NSG 601 Identify two barriers to change in your organization that are also prevalent in the research literature on change management

NSG 601 Identify two barriers to change in your organization that are also prevalent in the research literature on change management

NSG 601 Identify two barriers to change in your organization that are also prevalent in the research literature on change management

In any healthcare facility, when implementing quality healthcare initiatives, change typically occurs. Barriers to change are often faced and must be overcome with certain strategies to better the organization. Two barriers in my organization that are prevalent in literature on change management are staff resistance, and lack of planning. In trying to promote the use of standardized hand off communication tool, there may be barriers to the changes that will be implemented. For example, upon the implementation of a standardized hand off communication tool, some nurses may be hesitant to consistently use the hand off tool. Nurses often have a set way of doing things and completing tasks and thus may be resistant to using a standardized hand off communication tool. Miller (2021) found that nurses recognized that they should be using the IPASS method but were still hesitant to use it. Miller (2021) recommends certain strategies to assist staff in areas of resistance. For example, celebrating successes with staff using the hand off tool correctly, continued education on the importance of the hand off tool, and empowering staff to lead the patient safety initiative (Miller, 2021). These are all strategies that could aid staff in properly accepting the quality healthcare initiative of using a standardized hand off communication tool.

In addition, the lack of planning may pose a barrier to this quality healthcare initiative. Because the ultimate goal and aim of this quality healthcare initiative is to improve patient safety, it would be important for the initiative to be planned accordingly. Miller (2021) used a PDSA framework to implement the use of IPASS. This framework could be used in this initiative to better plan and implement the use of a standardized hand off communication tool. The strategic planning of the implementation is important to reach the goal of having 75% of nurses use the standardized hand off communication tool within 6 months.

In order to promote enthusiasm regarding the use of a standardized hand off communication tool, it would be important to use a tagline to promote the project. The tagline for this initative could be “Patient safety through communication”. The rationale of this choice would be that it is easily understood in a language that everybody can understand. Every staff member has the main goal of promoting patient safety and this tagline recognizes that. This tagline promotes the change by encouraging patient safety.

Below is a graphic that could be used to support this healthcare initiative and tagline.

References

Miller, D. (2021). I-PASS as a Nursing Communication Tool. Pediatric Nursing47(1), 30–37.

When it comes to change in any organization it can be met with both opposition and acceptance. What’s important is that management is open to collectively working together through good communication while taking the time to walk the opposition through the change process. Uncertainty and insecurity can hinder change at any institution. In my organization, I have noticed two barriers to change in the area of psychiatry, a technological barrier and mental illness-related stigma.

During the COVID-19 pandemic, many organizations were thrown into telemedicine for the first time and not all institutions were technologically equipped to perform telehealth visits appropriately. Lack of physician “preparedness and readiness, reimbursement was a key issue” as coding for the services was also difficult to navigate for providers (Ojha & Syed, 2020, p. 2). The reluctance grew through providers’ unwillingness and lack of acceptance, but through education and adequate training, the clinicians could find understanding in the incorporation of telehealth as there is supportive evidence that the intervention benefits the treatment of the patients.

Mental illness-related stigma is in our healthcare culture. Even providers with extensive education at times falter by

NSG 601 Identify two barriers to change in your organization that are also prevalent in the research literature on change management
NSG 601 Identify two barriers to change in your organization that are also prevalent in the research literature on change management

allowing interpersonal stigma to alter how they conduct themselves while providing care to patients. Patient-provider interactions are crucial as the patient can be made to feel “devalued, dismissed, and dehumanized” during these interactions (Knaak et al., 2017, p. 111). It has a negative impact on the patients, as patients will be reluctant to receive any care in the future, overall affecting the quality of care these patients deserve. Much emphasis needs to be placed on a better awareness of their unconscious biases, so the leadership can tackle these barriers head-on to lead to better outcomes for the patients. The institution needs to show providers how their decisions do have an impact on their recovery (Knaak et al., 2017).

The tagline “treat the illness, not the stigma” employs that providers at times unknowingly allow their stigma to get in the way of providing quality care to the psychiatric population. Sometimes the patient’s physical problems will go unmet as a provider’s bias comes between providing quality patient care. This delay in treatment can be life-altering and could cause unwarranted trauma to the psychiatric patient population as they may personally stop seeking help altogether. The tagline promotes providers to “stop and think” allowing awareness of one’s own bias to be out in the open. This skill can create the change in behavior that is needed when approaching psychiatric patients and meeting their care needs.

References

Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. The Canadian College of Health Leaders, 30(2), 111–116.

Ojha, R., & Syed, S. (2020). Challenges faced by mental health providers and patients during the coronavirus 2019 pandemic due to technological barriers. Internet Interventions, 21, 1–4. https://doi.org/10.1016/j.invent.2020.100330 (Links to an external site.)

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In order to implement change successfully in a healthcare setting, we need to be aware of what common barriers are perceived by nursing staff that prevent change. Two of these barriers that I have noticed include inadequate resources/support and the need for an entire workplace culture change. When a new policy or piece of equipment is being initiated on my unit, there is inevitably resistance, as nurses are busy and do not want to take time out of their day to learn how to perform a new task. However, once resources such as a sales rep who stays on the floor when a product is being rolled is offered or the unit as a whole begins partaking in a new policy, everybody will come together to implement change. For example, when the unit was introduced to the female external catheter (PureWick) everybody was resistant to this foreign concept – even with the knowledge that it would decrease the incidence of needing indwelling catheters and therefore decrease risk of  CAUTIs. However, when we were offered teaching daily by the PureWick rep and the unit began talking about how convenient these devices were, they became a staple product in our workplace. This demonstrated the importance of resources and culture change.

A 2020 study by Le-Dao et al. found that these two barriers are among four common themes in change management within healthcare. These researchers also found that insufficient leadership and improper use of a change management model such as PROSCI contribute to unsuccessful change (Le-dao et al., 2020). By identifying these themes we have a starting point for how to implement interventions in healthcare that will actually bring about change.

A main intervention within my project is to post signage around my unit that emphasizes the importance of remembering to make follow up appointments for patients before discharge. A possible tagline for my project that could be written into this signage is “follow through with the follow up!” This tagline encompasses the importance of making follow up appointments while acknowledging the fact that nurses know they are in part responsible for these appointments and should follow through with making them. This tagline employs a strategy of being catchy enough to stick into the minds of nurses, hopefully to keep them thinking about discharge.

I have attached a visual I designed that could be used as signage around my unit to emphasize the importance of making a follow up appointment to at least the PCP office of patients.

 

Le-Dao, H., Chauhan, A., Walpola, R., Fischer, S., Schwarz, G., Minbashian, A., Munro, A., D’Arcy, E., Allan, J., & Harrison, R. (2020). Managing complex healthcare change: A qualitative exploration of current practice in New South Wales, Australia. Journal of Healthcare Leadership, 12, 143. https://doi-org.rivier.idm.oclc.org/10.2147/JHL.S274958