DNP 835 Topic 2 Assignment: Innovative Approaches to Health Care, Change Theories, and Sustainable Change

Topic 2: Innovative Approaches to Health Care, Change Theories, and Sustainable Change

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An improvement team needs to consider the long-term sustainability of an improvement effort. This worksheet will help you outline the elements needed for a sustainability plan for your proposed evidenced-based quality and/or safety program design by taking you through a series of questions. By answering these questions, you will be able to develop a plan to ensure the longevity of the expected improvements from your proposed quality and/or safety program stick long-term.

For each category, use the questions provided to help you draft the necessary components that will be needed in a sustainability plan. Use one or two concise sentences to inform on each bullet point/question. Provide scholarly and peer-reviewed support accordingly.

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Areas for Consideration	Detailed Plan
Measurement After project completion: · What will you continue to measure? · What will you stop measuring? · What will you do if you see a negative effect? · What will you do if you see clinical significance, but not statistical significance?	· The organization has been hampered by cases of nurses burnout; hence a proposal for mental health wellness program has been proposed. Therefore, after the project’s completion, there are various aspects that I will continue to measure. They include job satisfaction, engagement in teamwork, and reported cases of medical errors (Kelly et al.,2021). These will be measured even after completion as they reflect the nurses’ burnout status. · There are various aspects that I will stop measuring. For example, commitment levels as it shall have been covered and reflected under engagement in teamwork. · Negative effects can also be observed upon implementing a project or a quality improvement initiative. Therefore, it is important to have a plan for resolving them. In cases where the negative impact is adversely impacting patients or the staff, then the project can be stopped for a review and inquiry into why the negative effects have been observed. · Clinical significance and statistical significance are both important in nursing research. Even though particular findings may not be statistically significant, they can still be clinically significant, meaning they are beneficial to the group under consideration (Lamé & Dixon-Woods, 2020). In such a case, I recommend that the project proceeds due to its potential importance to the group under consideration.
Ownership · Who will own the new process that was implemented? · How will you tell if the person is engaged and on board with the improvement process?	· The project has been designed to reduce nurse burnout. Therefore, as part of the plan, the organization will own the new process to be implemented. · Being engaged and on board with the improvement process is important as it enhances the successful implementation of the project and also ensures the continuity of the project after implementation (Carcone et al.,2022). I will tell if the person is engaged and on board by checking their commitment and willingness to be part of the project. I will also evaluate if they are ready to spare some time and spend in the implementation process.
Communication · How will you communicate about the change, and who will be the messenger? · When will communication take place? · How will you support individuals in the new process? · What type of training will you use after project completion? · Who will be responsible for that training?	· Communication of the proposed change to the relevant individuals is important since it enhances the chances of onboarding (Palinkas et al.,2018). Therefore, the intended change will be communicated through various strategies such as face-to-face conversations, emails, and text messages. I plan to take the central role of being a messenger. · The communication will take place at the beginning of the project. However, it is important to note that communication will occur throughout the project to help convey important messages during the project. · Offering support to the individuals regarding the new process is important. Therefore, I will offer them support by answering any questions asked regarding the new program and offering documentation where applicable. · Training is important to help the staff sustain the change as appropriate. Therefore, training will be offered as educational sessions and workshops. · The training will be conducted by a senior nurse educator with relevant skills in education and instruction delivery.
Change Management · How would you use your evidence-based change model to ensure adoption and sustainability? · How will you standardize the process so that it is easy to do the “new” right thing?	· Resistance and barriers to change can adversely impact the implementation process and adoption of a new strategy or intervention. Therefore, it is important to have a prior plan (Melnyk et al.,2021). I will respond by offering an adequate explanation of why the organization needs to embark on the mental wellness program. I also plan to approach individuals and have one-on-one discussions to help change their opinion about resisting the proposed change. · Evidence-based change models are important in leading change and ensuring that the change is successful. As such, Lewin’s change model phases of unfreezing, change, and refreezing will be used (Hussain et al.,2018). The third phase will be key in ensuring that the change becomes part of the organization’s culture, ensuring full adoption and stability. · The process should be standardized to ensure that individuals make no mistakes. Therefore, the process will be standardized by creating a guideline documentation showing when individuals should be involved in the program.
Workload · Is the change increasing the overall workload to the system? · If so, how can you decrease the workload? · If not, how will you communicate about what is changing and not changing?	· The proposed change is not connected with the workload. Therefore, it is expected to increase the overall workload to the system. · It will also be important to communicate what is changing and what is not changing. Therefore, I will use the organization’s official communication platforms to inform concerned individuals of what will be changing and what is not. Using the established organization’s channels will make communication more impactful.

Areas for Consideration

Detailed Plan

Measurement

After project completion:

· What will you continue to measure?

· What will you stop measuring?

· What will you do if you see a negative effect?

· What will you do if you see clinical significance, but not statistical significance?

· The organization has been hampered by cases of nurses burnout; hence a proposal for mental health wellness program has been proposed. Therefore, after the project’s completion, there are various aspects that I will continue to measure. They include job satisfaction, engagement in teamwork, and reported cases of medical errors (Kelly et al.,2021). These will be measured even after completion as they reflect the nurses’ burnout status.

· There are various aspects that I will stop measuring. For example, commitment levels as it shall have been covered and reflected under engagement in teamwork.

· Negative effects can also be observed upon implementing a project or a quality improvement initiative. Therefore, it is important to have a plan for resolving them. In cases where the negative impact is adversely impacting patients or the staff, then the project can be stopped for a review and inquiry into why the negative effects have been observed.

· Clinical significance and statistical significance are both important in nursing research. Even though particular findings may not be statistically significant, they can still be clinically significant, meaning they are beneficial to the group under consideration (Lamé & Dixon-Woods, 2020). In such a case, I recommend that the project proceeds due to its potential importance to the group under consideration.

Ownership

· Who will own the new process that was implemented?

· How will you tell if the person is engaged and on board with the improvement process?

· The project has been designed to reduce nurse burnout. Therefore, as part of the plan, the organization will own the new process to be implemented.

· Being engaged and on board with the improvement process is important as it enhances the successful implementation of the project and also ensures the continuity of the project after implementation (Carcone et al.,2022). I will tell if the person is engaged and on board by checking their commitment and willingness to be part of the project. I will also evaluate if they are ready to spare some time and spend in the implementation process.

Communication

· How will you communicate about the change, and who will be the messenger?

· When will communication take place?

· How will you support individuals in the new process?

· What type of training will you use after project completion?

· Who will be responsible for that training?

· Communication of the proposed change to the relevant individuals is important since it enhances the chances of onboarding (Palinkas et al.,2018). Therefore, the intended change will be communicated through various strategies such as face-to-face conversations, emails, and text messages. I plan to take the central role of being a messenger.

· The communication will take place at the beginning of the project. However, it is important to note that communication will occur throughout the project to help convey important messages during the project.

· Offering support to the individuals regarding the new process is important. Therefore, I will offer them support by answering any questions asked regarding the new program and offering documentation where applicable.

· Training is important to help the staff sustain the change as appropriate. Therefore, training will be offered as educational sessions and workshops.

· The training will be conducted by a senior nurse educator with relevant skills in education and instruction delivery.

Change Management

· How would you use your evidence-based change model to ensure adoption and sustainability?

· How will you standardize the process so that it is easy to do the “new” right thing?

· Resistance and barriers to change can adversely impact the implementation process and adoption of a new strategy or intervention. Therefore, it is important to have a prior plan (Melnyk et al.,2021). I will respond by offering an adequate explanation of why the organization needs to embark on the mental wellness program. I also plan to approach individuals and have one-on-one discussions to help change their opinion about resisting the proposed change.

· Evidence-based change models are important in leading change and ensuring that the change is successful. As such, Lewin’s change model phases of unfreezing, change, and refreezing will be used (Hussain et al.,2018). The third phase will be key in ensuring that the change becomes part of the organization’s culture, ensuring full adoption and stability.

· The process should be standardized to ensure that individuals make no mistakes. Therefore, the process will be standardized by creating a guideline documentation showing when individuals should be involved in the program.

Workload

· Is the change increasing the overall workload to the system?

· If so, how can you decrease the workload?

· If not, how will you communicate about what is changing and not changing?

· The proposed change is not connected with the workload. Therefore, it is expected to increase the overall workload to the system.

· It will also be important to communicate what is changing and what is not changing. Therefore, I will use the organization’s official communication platforms to inform concerned individuals of what will be changing and what is not. Using the established organization’s channels will make communication more impactful.

Adapted from “Sustainability Planning Worksheet” by the Institute for Healthcare Improvement (2019).

References

Carcone, A. I., Coyle, K., Butame, S., Harper, G. W., Aarons, G. A., & Naar, S. (2022). Using the Exploration-Preparation-Implementation-Sustainment (EPIS) Framework to prepare for the implementation of evidence-based practices into adolescent HIV settings. AIDS and Behavior, 26(12), 4093–4106. https://doi.org/10.1007/s10461-022-03735-0

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook, 69(1), 96–102. https://doi.org/10.1016/j.outlook.2020.06.008

Lamé, G., & Dixon-Woods, M. (2020). Using clinical simulation to study how to improve quality and safety in healthcare. BMJ simulation & technology enhanced learning, 6(2), 87. https://doi.org/10.1136%2Fbmjstel-2018-000370

Melnyk, B. M., Tan, A., Hsieh, A. P., & Gallagher‐Ford, L. (2021). Evidence‐based practice culture and mentorship predict EBP implementation, nurse job satisfaction, and intent to stay: Support for the ARCC© model. Worldviews on Evidence‐Based Nursing, 18(4), 272-281. https://doi.org/10.1111/wvn.12524

Palinkas, L. A., Garcia, A., Aarons, G., Finno-Velasquez, M., Fuentes, D., Holloway, I., & Chamberlain, P. (2018). Measuring collaboration and communication to increase implementation of evidence-based practices: the cultural exchange inventory. Evidence & Policy, 14(1), 35–61. https://doi.org/10.1332/174426417X15034893021530

Objectives:

1. Describe the role of the DNP-prepared nurse in managing costs.

2. Discuss barriers to cost management in health care.

3. Apply a change theory to ensure care delivery sustainability.

4. Evaluate a quality and/or safety issue in a health care setting.

May 12, 2022 – May 18, 2022 Max Points: 160

Resources

Building a Culture of Safety and Quality: The Paradox of Measurement

Read:

Bliss, K., Chambers, M., & Rambur, B. (2020). Building a culture of safety and quality: The paradox of measurement. Nursing Economic$, 38(4), 178-184.

Perspectives in Ambulatory Care. Return on Investment of a Centralized Telephonic Case Management Program in a Commercial Population

Read:

Russell Rodriguez, S. (2021). Perspectives in ambulatory care. Return on investment of a centralized telephonic case management program in a commercial population. Nursing Economic$, 39(1).

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx? direct=true&db=ccm&AN=148820889&site=eds-live&scope=site

Understanding Change Theory

View:

NDSUExtension. (2020, October 26). Understanding change theory [Video]. YouTube. https://www.youtube.com/watch?v=-F9tegnmiTo

The Business of Healthcare Podcast, Episode 38: Aligning Financial Incentives With Quality Incentives

View:

Kaiser, B. (Host) (2019, June 11). Aligning financial incentives with quality incentives (No. 38) [Audio podcast episode]. In The business of healthcare podcast. Center for Healthcare Leadership and Management.

https://businessofhealthcarepodcast.com/the-business-of-healthcare-podcast-episode-38-aligning-financial- incentives-with-quality-incentives#

Decreased Pediatric Trauma Length of Stay and Improved Disposition With Implementation of Lewin’s Change Model

Read:

Abd El-Shafy, I., Zapke, J., Sargeant, D., Prince, J. M., & Christopherson, N. A. (2019). Decreased pediatric trauma length of stay and

dnp 835 topic 2 assignment innovative approaches to health care, change theories, and sustainable change — DNP 835 Topic 2 Assignment Innovative Approaches to Health Care, Change Theories, and Sustainable Change

improved disposition with implementation of Lewin’s change model. Journal of Trauma Nursing, 26(2), 84-88. https://doi.org/10.1097/JTN.0000000000000426

https://lopes.idm.oclc.org/login?url=http://ovidsp.ovid.com.lopes.idm.oclc.org/ovidweb.cgi? T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00043860-201903000-00008&LSLINK=80&D=ovft

Implementing and Sustaining Bedside Shift Report for Quality Patient-Centered Care

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Becker, S., Hagle, M., Amrhein, A., Bispo, J., Hopkins, S., Kogelmann, M., Porras, E., & Smith, M. M. (2021). Implementing and sustaining bedside shift report for quality patient-centered care. Journal of Nursing Care Quality, 36(2), 125-131. https://doi.org/10.1097/NCQ.0000000000000509

https://lopes.idm.oclc.org/login?url=http://ovidsp.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?

Outcome Assessment in Advanced Practice Nursing

Read Chapters 2 and 8 in Outcome Assessment in Advanced Practice Nursing.

ADKAR: A Framework for Successful Change

View:

Massey, K. (2019, July 3). ADKAR: A framework for successful change [Video]. YouTube. https://www.youtube.com/watch?v=zXwJTZ2EA2Q

Implementation Science and Nursing Leadership: Improving the Adoption and Sustainability of Evidence-Based Practice

Read:

Nelson-Brantley, H. V., & Chipps, E. (2021). Implementation science and nursing leadership: Improving the adoption and sustainability of evidence-based practice. JONA: The Journal of Nursing Administration, 51(5), 237-239. https://doi.org/10.1097/NNA.0000000000001006

https://lopes.idm.oclc.org/login?url=http://ovidsp.ovid.com.lopes.idm.oclc.org/ovidweb.cgi? T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00005110-202105000-00003&LSLINK=80&D=ovft

COVID-19: Why the Economics of Healthcare Will Never Be the Same

View:

Glenn, L. (2020, August 11). COVID-19: Why the economics of healthcare will never be the same [Video]. YouTube. https://www.youtube.com/watch?v=HRboT_SsxP8

Assessments

IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care

This module examines value in health care. The concepts include cost, value, and their relationship to quality,

health care spending, the practitioners’ role in managing costs, and identifying and overcoming barriers to provide high-value and cost-effective care.

General Requirements:

Log into your IHI Portal using the link located in the Class Resources to access and complete the assigned module.

You are not required to submit this assignment to LopesWrite.

Upon completion of the module, submit your certificate to the assignment dropbox.

Learners will submit this assignment using the assignment dropbox in the digital classroom. In addition, learners must upload this deliverable to the Learner Dissertation Page (LDP) in the DNP PI Workspace for later use.

Directions:

Complete the “IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care” module before day 4 of this week. You will use the information learned in this module to answer the Topic 2 discussion question due day 5.

The estimated time for completing this module is 45 minutes, but for some learners it may take longer

Quality and Sustainability Paper: Part 1

This assignment will be completed in two parts, which will be synthesized into a final paper.

The purpose of this assignment is to investigate a quality and/or safety issue in a health care entity. You will use the issue and health care entity that you select in this assignment for Part 2 of the paper and for the sustainability assignments. You may use an issue identified at the practice site in your DPI Project.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.

This assignment requires that you support your position by referencing six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings. You are required to submit this assignment to Lopes Write. A link to the Lopes Write technical support articles is located in Class Resources if you need assistance.

Directions:

Describe the importance of quality or safety in the profession of nursing. Be sure to include:

1. Define quality and safety measures in your own words, and explain their link and importance in today’s nursing practice.

To better understand the current state of health care in the United States, identify three hurdles and three facilitators or techniques for overcoming the barriers. Provide answers for how health care organizations can deal with two of the obstacles. List two approaches or facilitators and explain how they can aid in the reduction or removal of obstacles. As an appendix, include the table.

Find a healthcare provider. Describe this thing in general terms without using its real name (e.g., location, size, profit or nonprofit, years in operation). Do not use the name of the healthcare organization or any of the individuals mentioned.

Explain how the health care entity measures a contemporary quality and/or safety issue and how that metric is implemented in nursing practice. All quality and sustainability assignments will be based on this topic.

Discuss the health care organization’s existing quality and/or safety program in relation to the quality and/or safety issue you selected. Identify the most important quality measurements or components currently utilized to evaluate the health care program’s results. Discuss what works and what doesn’t.

Include a list of the specific variables that were utilized to measure progress toward the program’s quality and/or safety goals.

DNP 835 Topic 2 Assignment: Innovative Approaches to Health Care, Change Theories, and Sustainable Change