Over the years, there have been several concerns regarding the threats posed to the patients by different errors when it comes to health care services and its delivery. Thus, it has always been a goal of different health institutions and organizations to reduce the risks and harms to patients and health care providers associated with care delivery through improved performance of professionals and increased effectiveness of the system. Some of the barriers to increase safety of the system include systems that have unexpected consequences due to high risks, absence of the difference systems linked with verbal, written, and electronic communication systems, absence of standardization within the system, and inadequate knowledge about the different ways to promote patient safety (Barnsteiner, 2011).
A report entitled “To Err is Human: Building a Safer Health System” that was released more than 15 years ago identified four different ways to improve patient safety namely establishment of research, leadership, procedures, and tools, identification of errors, increased standards to help improve performance, and to safely create systems that will be able to delivery patient safety (Sammer and James, 2011).
One of the main patient safety concerns is linked with information technology. Currently, there have been increasing concerns about information technology and its role in the improvement of the patient safety in healthcare. Several studies have identified different issues regarding the risks associated with the significant variations of not only the quality but also the safety of healthcare. Due to these issues, health expenditures have been observed to increase along with the mortality and morbidity of different diseases. To be able to address these concerns, several innovations in technology in health care have been done. However, applications created with the use of technology or eHealth applications still have increasing concerns. The insufficient focus given to the socio-technical aspect of the use of eHealth applications and other possible disadvantages of using technology in health care have been one of the concerns in patient safety. The concern with information technology mainly affects health care professionals like nurses, doctors, laboratory scientists, and even the staff because they are the people directly handling the technology. Technology becomes a problem when the professionals lack the appropriate knowledge when handling eHealth applications which can greatly affect patient outcome and satisfaction (Huckvale, et al., 2010).
Different theories can be used to solve these patient concerns. Some of the well-acknowledged theories and models that can contribute to systems change include complexity theory, chaos theory, change theory, and even innovation theory. Chaos theory is basically focused on procedures and frameworks that follow the usual rules and regulations but only in an unconventional way. On the other hand, complexity theory have been considered as a byproduct of the previously defined theory. The reason behind the claim is the involvement of different complexly characterized systems or systems that usually involves relationship or association with other systems or other components within the system (Tesson, n.d.).
Innovation theory can be expressed as a framework that permits innovations especially when it comes to technology. The main focus of this theory is directed towards effective and efficient communication within the organization and even among other organizations (Kaminski, 2011).
The last of the provided theories is the change theory which was adapted from the model described by Kurt Lewin. This model has been the most famous and significant theory among the mentioned theories because of its relevance when it comes to its application when dealing with the dynamics of the health care field. It has been claimed that changes in systems will only be possible and effective when the professionals and the organization are both willing to adapt to the change by clearly understanding the different factors that contribute to the occurrence of the event or change in the system. Three main components can be found in the model. These components include unfreezing, moving, and freezing or refreezing (Sutherland, 2013).
The model was constructed to pave way for the identification of the different elements that serves as a delay or hindrance towards the occurrence of the change. Restraining or static forces are the terms used to identify the factors that acts as opposing elements towards the change. On the other hand, driving forces is the term used to identify the elements that are responsible for the promotion or progress of a particular system change (Sutherland, 2013).
In the first element of the model, the “unfreezing stage” refers to the step of the theory where the hindrances and barriers related to the identified patient concern will be identified. It is also the step where relevant planning and brainstorming is done to come up with an efficient and effective strategy which will result to the reduction of the static or restraining forces and intensification of the driving forces. Identification of the important stakeholders or key players who are directly or indirectly affected by the systems change also occurs in this stage. The identified stakeholders will be congregated to create a stimulating relationship which promotes open communication to come up with different ideas and elements which can be classified as either static or driving force (Bozak, 2003).
The second element of the model which is the “moving stage” involves actual occurrence of the system change which happened due to the reduction of the restraining forces and the intensification of the driving forces. The strengthened presence of the driving forces contribute to the promotion or acceleration of the occurrence of the systems change. The production of the desired change due to the proper application and implementation of the proposal or project also belongs in this stage. Thus, it is important that the open communication that has been initiated during the unfreezing stage is maintained and strengthened in this stage (Sutherland, 2013).
The third element of the model is referred to as the “freezing stage” or “refreezing stage”. This stage basically involves evaluation and assessment of the effectivity and efficiency of the implemented project or proposal. This step is significant because it determines if the organization and the stakeholders affected by the change will be able to adapt to the systems change and if the change is stable enough to solve the main problem. It is important for the project to be accurately evaluated since the improvement of patient outcomes, patient satisfaction, and patient safety as a whole depends on the stability, efficiency, and effectiveness of the project (Sutherland, 2013).
Some studies that tackled the effect of change in the health care sector provided different effects and consequences. It has been stated that organizations and institutions work diligently in various locations, may it be operational or procedural, to be able to adapt to changes in the system. One of the important considerations that should be focused on is the retraining of the stakeholders, which is basically composed of the healthcare workforce, to be able to acquire appropriate and significant knowledge and skills associated with the change. The management and leadership styles should also be reviewed to be able to come up with a style which is appropriate for the current change in the system. It has been a common opinion that innovations in the field of technology should be considered because of the growing dependence of the industries and even the people to technology (Kaminski, 2011).
The role of the nurses that have reached the doctoral level or DNP are being accepted in the health care sector because they have been prepared to handle the highest possible level of nursing practice. The DNP nurses can greatly help in the fields of evidence-based practice, improvement of the quality of health care services and delivery, and systems management. Thus, these nurses have been claimed as cost effective. The main focus of these nurses have been pointed on ensuring that the needs of the patients, families, and communities are being met regardless of any changes that may occur within the system or the health care environment (Soobryan, n.d.).
There has been a growing concern for the improvement of patient safety because of the reports released by the Institute of Medicine’s Quality Initiative. The report emphasized the need of the United States health care system to be understood, measured, and improved. One of the important concerns raised in the report was the serious errors when it comes to the health care system along with the different safety concerns. Thus, the use of technology in the field of health care has been one of the proposals of different institutions and organizations to help improve patient safety (Savitz, et al., 2015).
The change model presented by Lewin can give a better picture of how technology has been used for the improvement of patient outcomes. Nurses are considered as the major stakeholders when dealing with the delivery of health care. Their roles include ensuring that the processes and outcomes are safe and of high quality. The changes experience in the health sector are one of the main reasons why nurses should be educated at the doctoral level to be able to understand complex demands of the nursing practice (Morath, 2011).
The main problem that causes safety concern that has been identified in the earlier paragraphs is the increasing occurrence of medication errors, decision errors, calculation errors, communication errors, and even monitoring errors which results to increasing rates of morbidity and mortality. Thus, decreasing the satisfaction of patients regarding the quality and delivery of health care services.
As part of the “unfreezing stage” of Lewin’s change model, it is important to determine the stakeholders or key players that are directly or indirectly involved in the change. The concerns in the safety of patients directly involves health care professionals such as the nurses, doctors, laboratory personnel, and even the staff while patients along with their families and relatives are indirectly affected. It is also in this stage where the brainstorming and planning of the change is done. According to Huckvale, et al. (2010), the most appropriate project for the continuously increasing errors in medications, calculations, systems, and monitoring is the application of information technology. The driving force for the change to occur is the increasing rates of morbidity and mortality along with the increasing occurrences of errors in health care service and delivery. On the other hand, the restraining force would include adequate knowledge of the health professionals that are handling the patients which have lesser chances of committing errors. When the patient safety continues to be a concerns while the number of adequately educated and skilled professionals keep on declining, the adaptation of information technology in the field of health care will continue.
For the second stage of the Lewin’s model known as “moving stage”, the implementation of the project will be done. Since application of information technology can occur in different ways, there can be various projects that can be done. One of the possible application of technology in the health care field is the bar coded medication dosages to help decrease the medication errors. It is important to consider this project since many patients are at risk of having complications or worse, dying due to wrong dosages of medications administered to them. Another project that involves technology are eHealth applications which can include computerized filing system of the patient information, diagnosis, and test results. This can greatly help minimize systems error and monitoring errors. An institution or organization wide application system is also possible. In this system, all of the results or information for the same patient can be easily accessed by health professionals and staff. This can greatly increase the efficiency and effectivity of professionals.
The last stage of Lewin’s model is the “refreezing stage” or “freezing stage”. This stage involves the implementation and evaluation of the eHealth applications, bar coded medication system, and organization wide applications. The evaluation of these projects are necessary to determine if the health professionals are adequately trained and educated to handle such applications and if the quality and delivery of health care services have improved.
The application of technology can bring different benefits. Thus, it can be expected that the medication safety will be focused on especially when it comes to error prevention. Automated documentations upon implementation will lead to maximized prescription, transcription, distribution, and administration safety. Additionally, technology can also help in the enhancement of alerts related to event-surveillance and drug events. Thus, it can be claimed that bar coded information of patients and their records can greatly widen the zone of patient safety. The accessible programs and applications due to technology can greatly help nurses in the identification and evaluation of the route and dose of the medication to be administered. Also, nurses can efficiently and flexibly respond to the changes in laboratory tests results. As an example, a patient which have been recorded to have low value for serum potassium can easily alert the nurse of that the patient needs medication to increase the level of potassium in his body. Automated information system for a health institution can also help in the standardization of the processes within the institution. This can greatly reduce possible miscommunication among colleagues. Standardized reporting of different laboratory results and diagnoses can greatly help nurses apply the appropriate tools and work materials without compensating the quality of their work (Lavin, et al., 2015).
Currently, the roles of advanced practice nurses are continuously expanding and developing as a result of the dire need of nurses who are trained to handle advanced levels of nursing practice (Kleinpell, 2014). These roles greatly contribute to an organization’s ability to adapt to the dynamic state of the health care system. They are also considered as main stakeholders when dealing with changes especially when using Lewin’s change model.
The primary concern when it comes to patient safety include increasing rates of mortality and morbidity and decreasing satisfaction and outcomes of patients and professionals. Thus, health institutions and organizations came up with the idea to incorporate information technology in the nursing practice using Lewin’s change model. As a result, the nursing practice have continuously researched on the numerous benefits and potential disadvantages that may be associated with the association of technology and healthcare.
References
Barnsteiner, J. (2011). Teaching the Culture of Safety. OJIN: Online Journal of Issues in Nursing 16 (3), Manuscript 5.
Bozak, M. (2003). Using Lewin’s force field analysis in implementing a nursing information system. Computers, Informatics, Nursing 21(2): 80-85.
Huckvale, C., Car, J., Akiyama, M., Jaafar, S., Khoja, T., Khalid, A.B., Sheikh, A., and Majeed, A. (2010). Information technology for patient safety. Quality and Safety in Health Care 19(2): i25-i33.
Kaminski, J. (2011). Diffusion of Innovation Theory. Canadian Journal of Nursing Informatics 6(2).
Kleinpell, R., Scanlon, A., Hibbert, D., Ganz, F.D., East, L., Fraser, D., Wong, F.K.Y., and Beauchesne, M. (2014). Addressing Issues Impacting Advanced Nursing Practice Worldwide. OJIN: The Online Journal of Issues in Nursing 19(2), Manuscript 5.
Lavin, M., Harper, E., and Barr, N. (2015). Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings. OJIN: The Online Journal of Issues in Nursing 20(2).
Morath, J. (2011). Nurses Create a Culture of Patient Safety: It Takes More Than Projects. OJIN: The Online Journal of Issues in Nursing 16(3), Manuscript 2.
Sammer, C. and James, B. (2011). Patient Safety Culture: The Nursing Unit Leader’s Role. OJIN: Online Journal of Issues in Nursing 16(3), Manuscript 3.
Savitz, L.A., Jones, C.B., and Bernard, S. (2015). Quality Indicators Sensitive to Nurse Staffing in Acute Care Settings. Advances in Patient Safety 4:375-385.
Soobryan, B. (n.d.). DNP and the Transformational Leaders. Journal of Nursing. Retrieved from http://rnjournal.com/journal-of-nursing/dnp-doctor-of-nursing-practice-transformational-leaders [Accessed on 23 Jan 2016].
Sutherland, K. (2013). Applying Lewin’s Change Management Theory to the Implementation of Bar-Coded Medication Administration. Canadian Journal of Nursing Informatics 8(1).
Tesson, K. (n.d.). Chaos theory, complexity theory and emergence. Inclusional Research Forum & Learning Space. Retrieved from http://www.inclusional-research.org/comparisons4.php [Accessed on 8 Jan 2016].
