Introduction
The New Horizons Community Mental Health Center serves the diverse population of Miami, FL, which predominantly includes Hispanic, White American, African American, and Haitian clients. Patients with depression constitute a large part of the population that the Center serves, but the Center’s health providers have been reporting issues in determining the treatment for certain cases, especially mild depression. This problem is common since it is not clear whether psychotherapy or pharmacotherapy is more effective for mild depression (Reid, Cameron, & MacGillivray, 2014). As a result, the following research question should assist the case: in psychiatric patients with mild depression, what is the effect of psychotherapy on health compared with pharmacotherapy?
The results of the study will provide the ground for the establishment of direct guidelines on depression management for the care providers of the Center, which will constitute the proposed change. The change is in line with the Center’s mission, which consists of providing high-quality care, and vision, which is to improve the mental health of the community. The culture of the Center is largely beneficial for the change since quality improvement is one of its values, but it is acknowledged that some resistance to change might take place because it is a common concern in change management (Anders & Cassidy, 2014). The issue is more likely to be encountered because all the providers of the institution will be involved in the change due to its significance; as a result, the engagement of the stakeholders will have to be carried out very carefully. Thus, the systems analysis of the settings is a requirement, and the present paper uses Kotter’s change model to this end.
Kotter Change Model Application
Stage 1
Kotter’s change model was not developed specifically for healthcare settings, but it has been used in them successfully and rather often (Anders & Cassidy, 2014; Small et al., 2016). The first step proposed by the model consists of creating a sense of urgency, which assists in “unfreezing” the situation and preparing the settings for change (Anders & Cassidy, 2014). The primary aim of this stage is to lead the change stakeholders to recognize the existing issues and opportunities, which provides motivation and informs future activities.
Status quo is unacceptable
Depression is a rather prevalent issue; for example, in 2014, 6.7% of the population of the US had a major depressive episode (Center for Behavioral Health Statistics and Quality, 2016, p. 3055). Depression is a significant health concern that has multiple negative outcomes for patients and their families (Olfson, Blanco, & Marcus, 2016). Also, depression presupposes healthcare expenses. However, the quality of care for patients with depression is reported to be suboptimal (Straten, Hill, Richards, & Cuijpers, 2015), and one of the relevant problems is medication over-prescription. Given the prevalence and consequences of the condition, this issue needs to be actively addressed.
It should be pointed out that over-prescription is a controversial matter. For example, Simon et al. (2015) demonstrate that antidepressants are used for mild depression relatively rarely and suggest that over-prescription is not a major concern. However, the effectiveness of antidepressant use for mild depression is not very well-documented, which is why it may be recommended to attempt non-pharmacological interventions before prescribing medications (Olfson et al., 2016; Reid et al., 2014; Spence, 2013; Straten et al., 2015). At the same time, the research on the effectiveness of psychotherapy for mild depression is also rather limited and inconclusive (Olfson et al., 2016). Olfson et al. (2016) suggest that more research is required to determine the relative effectiveness of psychotherapy and pharmacotherapy; for the time being, providers have to work with limited knowledge. It is apparent that the status quo is not acceptable: it is necessary to offer care providers more direct and clear guidelines to ensure the quality of care for mild depression (Spence, 2013). This fact can be used to create the sense of urgency.
Stakeholder feedback
A preliminary discussion with the stakeholders of the future change indicates that not all of them are aware of the problem of over-prescription, but relevant information attracts their interest, which should facilitate the process of creating the sense of urgency. The administration of the Center states that there are no clear guidelines in place to guide the prescription of drugs and psychotherapy for mild depression, and they admit that this fact is an issue. Providers point out that they prescribe both pharmacotherapy and psychotherapy for mild depression based on multiple factors. They report different preferences and suggest that additional data on the topic could better inform their actions, which indicates that they recognize the problem of insufficient evidence.
Concerning the patients, some of them report dissatisfaction with medication, believing that it might be detrimental to some aspects of their health, but many also express the belief that pharmacotherapy is more effective than psychotherapy. Therefore, patients are interested in conclusive information on the relative effectiveness of pharmacotherapy and psychotherapy. This information about patients’ attitudes should help to establish the sense of urgency for the providers and administration while also serving as a motivation for the patients to participate in the study. In summary, the first stage of Kotter’s model applies to the project and can be employed to its benefit for planning the change.
Stage 2
Coalition members
The second step of the model presupposes creating a guiding coalition, which is a group of people who are going to lead the change (Anders & Cassidy, 2014; Small et al., 2016). The present project will engage four key members. The Director of the Outpatient Clinic, who is a Registered Nurse, possesses a position of power, credibility, well-proven leadership abilities, and expertise. Similarly, the Psychiatric Medical Director, who is a Doctor of Medicine, has a position of power, which comes with credibility and leadership experience, and is an expert in psychiatric matters. The two remaining members are a psychiatrist (Doctor of Medicine) and a nurse (Nurse Practitioner). Despite not having a formal position of power, both have used their leadership abilities when required, and their experience with the Center supports their credibility and expertise. In summary, the members were chosen for their position power, leadership abilities, credibility, and expertise, as well as the willingness to promote change and participate in the project.
Coalition interaction
All the mentioned members have been working together for at least two years, which has provided them with the opportunity to develop respect and mutual trust towards each other. The team has encountered some misunderstandings in the past, but they were resolved with the help of the well-established communication promoted by the Director. Currently, the team exhibits a notable level of understanding and is ready to address communication issues if required. Also, the members of the coalition recognize the importance of the concept of caring and extend it towards their colleagues. These factors are significant for the second step of Kotter’s model and can facilitate the coalition’s work.
Coalition goal
The common goal of the guiding coalition consists of providing improved guidelines on the treatment of mild depression by establishing the relative effectiveness of psychotherapy and pharmacotherapy. This goal is in line with the Center’s vision and mission. Eventually, the coalition aims to improve the quality of care and patients’ safety while also facilitating the activities of the healthcare providers at the Center. Thus, the second step of Kotter’s change model is currently complete.
References
Anders, C., & Cassidy, A. (2014). Effective organizational change in healthcare: Exploring the contribution of empowered users and workers. International Journal of Healthcare Management, 7(2), 132-151.
Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 national survey on drug use and health: Detailed tables.
Olfson, M., Blanco, C., & Marcus, S. (2016). Treatment of adult depression in the united states. JAMA Internal Medicine, 176(10), 1482.
Reid, I., Cameron, I., & MacGillivray, S. (2014). Depression: Current approaches to assessment and treatment. Prescriber, 25(12), 16-20. Web.
Simon, G. E., Rossom, R. C., Beck, A., Waitzfelder, B. E., Coleman, K. J., Stewart, C.,… Shortreed, S. M. (2015). Antidepressants are not overprescribed for mild depression. The Journal of Clinical Psychiatry, 76(12), 1627-1632. Web.
Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotterʼs change model for implementing bedside handoff. Journal of Nursing Care Quality, 31(4), 304-309.
Spence, D. (2013). Are antidepressants overprescribed? Yes. BMJ, 346, f191-f191.
Straten, A., Hill, J., Richards, D. A., & Cuijpers, P. (2015). Stepped care treatment delivery for depression: A systematic review and meta-analysis. Psychological Medicine, 45(2), 231-246.