NUR 514 Describe an organizational change model that can be used in a dynamic health care environment

NUR 514 Describe an organizational change model that can be used in a dynamic health care environment

NUR 514 Describe an organizational change model that can be used in a dynamic health care environment

A number of changes in the organizations tend to fail in achieving the desired results; about 70% of the organizational changes fail to achieve their intended goals (Nilsen et al., 2020). This high failure rate is as a result of the failure to consider and identify the forces that facilitate the change and those that are opposed to the change. For this reason, I have selected Step 4: identifying and analyzing forces of change as one of the steps that needs to be comprehensively managed. According to Nilsen et al. (2020), studies have shown that organizational changes tend to be linked to the employees’ psychological uncertainty concerning the manner in which the changes will impact their work, roles and life in general. Therefore, it is important to consider the concerns of those affected by the change in order to ensure that the organizational changes are effective in achieving the desired goals.

References

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 (147), https://doi.org/10.1186/s12913-020-4999-8.

REPLY

 

A step that I believe is vital but missed is creating a vision or a charge for the project. At times, the group develops a solution without identifying the underlying problem. I have seen this in projects looking to find a quick solution to a problem without clearly understanding the actual problem being fixed. For example, my organization saw increased pressure injuries in the Intensive Care Unit. As a “quick fix,” upper administration implemented a device that monitors patient turns. This change in practice was not welcomed by staff and was an overall dissatisfaction. The device required a lot of troubleshooting and little evidence to support pressure injury prevention. Post-Implementation, a few content experts completed a root cause analysis on the cause of PI in the ICU. The analysis showed that the trend in pressure injuries was related to medical device-related and not caused by pressure from lack of turns. Ultimately, the project failed and left the staff discouraged about adding more work to a problem that was not occurring. Once we identified the cause behind the uptick in PIs, we collaborated with bedside nurses in pressure injury prevention strategies to reduce our PI rate by 60% within six months.

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Leaders could make a difference in the project by listening to the concerns with the device and taking a step back to

NUR 514 Describe an organizational change model that can be used in a dynamic health care environment
NUR 514 Describe an organizational change model that can be used in a dynamic health care environment

identify the underlying problem. Once the charge was created and pulled in the bedside nurse, there was a large amount of support from staff to accept the change. The problem turned into providing resources for the team to prevent PI’s rather than feeling like they were being punished with a device that monitors turn.

 

REPLY

 

While the Eight Steps of the Change Process looks great on paper, there are areas of this model that could fail. In my opinion, the step that fails most often is Step 3: Developing a Team Vision and Charge. This step is when the team engages to develop common goals and purpose, which is great when individuals from all roles are allowed to have their voices heard (DeNisco, 2021). More often than not, the team vision is not developed by anyone who actually works on the floor. Instead, the team vision is made by senior administration, who spend virtually no time working on the floor or conversating with individuals who do work on the floor. In larger organizations, I would say this is an even bigger issue, because administration can be very distant from the front-line staff. Often times, the change put into place is focused on patient satisfaction and budget, instead of focusing on staff satisfaction and safety. For instance, the organization that I work for went through some very drastic changes during the Covid-19 pandemic. One of the biggest issues was what the organization titled Buddy Nurses. This term indicates that any nurse can be floated to the ICU or ED and utilized as a partner for nurses who have a heavy patient load, with critical patients. Utilizing buddy nurses allows the organization to provide staff with incredibly unsafe staffing ratios. This technique may work if all nurses were trained equally to care for critical patients, but unfortunately that is not the case. We would often have new graduate ICU nurses caring for four or more intubated patients with a new graduate Pediatric nurse as their partner. As can be seen, this change was not safe and did not raise satisfaction for staff nor patients. However, if the development of this process would have included staff nurses who have inside knowledge, this process could have proved to be beneficial. This is why it is important to allow the voices of everyone to be heard, not just the senior administration who have limited current knowledge on patient care.

References

DeNisco, S.M. (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning.

REPLY

 

Upon review of table 5-1 (DeNisco, 2021) which enumerated and described the 8 steps of the change process of the 8-step model combining the traditional change theories, I think the implementation phase and the evaluation phase is where it’s more difficult to manage. I have seen proposed changes in our organization fail at this phase because, in the implementation phase, there were not enough resources to sustain the plan or in the evaluation phase, there was either not enough feedback or there was a lack of follow-through with the process. The most recent one is the implementation of a new patient and staff scheduling application. When it was first implemented, there was not enough training provided in the field. Although there were user guides available, there was not enough hands-on training for the staff that works directly with the patients. The staff did not understand the metrics that were being measured. They just know that we need to start using this application and it was mandatory. Another issue was the resources. This project was introduced when there was a huge issue with staffing, therefore the scheduling assistant won’t work with the short staffing situation. The tool itself can be very useful in planning an efficient workflow if all of these barriers were addressed before implementation. The feedback from the field was then taken into consideration later and some modifications were made. The scheduling application was reintroduced with more labor management information which proved to be useful, especially when considering the staffing hours required for patient care. It has since been used and the staff are now more familiar with the metrics that are measured in terms of labor management. The numbers and statistics became our guide in both patient and staff experience. It still has some hiccups and is still constantly being developed based on the need but has become a norm in all our clinics.

Reference:

DeNisco, S. (Ed). (2021). Advanced practice nursing: Essential knowledge for the profession (4th Ed.). Jones and Bartlett Learning