Virtual Teaching Hospital Research

Understand the principles of change management in health and social care or children and young people’s settings. 01.1 01.2 01.3 01.4

According to Krist-Ashman and Hull (2015), one of the dimensions change facilitator needs to consider is the change agent, that is, people in the organizations who also consider the change as needed. Therefore, in this case, Louisa will be the change agent. She can also work on interviewing managers of 4 units to see if there is any other can also be a change agent.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

Patients are medicated, in an unknown environment, attached to lines, drains, and physiologically impaired in some manner. They are at a very high risk for falling. The American Hospital Association explains how participating hospitals have reduced falls by 27% by using the bundles and toolkits from Hospital Engagement Network (AHA HEN), this process requires the interdisciplinary team involvement. Each has their own role, nursing plays a critical role in fall prevention, they are with the patient for 12hours in a hospital setting and have direct care with assessing, creating a care plan, implementation of interventions, and evaluation. They can report any concerns or data to the

Implementing a change project is a challenging step of the Capstone Change Project. This paper focuses on steps that must be taken to implement a change, strategies to ensure the success, involved stakeholders and their roles, educational requirements, safety issues, ethical considerations, and external or internal regulations’ effects on the process. It also include the change theory, nursing theory, and evidence based practice influences on the implementation process.

When organisations want to implement change they need to have a plan, taking into consideration existing information that leads to the change, stakeholders views have to be followed for successful implementation, the public views is important, service user’s expectations have to be met by appointing a service team.

The skills needed for a change agent are experience, success, respect, and leadership skills, and management competencies (Grohar-Murray & Langan, 2011). A change agent is anyone who has a positive attitude, communicates the goals of the organization and is willing to get involved to help facilitate these goals.

“A patient fall, defined as a sudden, unintentional change in position, coming to rest on the ground or other lower level, is a month the most commonly reported adverse hospital events, with more than 1 million occurring annually” (Mion,2014). Evidence supports these events lead to increase hospital expenses, longer hospital stays and mortality. With the inclusion of interdisciplinary teams and organization management to implement “all hands on deck’ with environment and scheduled intentional rounding, the goal is to decrease these event which would lead to a decrease in the negative impacts and outcomes of hospital stays.

Leaders change systems, structures and policies that have not yet been confronted. They hire, promote and develop employees who can implement the vision for change. In addition, they revitalise the process with a new round of projects or change agents.(Cengage Learning AUS, 2015)

A patient fall is one of the unit-based nursing-sensitive indicators in 6 East, a 22-bed adult unit in a 594-bed tertiary hospital in downtown Charleston, SC. The majority of the patients’ population in this unit is pre and post liver transplant, renal transplant, pancreas transplant, nephrology, urology, and general medicine. The fall rates in 6 East were 6.09 total falls per 1,000 patient days during the 1st quarter of 2015 and 7.56 on the 2nd quarter. These statistics were tremendously beyond the 3.28 total falls per 1,000 patient days of the National Database of Nursing Quality Indicators (NDNQI) benchmark of hospitals of > 500 beds. The significant fall rates in the unit accounted about 35% of the total falls on the hospital during the first half of the year. Although the hospital has a fall prevention program and policy, there is a knowledge gap among nurses and patient care technicians (PCT) regarding fall prevention due to lack of proper education reinforcement. This has led to an increase of staff non-compliance with the policy and fall rates in the unit. Furthermore, with the unit having high staff turnover rates, the newly hired staff members are not getting a proper staff education on fall prevention. Therefore, these newly hired staff members are unable to implement the fall prevention strategies and procedures efficiently.

Falls are one of the most common inpatient adverse events. According to the World Health Organization, a fall is defined as an event that results in a person coming to rest inadvertently on the ground or floor or other lower level (WHO 2016). In 2012, the cost of fall injuries totaled more than $36 billion. As the population ages, the financial toll for older-adult falls is projected to reach $59.6 billion by 2020. (NCQA 2015). Fall-related injuries account for up to 15 percent of rehospitalizations in the first month after discharge from hospital (Currie). Based on data from 2000, total annual estimated costs were between $16 billion and $19

The nursing staff will have the most important role in this process change. The nurses are the ones who see the patients first. The nurses will need to be onboard and understand that this process change will help us give our patients the knowledge they need as well as increasing their satisfaction. Each nurse will be responsible for maintaining the educational materials while making sure the information is accessible to our patients. An important part of this process change is to make sure the staff is onboard and the patients are receiving the information. The nurses will be able to influence and hold each other accountable for this process change. The nursing staff has the best interest of the patients and want to provide the best care they can. The nurses have the power to either bring this project along or they can hinder this

1. Diagnose the problem. 2. Assess the motivation and capacity for change. 3. Assess the resources and motivation of the change agent. This includes the change agent’s commitment to change, power, and stamina. 4. Choose progressive change objects. In this step, action plans are developed and strategies are established. 5. The role of the change agents should be selected and clearly understood by all parties so that expectations are clear. Examples of roles are: cheerleader, facilitator, and expert. 6. Maintain the change. Communication, feedback, and group coordination are essential elements in this step

what exactly is happening. Change agents are critical as they are the sources of energy and intellect that help organizational members recognize the need for change, see what the future may look like build support, and mobilize the troops to move towards the vision, assess where and how to proceed next . The change phase is analyzed with context to certain theories which fits the best in different situation. In this case we came to know that while the change phase is going on with have to keep certain factors in our mind which are related to the strategies to be implemented during the change phase. The expansion was there but after the expansion they did not focus on strategically planning and the implementation.