IMPLEMENTING CHANGE WITH AN INTERPROSESSIONAL APPROACH PRESENTATION NUR 514

IMPLEMENTING CHANGE WITH AN INTERPROSESSIONAL APPROACH PRESENTATION NUR 514

IMPLEMENTING CHANGE WITH AN INTERPROSESSIONAL APPROACH PRESENTATION NUR 514

Successful change is one of the biggest challenges that modern organizations face. A strategic necessity for change is always needed in this fast-changing world. Besides, if things are not done differently, organizations are unlikely to succeed or last. I will start by describing the background of a situation in my current healthcare organization where change did not go as planned, including the rationale and the purposed goals of the change. In addition, I will identify the key interprofessional stakeholders, both internal and external, that should be involved in change efforts. I will then identify an appropriate change theory or model and discuss how it can be used to achieve results. I will also outline a plan that I would adopt to utilize the change in the healthcare organization. Lastly, I will discuss the impact on the organization if the change initiative would be unsuccessful again, and the potential steps the interprofessional team should take if the change is ineffective.

Brainstorming Questions

1.Do you remember the 3 C’s of change leadership?

2.What are the three key steps of leading the process of strategic change?

3.What are the crucial qualities of leading people?

4.How have you ever affected positive change in your current or former organization?

5.How can you spur positive change on behalf of your organization?●

  In my current healthcare organization, the hospital management introduced the Computerized Physician Order Entry (CPOE) Systems, which were to be used by doctors, consultants, pharmacists, and nurses to prescribe, dispense and administer medications to patients. The prescribing clinician was supposed to use the CPOE to prescribe a patient’s drug by indicating patient information such as age, sex, known drug allergies, current medications, chronic illnesses, and the diagnosis (Baysari et al., 2018). The clinician was also supposed to input the correct medication, the dose, and the frequency of administration. The information would then be sent to the pharmacist who would receive the prescription, ensure the prescribed drug and dose is appropriate for the patient, and dispense the medication. The medication would then be distributed to the patient or a nurse for hospitalized patients. The system would also propose a preferable drug that would suit a patient’s condition and would have no drug interactions with current medications (Holmgren et al., 2019). Nevertheless, the training on the use of CPOE was conducted for four weeks and was done in a hurry. A majority of health providers in the organization did not attend all the training sessions, and for those who were on annual leave did not attend any training sessions. Besides, the sessions had more theory sessions than practical sessions, yet the providers required to be equipped with skills on how to enter patients’ information in the system, searching for drugs and rebooting the system. 

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  There was a challenge in using the CPOE system since there was not adequate time to train the staff on how to use the system. This resulted in clinicians sending the wrong patient prescriptions, and the pharmacists had a hard time dispensing the drugs. This further caused delayed delays in the pharmacy since the pharmacists had to contact the clinician to correct the drug for most patients. Patients had to wait for long before being served due to the mix up in the prescriptions. The staff also had challenged in rebooting the system, which led to further delays as the IT team had to come to fix the system diagnostics issues.

  The health providers further resisted the change since they had not been consulted on their views about the adoption of the CPOE system. Besides, they did not have a specific person they would consult when they needed guidance on the rebooting of systems or transmission of data (Baysari et al., 2018). The management was forced to stop the use of CPOE and advised the staff to prescription papers until they come up with a plan to have a smooth adoption of the system. The organization went back to using prescription papers, which were associated with medication errors that resulted in adverse drug reactions in some patients.

  The rationale for changing the drug prescription process from using prescription papers to using technology systems was the need to adopt and integrate technology in the delivery of services within the organization. Other facilities had adopted the use of CPOE, which had been successful and had significantly reduced medication errors during the prescription and dispensing of drugs (Page, Baysari, & Westbrook, 2017). Besides, health organizations were continuously being encouraged to embrace technology and adopt the use of technology systems to reduce human errors and promote better health outcomes. The use of technology would ease and fasten drug ordering and save time hence enhancing services and improving customer satisfaction (Coustasse et al., 2015). Besides, the change was directed to enhance the drug prescription process since there were reports of patients adding their preferred medications in the paper prescriptions, which had not been authorized by the clinician. There was also a need to reduce medical errors, which were mostly caused by ambiguous handwriting and often gave the pharmacists a hard time reading and interpreting the written prescriptions.

  The CPOE was also adopted to prevent cases where patients were prescribed with drugs they were allergic to and drugs that interacted with other medications that they were currently taking. By using the CPOE, the system would guide the clinicians on the most appropriate medications that would have minimal side effects and no interactions with other prescribed drugs (Gellert, Ramirez, & Webster, 2015). Moreover, the change to CPOE was a result of many complains of clinicians prescribing drug overdoses, and the system would help to correct the dosage as per a patient’s age and diagnosis.

  The goal of the change from use of prescription papers to CPOE system was to embrace health technology in the era of technology. The organization aimed at easing the drug prescription process from when a drug was prescribed to when it was collected and administered to patients. This would also facilitate the pharmacists’ work of reading ambiguous handwriting and having to contact the prescribing clinician to clarify a prescription. The change also purposed to prevent drug prescription errors, which kept the organization at risk of being involved in medico-legal issues (Gellert, Ramirez, & Webster, 2015). Another goal was to promote patient safety by prescribing patients with correct drug dosages, medications that would have minimal adverse effects, and those with minimal or no drug interactions. The organization’s aimed to provide the best quality care possible that promotes patient safety and is cultural sensitive (Baysari et al., 2018). Besides, the system would direct nurses on the right route of drug administration, frequency, and how to monitor a drug’s effects. It would also ensure that clinicians observed the five rights of drug administration i.e right patient, right drug, right dose, right time, and right route.

  Furthermore, the hospital management wanted to ensure correct billing of medications since all prescribed drugs would be recorded under the patients’ inpatient or outpatient numbers. This would ensure equal compensation with insurance companies (Coustasse et al., 2015). Nevertheless, the goals of the change were not achieved due to poor planning on how to implement the use of CPOE system including inadequate training and failing to collect views from the key stakeholders.  

  A stakeholder is a person who has something to gain or lose through the outcomes of a planning process, program, or project (Kneafsey et al., 2016). In the case of the change situation in the healthcare organization, key stakeholders include the people who either gained or incurred losses from the change strategy. 

  Internal stakeholders are individuals in an organization who take part in the coordination, funding, resourcing, and publication of the change strategy from a local health and well-being partnership (Kneafsey et al., 2016). They include the management and employees of an organization. In a healthcare organization, the key internal stakeholders include Director of Public Health, Head of Health Intelligence and Information, Procurement staff, Director of Nursing, Trustees, Board committee members, communications department, Public Health Manager.

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.

IMPLEMENTING CHANGE WITH AN INTERPROSESSIONAL APPROACH PRESENTATION NUR 514 References

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In 1947 Kurt Lewis introduced one of the earliest change models, one of which we still use today. This was the three-step model it is inclusive of unfreezing, freezing, and refreezing (DeNisco, 2021). Change is businesses, especially in healthcare are constantly occurring at a rapid pace. However, with earlier change models one thing that was not taken into account, was interpersonal relationships and how persons will act with the change, personal biases and emotions can lead to a change model becoming less effective and potentially leading to failure.

The newer eight-step model, takes relationships and biases into account. Throughout the eight-step process, modifications can be made starting with step one.

Step 1: Making Sense/Unfreezing

Step 2: Leading or Serving on an Interprofessional Change Team

Step 3: Developing a Team Vision and Charge

Step 4: Identifying and Analyzing Forces of Change

Step 5: Developing a Work Plan for Change Implementation

Step 6: Implementing Change

Step 7: Evaluating Outcomes and Refining as Needed

Step 8: Incorporating Changes into the Culture/Refreezing

In the beginning of the eight-step process, change is proposed by upper management. As we progress through the eight steps, a diverse representation is created from staff members, clinicians, and informal leaders (DeNisco, 2021)

In healthcare practice in Arizona, licensed practical nurses (LPN) were able to practice bedside in acute care facilities such as hospitals. However, overtime that was phased out with more nurses graduating with their bachelors in nursing. Throughout the pandemic, the nursing shortage increased with the senior nurses retiring. Not only did this lead to an overall nursing shortage, it led to a lack of nurses available to train new graduate nurses. Banner facilities, to offset this have implemented the usage of LPNs once gain. While they are not able to take a patient assignment, they are able to task on the units they have been assigned. They are able to do admissions, medication reconciliation, start IVs, and many other things. However, amongst staff the LPN has been pushed aside on many occasions as the tasks they complete have been done incorrectly or not up to the nurses’ expectations.