Change Initiative: Implementation, Evaluation, and Sustainability

Change Initiative: Implementation, Evaluation, and Sustainability

Issues in Veteran’s Affairs Hospital in the Management of Sepsis

Notable challenges faced in the emergency department at the Veteran’s Affairs Hospital (VAH) is the management of sepsis which leads to suboptimal patient outcomes. Notable issues on this include delayed recognition and treatment, inadequate communication among staff, and a lack of consistence in adherence to evidence-based protocols by the staff. As a result of this, the rate of sepsis mortality has been consistently higher than national benchmarks. According to Tirandi et al. (2023), this situation often leads to patients experiencing prolonged lengths of stay in hospital and increased risk of complications. Given this, a change initiative that focuses on the implementation of a sepsis protocol and improving staff education and communication is required as it would potentially lead to timely and effective care.

External and Internal Driving Forces, Contributing Issues, and the People Affected

There are major driving forces to this issue with the external ones including the Centers for Medicare and Medicaid Services (CMS). According to Pakyz et al. (2021), the CMS emphasizes on sepsis care and reimbursement policies. Another external driving force is the Joint Commission’s sepsis performance measures which has its recommendations for appropriate sepsis care for healthcare organizations. Notable internal driving forces include the quest to improve the levels of patient satisfaction and reducing patient readmission rates. Notably, the lack of standardized sepsis protocols, inadequate staff training, and poor communication among care teams are some of the main contributing factors. Research has shown that the people most affected by this issue are veteran patients who are at a comparatively high risk of delayed or inadequate sepsis treatment Change Initiative: Implementation, Evaluation, and Sustainability. The authors also moted that the emergency department staff are also impacted as they face challenges in providing optimal care due to these issues.

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Stakeholders Involved and How They Will Be Affected

There are several stakeholders involved in this sepsis protocol change initiative with the major ones being the emergency department staff, patients, patient families, hospital administrators, and quality improvement teams (Tirandi et al., 2023). Successful implementation of this initiative will impact these stakeholders in a variety of ways. For example, while the staff will be expected to adapt to the newly implemented protocols and training. Patients and families will profit from timely and effective care and ultimately improved health outcomes. Pakyz et al. (2021) have however cautioned that the increases roles and responsibilities of nurses in the emergency department could lead to stress in the initial days but overtime their confidence and competence in sepsis care would grow. Administrators will also be impacted in that they will be responsible for supporting the entire initiative and allocating resources. Quality improvement teams, on their part, will be required to constantly monitor and evaluate the success of the initiative.

My Role and Responsibility as a Change Leader, and Applied Leadership Theories

In my position as a change leader, it will be my role to facilitate and guide the implementation of the sepsis protocol change initiative. I will do this by effectively communicating the need for change. Other responsibilities I will be tasked with is building coalitions among internal and external stakeholders as well as empowering staff to adopt new practices. More importantly, I will apply the theory of transformational leadership theory whereby I will emphasize on inspiring and motivating staff to embrace the proposed change (Baker, 2019) A second theory that will be applied is situational leadership through which I will adapt my leadership approach to meet the needs of individuals and the current situation. Principles of effective change leadership for example active listening and transparent decision-making will be applied to facilitate for the development of a culture of continuous improvement.

Change Agents Required

The success of this proposed implementation will rely on the use of change agents. Drawing from this, the notable ones in the current organization include physician and nurse champions (Katowa-Mukwato et al., 2021). Physician champions will be tasked with providing the overall lead for the project whereby they will promote the adoption of the protocol. In their capacity, they will be expected to offer necessary guidance during its implementation. Nurse champions will, on their part, tasked with offering training and mentorship to their colleagues. Baker (2019) commented that these healthcare professionals are also tasked with providing feedback on the effectiveness of such initiatives. Quality improvement specialists are the third group whose responsibility will be the analysis of data through which they will be able to identify areas that need improvement. Educators are the next change agents and will be involved in the development and delivery of training sessions. Frontline staff for example nurses and respiratory therapists will take the responsibility of providing valuable insights and feedback as justified by the fact that they will have a direct stake in the change.

Change Model to Help Develop Strategies: PDSA

PDSA
Relevance to the Organization

Research by Katowa-Mukwato et al. (2021) revealed that the PDSA model is relevant for healthcare organizations implementing change projects. Reflecting on this, the use of this model in our organization will be appropriate as it offers an iterative approach to change by focusing on testing, evaluating, and refining solutions. With this in mind, it will be helpful in the implementation of the new sepsis protocol in a structured and data-driven manner.

Strategic Aspects Using Your Model

Plan – In this first step of the model, the current sepsis problem will be defined, goals to address the issue established and a plan for the new sepsis protocol established. To effectively achieve this, a multidisciplinary team will be involved and this will include clinicians, administrators, and quality improvement specialists. Action required here is for a thorough assessment to be conducted which will be resourceful in identifying key stakeholders followed by a detailed plan Change Initiative: Implementation, Evaluation, and Sustainability.

Do – this is the second step whereby the new sepsis protocol will be implemented on a small scale. The stakeholders involved at this level are the frontline staff, patients, and families. The action that will take place here is staff education, conducting of dry runs, and testing the new protocol in a controlled environment.

Act – In this step, the generated results will be evaluated with areas that require improvement identified. Needless to say, this will form the basis for refining the protocol. Professionals involved in this third step are data analysts, quality improvement specialists, and stakeholders. The actions will involve the collection and analysis of data, conducting of feedback sessions, and iteration of the protocol based on findings seeking continuous improvement.

Study – this is the last step of the model and involves the evaluation of the effectiveness of the new protocol and sharing of collected results. Primarily, the individuals involved will be made up of patients, and families and the specific actions involving a comparison of outcomes, conducting surveys, and sharing results with stakeholders to reinforce the change.

Potential Barriers to Change

Expected barriers to change are resistance to new protocols, lack of resources, and staff turnover. These can be overcome by providing ongoing training and support, engaging staff in the change process, and promoting communication. To remedy emerging or unforeseen circumstances a flexible and adaptive plan would be established and this would run alongside regular reviews and adjustments to this approach (Almutary et al., 2020). The success of the change initiative will require several evaluation methods with the primary one being tracking metrics such as sepsis mortality rates, adherence to new protocols, patient satisfaction scores, and staff confidence and competence in sepsis care. Other metrics that will be assessed are time-to-treatment and quality improvement metrics such as the reduction in hospital-acquired sepsis cases (Pakyz et al., 2021). These quantitative measures will be supplemented by the use of regular surveys, focus groups, and interviews which will be aimed at assessing the impact of the change initiative on staff and patient outcomes. Lasting change from this implementation will be guaranteed by measures to support and promote continuous change. Drawing from this, new practices will be institutionalized through policy updates, and offering of ongoing training and coaching. Change Initiative: Implementation, Evaluation, and Sustainability Constantly celebrating success and conducting regular reviews of processes will be equally helpful. Fostering a culture of accountability and transparency will also be valuable as it will encourage staff participation in decision-making and improvement initiatives. The change plan developed through this project aligns with the organizational mission to prioritize patient safety and quality care and addresses stakeholder concerns by improving communication, reducing medical errors, and enhancing patient satisfaction.

References

Almutary, A., Althunayyan, S., Alenazi, K., Alqahtani, A., Alotaibi, B., Ahmed, M., … & Almazroua, F. (2020). National Early Warning Score (NEWS) as prognostic triage tool for septic patients. 
Infection and Drug Resistance
, 3843-3851. https://doi.org/10.2147/IDR.S275390

Baker, J. C. (2019). 
Transformational leadership and workplace effectiveness
 (Doctoral dissertation, Northcentral University).

Katowa-Mukwato, P., Mwiinga-Kalusopa, V., Chitundu, K., Kanyanta, M., Chanda, D., Mwelwa, M. M., … & Carrier, J. (2021). Implementing Evidence Based Practice nursing using the PDSA model: Process, lessons and implications. 
International Journal of Africa Nursing Sciences
, 
14
, 100261. https://doi.org/10.1016/j.ijans.2020.100261

Pakyz, A. L., Orndahl, C. M., Johns, A., Harless, D. W., Morgan, D. J., Bearman, G., … & Stevens, M. P. (2021). Impact of the Centers for Medicare and Medicaid Services sepsis core measure on antibiotic use. 
Clinical Infectious Diseases
, 
72
(4), 556-565. https://doi.org/10.1093/cid/ciaa456

Tirandi, A., Arboscello, E., Ministrini, S., Liberale, L., Bonaventura, A., Vecchié, A., … & Carbone, F. (2023). Early sclerostin assessment in frail elderly patients with sepsis: insights on short-and long-term mortality prediction. 
Internal and Emergency Medicine
, 1-11. https://doi.org/10.1007/s11739-023-03223-w Change Initiative: Implementation, Evaluation, and Sustainability

 

Assessment Description- Change Initiative: Implementation, Evaluation, and Sustainability

You will utilize your change model for this assignment. Review the feedback submitted by your instructor on your previous change model assignment. Make any changes or modifications necessary for the submission of this assignment.

Evaluate the performance of your organization or department. Identify an area that would significantly benefit from initiating a change. Write a paper (1,500-1,750 words) in which you describe the particular area you propose to address through a change initiative within the Veteran’s Affairs Hospital VAH in Amarillo TX in the emergency department such as a sepsis protocol. Include the following for your company:

Discuss the issues in this area and the current outcomes as a result of the issues.

Describe the external and/or internal driving forces, contributing issues, and the people affected.

Evaluate the stakeholders involved and discuss how they will be affected by your change initiative.

Clarify your role and responsibility as a change leader. Discuss the leadership theory (or theories) you will use to guide the change process.

Discuss the change agents you need to recruit in order to successfully implement your change. Describe the roles of these change agents.

Utilize your change model to develop strategies: (a) Explain the relevance of this model to your organization; and (b) Present the strategic aspects using your model. Be sure to clearly define the purpose of each aspect, the people involved, and the actions that need to be taken.

Identify, or predict, the potential barriers to change. Discuss possible ways to overcome these obstacles, including methods for dealing with emerging or unforeseen circumstances that could impede implementation.

Describe the evaluation methods you will use to determine the level of success of your change initiative. Discuss what metrics or measureable determinates you will use.

Propose strategies to anchor change or support continuous change.

Establish how your change plan supports the organizational mission/goal, genuinely addresses stakeholder concerns, and will serve as an equitable contribution for the community or society overall.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MSL, MBA, MSL in Leadership with an Emphasis in Homeland Security and Emergency Management 1.5

Demonstrate flexibility and adaptability in response to changing or unknown circumstances.

MSL, MSL in Leadership and Homeland Security and Emergency Mgmnt 3.5; MBA and MSN Leadership in Health Care Systems 6.2; MBA and MSL 6.5

Develop strategy for implementing and managing change within an organization. Change Initiative: Implementation, Evaluation, and Sustainability