Strategic Change and Quality Improvement - Assignment Example

? Strategic Change and Quality Improvement al Affiliation Strategic Change and Quality Improvement Introduction The change process that could be implemented in one’s work setting is deemed part of evidence-based practice through the use of multidisciplinary teams in treating patients with chronic illnesses. Accordingly, multidisciplinary teams, defined as collaborative practice teams which are composed of physicians, nurses, and allied health professionals, were found to be more effective in treating patients who are diagnosed with prevalent chronic diseases (Titler, n.d., pp. 9-10). In a study conducted by Codispoti, Douglas, McCallister, & Zuniga (2004), the use of multidisciplinary teams evidently improved patient care through: improved satisfaction and management of patients; establishment of collaborative teamwork; forging effective team communication; enforcing regular patient monitoring and follow-up; and use of electronic records or other improved patient care systems (Codispoti, Douglas, McCallister, & Zuniga, 2004, p. 201). Still, in another discourse, the use of multidisciplinary teams to improve primary care was also found to be effective (Cote, et al., 2002). In this regard, the current discourse hereby aims to propose the implementation of using multidisciplinary teams in the health care setting. The paper would initially present the rationale for the proposed change; prior to detailing the benefits that the change could generate for the health care institution. Likewise, the group and members who should initiate or lead in the proposed change process would be determined and presented in terms of their significant contribution to the recommended transformation. A proposed timeline would also be structured, in conjunction with an evaluation process which aims to determine the gauge or measure for the proposed change’s success. Rationale for the Change To ensure that any proposed change in any field of endeavor would be successful and valid, the need for change should be appropriately supported, as well as explicitly identified and aptly communicated to various stakeholders. There is an internal need for the change in the current health care setting in terms of marked levels of return of the patients for re-admission to the health facility due to recurring illness. Thus, it could be deduced that the symptoms that were initially relayed were addressed; but not comprehensively to encompass other possible avenues for recurrence or deterioration of health conditions. Therefore, rather than seeing just an attending physician to address the illness; it was evident that other members of the professional team could have been needed to provide medical advice and improve patient care. A multidisciplinary team is defined as consisting of “psychiatrists, clinical nurse specialists/community mental health nurses, psychologists, social workers, occupational therapists, medical secretaries, and sometimes other disciplines such as counsellors, drama therapists, art therapists, advocacy workers, care workers and possibly others not listed” (College of Psychiatrists of Ireland, n.d., p. 1). The definition was corroborated in the study conducted by Ababat, Asis, Bonus, DePonte, & Pham (2013) who emphasized that “multidisciplinary care conferences, have been defined as planning and evaluating patient care with health professionals from a variety of other health disciplines. Key activities that can be integrated into interdisciplinary rounds (IDRs) include summarizing patient health data, identifying patient/family problems, defining goals, identifying interventions, discussing progress toward goals, revising goals and plans we needed, generating referrals, reviewing discharge plans, and clarifying responsibilities related to implementation of the plan” (p. 1). As such, the need for multidisciplinary teams have been stressed to encompass a wider scope of patient care through covering varied disciplines and a more comprehensive health care. Concurrently, external factors which support the need for change include other health care institutions’ application of multidisciplinary teams which could manifest core advantage in this aspect of patient care. As such, there is a need to be apprised of new trends in evidence-based practices regarding the use of multidisciplinary teams to compete effectively in the health care sector. Audience Who Needed to be Convinced Since the proposed change would be composed of various members of the multidisciplinary team, the audience who needed to be convinced of the proposed change are the members of the Board of Directors and the Executive Management Team of the health care institution. It is therefore importance to justify that the change is needed and that the current resources of the hospital could accommodate implementation of the change process. For one, there are available members of the mutlidisciplinary team who are more than qualified and competent to do their responsibilities to address various patients’ needs. Likewise, the support system (administrative personnel, electronic medical records system, and other support facilities) are in place and could be utilized in implementing the change process. Finally, the change agents in the person of unit manager or nurse managers of each nursing unit could aptly assist in implementing the change process due to the theoretical knowledge gained regarding change management within the health care setting. Benefits of the Proposed Change From among the benefits emphasized of using multidisciplinary teams, the summarized discourse noted by Ababat, Asis, Bonus, DePonte, & Pham (2013) is cited, to wit: “the most obvious benefits of implementing multidisciplinary rounds in any clinical setting is the increase in communication and teamwork between members of the health care team” (par. 4). Other benefits which were aptly supported by secondary sources of information include: (1) greater teamwork through increased collaborative efforts which result in increased quality of patient care; (2) “multidisciplinary rounds also provide a chance to detect any ethical concerns, such as decisions about health care directives and do-not-resuscitate directives, which allow the health care team to view the patient holistically” (Gagner et al., 2003; cited in (Ababat, Asis, Bonus, DePonte, & Pham, 2013, par. 5); (3) easy to be implemented in various units within the hospital setting; (4) has evidently proven to increase patient safety; and (5) has been noted to be effective in decreasing the length of stay of patients confined in health care institutions (Ababat, Asis, Bonus, DePonte, & Pham, 2013). As confirmed, “communication and collaboration among healthcare professionals are critical to delivering high quality and safe patient care” (ACCN, 2008; cited in Ababat, Asis, Bonus, DePonte, & Pham: Recommendations, 2013, par. 1). Finally, previous research on the subject also validated that “although multidisciplinary rounds took more time than conventional rounds, there was a significant benefit in terms of patient outcomes, length of stay, and efficiency found from the systematic collaboration between disciplines” (Ababat, Asis, Bonus, DePonte, & Pham, 2013, par. 9). Although there are obviously more benefits or advantages of using multidisciplinary teams in health care environments, it is also appropriate to present some barriers that could hamper effective implementation. These barriers could include: time constraints, availability of competent and highly qualified members of the multidisciplinary team, and the need for nurses to join IDRs with other members of the team and be heard in the decision-making process (Ababat, Asis, Bonus, DePonte, & Pham, 2013). Time constraints included the time for making IDRs on a uniformed and available time slot for all members. Thus, the process should emphasize the enhanced quality of service accorded to the patients; in contrast to stressing the length of time spent for making the IDRs. The Implementation Plan To effect this proposed change, using the three stages in implementing change, the following are perceived to be enforced: (1) unfreezing stage would stimulate health care practitioners to feel and recognize the need for change; (2) the transition or changing stage actually involves the introduction and application of the new patterns of behavior: meaning, orienting all members of the multidisciplinary team to be instrumental and contributory in patient care for chronic illnesses; and (3) refreezing stage enforces crystalization and the needed adoption of the proposed behavior (Kurt Lewin 3 Phases Change Theory Universally Accepted Change Management, 2012, p. 1). These stages are crucial to first effectively establish the need and to slowly implement change in a slow but effective process. Through soliciting comments and inputs from the health care practitioners, all concerns could be addressed. Likewise, if issues and concerns are immediately communicated, there would be lesser incidences for resistance to the proposed change. Skills Needed to Enforce the Change To assist in going through the change process, the change agent: health care managers and the executive team must have the proper theoretical framework and resources to invite members of the multidisciplinary team. The change agent should also assume the following skills: effective communication, seeking consultation and participation, envisioning rewards or benefits of the new system, and assuring continued support to health care practitioners through emphasizing job security and promotions. As emphasized, “when a patient is seen by any member of the multidisciplinary team their problems will be discussed confidentially by the team and a care plan will be formulated to decide which team members are best positioned to help. Patient confidentiality is considered an essential aspect of treatment, and is carefully maintained within the team” (College of Psychiatrists of Ireland, n.d., p. 1). Proposed Timeline for the Proposed Change The following timeline is hereby presented as a guideline for the proposed change process: Details Time Frame Solicitation of Comments and Inputs of Proposed Change July 15 to July 31, 2013 Presentation of Proposed Change (Use of Multidisciplinary Team) August 5, 2013 Review from the Executive Team and Board of Directors August 10 to 15, 2013 Implementation Plan August 15 to Sept. 15 Monitoring of Success and Need for Corrective Actions Sept 16 to 30, 2013 The time frame could be adjusted depending on the feedback from affected stakeholders, and the level of inputs or comments that need to be effectively addressed. Likewise, any resistance to the proposed change is expected to stall its smooth implementation. Thus, allowances for adjustments should be made to ensure that the recommended change would be fully operational by the end of September 2013. Strategies for Change There are different strategies which could be designed by managers in the health care setting to ensure that resistance to change is minimized or completely negated. To improve the responses to change or to eliminate any resistance, managers apply the strategies for change; such as: communicating the need for change; relaying the benefits and costs of the change; obtaining support; implementing change by small steps at a time; monitor and diagnose any post change problems and effectively address them. The ideal scenario is for change agents to create an atmosphere that supports change and at the same timee, minimize or overcome resistance to it. As such, change managers should be able to assist the stakeholders who would be affected by the proposed change to see the rationale for the change and to solicit their participation in planning the change process and in gaining stipulated benefits from it. Communication is a crucial facet in the process of change. As emphasized, “people who would be affected by the change should be informed about it before it takes place, and not after. Communication educates the users of change about the need for and its consequences. Full disclosure and transparency prevents the formation of rumors, misunderstandings, and intrigues. Management should provide as much information about the proposed change as possible to ensure that is is properly understood” (Martires & Fule, 2004, p. 372). Likewise, since there are diverse members of the proposed multidisciplinary team, consultation and participation of each team member should begin in the initiation stage. Thus, the rationale for the change; as well as the benefits which would be accorded, not only to the health care practitioners; but more so, to the patients, should be appropriately disseminated. Any adverse reaction or reasons for resistance should be gathered and immediately addressed. Measures for Success The proposed changes are made to boost the performance of people. As such, after implementing the recommended change, standards or goals that would have been explicitly stated to be attained should be appropriately measured. The job of change managers does not end after the changes have been made (Martires & Fule, 2004). If performance has not improved, the root causes have to be found and corrective measures must immediately be taken. Thus, the ultimate success of change efforts rests on the acceptance of stakeholders who would be directly affected by the change. Success should mean the creation of a new and higher level of performance by people in the organization. Thus, employee support for and commitment to the implemented change becomes an objective that is integral to the goal of the change itself. Conclusion The current discourse has successfully achieved its aim of proposing the implementation of using multidisciplinary teams in the health care setting. As presented, there are evidences of greater benefits that multidisciplinary teams could accord in terms of increasing the overall quality of patient care. Thus, to ensure support and effective implementation, change agents should be able to follow the three stages in implementing change; as well as in designing strategies which would successfully manage the change process. The proposed audience who needed to be convinced for the proposed change was likewise identified. The timeline for implementation was also clearly presented. Finally, one is convinced that through the implementation of the use of multidisciplinary teams in the health care setting, the initial concerns of marked levels of re-admission of previously confined patients would eventually be minimized. This would be an indication that a higher level of quality and holistic patient care was appropriately and effectively accorded through the use of multidisciplinary teams. References Ababat, V., Asis, J., Bonus, M., DePonte, C., & Pham, D. (2013). Multidisciplinary Rounds In Various Hospital Settings. Retrieved from RN Journal: http://rnjournal.com/journal-of-nursing/multidisciplinary-rounds-in-various-hospital-settings American Association of Colleges of Nursing. (2008). The Essentials of Baccalaureate Education for Professional Nursing Practice. Retrieved from aacn.nche.edu: http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf Codispoti, C., Douglas, M., McCallister, T., & Zuniga, A. (2004). The use of a multidisciplinary team care approach to improve glycemic control and quality of life by the prevention of complications among diabetic patients. Retrieved from J Okla State Med Assoc: http://www.ncbi.nlm.nih.gov/pubmed/15212108 College of Psychiatrists of Ireland. (n.d.). What is a Multidisciplinary Team? Retrieved from irishpsychiatry.ie: http://www.irishpsychiatry.ie/Helpful_Info/Irish_Services_for_mental_health_problems/WhatisaMultidisciplinaryTeam.aspx Cote, I., Farris, K., Feeny, D., Johnson, J., Ross T. Tsuyuki, R., Dieleman, S., . . . Sandilands, M. (2002). USING MULTI-DISCIPLINARY TEAMS TO IMPROVE PRIMARY CARE: QUALITY OF MEDICATION USE IN THE COMMUNITY. Retrieved from Institute of Health Economics: http://www.ihe.ca/documents/2002-01paper.pdf Gagner, S., Goering, M., Halm, M., Sabo, J., Smith, M., & Zaccagnini, M. (2003). Interdisciplinary rounds: impact on patients, families, and staff. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, Vol. 17, No. 3, 133-144. Kurt Lewin 3 Phases Change Theory Universally Accepted Change Management. (2012). Retrieved from Change Management Consultant: http://www.change-management-consultant.com/kurt-lewin.html Martires, C., & Fule, G. (2004). Management of Human Behavior in Organizations. Quezon City: National Bookstore. Titler, M. G. (n.d.). Chapter 7. The Evidence for Evidence-Based Practice Implementation. Retrieved from ahrq.gov: http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/TitlerM_EEBPI.pdf Read More