LDR 615 Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability

LDR 615 Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability

LDR 615 Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability

Nurses and other healthcare providers play an essential role in promoting optimum health outcomes for the populations they care. They adopt evidence-based interventions that address current and emerging needs in healthcare. Part of the nurses’ role in healthcare entails the analysis of the healthcare environment to identify opportunities for change and improve the performance of their organizations. Safety and quality issues in nursing and healthcare threaten the realization of the desired care outcomes. Therefore, the purpose of this paper is to analyze the issue of medication errors in my practice site and utilization of the developed theory to propose approaches to address it.

Issues in the Area and Outcomes

The practice site is a hospital that provides general and specialized care for diverse patient populations. The organization leads in the region in the provision of high-quality, safe and efficient care. Despite its reputation, the hospital has witnessed a rise in the medication error rate above the quarterly benchmark data. Medication errors comprise a safety issue in nursing and healthcare. Medication errors are largely defined as preventable events that increases the risk of harm or inappropriate medication use(Escrivá Gracia et al., 2019). Medication errors occur when the medication is under the  care or handle of  a healthcare provider or patients.

The rise in medication errors have had negative outcomes on patients and the organization. Some of the patients have suffered unintended harm because of the errors. Issues such as drug interactions and adverse drug reaction cause unintended harm to the affected patients. Medication errors have also increased costs that patients incur. The harm from medication errors results in increased length of hospital stay and complex care, hence, high costs of care. Medication errors have also increased resource utilization in the organization. The hospital uses most of its resources to manage preventable harm to the patients, hence, a decline in its performance(Alghamdi et al., 2019; Thomas et al., 2019). Therefore, change initiatives to address the issue of medication errors should be implemented.

External and or Internal Driving Forces

Medication errors arise from some internal driving force. One of them is nursing shortage. The shortage of nurses increases the workload, occupational stress, and burnout among the few nurses. Increased workload and burnout are crucial predictors of medication errors in nursing. The other internal driving force is the number of medications. The risk of a medication error increases when a patient is on multi-drug therapy. Dual therapy also predisposes patients to committing the errors if they have low level of understanding about the use of the medications. The other internal driving force contributing to medication errors is the lack of medication administration protocols. Examples include nurses being non-adherent to the use of the five rights of medication administration and double checking to minimize the risk of medication errors(Alghamdi et al., 2019; Escrivá Gracia et al., 2019; Thomas et al., 2019). The additional internal driving forces include the lack of teamwork, organizational culture, and lack of competency among staff on the use of technologies for medication processes. Medication errors affect patients, nurses, physicians, and pharmacists.

Stakeholders Involved

A change initiative to address the issue of medication should be adopted. The change initiative will involve several stakeholders. They will include nurses, nurse leaders, nurse managers, physicians, and pharmacists. The proposed change entails training the stakeholders about the best practices for the prevention and minimization of medication errors. The proposed change will affect the stakeholders. The change will require the adoption of new behaviors among the healthcare providers(Escrivá Gracia et al., 2019). They will also have to engage in continuous improvement initiatives in the practice site to ensure the adoption of best practices to prevent and minimize medication errors.

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Role and Responsibility as a Change Leader

I will play several roles as a change leader. One of the roles is assessing readiness for change among the

LDR 615 Benchmark - Change Initiative Implementation, Evaluation, and Sustainability
LDR 615 Benchmark – Change Initiative Implementation, Evaluation, and Sustainability

stakeholders. Informed assessment data should inform the implementation of the proposed change. Change leaders utilize interventions such as administering staff surveys and interviewing them to determine the readiness for change and needs. The other role is communicating the need for change. The adopters of change should be made away of why the existing system and processes should change. They should be provided with accurate information about the negative effect of the current situation and need for change.The other role as a change leader is managing change. The risk of resistance to change among the adopters is high. As a result, I will adopt interventions such as staff training and their active involvement to facilitate their readiness of change(Dang et al., 2021). The additional roles include communicating plans for change, keeping track of change initiatives, and connecting change initiative to strategy.

Leadership Theory

I will adopt participative leadership theory when implementing the proposed change. Participative leadership theory recognizes the need for leaders seeking input from the followers before implementing an initiative. Leaders encourage followers to express their insights into how to implement the change and best strategies to achieve the desired outcomes. Participative theory will promote stakeholder empowerment and ownership of the change initiative(Dang et al., 2021; Nilsen et al., 2020). I will retain the right to enable the followers to give input about the change.

Change Agents and their Roles

The change agents for the proposed change will be varied. They will include nurse leaders, nurse managers, a physician and pharmacist. Nurse leaders will lobby for the resources needed for the change. They will also provide supervisory roles in the change implementation process. They will provide insights into best practices that can be adopted to achieve the desired project outcomes. Nurse managers will work closely with the nurses in the implementation of change. They will provide the supervisory role and obtain feedback from the nurses on how the change outcomes can be improved further. The physician and pharmacist will be involved in the development of change strategies that will meet the needs of other physicians and pharmacists. They must be involved in the process since they prescribe and dispense drugs. Therefore, their role contributes to the medication errors in nursing and healthcare.

Utilization of the Change Model

The developed model is applicable for use in the proposed change. The model has steps that include needs assessment, planning, implementation, monitoring, evaluation and communicating findings. The model is relevant to my organization because of some reasons. First, it supports continuous improvement of systems and processes. The systematic and interdependence of the steps imply that its use enable the adoption of best practices only in the implementation of change(Bonawitz et al., 2020). The relevance to the organization is also attributed to the fact that the model supports efficiency by assessing the need of a change in addressing the organization’s needs before its adoption.

The developed model has a range of strategic aspects. One of them is the identification of the relevance of the change in the needs analysis stage. The needs analysis also ensures the alignment of change with the organization’s vision and mission. The other strategic aspect is the development of goals, objectives, and strategies in the planning phase. The stakeholders that include nurses, physicians, and pharmacists use the assessment  data to develop a plan of  action. The other strategic aspects include training, open communication seeking and communicating feedback in the implementation, monitoring, and evaluation stages(Heinen et al., 2019). The change stakeholders that include nurses, physicians, and pharmacists will undertake these roles.

Potential Barriers to Change and How to Overcome Them

The implementation of the change may face some barriers. One of them is inadequate support from the hospital. Inadequate support may arise from competing needs in an organization that  affect resource use and allocation. This barrier will be addressed by aligning the aims of the change with the organization’s mission. Aligning will enhance the need and relevance of the proposed change. The other potential barrier is resistance from the staff. The staff may not be willing to adopt the change. This may arise from factors such as fear of the unknown impact of the change, lack of knowledge and skills related to the change(Dang et al., 2021). Strategies such as training and education, active stakeholder participation, open communication, and rewarding performance will be adopted to address this barrier.

Evaluation Methods

Outcome and process measures will be used to evaluate the change. Outcome measures provide insights into the effectiveness of the adopted interventions in achieving the set results in the change initiative. Process measures evaluate the effectiveness of the strategies that were used to implement the project. Outcome measures will include the rates of medication errors, costs of care, length of hospital stay, and harms due to medication errors following the implementation of change. The data on these measures will be obtained before and after the change and analyzed to have a clear understanding of the impact of the change on clinical outcomes. Process measures will include staff perceptions about the effectiveness of training, engagement strategies, resources management, and teamwork approaches that were used in the project implementation(Jeffries, 2022). Surveys and interviews will be conducted among the staff to obtain information about their subjective experiences with the change.

Strategies to Anchor Change or Support Continuous Change

It is important to support continuous change to enhance safety and quality in the practice site.  One of the strategies that should be considered to achieve this objective is the provision of regular training and education to the staff. Regular training and education would empower them with the competencies needed to support the use of best practices to minimize and prevent medication errors. The other strategy is regular assessment and providing feedback(Moran et al., 2023). The assessment data will inform continuous improvements in the organization’s systems and processes.

How the Plan Supports the Organizational Mission/Goal

The change plan supports the organizational mission of promoting safety and quality in the patient care processes. The reduction and prevention of medication errors eliminate any risk of unintended patient harm, hence, safety and quality. The change also aligns with the organization’s goal of implementing initiatives that contribute to evidence-based practice. The proposed change will improve the existing systems and processes, which will form part of the evidence-based strategies in the organization.

Conclusion

The issue identified in the practice site is medication errors. Several internal factors contribute to the problem. The developed change model is relevant to the organization. The model will inform the strategies that will be adopted to achieve the desired change outcomes. Stakeholders will be actively involved to ensure sustainable change.

References

Alghamdi, A. A., Keers, R. N., Sutherland, A., & Ashcroft, D. M. (2019). Prevalence and Nature of Medication Errors and Preventable Adverse Drug Events in Paediatric and Neonatal Intensive Care Settings: A Systematic Review. Drug Safety, 42(12), 1423–1436. https://doi.org/10.1007/s40264-019-00856-9

Bonawitz, K., Wetmore, M., Heisler, M., Dalton, V. K., Damschroder, L. J., Forman, J., Allan, K. R., & Moniz, M. H. (2020). Champions in context: Which attributes matter for change efforts in healthcare? Implementation Science, 15(1), 62. https://doi.org/10.1186/s13012-020-01024-9

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines, Fourth Edition. Sigma Theta Tau.

Escrivá Gracia, J., Brage Serrano, R., & Fernández Garrido, J. (2019). Medication errors and drug knowledge gaps among critical-care nurses: A mixed multi-method study. BMC Health Services Research, 19(1), 640. https://doi.org/10.1186/s12913-019-4481-7

Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378–2392. https://doi.org/10.1111/jan.14092

Jeffries, P. (2022). Clinical Simulations in Nursing Education: Advanced Concepts, Trends, and Opportunities. Lippincott Williams & Wilkins.

Moran, K. J., Burson, R., & Conrad, D. (2023). The Doctor of Nursing Practice Project: A Framework for Success. Jones & Bartlett Learning.

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., &Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20(1), 147. https://doi.org/10.1186/s12913-020-4999-8

Thomas, B., Paudyal, V., MacLure, K., Pallivalapila, A., McLay, J., El Kassem, W., Al Hail, M., & Stewart, D. (2019). Medication errors in hospitals in the Middle East: A systematic review of prevalence, nature, severity and contributory factors. European Journal of Clinical Pharmacology, 75(9), 1269–1282. https://doi.org/10.1007/s00228-019-02689-y