Application of A Model to Identify a Process That Require Change

Introduction

The field of health is dynamic, and it’s always in a constant change. Nursing a significant stakeholder in health care is not spared either, since it is an adaptable role in which things change swiftly. New research models and evidence-based practices are encouraged in clinical practice to provide more innovative and better methods of delivering patient care and sustaining life. With new evidence and new ways of practicing, comes a reciprocal need for changes within the clinical setting to improve patient experience and promote quality nursing practices. The purpose of this article is to identify and articulate a healthcare issue, problem, or inefficiency that requires change. Besides, the author is expected to utilize a risk tool that to determine the problem and finally use a change model (in this case, Curt Lewin’s Change Theory) to describe and implement a real change.

Application of A Model to Identify a Process That Require Change

The author utilized a rational decision-making model to conduct a risk assessment and come up with a decision to the problem. This model for decision making has seven steps that are followed (Chaffee, 1983). The first step is to verify and define the problem. From the author’s covert observation, the need for change to a new type of report is needed. It has been identified in the surgical Unit after visiting the area and listening to various complaints from the nursing staff. It was observed that the type of report that is currently taking place is unique by all standards, and it has been christened ‘silent report.’ Feedback from some of the nursing staff demonstrated that they do not know their patients adequately and that they find it had to prepare for their shifts or even ask relevant questions to enable them plan appropriately for their patients.

In the second step, the author brainstormed on the possible solutions for the problem. Information for possible solutions was obtained from the internet, and the author also relied on own knowledge of best practices. The author proposed bedside shift report as the strategy to this problem. The third step is setting standards of success and failure of the potential solution. The author suggests that if the change would be to ensure safe handover off of care between nurses by involving the family and the patient. This form of reporting has the potential of improving the quality of care, the safety of the patient, the experience of patient care provided, and increased accountability between nurses. In the fourth step, the author determined the consequences of the solution by utilizing SWOT analysis where the strength, weakness, opportunities, and threats of the settlement are determined. The author found that the process of bedside shift report comprises of the outgoing and incoming nurses meeting outside the room of the patient and not in the nurse’s station and exchanging information about the baseline information of the patient. It also provides an opportunity for nurses who are going to terminate the close relationship that was formed with the patient and introduce the incoming nurse. The sixth step is to track and analyses the results of the test. According to various studies that have been done on the bedside shift report, many advantages such as improved quality of care, the safety of the patient, experience of patient care provided, and increased accountability between nurses were some of the notable advantages (Laws & Amato, 2010). And therefore, since the writer desired such changes, then the author will go ahead with the seventh step, which is implementing the solution. To achieve the solution, detailed planning and implementation among the unit managers and staff nurses are required.

A committee would be appointed to plan, educate, and oversee this implementation process to reduce the burden for change to the unit manager. The potential benefits that nurses and patients will reap from this new change would be thoroughly explained, and the staff opinion and feedback would be discussed together to set up a trial followed by a survey among patients and staff. Once results are received, it will be presented to the Unit in charge and made available to the staff nurses. If enough positive feedback is gathered, the next phase in the process will be made permanent.

 

Figure 1: Rational Model Decision making model

Outline of Change Model

Lewin’s Change theory describes the restraining and driving forces of the change process and its three stages. The first stage in unfreezing, which occurs when people who are affected are meet with inconvenience and resistance (Kaminski, 2011). The next stage is referred to as moving, wherein those persons who are resistant adopt the idea, accept, and familiarize themselves with the bedside report process. Refreezing is when the change process of the bedside shift report is implemented, and workflow is changed and improved (Kaminski, 2011).

The implementation of the change process will follow the numerous stages advanced by Curt Lewin’s theory. During the phase of unfreezing, the author of this article will involve the management of the hospital where a committee of nurses will be formed to spearhead the change process. The committee will comprise mostly of staff nurses, Clinical Nurse Specialist, Director of Nursing, and Chief Nursing Officer. They will formulate a standardized method of communication, presentations, and educational materials for employees and followed by a formulation of a plan for transition. Awareness campaign spearheaded by the formed committee will be instrumental in promoting awareness among nurses and notifying them about empirical findings that show support to bedside shift reports by both patients and nurses. At first, legitimate concerns may be present; however, with a thorough standardization process and comprehensive education, limited interests are expected.

As with any change process, matters, and questions arising out of this awareness campaign will be answered promptly by the committee. Restraining forces in the unfreezing stage may include concerns of how long the process of bedside shift report may take due to patients that have extended stays on the surgical unit part. Emotional responses are expected such as frustrations from those nurses who view the proposed changes as unnecessary. “Barriers to conducting report included an inability to access the patient Kardex, frequent interruptions, idle chatting, agency staff requiring additional information and time. Also, the staff believed they had to justify what they had done on their shift, and the report is unclear. Past attempts to change the report processes were often met with resistance.” (Benson, Rippin-Sisler, Jabusch, Keast, 2007). Resistance to this change can be managed by creating an environment of open communication where employees can share their concerns, voice opinions, share insights and ideas, which will enable them to participate in the decision-making process actively. Once that is achieved, the author expects movement where all new staff nurses will adopt the original method about the bedside shift report. Ultimately, patient satisfaction is increased because of personal involvement in care. The patients can see and communicate with the individuals providing them care, which decreases anxiety concerning their care and the events they may face during hospitalization. (Baker, 2010)

After the nurses have adopted this reporting method and those who are laggards encouraged to take the new norm. The committee that was set to spearhead the process will then move in to cement the process through refreezing. It will be done by making it an essential organizational process. The Director and Chief Nursing Officers will assist the committee in policy development. Thus, manufacturing bedside shift reports a standardized method of communication in which responsibilities are clearly defined, and accountability is increased.

Conclusion

In conclusion, Bedside shift report was found to enhance communication, accountability, and patient safety. Lewin’s change theory supports the need for change, and outline stages through a change process and how to change implementers can intervene to achieve the intended goals. Increased patient involvement and lack of destruction are some of the benefits of bedside reporting. Also, increased patient safety, building teamwork, and enhancements of accountability between colleagues When these stages are anticipated and addressed appropriately, the administration will be able to better deal with issues that may arise. When a change process is initiated, implemented, and managed, goals are accomplished, and an organization is successful in better caring for their patients and employees, as in the case described on implementing bedside shift reports.

The support of the unit leadership is necessary during the entire process to ensure adherence to the provided guidelines. The need for communication, consistent reinforcement, and education has been pointed out as essential to integrate this change in process across time effectively.