Exploring the Rationale for Change: The case of an integrated trauma centre - Essay Example

Exploring the Rationale for Change: The Case of an Integrated Trauma Centre By of Introduction Trauma Centers are health facilities that provide both in-patient and outpatient medical services to traumatized patients. Most of renowned trauma centers offer services that are reimbursable by compensation funds self-pay and other insurance health plans (Freeman, 1999). Nonetheless, clients without private or public health insurance covers are also liable to the services offered at many of the trauma centers provided they are in a position to pay for the said services (Garey & Lorber, 2008). One such integrated trauma center is the Integrated Trauma Center at the Justice Resource Institute in Brookline, Massachusetts. Among the service offered at the Integrated Trauma Center are specialty services such as assessment services, Comprehensive Adult Trauma Evaluation and Clinician or self-referral among other services. The array of specialized services offered are not only available at the Center but are also conducted in off-site locations for people of all age groups. In fact, evaluation and testing services are offered even in residential places, particularly for girls and young women, but at an additional fee. In addition, the services provided by the clinic are available at the local, regional and national levels. Therefore, the core objectives of the Integrated Trauma Center at the Justice Resource Institute in Brookline, Massachusetts is, among others, to offer specialty evaluations and testing, to develop, formulate and implement differential diagnosis and carry out treatment planning on mentally ill patients. In addition, the Center recommends continued primary and adjunctive intervention strategies for traumatized people. Despite the successes it has achieved so far, there is still need for changes and improvements at the Center, mores so regarding its core functions specified above. This paper explores the rationale for change at the Integrated Trauma Center at the Justice Resource Center in Brookline, Massachusetts. In addition, the paper discusses the various concepts and models that underline the design of the health care services offered at the Center and the possible models of change that may be implemented at the Center. The paper also looks at the different organizational cultures and their impacts on the services offered at the Center. The Rationale for Change at the Integrated Trauma Center Just like in the other facilities in the healthcare industry, the Integrated Trauma Center at the Justice Resource Institute in Brookline, Massachusetts, requires a lot of changes in the implementation of its strategies and policies to provide health care to trauma patients. Among the factors that make change inevitable at the Center are the changing demographic of trauma conditions/patients and the accompanying increasing socio-economic challenges (Hoyt & Coimbra, 2007). In addition to the fact that the population is aging, there is a parallel growth in the proportion of the population with chronic trauma illnesses with similar cases of mental illness, majorly characterized by cognitive decline. The rise in the number of patients with chronic trauma conditions has particularly highlighted the need to change the management and treatment of traumatized patients at the facility. The migration and movement of people from different parts of the country and the world has also presented a lot of challenges to trauma management facilities, necessitating the acquirement of new equipment, skills, approaches and technology to effectively handle the myriad conditions that come with the migrations and inflow of people into new areas (Wald et al., 2011). The Duke Heart failure Program at the Duke University Health Systems is an example of health care that has been redesigned to exploit a multi-faceted approach focusing on medication, lifestyle and surgical procedures. The increased populations of chronically traumatized patients and mental conditions, coupled with the dwindling number of mental health professional have made the health facility to encounter quite a number of challenges. The other rationale for change at the Integrated Trauma Center is the heightened demand by citizens for better services in terms of quality and their well-being. Consequent to the increased client awareness on service quality and well-being, healthcare and social costs have increased to hitherto unseen levels, more so health expenditures on the aging and long-term patients (Hogg et al., 2005). To address the above challenges effectively, the facility must formulate, implement, evaluate and reform certain major changes regarding its policies, strategies, practices and procedures (Gergen & Tojo, 1996). That is, the changes would also be necessary for the proper management of the Center’s health care and for its improved general efficiency and effectiveness. Among the major areas of the Center that would require improved efficiency include the Center’s workflow, the integration and treatment/diagnosis of trauma related illnesses and the reduction of the length of hospital stay for acute and chronic trauma cases (Committee on Trauma, American College of Surgeons, 2008). The need to implement changes at the facility should be recognized at all its organizational levels, as envisioned in its objectives and policies, which emphasize patient-centered health management. In fact, there should be a shift from the policy of treating patients to that of keeping traumatized people healthy. To avoid becoming unsustainable therefore, the mental health facility will have to implement certain radical changes in its practices and long-term policies (Medzon & Mitchell, 2005). Concepts and Models of Healthcare Design For the Integrated Trauma Center at the Justice Resource Institute in Brookline, Massachusetts to implement any radical changes, the designs of the services it provides to its patients must meet the ever-changing challenges of the health care needs of mental illness patients. For instance, a model of treating trauma known as Trauma Case Management (TCM) would be quite productive for the Center. In this trauma management model, a patient is overseen and his/her care coordinated only by nurses or physicians with expertise in trauma management (Pierog, 1991). The trauma nurses/physicians visit their patients each day, reviewing their progress and ensuring the provision of optimal care. In this regard, the nurse informs the patient, the nursing team and the entire medical staff of the management plan and progress of every trauma patient (Hauser et al., 2010). The Trauma Case Management is particularly effective on inpatient trauma clients whose myriad surgical and medical specialty requirements would overwhelm non-expert/primary medical staff. Moreover, the many diagnostic tests, therapeutic interventions and other related health care services that would reduce mortality and morbidity in inpatient trauma clients necessitate the use of the Trauma Case Management model (Murphy, 2004). A primary medical team would therefore find it rather overwhelming to ensure that such a complex health care is provided in time, efficiently and in a well-organized manner. The Trauma Case Management would for that reason, ensure that such intricate details of trauma inpatient care are not forgotten or overlooked. The major intervention strategies entailed in Trauma Case Management include daily ward rounds, review of patient notes to identify and address any contradictions of medical orders and collaboration among multiple health care givers. Importantly, TCM allows for an effective communication among medical teams, paramedical and the nursing staff (Forsythe et al., 2011). In this regard, TCM enables the identification of any barriers to effective health care delivery in healthcare facilities. In addition, TCM would allow for the informing of the multiple teams, nursing and allied health staff, and patient of a new development on every trauma inpatient (Harrahill & Eastes, 1999). Trauma Teams and the Humanitas Management Model The concept of a dedicated trauma team would also be useful in prompting change at the Integrated Trauma Center. Crucial in these dedicated trauma teams would be case managers although the directorship of the team should fall under a trauma surgeon. The main role of the trauma team would be to admit trauma patients and to oversee patient care with a coordinated holistic approach (Tintinalli, 2010). Researches have consistently shown that trauma patient mortality rate is substantially reduced if enhanced trauma programs, characterized by dedicated trauma admitting and diagnosing teams are applied in treating trauma (Wald et al., 2011). Therefore, the integration of trauma treatment with the concepts of dedicated trauma teams would go a long way in improving continuity and increasing the positive impacts of the quality care provided by this model of trauma management. The Humanitas Management Model is the other possible approach that the Integrated Trauma Center could use to implement changes at the facility. This model, practiced by the Instituto Clinico Humanitas, emphasizes the full utilization of the facilities available for managing and treating trauma patients at the facility. In addition, the model places a lot weight on the efficient running of the daily operations of a trauma -health care facility. For instance, with reference to trauma inpatients, the model would see the trauma Center regarding patient bed space as a high-value resource. The other resource/operation that the facility would lay emphasis on according to the Humanitas Management model, also practiced at the Intermountain Health Care facility, is the running of surgeries at the facility (Dutton et al., 2003). In this regard, the Center would establish dedicated surgery teams for both day and night shifts, both skilled in the time-saving surgical protocols for the many categories of trauma illnesses. A good illustration of a medical center that has time-saving surgical policies is the Rittenhouse Medical Center where time is strictly observed during surgeries and the best understanding of surgical procedures emphasized. Change Management It would be an exercise in futility for the facility to propose or initiate changes without establishing proper change management policies and strategies (Hiatt, 2011). There are numerous models upon which the Trauma Center may base the implementation of its change policies and strategies. An example is the 4-D Process of Appreciative Inquiry. The four major steps proposed by this model to implement change are Dream, Design, Deliver and Discovery. While Dream refers to the envisioning of the impacts of change, Design refers to the co-structuring the future of the facility during and after change implementation. On the other hand, Delivery implies the need to sustain the change initiated. Finally, Discovery refers to the appreciation of the impacts of the change. The types of changes that could be established at the Trauma Center, notwithstanding whether they are mission changes, strategic changes, operational changes, technological and attitude/behavior changes, would require effective management practices. The core elements of proper change management that the Integrated Trauma Center may emphasize to achieve the expected changes include organization and personal change (Millar et al., 1996). There are certain principles that the Center must apply so that the expected organizational change is properly managed and becomes successful. In fact, observing the same principles would be effective in achieving personal change among the Center’s staff (Arvid, 1976). First, there must be thoughtful planning and the sensitive implementation of the planned changes, a feat only achievable by wide consultations among all the stakeholders of the facility, particularly those to be affected by the proposed changes (Cheney et al., 2004). In other words, a forced, unachievable and unrealistic change could be counterproductive on the nature and quality of service offered by the Center. Besides being relevant to the facility, its patients and staff, the proposed changes must be measurable. These latter principles are particularly important for the personal aspects of change at the Trauma Center. Before a change is initiated at the Integrated Trauma Center, it would be important that what the change would achieve for the facility and those the change is likely to affect are identified (Fernandez, 1999). To manage change at the facility, therefore, a structured approach to transitioning the facility’s individuals, teams and organizational components should be adopted. That is, there must be an intended shift from the immediate situations or circumstances at the facility to a desired future state. The change management must consequently endeavor to win the Center’s employees over so that they embrace the changes to be implemented at their workplace (Curtis, et al., 2002). The changes expected at the facility must therefore not only be formally introduced but must also be approved by all the stakeholders at the Trauma Center. In fact, the management of any change at the facility should begin with an assessment of the immediate circumstances in which it operates. It is only via this assessment that the concerned persons or teams may identify the need for changes and the Center’s capability to implement the changes (Reilly et al., 2006). Furthermore, the objectives, the contents and the activities to be incorporated during the implementation of a change must be specified and such information disseminated to all the stakeholders (Filicetti et al., 2007). Creative and critical marketing of the idea for change and internal communication are thus central to any change initiative the Trauma Center may embark on. The management of the benefits accruing from change and the need to define and explain the calculable aspects of change to stakeholders would also go a long way in making change achievable at the Integrated Trauma Center (Harter et al., 1989). Significantly, the theories, costs, risks and investments associated with change strategies should be constantly monitored to ensure the initiated changes are not counterproductive but helpful in the achievement of organizational and personal goals. The other vital components of change management that would be useful to the Trauma Center are an effective training and upgrading of skills in the organization’s personnel to make them be at par with the stipulated changes. Moreover, such educational or training activities would counter cases of resistance to changes by employees, thereby aligning them with the overall policies and strategies of the Center (May & Dennis, 2005). Conclusion The multiple injuries associated with trauma patients and the complex nature of trauma management requires proper coordination and communication to ensure the delivery of effective health care. The Trauma Case Management (TCM) is a diverse and quite rewarding model that Integrated Trauma Centers could employ to change and improve their performance in terms of patient care. 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