Questions and Topics We Can Help to Answer
Paper Instructions;

Critiquing a Change Effort
As a nurse leader, you need to have the skills and knowledge to collaborate and communicate with those who plan for and manage change. This capacity is valuable in any health care setting and for many different types of change. Furthermore, it is essential to be able to evaluate a change effort and determine if it is promoting improved outcomes and making a positive difference within the department or unit, or for the organization as a whole.
To prepare:
•    Review Chapters 7 and 8 in the course text. Focus on the strategies for planning and implementing change in an organization, as well as the roles of nurses, managers, and other health care professionals throughout this process.
•    Reflect on a specific change that has recently occurred in your organization or one in which you have worked previously. What was the catalyst or purpose of the change?
•    How did the change affect your job and responsibilities?
•    Consider the results of the change and whether or not the intended outcomes have been achieved.
•    Was the change managed skillfully? Why or why not? How might the process have been improved?
By Day 3
Post a summary of a specific change within an organization and describe the impact of this change on your role and responsibilities. Explain the rationale for the change, and whether or not the intended outcomes have been met. Assess the management of the change, and propose suggestions for how the process could have been improved.

Media for discussion/ Media
Laureate Education (Producer). (2012g). Organizational dynamics: Planned change and project planning. Baltimore, MD: Author.

“Organizational Dynamics: Planned Change and Project Planning” Program Transcript KATIE SKELTON: Nurses are incredible change agents. One-on-one with patients, they educate. And more important than just teaching someone, it's really helping that other person, the patient, or the family, understand the implications of a lot of that change. RICHARD RODRIGUEZ: As nurses, our day is centered around change. It's rare when you come in at the beginning of your shift, and you leave at the end of you shift, and everything's just the same. NARRATOR: To thrive in the complex and competitive health care environment, today's organizations must be able to capitalize on the strengths of nurse leaders to plan for and navigate change effectively. Katie Skelton, Richard Rodriguez, Carmen Ferrell, Doris Fischer, and Carina Perez from St. Joseph Hospital in Orange, California, discuss the implementation of an electronic record system designed to meet reporting requirements, promote quality in patient safety, and address the needs of various groups throughout the organization. FEMALE SPEAKER: The patient's up here. This one's been assigned. This one's for oncology, and then I have-- RICHARD RODRIGUEZ: One of the key challenges that we're facing is workflows. Now, what I refer to a workflow is, how do I do this particular task today? How do I get from point A to point B to point C? The best example I have in regards to workflows is relatively simple. So the nurse goes in and assesses the patient at the bedside, then has to remember all that information and come out to the nurse's station and fill out their daily assessment as to what they assessed. I've caught myself, and I've caught many other nurses sitting there, well, what exactly did I assess? CARMEN FERRELL: So one of the projects that this hospital decided to take on is clinical information, to essentially capture all the pieces that are going to be delivered to the patient, both from a nursing, a physician, a multidisciplinary kind of perspective. There's 14 hospitals in our health system. So as a larger organization, we decided to adopt MEDITECH. FEMALE SPEAKER: If they have 12 patients, they can place all their post-ops. CARMEN FERRELL: And within MEDITECH, there are modules that you build to be able to capture the different care, either from a physician prospective, nursing prospective, or whatever other discipline that you have. Behind all of that, there © 2012 Laureate Education, Inc. 1 are pieces like admitting, medical records, the financial piece that goes along with it. So all of those pieces have to be collaborated, so to speak, together. DORIS FISCHER: As you see when you scroll across, you'll get a drop-down list- - For other institutions that are already up electronically, gathering of that data now allows you to critically view that data and pull out those items you may not have noticed before-- those little gaps, those little pieces of information that went unnoticed on a paper documentation. RICHARD RODRIGUEZ: So now, you're changing the workflow. You're telling the nurse, now you've got to stay at the bedside and document at the bedside. That's a positive change. Now, you're there. You're assessing the patient. You're able to document on the computer and get more accurate information, which is really what we're aiming towards, is getting accurate information in a timely manner. With each individual problem, I want you to come down here and change the target date on each long-term outcome. KATIE SKELTON: Well, I love the idea, certainly, that nurses will be spending more time at the bedside. As we have rolled it out with the computers in the rooms, being able to do an assessment and have immediate input of that data into the EMR and having that available to everyone else immediately, I think is huge. CARINA PEREZ: So the importance of rolling out a project is communication, excellent leadership support, and preparation, preparation, preparation. With your preparation, you're able to anticipate challenges, find gaps in workflows, develop new processes to really have a smooth implementation. And you also need a good adoption period. You can't constantly be changing people's world. You have to give them time to adapt. We're teaching nurses of all skill levels, of various cultures, of various degrees of education about technology, so we have to take all of that into account when we're implementing a system. FEMALE SPEAKER: The ortho? Ortho's not here. CARMEN FERRELL: You need to have a leader that is very dynamic, in the sense of not only understanding the project, but wanting to push this project through. Because this project has the challenge of not just being a hospital project, but a health system project. So what does that mean? © 2012 Laureate Education, Inc. 2 Well, it means that there's several people that are in charge of the project at the same time, with different dynamics. What perhaps the health system wants is not necessarily what the hospital wants. So the leader at the hospital setting must figure out a way to bridge these two needs and come up with a good place for the hospital to be at. And also be able to interpret what both nursing, physicians need and want, to make sure that they can deliver that, again, safe patient care. CARINA PEREZ: So actually, in this project, we had four major phases. And in each phase we had a pilot phase. So the area that I was critically involved in that recently just went live is advanced clinical documentation. And we went up with three units before we went up with the entire house. This was kind of our trial period. Is it going to work? What things can we improve before we push it to the house? It was comprised of mom/baby unit, ortho, and gen surg. FEMALE SPEAKER: So the time was-- We started approximately at 16:45. CARINA PEREZ: There have been surprises. There was a surprise in how this type of change has such complexity. And our health system truly is interrelated. There has to be clear communication throughout. CARMEN FERRELL: About six months ago, the network went down, meaning that there were parts of the computer memory that wasn't working well. And so what it did for the project, it slowed it down for six months. We went from a 12- month timeline to a 6-month timeline, now making it actually impossible to meet the needs of both the health system, the hospital, and the patients. Because we were able to go and talk to the health system and create a very sound mitigation plan with dollars attached to it and different milestones attached to that timeline, we were able to get that extension and get the money needed to be able to now present the project in an 18-month trial. So there's always challenges in this world. FEMALE SPEAKER: Let me pull it up. DORIS FISCHER: Nursing needs to understand that once technology is in the hand, it's that instantaneous. You no longer have to think about it. And it becomes something that gives you more time to care for that patient. It allows you to become a holistic nurse, where you're now back to what nursing started as. So the least amount of time that you need to spend with documentation, or the quicker you can get information from the sources that you need it from, the more time you have to understand that patient, to assess and to care for that patient. So the patient is still, and always has to be, the center of anything that nursing does. © 2012 Laureate Education, Inc. 3 FEMALE SPEAKER: 98.3. Yay, he's done a great job. FEMALE SPEAKER: OK. Well, let him warm up a little more. DORIS FISCHER: Changing the culture of nursing really is getting those champions who understand where technology is going and the benefits that it's going to bring to the patient and the bedside. They're the champions that are going to mentor those that are a little reluctant for that change. RICHARD RODRIGUEZ: So, Karen, this screen right here is letting you know that you have added the care plan to your patient, and you know-- So when I start dealing with a nurse who's visibly bothered by what's going on, visibly anxious with what's going on as far as documentation is concerned, I always say, think to what your day involves. Your day involves change. This is just another change that's being introduced. And we're going to incorporate it into our daily care of our patients. And in the end, it's about patient safety.



Assignment: Application: Planned Change wk 4
in a Department or Unit
Health care organizations are continuously immersed in change from the emergence of new policies, to promote quality care and improve patient safety to keeping pace with the rapid growth in knowledge and best practices. Establishing a solid framework for planning and implementing change is a wise move, as it provides a foundation for the extensive coordination that will be needed to successfully facilitate the change.
For this Assignment, you propose a change at the department or unit level and develop a plan for guiding the change effort.
To prepare:
•    Review Chapter 8 in the course text. Focus on Kurt Lewin’s change theory, and contrast it with other classic change models and strategies.
•    Reflect on problems, inefficiencies, and critical issues within a specific department, unit, or area in your organization or one with which you are familiar. Select one issue as a focal point for this assignment, and consider a change that could be made to address the issue.
•    Think about how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.
•    Using one of the change models or strategies discussed in Chapter 8, begin formulating a plan for implementing the change within the department/unit. Outline the steps that you and/or others should follow to facilitate the change effort. Align these steps to the change model or strategy you selected.
•    Determine who should be involved in initiating and managing the change. Consider the skills and characteristics that are necessary to facilitate this change effort.
To complete:
By Day 7
Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:
•    Identify a problem, inefficiency, or issue within a specific department/unit.
•    Describe a specific, realistic change that could be made to address the issue.
•    Summarize how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.
•    Identify a change model or strategy to guide your planning for implementing the change. Provide a rationale for your selection.
•    Outline the steps that you and/or others would follow to facilitate the change. Align these steps to your selected change model or strategy.
•    Explain who would be involved in initiating and managing this change. Describe the skills and characteristics that would be necessary to facilitate the change effort.