Preventable hospital re-hospitalizations are key quality and patient safety concerns. Statistics suggest that one in every five Medicare enrollees is re-hospitalized within 30 days of discharge from an acute care facility, and an estimated 75% of these readmissions are avoidable. Readmissions are expensive costing the United Sates (US) healthcare system an estimated $17 billion annually. The 2010 affordable care act established the Medicare Hospital Readmissions Reduction Program. This program offers a financial incentive to hospitals to reduce excess readmissions (Robert Wood Johnson Foundation, 2013). In efforts to avoid Medicare penalties, hospitals around the country have implemented programs aimed at lowering readmission rates for specified conditions. This paper will describe an intervention aimed at lowering 30-day readmission rates for elderly patients with acute myocardial infarction, pneumonia, and congestive cardiac heart failure implemented in one hospital. Further, it will analyze and explain the dynamics of the intervention using Burns (1978) theory of transformational leadership and Abraham Maslow’s hierarchy of human needs.
The intervention to be analyzed involved a change in practice that is an intervention that was aimed at reducing the number of elderly patients with congestive heart failure, acute myocardial infarction, and pneumonia readmitted within 30 days of discharge. This intervention was necessitated by a change in legislation that required the Centers for Medicare and Medicaid to cease reimbursing hospitals for readmissions for the three conditions occurring within 30 days of discharge. The legislation was instituted because these readmissions were increasing the costs of healthcare in the country yet they were deemed preventable. Consequently, the hospital stood to incur huge financial costs as a result of reduced reimbursement for the three conditions. The proposed intervention incorporated a number of evidence-based components aimed at addressing the root causes of preventable readmissions. These components included risk assessment on admission, early discharge planning, and transition care. A team appointed by the senior management in consultation with staffs was given the responsibility of spearheading planning and implementation of the change. Once approval for the intervention was obtained from the senior management, all staffs at the facility were sensitized on the need for the change through powerpoint presentation during weekly continuous medical education sessions. Pamphlets detailing the underlying problem, paucities in care that were contributing to the problem, and proposed intervention were also distributed to all staffs in the facility. A one week workshop was organized to train all staffs about the components of the intervention, responsibilities of the various staffs and use of project tools and other resources. The workshop was launched by the senior management of the hospital. Continued support was offered to the staffs via on-job training by the members of the project team
Although simply described above, implementation of the change was more complex. The team responsible for spearheading the change employed a number of strategies to ensure that the proposed changes were successfully implemented. Firstly, the team recognizing that there are different types of adopters to change first targeted innovators and early adopters. These individuals were identified in each department and empowered to be champion leaders for the change in their departments. Empowerment was achieved through one-to-one and group training. By acting as change agents and role models, the champion leaders demonstrated to other staffs that the proposed changes were achievable. They also played another useful role that is opinion leaders. As opinion leaders, they utilized the informal communication network in the organization to raise awareness on the need for the change amongst staffs and in effect, influenced their opinions regarding the change positively. In so doing, they sparked the initial take off of the adoption of the changes in practice. To reinforce the efforts of champion leaders, the team responsible for spearheading the implementation of the change spread information about the proposed change to all staffs through formal networks. They then employed social reinforcement from champion leaders to shape positive opinions about the change amongst staffs. Once the adoption process had commenced, they provided continued support to staffs through on-job training to ensure sustainability of required changes. To motivate staffs to adopt the proposed changes, the project team communicated and sought to demonstrate its relative advantages as compared to current practice and compatibility with current practice, values, and needs of the staffs. The team also simplified the proposed change by breaking it down into simple and easy to implement steps.
Burns (1978 as cited in Kelly & Tazbir, 2013) theory of transformational leadership will be used to analyze the above intervention. Burns (1978 as cited in Kelly & Tazbir, 2013) defined a leadership situation as one that occurs when individuals with certain purposes and motives mobilize, in conflict or competition with others, organizational, psychological, political, and other types of resources to awaken, engage, and meet the motives of followers. Based on this definition, the essential elements of leadership are leaders with positive and productive purposes and motives and followers whose needs are satisfied. The definition also suggests that leadership happens in situations characterized by conflicting purposes and motives. Burns (1978 as cited in Kelly & Tazbir, 2013) defined transformational leadership as leadership that transpires when two or more individuals engage with others in a manner in which leaders and followers enhance each other’s levels of motivation and morality. In simple terms, both leaders and followers find purpose and meaning in their work and grow as a result of their relationship. The role of a leader in this form of leadership is to meet the needs of followers and in effect, motivate them to perform better. The needs of followers referred to by Burns in his work are higher level needs like self-esteem and self actualization. Burns also described transactional leadership which is a contrast of transformational leadership. According to Burns (1978 as cited in Kelly & Tazbir, 2013), leaders in transactional leadership, engage others with the aim of making an exchange. This exchange in organizations typically involves recognition for service and salary. The exchange happens in a transactional situation and results in the satisfaction of the needs of both the leader and followers. The purposes of the two parties are, however, separate and unrelated and lack a common vision.
Abraham Maslow’s (1943) hierarchy of needs is the theory of motivation that will be used to analyze the intervention in question. The theory posits that human beings have six levels of needs that are physiological, safety, love and belonging, self-esteem, self-actualization, and aesthetics. These sets of needs are arranged hierarchically starting with physiological needs with aesthetic needs being at the top of the hierarchy. Basically, the theory posits that a person’s behavior is dominated by a particular level of need until the group of need is satisfied following which the next group of need arises.
The leadership strategy employed in the implementation of the change intervention utilized concepts from transformational leadership theory and Abraham Maslow’s hierarchy of human needs. The team spearheading the project inspired and empowered staffs at the facility to work together with the aim of reducing 30-day readmissions for elderly patients with congestive cardiac failure, pneumonia, and acute myocardial infarction. The project team achieved this by behaving in accordance with the values they were advocating for, providing a vision of a preferred future that reflected mutual values, and through empowerment of staffs. In so doing, they inspired and empowered staffs to commitment beyond self-interest and commit to a shared vision and action that led to change. They also influenced staffs to a higher level of conduct and achievement. In addition, they helped meet the self-esteem and self-actualization needs of staffs by helping them find meaning and purpose in their work and become leaders. This was significant as the organization was already meeting the physiological, safety, and belonging needs of the staffs by paying good salaries, providing a safe working environment, and allowing employees to participate in the management of the hospital.
Regarding what I have learnt from the whole process, the intervention helped me realize the importance of addressing the needs of staffs when planning change. Previously, I only gave priority to organizational needs such as the need to contain operational costs when planning change. The incident has, however, helped me realize that meeting the needs of employees is essential to the success of any change interventions. The incident has also helped me recognize the essential role informal leaders can play in the realization of change. For a change intervention to be successful, it is important to convert followers to leaders and change agents by motivating and empowering them. This helps them meet their higher level needs of self-esteem and self-actualization by helping them find purpose and meaning in their work. In future, I plan to actively involve all staffs in the planning and implementation of change interventions. I will integrate other staffs in the identification and actualization of a shared vision and future of the organization.
In summary, this paper has analyzed and explained the dynamics of a change intervention using Burns (1978) theory of transformational leadership and Maslow’s hierarchy of human needs. The change intervention was aimed at reducing the number of preventable hospital readmissions for elderly patients with acute myocardial infarction, congestive heart failure, and pneumonia. This intervention was necessitated by changes in legislation that imposed financial penalties on hospitals with excessive re-hospitalizations for these three conditions. The intervention was headed by a team. The team employed concepts of Burns (1978) transformational leadership theory and Maslow’s hierarchy of human needs. It motivated and empowered staffs at the facility to commitment to a common vision and action. In so doing, it converted employees into leaders and change agents. The team achieved this by demonstrating mutual values and satisfying the self-esteem and self-actualization needs of the staffs. From this incidence, I have learnt the importance of addressing employee needs in tandem with organizational objectives. I have additionally recognized the value of fully engaging employees in change interventions. In future, I will employ the concepts of transformational leadership and Maslow’s hierarchy of human needs when planning and implementing change interventions.
References
Robert Wood Johnson Foundation (2013). Medicare hospital readmissions reduction program: To improve care and lower costs, Medicare imposes a financial penalty on hospitals with excess readmissions. Retrieved from http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_102.pdf
Kelly, P. & Tazbir, J. (2013). Essentials of nursing leadership and management. Hammond, Indiana: Cengage Learning.
