Patient safety is a concept that continues to arouse debate in healthcare, as stakeholders in this industry try to delineate ways in which this can be achieved safety can be achieved. Hospital Associated Infections, HIAs, is one of the challenges facing the efforts of maintaining quality and patient safety. WHO (2015) observed that 10 out of every100 people receiving in-patient services acquire HIAs, which consequently leads to longer hospital stays, increased medical expenses, and fatalities and/or disability among the patients. Calfee (2012) estimated that Medicare and Medicaid spend thousands of dollars every month in treating HIAs.
Unlike the common belief that only healthcare practitioners are responsible for the safety of patients while they are in hospitals, studies indicate that patients, their visitors, and other staff working in hospitals have a critical role to play ensuring patient safety. Similarly, prevention of HIAs is the responsibility of anyone who comes into contact with the patient while he/she is in care (Calfee, 2012). The WHO guidelines provide a clear outline on how to prevent these infections. However, these guidelines are not strictly adhered to by patients, visitors, and practitioners due to ignorance. Retraining the nurses on the importance of adhering to the WHO guidelines is critical in improving the quality standards in the hospital, hence reducing the frequency of the infections.
Through this exercise, a better understanding of the impact of change theories, threats that face the future of patient safety improvements, and models that support patient safety and advanced practice nursing, will be achieved.
Description of Selected Change model for Quality Improvement Proposal
Change is inevitable, especially in the healthcare industry where new innovations are discovered often, and this requires the adoption of new approaches in order to remain relevant and competitive. Patient safety is threatened, and driven, by these innovations in equal measure. The selected patient safety concern for quality improvement of patient safety is HIAs, which continue to not only threaten the safety of the patients, but also to undervalue the very existence of advanced practice nursing. The adverse effects of HIAs on the patients, practitioners, and the healthcare industry in general, call for change in patient safety guidelines. The change model that will be utilized for quality improvement proposal is the Kurt Lewin change model.
Kurt Lewin is recognized as the father of social psychology due to his numerous works in the aspect of change in human beings. Kurt created his change management model in 1950 based on the psychology of human beings, and he found that human beings operate under safety zones in the advent of change (Bargal, 2012). This change model was selected as the model of choice in implementing the proposed change due to its simplicity, which makes it easily applicable to a variety of change scenarios. Additionally, Lewin’s model is a widely used, as it is applicable in a variety of business areas, including healthcare. Kurt, in his change model, identified three stages of change;
Unfreeze
Kurt acknowledged that it is in human nature to naturally resist change, unless motivation for the change is provided. Bargal (2012) observed that people resist change for a variety of reasons, including uncertainty and fear of unknown, mistrust, fear to fail, and lack of proper preparation for the change. Burns and Cooke (2013) suggested the active involvement of all stakeholders/employees who will be affected by change from its inception, until the change is implemented, as a way of minimizing resistance. Kurt Lewin called the stage at which myths are demystified and trust built, as the unfreezing stage. This stage involves the active preparation of the people who are going to be affected by the change by providing them with facts for the change.
In addition, the benefits of the change are weighed against the disadvantages, with the aim of reducing the risk of resistance to the proposed change. Managers and leaders may also employ the tactic of reward and/or punishment at this stage as motivation for the employees (Day & Shannon, 2016). In reducing the rate of HIAs in the hospital, the approach is to train the visitors, patients, and practitioners on the importance of adhering to the WHO guidelines. Unfreezing can be achieved by providing the stakeholders with statistics on the consequences of HIAs, while giving rewards to those who adhere to the new approaches.
Transition
This is the action stage of the Lewin’s change model, and it is defined by taking actions towards the proposed change (Burnes & Cooke, 2013). After all the stakeholders have been prepared for the change in the unfreezing stage, the transition begins. The transition is characterized by the adoption of the new approaches of doing things. It is imperative to note that this stage is characterized by more fear and mistrust, and reassurance is of vital importance if the proposed change is to be successful.
The leadership of management must avail the resources required to fuel the change, as Bargal (2012) identified lack of resources as one of the major reasons for unsuccessful transitions. Lewin, in his change model, suggested coaching and providing room for mistakes as one of the strategies for a seamless transition. Irrespective of all steps taken to ensure that the transition is successful, a proposed change may also fail if there are no clear communication channels. At this stage, the stakeholders will have many questions and uncertainties. Communications should be established in such a way that the staff do not feel threatened for ‘not knowing’.
Refreeze
Refreezing, according to Lewin, is a critical stage in the process of change. The refreezing stage is characterized by establishment of stability after the change (Day & Shannon, 2016). During the transition stage, there is no stability, as people may find themselves going back to the old ways of doing things. However, the refreezing stage ensures that the old ways are completely abandoned (Burns and Cooke, 2013). People become comfortable using the new approaches that there is no room for mistakes or the old approaches. Refreezing doesn’t happen instantly, and may take years. The management should continue to provide support and resources, until the refreezing is achieved.
Presentation of Selected Change Model for Quality Improvement Analysis
Calfee (2012) defined Hospital-Associated Infections as any type of infection that an individual acquires either as a result of direct medical intervention, or as a result contact with a healthcare setting. These infections pose a profound risk to the wellbeing of patients, as they are known to increase mortality and disability rates. In addition, HAIs lead to the loss of thousands of dollars in medical expenses, as people who acquire the infections require more treatments and longer hospital stays.
Reducing the frequency of infections associated with healthcare settings is critical in improving the safety of the patients. The proposed program involves the training of staff, patients, and staff on how to prevent HAIs using WHO guidelines. It is critical to note that patients and visitors leave the healthcare premises once they get well, and therefore, continued creation of awareness among new patients and visitors will be the role of the nurses, so as to sustain the project. The objective of the proposed project is to reduce the rate of HAIs by 30%, consequently cutting costs associated with the infections by 8%.
DNP-prepared leaders will play a major role in the achievement of the expected outcomes. According to Redman, Pressler, Furspan and Potempa (2015), the role of DNP-prepared nurses became eminent in 2001, after the IOM’s report titled “crossing the quality chasm” (Redman et al., 2015). The role of nurses in ensuring high quality of care services was acknowledged, and approaches of exploiting these potential established. While it is important to remember that DNP is a degree, rather than a role, and it is also important to note that it prepares nurse leaders and managers who work in clinical settings for their roles. DNP-prepared nurses have critical skills in translating evidence-based research into practice, which contributes greatly to the improvement of the quality of care services.
DNP-prepared nurses have a wider scope of training compared to APNs, which gives these nurses critical skills in leadership and administrative roles (Redman et al., 2015). DNP-prepared nurses can utilize their administrative and leadership skills in managing change projects, in addition to initiating the required changes accordingly. Leadership skills can be employed to initiate change, such as the strict use of WHO guidelines to prevent HAIs. Additionally, the DNP-prepared nurses can help manage the change by utilizing the management skills and availing the resources required for change.
The administrative skills that the DNP-prepared nurse possesses are also useful in the evaluation of the sustainability of the proposed changes (Redman et al., 2015). Some changes are important, but their sustainability can be challenging. Therefore, it is critical that before the change is implemented, the viability is evaluated. DNP-prepared nurses possess the special skills that enable them to assess the viability of change programs before implementation (Chism, 2015).
Although the sustainability of this change project is challenging due the fact that hospitals receive new patients and visitors every so often, it is critical to establish a sustainability approach. For this project, nurses will be trained to train new patients and visitors on how to adhere to the WHO guidelines. DNP-prepared nurses, once again, come into interplay in ensuring the sustainability of the project, as they employ their research skills to rigorously look for ways through which sustainability of the project can be achieved.
Conclusion
Improving the quality of care is critical in ensuring the safety of the patients. In the recent past, improving the quality of care has gained impetus as healthcare professionals, the government, and healthcare providers devise ways through which quality and patient safety can be achieved. One of the major challenges to the safety of patients is the Healthcare Associated Infections, which affects 10 out of every 100 patients receiving care in hospital or any other healthcare setting. Not only do these infections lead to increased healthcare costs, but it also leads to increased risk to death and disability.
HIAs also threaten the aim of healthcare, which is to prevent harm on patients. This paper addressed a change program intended to reduce the frequency of these infections. To implement this project, the three stages of Kurt Lewin’s model were utilized. This change model was chosen due to its simplicity in application and ease of use. Additionally, the role of DNP-prepared nurses in the evaluation of the sustainability of change programs was evaluated. It is evident that the role played by the DNP-prepared nurses in instituting and managing change is vital.
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