Abstract
Every health organization has the goal of providing quality, safe, and cost-effective care to patients. Some safety issues reported in hospitals today question the role of the health sector in improving the health outcome of the community. Many hospitals record poor patient outcomes because of the inability of the management to plan duties and changes in shifts between nurses caring for patients in hospital wards. Poor inter-shift reports between registered nurses act as one of the most common problems threatening patients' safety and delivery of quality care in hospitals today. Technology plays a significant role in influencing communication between colleagues in the organization. The report aims at utilizing modern technological advancements to create a plan for improving communication between RNs during shift handovers. The proposed plan involves the development of an Inter-Shift Mobile Application at Santa Clara Valley Medical Center (VMC). Each RN will be required to have Smartphone installed with the app to help improve speedy and effective communication during inter-shift handoffs.
1.0 INTRODUCTION
Every health organization has the goal of providing quality, safe, and cost-effective care to patients. Some safety issues reported in hospitals today question the role of the health sector in improving the health outcome of the community. Moreover, issues associated with medical errors play a critical role in causing serious injuries to patients and their families. Many hospitals record poor patient outcomes because of the inability of the management to plan duties and changes in shifts between nurses caring for patients in hospital wards. Poor inter-shift reports between registered nurses act as one of the most common problems threatening patients' safety and delivery of quality care in hospitals today. The following recognizes poor communication between RNs as the main cause of the problem and develops a plan to improve communication between RNs.
On the other hand, technology plays a significant role in influencing communication between colleagues in the organization. The proposed plan aims at utilizing modern technological advancements to create a plan for improving communication between RNs during shift handovers. Technology makes many tools available for improving communication between healthcare professionals and patients (Eaton, 2010). The introduction of the social media tools such as the Facebook, Twitter, Youtube, and MySpace makes it easier and efficient for health providers to share information with one another or between providers and patients. Additionally, technology advancements keep growing each day. One of the innovations that play a significant role in addressing the problem of poor inter-shift reporting systems between RNs is the creation of a mobile App for improving nurse-nurse communication. The report proposes an Inter-shift mobile Application to help improve inter-shift reporting systems at VMC to promote patient safety and healthcare quality. At VMC, nurses are fond of sharing computers and this interferes with patient privacy and confidentiality. The app will be equally helpful in determining the success that comes with the proper management of the nurses by ensuring patient's privacy by promoting one-nurse-one Smartphone. Additionally, the app will offer the necessary control for the nurses and other workers at VMC by improving their efficiency when attending to patients.
1.1 Specific problem requiring change
According to Friesen, White, and Byers (2008), transfer of critical health information about a patient from one healthcare professional to another act as an integral component of ensuring an effective transition. At VMC, a nurse in the current shift must hand off all information about the patient to the next nurse through bedside reporting system that affects privacy during the transfer of patient data. Many health providers do not care about the handoff and because some assume the next provider understands the protocol or because of the ignorance among nurses. The evolvement of the healthcare sector introduces problems with poor inter-shift reporting system as experienced today. Currently, hospitals accommodate more patients because of prevailing health conditions and the occurrence of new health problems requiring frequent visits to health centers. Additionally, the advancement of the communications and information technology makes people more reliant on technology that may cause problems with communication because of system failures. These two conditions make inter-shift reporting system between RNs poor that affects patients’ outcome. The current healthcare system needs to create a change plan to help prevent the problem to ensure future patients receive safe and quality care at all times. Through proper implementation of the app, the handoff process will be enhanced as it will be easy for intake and output of excellent medical services. The patients will be handled accordingly in the laboratory following the discovery of the causes of the pain and the relevant nursing care will be provided to the patient (Friesen et al, 2008)
1.2 Clinical situation description with appropriate need for change data
The belief that hospitals are the best place where people receive safe and quality care has now received major doubts. The time spent when nurses exchange patient information during inter-shift handovers is costly and most nurses prefer leaving patient records for the next nurse to go through and understand the patient’s needs. Health organizations experience major challenges planning for an effective inter-shift reporting system that ensures a smooth exchange of duties from one RN to the next during a shift. Poor communication between nurses acts as one of the relative risk factors affecting inter-shift reporting in hospitals. The issue causes more than 65 % of all cases reported in hospitals (Antwi and Kale (2014). Effective communication during nursing shift handovers facilitates the continuity of care and ensures patient safety. A proper intervention towards improving the inter-shift reporting system among RNs helps reduce the problem. A study by Malekzadeh, Mazluom, Etezadi, and Tasseri (2013) revealed an increase in patient outcome and safety after an intervention that ensured nurses communicated effectively during shift handovers.
On the other hand, the problem of poor inter-shift reporting system makes patients and their families more engaged about their health. The problem is more severe for patients in Emergency Departments and those suffering from chronic diseases compared to other patients. For example, the Nurse Bedside Shift Report tool helps informs the patient and the family about bedside shift reports and recommends to them how to become engaged in the process. However, poor reporting caused by inappropriate communication leads to nurses not providing patients and their families with the correct information. Eventually, families and people visiting the patient ends up interfering with the treatment process because they lack proper guideline on how to deal with the patient especially when it comes to feeding. On the other hand, lack of proper information about the patient’s conditions such as the time for medication causes a lot of confusion on the oncoming nurse, which ends up affecting the delivery of care and the safety of the patient.
1.3 Individual/Committee involved
The modern healthcare setting needs many reforms that require contributions from individual, groups, or committees to address the much-needed change in the delivery of care to the society. Facilitating healthcare reforms in the United States healthcare sector needs healthcare managers and decision makers to have a clear picture of the prevailing condition to help them come up with an innovative plan. The success of the change process at VMC requires a total commitment of individual proposing the change and healthcare stakeholders responsible for ensuring RNs adhere to the proposed change. Such individuals include the nursing practitioners and directors, nurse educators, finance team, and IT professionals in the healthcare sector. Managing change in the healthcare sector has many challenges because the process involves many stakeholders. The proposed change must meet demands of every stakeholder and ensure the health care organization, the patient, and the community benefits from the plan. According to Antwi and Kale (2014), change management models play a significant role in ensuring the success of the organizational chance plan. The three stages are unfreezing, moving, and refreezing. The selection of an effective change management process helps in promoting the success of the change process.
1.4 Statement of desired change
Communication between healthcare professionals is vital in promoting quality of care to patients by ensuring a constant flow of patient's information from one provider to the other.
1.5 Role of change agent and targets for change
Change agents play a big role in providing guidelines and pieces of advice on how to implement and maintain the proposed change plan. Change agents range from individual consultants to organizations and groups. Change agents should always be ready to guide the change management team on different paths and offer solutions to problems identified during the plan implementation process.
Targets for change
The proposed change has the following targets:
To improve inter-shift reporting systems between RNs
To ensure nurses utilize modern technologies to promote quality and safety in healthcare
To help meet the U.S. healthcare reforms
2.0 DRIVING AND RESTRAINING FORCES
Changes within the organization face two main types of forces, the driving, and restraining forces. The Force Field Analysis process helps change agents identify these forces and classify then effectively. The process analyzes all forces associated with the planned change process and establishing their individual impacts through weighing their benefits and shortcomings.
Driving forces
The U.S. health care sector calls for health care reforms and would be on the forefront to support the change plan
The high need for implementing health information technologies to promote patient outcome
The society and the community support the plan
The readily available resources (most RNs have smartphones to facilitate communication)
Restraining forces
o Lack of adequate funds to support the change plan
o Nurses not well versed with the use of mobile technology to facilitate communication
o Some nurses may assume and ignore the change process
o Individual culture and norms
3.0 PROPOSED PLAN
Recent studies have revealed a lack of appropriate data for establishing the specific cause of the problem of poor inter-shift reporting systems among nurses. Wakefield, Ragan, Brandt, and Tregnago (2012) conducted a study to establish the level of coordination of care in nursing bedside shift reporting. The study identified numerous interventions that drive patient satisfaction. Some of the identified drivers included perceived staff-staff and staff-patient communications, perceived staff caring, perceived staff responsiveness, and perceived staff quality of care. Research findings from Wakefield, Ragan, Brandt, and Tregnago play a critical role in determining the most effective plan to offer a solution to the problem of poor inter-shift reporting systems between RNs. The study cited poor nurse-to-nurse communication as the main cause of the problem; hence, the proposed plan focuses on improving staff-staff communication.
Professionals at VMC rely on paper chart components, personal reporting tools, and computerized records to assimilate patient’s data when preparing a bed shift report. The presence of a single computer in the hospital for carrying out inter-shift creates delays during handoffs. Additionally, cases of nurses relying on their personal memories to keep patient's information are common. These play a role in improving inter-shift reporting between nurses during handovers, but they are not very effective. The presence of advanced technologies and improvement in the communication process leads to the introduction of more sophisticated tools that are effective, efficient, and error-free. Experts in the health information system worldwide have thought of different solutions to inter-shift reporting challenges by implementing the mobile technology. According to a study an improper inter-shift strategy 23% of physicians could identify the responsible nurses for their patients and only 42% of nurses could recognize the responsible physician for the patients in their concern (Hughes, 2008). The inter-shift mobile app will have a significant impact in improving inter-shift reporting among RNs.
The proposed plan will utilize the Smartphone technology using a mobile-based application to improve communication among nurses during handoffs. The application will contain data from important patient charts that nurses need to provide care. The application will also have medical records of individual patients as retrieved from the charts. The application works under three important phases, the user interface, service interface consisting of the web server services, and the resource interface that houses the database. Nurses will be required to have Smartphones to ensure total implementation of the process. Every RN will download and install the application on their mobile gadgets. Nurses will be required to set their personal accounts and use personal identification numbers (PIN) to access the application to prevent unauthorized authentication.
Benefits of implementing the proposed plan
The Inter-shift mobile application creates a better opportunity for RNs to exchange patient information during shift handovers. Unlike the normal computer stations that contain patient’s charts and information, the mobile application will offer a more flexible inter-shift handover because the nurse can easily study view the schedule at any place and any time. Additionally, the application has a reminder that helps the nurse plan for activities for different patients. For example, the reminder helps the nurse plan for medication of different patients. The reminder also helps notify the nurse of any other activity that needs an immediate attention such as turning the patient in case the person is bed ridden.
3.1 Plan implementation process
3.1.1 Getting Approval for the proposed change
The team will need approval from VMC management to implement the change. The management needs a proposal, the timeline, and the budget.
3.1.2 Handling the cost
The program is much costly, and the hospital needs to implement it in phases to cater for the high cost. Nurses who already have Smartphones will not need additional gadgets to reduce the cost of implementing the plan.
3.1.3 Activities involved in the change
Activity 1: Obtaining approval from relevant authorities
The relevant authorities represented by the government and hospital representatives must approve the proposed plan. A proposal will be presented to government agencies dealing with health care issues and the hospital management requesting them to approve the project. All relevant information including the identified problem, solution, and the proposed plan will be included in the proposal.
Activity 2: Developing and implementing the change
The proposed change involves the application of technology. ICT experts in the field of health will be employed to develop and run the application. The management takes control of implementing the change by engaging the staff into adopting new changes after the ICT experts release the App.
Activity 3: Special preparation
The RN staff needs to undergo a special preparation to make them ready for the change. Members must undergo training to help them familiarize with the new reporting system and make others know how to use Smartphones. Additionally, the healthcare management will undergo special preparation to equip them with skills on how to troubleshoot issues arising from the use of the Inter-Shift Mobile App. The nursing educators will offer education or training regarding a number of processes that the app undertakes at a specific time.
Activity 4: Obtaining and using resources
The application will utilize health records and other resources from the health organization. The team responsible for approving the proposal will be requested to make information available to ICT experts to help in programming the Application. Additionally, nurses will obtain information about individual patients while doing normal checkups but with the approval of the hospital management.
Activity 5: Participation in the change process
The need for change in the healthcare sector calls upon health professionals to take part in the change process. Participation in the following plan entails offering rewards to RNs recording fewer cases of patient insecurity and showing total dedication towards sharing information in their wards. Giving rewards helps motivate other nurses leading to an overall improvement in the inter-shift reporting system.
3.1.4 Unfreezing, Freezing and Refreezing the change
Unfreezing the change
The unfreezing of the change will take place during activity 2 of the change implementation process. Change team will conduct a pilot test to establish the significance of the change process. Only two wards, one for emergency patients and the other for normal patients will be used. Nurses will be served with smartphones installed with the app. The team involved in the evaluation will test the impact of using the new system in selected wards. The outcome of the freezing stage will provide a go through to the next stage. The process takes three months to establish the outcome.
Freezing the change
The following represents the step when the change team adopts the change after getting the outcome of the unfreezing process. The whole hospital staff will change into using Smartphone mobile app to conduct inter-shift process for patients admitted in different wards. The hospital management and other stakeholders will engage in an official launch of the inter-shift mobile app reporting system. Activities 3 and four will be set for the freezing stage. The freezing will take 4 to 12 months to complete.
Refreezing the change
After total implementation of the change process, the change team must engage in continuous monitoring to keep the program running effectively. The change team will carry out frequent tests to determine any additions necessary to improve the outcome. The refreezing takes place twice every year after the launch of the program.
Significance of the process
The strategy will be highly useful in designing the flow of activities through the app. The unfreezing stage will have tested the app against certain challenges that are evident in healthcare centers for adoption. The freeze stage will measure how useful the app will be used in enhancing healthcare and assuring people of good health through accurate and speedy medical services through practical use or adoption by healthcare facilities. Through the last stage of refreeze, it will be easy to determine the enhancements that may be made to ensure successful implementation of the app in successful medical activities.
3.1.5 Costs involved
The change process will incur VMC a lot of resources. The involved include;
§ Cost of developing the app (Paying the IT experts, buying mobile gadgets, and mobile data)
§ Costs associated with training the staff on how to operate the new program
§ Cost of researching about the change
4.0 EVALUATION CRITERIA AND PROCESS
The evaluation criteria help in measuring the success of a change process. The evaluation process occurs after two years of implementing the proposed change. The focus of the evaluation will be the ability of the change plan to meet health care goals and aims. The main measurable factors based on the current problem are patient outcome determined by safety, quality, and nurse-nurse relationship. A selected research firm will carry out an investigation on selected healthcare organizations to determine the impact of the proposed change in improving and solving the problem. The investigation will run for 15 months to allow the research team to gather adequate data.
4.1 Evaluating patient outcome
The safety of patient will be evaluated based on the present and past records. The team will collect data from the patient to determine the level of satisfaction from RNs and compare it with the data recorded in the past. An improvement in patient's satisfaction shows a positive outcome. On the other hand, the evaluation will test the quality of care offered to the patient. A comparison of the past records when nurses used paperwork and other shift handoffs practices with the current mobile app will be used to determine the outcome of the proposed change.
On the other hand, the hospital management takes the responsibility of seasonal conduction evaluations on the staff. The management keeps records of any shortcoming of the new system and any recommendation from the hospital staff to help the system function effectively and achieve the high patient outcome.
5.0 CONCLUSION
Health care providers have a great duty of maintaining patient safe and secure in the hospital environment. The establishment of an effective and efficient tool that supports changes in health care delivery by promoting patient safety and improving the quality of care helps transform the healthcare sector. The proposed mobile App plays a critical role in improving communication between RNs by ensuring improved inter-shift reporting during handoffs at VMC. Technological advancement has a significant positive impact on improving the quality of care. Additionally, the health care sector should support changes, such as the one proposed in the report, to ensure quality and safe delivery of care in the future.
References
Antwi, M., and Kale, M. (2014, January). Change management in healthcare: Literature Review.
The Monieson Centre for Business Research in Healthcare.
Eaton, E. V. (2010). Handoff Improvement: We need to understand what we are trying to
fix. The Joint Commission Journal on Quality and Patient Safety, 36(2), 51-72.
Friesen, M. A., White, S. V., and Byers, J. F. (2008). Handoffs: Implication for nurses in Patient
safety and quality: An evidence-based handbook for nurses. Rockville (MD): Agency for
Healthcare Research and Quality (US).
Hughes, R. (2008). Patient safety and quality. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Dept. of Health and Human Services.
Malekzadeh, J., Mazluom, S. R., Etezadi, T., & Tasseri, A. (2013). A Standardized Shift
Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units. Journal of Caring Sciences, 2(3), 177–185.
Wakefield, D. S., Ragan, R., Brandt, J., and Tregnago, M. (2012, June). Coordination of Care:
Making the transition to nursing bedside shift report. The Joint Commission Journal on Quality and Patient Safety, 36(6), 243-254.
