Category: Nursing

Team Building and Addressing Barriers to Planned Change

STRATEGIC PLANNING IN HEALTH CARE ORGANIZATIONS

Discussion: Team Building and Addressing Barriers to Planned Change

Planning and implementing change can be quite challenging, especially in a complex health care environment. No matter what kind of change is undertaken, there are likely to be some obstacles. Yet, wise leader-managers, and those with whom they work, recognize that change is necessary and revitalizing; they see that planned change can not only contribute to organizational sustainability but also promote high-quality care and positively impact patient outcomes. These leader-managers harness a larger vision and engage in forethought and analysis to minimize and address barriers to planned change.

Based on what you have learned about the change process and strategic planning, what barriers do you think may arise related to the change you are proposing through your Course Project? How would you cultivate stakeholder involvement and promote team building for your planned change?

As you think about these questions, consider the following statement: “The system will evolve based on changes in the behavior of the people in the system” (Nesse, Kutcher, Wood, & Rummans, 2010, p. 27).

Do you agree? Why or why not? How does this relate to the specifics of your strategic plan?

To prepare:

Review the information presented in the Learning Resources, including Dr. Carol Huston’s comments on addressing barriers to implementing a strategic plan change. Consider insights related to change theory, common barriers to change, and strategies for addressing these barriers that relate to the implementation of your proposed change.

Identify specific barriers you are likely to encounter with your proposed change, including resistance to change. Evaluate strategies that may be used to minimize or address these barriers.

Think about the value of stakeholder involvement in planned change, as well as the specifics of stakeholder participation in your strategic plan to champion the change. Who should be involved in strategic planning and at what point? How could they serve as change champions?

Post an explanation of strategies you would use to minimize or address barriers, including resistance to change, related to your strategic plan. Explain how you would promote stakeholder involvement for your proposed change, and encourage them to become change champions.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Provide feedback on their strategies for addressing barriers to change.

Suggest additional strategies for addressing barriers or resistance.

Offer additional insights for identifying appropriate stakeholders.

Suggest additional stakeholders or change champions to be involved.

Required Readings

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Chapter 8, “Planned Change” (pp. 162–180)

(Note: You may have read this in a previous course.)

Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

Review Chapter 7, “The Three Key Elements of the Strategic Planning Process: A Vision That Guides Nursing’s Future Action”

“The Architect, Change Agent, and Communicator: Three Crucial Roles in Strategic Planning” section (pp. 135–136)

Chapter 9, “Understanding Change Theory: Strategic Planning Change Agents” (pp. 171–194)

Chapter 10, “Communicating the Strategic Plan” (pp. 195–212)

Chapter 11, “Eight Cautionary Tales of Strategic Planning” (pp. 215–226)

Chapter 9 examines change theories and how these theories can be applied in strategic planning. Chapter 10 explores the importance of communication throughout the strategic planning process and how strong communication and reduce barriers to change. Chapter 11 provides examples from the field of strategic planning efforts.

Gerrish, K., McDonnell, A., Nolan, M., Guillaume, L., Kirshbaum, M., & Tod, A. (2011). The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. Journal of Advanced Nursing, 67(9), 2004–2014.

Retrieved from the Walden Library databases.

This article describes some of the barriers to change (in this case, implementing evidence-based practices) that nurses encounter and examines knowledge brokering to facilitate change.

McMurray, A., Chaboyer W., Wallis, M., & Fetherston, C. (2010). Implementing bedside handover: Strategies for change management. Journal of Clinical Nursing, 19(17/18), 2580–2589.

Retrieved from the Walden Library databases.

This article examines a change in nursing handover practices to analyze change management with attention to individuals’ attitudes, motivations, and concerns. See Figure 2 for example of unfreezing, moving, and freezing.

Nesse, R. E., Kutcher, G., Wood, D., & Rummans, T. (2010). Framing change for high-value healthcare systems. Journal for Healthcare Quality, 32(1), 23–28.

Retrieved from the Walden Library databases.

The authors address factors that impede change and discuss change management principles, including the value of team investment for facilitating change.

Developing a Balanced Scorecard in Healthcare Organizations

STRATEGIC PLANNING IN HEALTH CARE ORGANIZATIONS

Discussion: Developing a Balanced Scorecard

How does a group gauge whether the strategic changes they implement are creating sound business results?

The effective use of a balanced scorecard can facilitate alignment between strategic initiatives and day-to-day operations. The balanced scorecard may serve as a valuable tool for monitoring progress and assessing the outcomes of a strategic plan and provide a practical means of communication.

In this Discussion, you examine the use of a balanced scorecard to measure performance related to finances, customer/client satisfaction, internal processes, and learning and growth.

To prepare:

Review the information in the Learning Resources, including this week’s media presentation, focusing on the development of performance metrics for a strategic plan. See Figure 8-6: Design your Balanced Scorecard in the Sare and Ogilvie course text.

With your Course Project in mind, think about how you would develop a balanced scorecard to measure performance, including the processes you would use to gather appropriate data.

Consider how the use of a balanced scorecard reflects the importance of being able to evaluate progress, assess the impact of planned change on performance, and determine if the costs are justified in terms of the outcomes.

Post an explanation of your plan for creating a balanced scorecard as part of your Course Project, including the processes you would use to gather data to measure performance. Explain how the use of this balanced scorecard would enable you to evaluate progress, assess the impact of your proposed change, and determine if the costs are justified in terms of the outcomes.

Read a selection of your colleagues’ responses. (I will send the peer responses on the handshake private message)

Respond to at least two of your colleagues on two different days by offering suggestions for further developing their balanced scorecards. Ask questions to peer responses at the end of every response. Cite your responses.

Developing a Balanced Scorecard in Healthcare Organizations Required Readings

Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

Chapter 8, “Overview of Strategic Planning Theories: Strategic Planning Architecture” (pp. 147–166)

Fields, S. A., & Cohen, D. (2011). Performance enhancement using a balanced scorecard in a patient-centered medical home. Family Medicine, 43(10), 735–739.

Copyright 2011 by Society of Teachers of Family Medicine. Reprinted by permission of Society of Teachers of Family Medicine via the Copyright Clearance Center.

The authors discuss using a balanced scorecard for quality improvement in patient-centered medical homes.

Groene, O., Brandt, E., Schmidt, W., & Moeller, J. (Aug 2009). The balanced scorecard of acute settings: Development process, definition of 20 strategic objectives and implementation.International Journal for Quality in Health Care, 21(4), 259–271.

Copyright 2009 by Oxford University Press – Journals. Reprinted by permission of Oxford University Press – Journals via the Copyright Clearance Center.

In this article, the authors discuss the use of a balanced scorecard as a tool for strategic planning in hospitals. The article includes an example of a strategy map, timeline, and balanced scorecard.

Jeffs, L., Merkley, J., Richardson, S., Eli, J., & McAllister, M. (2011). Using a nursing balanced scorecard approach to measure and optimize nursing performance. Nursing Leadership, 24(1), 47–58.

Copyright 2011 by Longwoods Publishing Corporation. Reprinted by permission of Longwoods Publishing Corporation via the Copyright Clearance Center.

Kollberg, B., & Elg, M. (2011). The practice of the balanced scorecard in health care services.International Journal of Productivity and Performance Management, 60(5), 427–445.

Retrieved from the Walden Library databases.

The authors look at the use of a balanced scorecard for health care performance management in Sweden.

Lupi, S., Verzola, A., Carandina, G., Salani, M., Antonioli, P., & Gregorio, P. (2011). Multidimensional evaluation of performance with experimental application of balanced scorecard: A two year experience. Cost Effectiveness and Resource Allocation, 9(1), 7.

Retrieved from the Walden Library databases.

This article examines the application of a balanced scorecard within a unit in a hospital to compare performance results and goal achievement.

Balanced Scorecard Institute. (2013). Balanced scorecard basics. Retrieved fromhttp://www.balancedscorecard.org/BSCResources/AbouttheBalancedScorecard/tabid/55/Default.aspx

View the information on this website to learn about balanced scorecards.

Mountain State Group. (n.d.) Balanced scorecards for small rural hospitals: Concept overview and implementation guidance. Retrieved March 13, 2013, fromhttp://www.ruralcenter.org/sites/default/files/Final%20BSC%20Manual%2010.18F.pdf

The Scarborough Hospital. (2013). Balanced scorecard. Retrieved fromhttp://tsh.to/pages/Balanced-Score-Card

This website provides an example of a balanced scorecard.

Sunnybrook Health Sciences Centre. (2013). Balanced scorecard. Retrieved fromhttp://sunnybrook.ca/scorecard/index.asp#sr

Diabetes

The patient must maintain a good flycemis control. Great point! Patients with diabetes have very comprehensive learning needs. It requires lifestyle changes in order to manage their disease. The teaching plan should be customized according to patient’s needs because there is more compliance on prescribed regimen when they understand what diabetes is. “The learning needs are focused on managing their glucose levels and preventing complications of diabetes. Learning needs for managing diabetes are complex and include: monitoring blood glucose levels, menu/food planning, exercise, medications, skin care, management of co-existing disease processes, knowledge of medications, knowledge of the disease process and how to manage hypo/hyperglycemic episodes

MRSA in wound

Adding one more point to the factors which affects the wound healing are infection and lack of oxygenation to the tissues on affected leg. The impact on MRSA in patient wound can vary from person to person. The patient with MRSA in wound can express more anxiety and pain on affected area. Health care workers needs to find out the suitable dressing to the wound for better healing every day (www.woundinterntaional.com).An effective antibiotic to prevent infection is necessary in case of Ms.G. Also topic application of antimicrobial drug will help to decrease the infection. Ms.G needs to be educated on prevention of infection through proper hand washing .She needs to be educated about the medication and encourage Ms.G to complete the course of antibiotic. Follow up with wound care nurse or home health nurse is essential for Ms.G after the discharge from the hospital. Early ambulation will help to improve the oxygenation to the area affected. Education and follow up is important to prevent further problems

Diabetes, poor diet and infection

Discussion Question

1.The clinical manifestations that Ms. G is experiencing are pain and heaviness in her leg, an open round yellow-red wound above medial malleolus with moderate amount thick yellow drainage measuring 2cm diameter and 1cm deep. Her left leg is red from knee to ankle, her left calf measures 3 inches greater then right calf, and her labs reflect elevated WBCs, elevated Neutrophils and elevated Bands. Ms. G also has a temperature of 38.9C (102.02 F) and a positive wound culture of Staphylococcus aureus.

After reviewing these clinical manifestations, it appears that Ms. G has an infection. Fever along with the red leg swelling and discharge from the wound are all signs and symptoms of an infection. I would call the primary physician asking for orders for antibiotics and for treatment orders for the wound. I would then give her an antipyretic per standing orders to lower the temperature. And lastly, I would encourage Ms. G to drink plenty of fluids. During fever, fluids are lost through insensible water loss which is from the respiratory tract and sweating. Encouragement for fluid intake is crucial since Ms. G is at risk for dehydration.

2.The muscle groups effected by Ms. G’s condition are: Soleus muscle, gastrocnemius muscle, extensor digitarum longus muscle, extensor hallus longus and fibularis brevis

3.Both the subjective and objective data are very significant in determining an appropriate course of action. It provides essential information to guiding the current treatment. Follow-up lab values for WBC, Neutrophils, and Bands as well as monitoring temperature and wound drainage will all allow for determining if the appropriate antibiotic was chosen and if the infection is being effectively treated. “Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections” (Tong, et al, 2015). “Antibiotic is the primary treatment for this infection” (Tong et al, 2015). Due to this localized wound infection caused by a bacteria, the neutrophil counts are high because they “are the early responders to an acute bacterial infection and arrive in large numbers very quickly” ( Copstead-Kirkhorn & Banasik, 2014). The follow up labs for the Neutrophil count after the treatment starts will help to determine if the infection is being resolved.

The data of Ms. G’s weight, height, diagnosis of diabetes, in bed for 3 days with no one to help prepare her meals, and applying a heating pad to a red, painful leg are all subjective and objective data that guide the need for education of current condition as well as education for future preventative care. Adults with diabetes hold responsibility for managing of their conditions. Ms. G will need to understand how to best take care of her diabetes. She will be taught that her weight is a contributing factor to being diabetic. “The more fatty tissue you have, the more resistant your cells become to insulin” (Mayo Clinic Staff, 2016), increasing her need for diabetic medications. The need for a proper diet to control her weight will also help control her blood sugar levels. Ms. G will need to learn to examine her feet for wounds. Diabetes causes less blood flood to the feet, and nerves and blood vessels can be damaged causing neuropathy. This loss of sensation can lead to serious foot problems involving the ankle and leg. Ms. G needs encouragement for a life-style-change. A list of resources for assistance with proper diabetic diet, weight management and diabetes support group will help Ms. G learn more about preventive care for her condition. And it must not be forgotten that Ms. G will also need to learn that applying heat to an area that is inflamed and red will exacerbate the redness and could cause localized skin damage leading to more wounds. There is a lot of education that needs to be provided to Ms. G which is based upon the subjective and objective data collected.

4.Diabetes, poor diet and infection are the factors that are present in this situation that could delay wound healing. Having diabetes causes poor circulation because “narrowed blood vessels lead to decreased blood flow and oxygen to a wound. An elevated blood sugar level decreases the function of red blood cells that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, a wound heals slowly” (Wound Care Center.Org, n.d.). The wound needs to be taken care of immediately which includes being assessed by a wound team and following prescribed wound care treatment.

Precautions to prevent delayed wound healing are for Ms. G to follow a proper diet to ensure she is getting enough protein which is needed for wound healing and not to limit carbohydrates for better blood sugar management. High glucose levels as noted above causes decrease circulation, delaying wound healing. Also, it is essential she follows the prescribed wound treatment orders. If wound bandages are not changed, a build-up of discharge can further exacerbate and delay wound healing. She must complete the course of antibiotics to ensure the bacterial infection is destroyed. And, lastly, with anyone who is diabetic, Ms. G must practice good diabetic management for healthy glycemic control…Diabetes, poor diet and infection…

Healthy People 2020 and Evidence-Based resources

As a healthcare professional, understanding where to locate evidence-based resources in order to help your patients benefit from that knowledge will be useful in your career. One such resource is The National Center for Health Statistics. The Center has established Healthy People 2020 for tracking the nation’s health. In this assignment, you will begin from the topic you selected and propose a culturally competent, as defined by SAMHSA, community based health program.

Go to the Healthy People 2020 website and find the Topics & Objectives. Once you have located the 42 topic areas discussed on the website, choose a topic in which you are interested.

Write a 1,500-1,750-word paper in which you propose a community health program related to the topic you selected. Include the following in your proposal:

An overview of the program you are proposing. What is it? Who are the population(s) it will serve?

A rationale for the program.

A discussion of how the program will be established as and will remain culturally competent.

A discussion of how the program could be affected if budgetary restraints limited research in that field.

Staphylococcus aureus (MRSA) and Vancomycin

To comment…

Hi, Staph Aureus has become so strong and resistant over the years of treatment, now there is MRSA, MSSA, and more to come. I have always kept the communication lines wide open with the pharmacists I work with, asking all types of questions and they are so resourceful to us as nursing staff. I have also heard over many years of the over use of antibiotics and the fact these super bugs are growing stronger every year and more and more infected patient’s and also the public, are driving antibiotic immunity to a scarce level. Now you may agree that VRE (Vancomycin Resistant Enterococcus) scares us all more than MRSA…lol..but true… In the little ED I am working in right now I like to say to my co-workers, there is a sepsis craze going on around us and we laugh yet we get annoyed with the insane amount of blood cultures we draw and lactic acids we run… But the most common antibiotic we give is 1st line Zosyn, then Vancomycin and our pharmacy is sometimes slack getting us the medications on time and the vancomycin is often becomes the first dose we have to give, I would be asking that physician an awful lot of questions about why vancomycin??? And unfortunately they have almost no other choice but to administer it….on and on the medical field goes…

Vancomycin may be overused for the treatment of hospital-acquired pneumonia, perhaps because of physicians’ perceptions that patients are at high risk for methicillin-resistant Staphylococcus aureus (MRSA). The MRSA-culture-negative patients continued to receive vancomycin for a varying duration after the culture results were known (ICAAC, 2006). Staphylococcus aureus (MRSA) and Vancomycin.

CMS payment system

1. Initial CMS payment system Post: You will discuss the CMS payment system. Summarize your understanding of this payment system in your initial post. Include an overview of CPT, ICD, and HCPCS by discussing the differences between them in your post. Your entire initial post should be between 300-400 words. Your initial post is due no later than Thursday of Week 2. Use the Green & Rowell text and visit the AHIMA (American Health Information Management Association) site to find information and links that will help you explain the CMS payment system.http://www.ahima.org/resources/reimbursemethod.aspx

Also, answer the following:

1. What payment methodologies does the CMS use?

2. How do CPT, ICD, and HCPCS codes differ?

2. Second CMS payment system Post: Respond to ONE student’s initial response only. In your response, provide a comment that demonstrates you have read and understood their summary and overview. This response should be about 100-150 words in length.

To begin discussing in this forum, click the forum title. Then, click Create Thread on the Action Bar to post your initial reply. To reply to a fellow participant, click the title of the initial post, then click Reply.

CMS payment system Rubric:

Week 2 Project Rubric

Expectations and Points Awarded

Exemplary

Acceptable

Needs Improvement

Unacceptable

Posting Requirements

50 pts

Student’s initial response is thorough and the word length requirement is met. Standard English language writing standards are adhered to. The post is free of spelling, writing, and grammatical error. The post is made no later than Thursday. The post includes APA in text citation and a reference.

50 pts

The student does not submit their initial post by Thursday.

35 pts

Student’s initial post does not meet the word length requirement and there are spelling, writing, and grammatical errors. APA in text citation is not used.

20 pts

Student does not post an initial answer to address the topic or answer the question, and/or does not make any responses at all.

0 pts

Response Skill

50 pts

Student responses demonstrate they have read the material and their classmates post. Correct citation and reference is included, with APA format.

50 pts

Student response lacks some clarity and is cited and referenced, but with minor APA format errors.

35 pts

Student responses lack clarity and have many APA citation and reference errors.

10 pts

Student does not complete the assignment by posting the required two responses.

0 pts

Objectives of the Patient Bill of Rights

Using the information from the HIPAA text, answer and discuss the following:

1. What do you believe is the “moral and legal premise” of patient autonomy”?

2. Explain in your own words the objectives of the Patient Bill of Rights.

Moral and legal premise of patient autonomy

Using the information from the HIPAA text, answer and discuss the following:

1. What do you believe is the “moral and legal premise” of patient autonomy”?