Change and Negotiation Plan and Summary
The role of managers in the organization is crucial since their work affects the levels of income and expenses, the implementation of organizational objectives, and they are responsible for personnel management. When a health care institution is to experience significant changes, the role of managers in administering the staff becomes increasingly important as they affect and determine the degree of job satisfaction of the employees as well as their preparedness to changes in the work and working conditions (Media-Partners, n.d.).
Most importantly, managers are responsible for the levels of employee initiative and readiness to learn the new approaches to service provision. The practicum change is concerned with strategies to improve the door-to-balloon (D2B) time in the STEMI patients at Kendall Regional Medical Center (KRMC), and it is essential to consider all the possible aspects of its implementation to ensure that the management staff will be able to execute the change in the most effective way.
D2B is the interval between the arrival of a STEMI patient in the hospital and the commencement of treatment, in particular, the insertion of a catheter into the patient’s body. It is believed that reducing the D2B time is to result in positive patient outcomes for a number of reasons (Mehta et al., 2014). The current standards of care provision require an interval of less than 90 minutes between the arrival of a patient in the catheterization lab (cath lab) and the initiation of reperfusion. Thus, the proposed change is addressed to the stakeholders of KRMC, and it seeks to persuade them that the improved D2B will be a major step toward the effective combating of STEMI.
However, the successful shortening of D2B time requires effective coordination and collaboration of all the key stakeholders that include both the patients and their families and the STEMI team (Mehta et al., 2014). The core of the negotiation plan lies in a well-guided intervention protocol that is to result in improved timelines for each stage a STEMI patient goes through before reperfusion is finally administered at the cath lab. The main objective of the negotiation plan is to facilitate the active engagement of the stakeholders to achieve the desired D2B times taking into consideration the aspects that are likely to have a direct or indirect impact on the proposed change.
The KRMC hospital leadership represents the audience as it plays a principal role in the change management. The leadership carries the responsibility in regulating the organizational and policy issues such as the personnel training and action plan required for the successful improvement of care provision (Media-Partners, n.d.).
In addition, the individualistic behaviors of the staff members should be obviated to create an integrated team that would collaborate effectively, which is also the liability of the center’s leadership. As communication is one of the most crucial aspects in terms of the negotiation plan, it should be organized so that it promotes the efficient cooperation of the stakeholders.
It should be noted that both internal and external factors play critical roles in the failure or success of change management. However, effective consideration of the change project using an appropriate implementation plan can mitigate the possible complications and obstacles. Some of the obstacles to effective implementation of the projects are connected with the patients.
For instance, most of the delays in care provision are related to ignoring symptoms, reluctance to bother others, and lack of knowledge of some factors related to STEMI. In addition, only 60% of STEMI patients use ambulance (Mathews et al.,2011). Also, it is vital for all PCI centers, in collaboration with EMS and STEMI referring hospitals in different areas, to have shared and common STEMI protocols to enhance timely access to reperfusion for all STEMI patients.
Among the internal factors that could lead to delays is the lack of coordination between various departments, including departments of emergency response, cardiology, and interventional cardiology that need to work together to reduce delays while sharing knowledge on the best practices.
For that reason, administrative support should be considered a driving force in facilitating the effective execution of the change project. Nurse leaders should encourage open communication and sharing the expertise, develop standard procedures and protocols, and other guidelines to boost the delivery of care. Thus, human factors, processes, procedures, and organizational factors could either support or derail the project.
As stated above, earlier intervention in STEMI patients leads to better health outcomes. The aim of the change theory is to guide the implementation of the change project to reduce the D2B time. In this relation, the Lean concept focuses on STEMI patients as a Quality Improvement Tool as it will enable determining what STEMI patients require in creating the value, which is the reduced D2B time. Any intervention process that does not create value for the patient is wasteful and is, therefore, a target for process improvement to reduce the D2B time and improve patient outcomes (Abuhejleh, Dulaimi, & Ellahham, 2015).
The concept of Lean implies the involvement of all stakeholders in the care providers to take active roles in improving quality. According to this concept, every nurse and physician should be vigilant to identify and address poor quality services and waste that lead to longer D2B time. Nurse leaders have specific roles and are liable for facilitating effective management on all the levels of the organization regarding the change.
The proposed approach would boost patient flow and reduce waste from the intervention processes. A cause analysis will be carried out to define sources of errors. Quality Improvement efforts require the medical facility of the KRMC to introduce new policies, processes, procedures, and systems for STEMI patients to improve D2B time and imply that all stakeholders embrace change to manage the transition (Mitchell, 2013).
Proposed Change Strategies
Change management is essential to guide and sustain a culture of quality in health care organizations. Quality Improvement entails creating policies, systems, and procedures to safeguard operational improvement and a high organizational culture (Mitchell, 2013). The strategy implies the required accreditation, which will ensure that the medical institution meets standards for quick diagnosis of heart attacks, offering initial intervention, steadying patients, and transferring them to the center.
Further, the proposed change assumes that the receiving center works on a 24/7 basis for mechanical percutaneous coronary intervention and is staffed by appropriately trained and experienced interventional cardiologists. Needless to say that the change will be implemented in compliance with the existing health laws and regulations alongside ACC/AHA guidelines.
In terms of the organizational structure, it is planned to execute the combination of the environmental-adaptive, normative-reeducative, power-coercive, and empirical-rational change strategies to implement the change in the organization. It will be carried out on all the levels including all the stakeholders (STEMI patients and their families, emergency department physicians, emergency medical response/paramedics, emergency department staff, RNs, STEMI team, PBX operators, and invasive cardiology). It is advisable to utilize the mix of the four strategies to achieve both the change for the short-term and long-term preventing random errors at different levels of the alteration in place (Bengoa, 2013).
The key stakeholders include both the patients and the STEMI team. Reducing D2B time for STEMI patients should start with patients and their family members to avoid delays. As mentioned earlier, ignoring symptoms, reluctance to bother others, and lack of knowledge related to STEMI results in the procrastination in care provision.
In addition, according to the data, the in-hospital mortality rate for the patients who delayed in providing consent for the emergency PCI amounts to approximately 10% (Peterson, Syndergaard, Bowler, & Doxey, 2012). Thus, the delays related to patients and their families may greatly complicate the implementation of the change.
Further, the emergency department physician is liable for the activation of the cath lab and urgent physical transfer to the prepared by in-house nurses laboratory. If a cardiologist is directly consulted by the emergency department physician, rather than by internist, the possible delay when processing the patient will be eliminated (Peterson et al., 2012). Also, the practicum change project might be affected by the role of paramedics and their expertise while advanced training is required for the successful performance of the triage of STEMI patients. If the paramedics do not receive such education, they will not be able to interpret 12-lead ECGs and initiate intravenous access.
The STEMI team, PBX operator, and intervention cardiologists are among the key stakeholders as their efficiency is directly linked to their abilities to cooperate, their level of expertise, and knowledge. The STEMI team is responsible for administering the PCI procedure on a patient. Proper training is essential to ensure that reperfusion is initiated within a reasonably short period.
The STEMI team consists of CVL nurses, a cardiologist, and cardiovascular and perfusion technicians. Additionally, many interventional cardiologists and cath lab technicians are relatively new. There is a need to educate the new staff on the hospital’s intervention procedures for STEMI cases. Proper coordination of the STEMI team can result in reduced D2B time. This coordination can only be achieved through efficient training accompanied by teamwork.
Prior to implementing change, nurse leaders should define the change vision to reflect on the desired state and perform a primary assessment (Zhang, Flum, West, & Punnett, 2015). It will allow the administration to formulate a change management plan and determine the significant obstacles, goals, and, objectives. They should also consider training plans, task delegation, resource allocation, and communication strategies (National Association of County and City Health Officials, 2013). The change process will include quality management that is related to objectives that focus on reducing D2B time, practitioner training, and communication needs of the stakeholders.
During the implementation process, the leaders will constantly monitor and evaluate the progress, reflect on the gaps, gather feedback, and define the best practices to sustain change and development (National Association of County and City Health Officials, 2013). The medical center will promote change as a part of its formal and informal organizational culture through the application of the official policies and procedures that reflect standards to achieve reduced D2B time.
Communication Plan and Negotiation Strategies
The communication plan reflects the multiple goals related to the multi-step process of the practicum implementation. For instance, choosing the vendor of remote defibrillator/monitors equipped with features that are easy to configure and the functionality of which is guaranteed; utilizing the applications for the cardiologists that would enable them to retrieve the ECGs from the EHR systems directly to their smartphones or tablets. Moreover, cross-training the paramedics to read ECGs is an essential part of the plan.
The realization of these goals is concerned with the internal and external interaction. However, effective external communication is more crucial while there is a high possibility that the staff will be reluctant to comply with numerous regulations and new practices that were introduced to implement the change. Consequently, it is planned to utilize various strategies to ease the situation. For instance, the strategy of mass communication allows utilizing cost-effective, scalable tools to introduce the change. It can be furnished using emailing, newsletters and memos, video conferencing, and intranet communication.
The leadership will be able to gather employee feedback through interactive communications using such tools as discussion boards and hotlines as well as specialized pages initiated for questions and answers related to all the issues of the change. This strategy is helpful when educating the conservative employees who will have difficulty in addressing the proposed change (Bourek, 2014). Personal communications strategy will enable conducting informational sessions and workshops as well as frequent meetings so that the employees will be able to ask questions and the leadership will be able to strengthen the initiative.
In conclusion, the success of the change depends on numerous factors and forces that may interfere with its implementation. Introducing relevant policies and guidelines to educate the stakeholders about the executed change should support the informational and educational needs of the staff. In addition, attracting specialists to share their expertise will encourage more rapid implementation of the new approach. However, it is essential to raise the awareness of people about the practices of proper behavior when feeling unwell. The combination of these attitudes will allow achieving the desired outcome, which is the reduced D2B times in STEMI patients.
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