theory shows that the desired change occurs after the positive forces override the opposing forces (Rosenbaum et al., 2018). Therefore, it is essential to use relevant and appropriate strategies to overcome the restraining forces. The possible resistance to change can be overcome by undertaking a clear communication initiative and making every member understand why the change is necessary (Bel et al., 2018).

                    This step will ensure that they buy into the idea and effectively support the initiative. Their opinions and thoughts should also be integrated into the process if possible; this will make them feel a sense of belonging and feel part of the project hence lowering the chances of resistance. Inadequate resources can derail the implementation process (Fadlallah et al., 2018).

                     Therefore, a funding request to the relevant entities supporting the initiative and ensuring that the needed resources are procured and made available in time. The opposing force of lack of stakeholder engagement will be overcome by timely communication with the stakeholders and promptly addressing their concerns. They will also be encouraged to participate actively and contribute to ensure that they feel part of the project.

Gantt Chart Information

                      A Gantt chart is a powerful tool that helps visualize the significant tasks of activities performed in a health improvement project process by indicating the start dates, end dates, the progress, and who is assigned to do what (Astafeva, A., & Gazizulina, 2021). In support of the Gantt chart, the start and end dates of the major activities are indicated below.

Task	Start Date	End  Date
Planning	25-Jan-22	01-Feb-22
Literature Search	28-Jan-22	02-Mar-22
Project Design	30-Jan-22	03-Apr-22
Implementation	04-Apr	02-Jun-22
Follow up	03-Jun-22	25-Jul-22

                     The approach used in creating the Gantt chart was through the Microsoft Excel software. This software enables a smooth creation of the Gantt chart with possible modifications added to customize the output. The information to formulate the Gantt chart through a comprehensive literature search on the significant activities in the health improvement implementation plan.

                        The literature search was therefore vital in offering the possible activities to include. Consultation with the nurse manager was also crucial since they have engaged in many health improvement projects. Therefore the advice was used to modify the information obtained from the literature search to make it more relevant. The five high action items, identification of the action phase and the start and end dates were determined through a collaboration with nurse manager and nurse leader, both who have vast experience in implementing quality improvement and evidence-based practice projects.

                       A complete Gantt chart is in Appendix J.

Scope Statement

                       The project’s justification is that patients living with dementia are more prone to falls, and therefore there is a need to design programs that can prevent these fall events (Modarresi et al., 2019). Even though various programs for fall prevention exist, these programs are still inadequate; as shown in the increased cases of patient falls, it needs more robust programs.

                      The goals of this project entail using health information technologies to prevent and reduce the rate of falls among patients with dementia. The project aims at achieving measurable goals that include a reduction in the rate of falls among patients with dementia, costs incurred, and average hospital stay by these patients. Evidence shows that adopting interventions to reduce and prevent patient falls enhances patient care safety, quality, and efficiency. 

                         The project deliverables include a well-tested, acceptable, and usable walking program for preventing falls among patients living with dementia. Another deliverable is acceptable levels of adherence to the use of the walking program.

                        The key performance indicators include reduced rates of falls among patients living with dementia, reduced costs incurred by patients living with dementia, and reduced duration of hospital stay.

The project’s outcome is reducing the rate of falls among patients with dementia.

                          The secondary outcomes include the reduction in the costs incurred by patients with dementia, hospital stay, and improvement in the overall efficiency in the institution. The project aims to decrease elderly patient falls on the Medical-Surgical Unit by 30%, beginning October 2, 2021, to July 30, 2022, through the implementation of the STRIDE Early Mobility program. 

Communication Management Plan

                            A communication management plan ensures effective communication throughout the project phases. Therefore, correct information should be communicated promptly to the right people (Samáková et al.,2018). Therefore, the intended receivers of the communication are the implementation team, the stakeholders, and policymakers.

                        The context of the communication will be from the pre-implementation period, during the implementation period, and the post-implementation period. Expected communication outcomes include improved processes and activities during the implementation face, increased by in and reduced resistance to the proposed change.

                     While the key messages will depend on the phase of the project, the underlying theme will be rallying the efforts of everyone to support the project. The message medium will majorly be through email as it is official and can send multiple and bulk messages simultaneously. The Covid-19 protocols and restrictions will be the barest minimum for face-to-face messages conveyance meetings.

References

Astafeva, A., & Gazizulina, L. (2021). Project management tools in the organization of language training of students in the technological university. In INTED2021 Proceedings (pp. 10659-10665). IATED. http://dx.doi.org/10.21125/inted.2021.2236

Bel, R., Smirnov, V., & Wait, A. (2018). Managing change: Communication, managerial style and change in organizations. Economic Modelling, 69, 1-12. https://doi.org/10.1016/j.econmod.2017.09.001.

Fadlallah, R., El-Jardali, F., Hemadi, N., Morsi, R. Z., Abou Samra, C. A., Ahmad, A., … & Akl, E. A. (2018). Barriers and facilitators to implementation, uptake, and sustainability of community-based health insurance schemes in low-and middle-income countries: a systematic review. International journal for equity in health, 17(1), 1-18. https://doi.org/10.1186/s12939-018-0721-4

Hodgson, N., & Gitlin, L. N. (2021). Implementing and sustaining family care programs in real-world settings: Barriers and facilitators. Bridging the family care gap, 179-219. https://doi.org/10.1016/B978-0-12-813898-4.00006-3

Leeman, J., Birken, S. A., Powell, B. J., Rohweder, C., & Shea, C. M. (2017). Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice. Implementation Science, 12(1), 1-9. https://doi.org/10.1186/s13012-017-0657-x.

Lock, D. (2017). The essentials of project management. Routledge.

Modarresi, S., Divine, A., Grahn, J. A., Overend, T. J., & Hunter, S. W. (2019). Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review. International psychogeriatrics, 31(9), 1287-1303. https://doi.org/10.1017/S1041610218001783.

Northwood, M., Ploeg, J., Markle‐Reid, M., & Sherifali, D. (2018). Integrative review of the social determinants of health in older adults with multimorbidity. Journal of Advanced Nursing, 74(1), 45-60. https://doi.org/10.1111/jan.13408

Peek, K., Bryant, J., Carey, M., Dodd, N., Freund, M., Lawson, S., & Meyer, C. (2020). Reducing falls among people living with dementia: A systematic review. Dementia, 19(5), 1621-1640. https://doi.org/10.1177%2F1471301218803201

Radujković, M., & Sjekavica, M. (2017). Project management success factors. Procedia engineering, 196, 607-615. https://doi.org/10.1016/j.proeng.2017.08.048.

Rosenbaum, D., More, E., & Steane, P. (2018). Planned organizational change management: Forward to the past? An exploratory literature review. Journal of Organizational Change Management. https://doi.org/10.1108/JOCM-06-2015-0089

Samáková, J., Babčanová, D., Chovanová, H. H., Mesárošová, J., & Šujanová, J. (2018). Project communication management in industrial enterprises (step by step). In Digital Communication Management. IntechOpen. (Samáková, et al.,2018).

Straus, D. A. (2017). Managing meetings to build consensus. In Multi-Party Dispute Resolution, Democracy and Decision-Making (pp. 389-425). Routledge. https://www.taylorfrancis.com/chapters/edit/10.4324/9781315248592-15/managing-meetings-build-consensus-david-straus

Teixeira, G. F. G., & Junior, O. C. (2019). How to make strategic planning for corporate sustainability?. Journal of Cleaner Production, 230, 1421-1431. https://doi.org/10.1016/j.jclepro.2019.05.063.

Young, H. M., Bell, J. F., Whitney, R. L., Ridberg, R. A., Reed, S. C., & Vitaliano, P. P. (2020). Social determinants of health: Underreported heterogeneity in systematic reviews of caregiver interventions. The Gerontologist, 60(Supplement_1), S14-S28. https://doi.org/10.1093/geront/gnz148

Zwikael, O., Chih, Y. Y., & Meredith, J. R. (2018). Project benefit management: Setting effective target benefits. International Journal of Project Management, 36(4), 650-658. https://doi.org/10.1016/j.ijproman.2018.01.002

Appendices

Action Plan (Appendix H) (D158):

Action Item Owner Role or Title Five Action Items (specific, high-level) Phase Action Item Will Be Completed (e.g., pre-, during, or post- implementation) Target Due Date   1. Nurse manager and Nurse leader         Planning-This involves establishing a foundation for the whole project such as timeline, resources needed and role description Pre-implementation 01-Feb-2022 2. Nurse leader and nurse       Literature search and review-This involves a comprehensive research on what exists in literature regarding patients falls, strategies used, and possible gaps Pre-implementation 02-March-2022 3. Nurse manager         Project Design- This action entails putting together all the specifics of the project’s requirements in readiness of the implementation Pre-implementation 03-April-2022 4.   Nurse manager and Nurse educator     Implementation- the action entails testing the STRIDE program among the older adults and evaluating its impacts, before rolling out the program in every unit Implementation phase 02-June-2022 5. Nurse manager and nurse leader       Follow-up-this action entails monitoring how the program functions and making necessary adjustments to ensure that it is effective in the long term Post-implementation 25-July-2022

Appendix I

Healthcare Improvement Project

Force Field Analysis Template

Force Field Analysis
A force field analysis will assist you in identifying the driving and restraining forces for implementing your healthcare improvement project. In the table below, list three positive forces that will drive the implementation of your project and three negative forces that will restrain it.
3 Positive (Driving) Forces	3 Negative (Restraining) Forces
Positive organizational support	Possible resistance to change
2. Effective communication	2. Inadequate resources
3. Strong commitment from the leadership team	3. Lack of stakeholder engagement

APPENDIX J

GANTT CHART