Planned Change in a Department or Unit

Identify Problem: Hospital Discharge Delays 

One of the most critical issues in my hospital of choice, Cincinnati Children’s Hospital Medical Care, is bed capacity management in the wards. This issue is especially escalated by the inefficient hospital discharge patterns that affect the patient flow, care management, and ends up increasing the cost of care at the hospital. There is need to ensure that there is no waiting delays at the moment when patients and their families are ready to leave the hospital. Over time, there have been several projects at the hospital that are directed towards discharging a given number of patients are a specific time of day with the goal of freeing up beds. However, there have been several cases of inefficiencies, which have resulted in delays in transfers and admissions. For a long time now, lengthy delays and unpredictable discharges have been the key roadblocks preventing efficient patient flow in the hospital. A longer than necessary stay in the wards translate to higher costs for all the involved parties.

A specific and Realistic Solution to the Issue 

The project team that focuses on change management at Cincinnati Children’s Hospital Medical Care sets out to implement a standard discharge criteria for about ten common inpatient diagnoses based on expert consensus and available evidence. This information is will be embedded in an electronic medical record to facilitate a new and more efficient discharge process that focuses on the patient needs, discharging them immediately they are medically ready. This new process is undoubtedly a reflection of the commitment of the hospital towards easing things for all the involved parties during the treatment process. It is important to understand that families are a core principle for the hospital, and if something does not work for them, then there is no choice but to change it.

Through this proposed change in the systems, it will be easier for nurses to keep track of the patient performance and monitor when they meet the hospital’s discharge goals. Physicians are also better positioned to prioritize early rounding. This intervention helps streamline the prescription filling processes at the pharmacy and improves the efficiency in the discharge process. There will be a consistent communication avenue for the patient needs between all the involved care providers at all time. This change is focussed on the patient needs above everything else, which means that the patients are discharged when ready and not when the hospital needs a bed. The proposed change is set to greatly decrease the waste that is associated with inefficient discharge processes, which means that the hospital, health plans, and families will now enjoy substantial cost savings.

Through these changes, Cincinnati Children’s Hospital Medical Care will enjoy decreased costs and improved patient flow. The goal is to see a 38 percent increase in the number of patients who are discharged within two hours of admission, resulting in approximately $6.0 million estimated cost savings.

Alignment of the Change with the Organization’s Mission, Vision, and Values as well as Relevant Professional Standards. 

The mission of Cincinnati Children’s Hospital Medical Care is to enhance and guarantee the quality of care offered at an affordable cost. The hospitals vision is to get to a point where there is a streamlined flow of patients who all receive the best treatment that there is and leave the hospital within the shortest time possible. The hospital is driven by the key values of high quality of care for all patients without any bias, seamless communication between all the care providers to ensure that the patient receives the best care that there is, waste reduction in all ways possible, and offering price-sensitive care to make the treatment affordable for patients of all classes.

The proposed change focuses on enhancing the hospital discharge processes and eliminating all the potential delays, something that is undoubtedly completely in line with the hospital’s vision, mission, and value proposition. The first step towards ensuring proper quality of care and affordable cost is by ensuring an efficient flow of systems at the hospital. This trickles down to the communication systems between the caregivers. The use of an electronic medical record will help facilitate a new and more efficient discharge process that focuses on the patient needs, discharging them immediately they are medically ready. Through the electronic records, it will also be easier for all the involved caregivers to give keep track of the patient’s progress in all aspects and all collaborate for the wellbeing of the patient. That said, this proposed change is undoubtedly in line with the organization’s mission, vision, and values as well as relevant professional standards.

Change model to Guide the Implementation of the Change: Lewin’s Model 

The proposed model for implementing the change to electronic recording of patients’ information at Cincinnati Children’s Hospital Medical Care is the Lewin’s model. This model is excellent because it splits the change process into three distinct stages, which makes it possible to break large chunks of process into smaller activities for a more seamless implementation within the company. The proposed change is not very small and it involves several protocols. As a result, it is essential to break the process down into tinier, more palatable chunks, and this is where Lewin’s model comes in handy.

Steps Followed to Facilitate the Change 

Lewin’s model is comprised of three stages of change management, and this is what we will follow when implementing the suggested change at Cincinnati Children’s Hospital Medical Care:

Unfreeze 

Now that we have realized that the organization needs change, we will begin by unfreezing the current processes to analyze how patient records are currently being kept and how the caregivers are communicating with one another. In this step, the project managers will analyze every human interaction and every step taken, looking out for potential improvements, regardless of how much might need to be unearthed and how in-depth one might have to go. This step will help eliminate any commonly accepted mistakes and potential of bias, giving the perspective on the need to change the cause of the problem and not just the symptoms. Through unfreezing, it will also be possible to deal with the natural resistance of the organization to the proposed change. It will be easier to prepare the team for the proposed elements, and by so doing, it will be easier for the proposed elements to take hold upon implementation. It is during this process that all the involved shareholders will learn about the shortcomings of the current system and the benefits of the proposed changes. By so doing, it will be easier for them to embrace the new system with little or no resentment.

Make changes 

Once every shareholder involved has been prepared about the new change, the next step will be to implement the changes. The first step will be to introduce a digital system for recording patient information and data. This process requires extensive education, support, and communication to help reduce the difficulties experienced during the transition process and address any potential problems when or before they arise. In this case, the team will need will need extensive training on how to use and maximize the benefits of the new technology. Another important aspect of this stage of regular communication with all the team members to understand how they are adapting to the new technology, what they love about it, and the challenges that they are facing. The IT team will be responsible for the installation of the new system in the hospital computers and train all the involved staff on how to use it.

Refreeze 

Finally, after all the changes have been measured, deployed, and adjusted based on the feedback given, it will then be time for the organization to refreeze its new status quo to ensure that the old habits do not resurface anymore. This step will be achieved by ensuring regular reviews to see to it that the new technology is completely followed. All the consistent users of the new technology will be rewarded to encourage every stakeholder to embrace digitization at the hospital. This stage will be easier if the project managers listened and applied the feedback given by the users because then this means that the employees will be more invested in the new technology and they will want it to succeed.

References 

Heller, B. R., Drenkard, K., Esposito-Herr, M. B., Romano, C., Tom, S., & Valentine, N. (2004). Educating nurses for leadership roles.  The Journal of Continuing Education in Nursing ,  35 (5), 203-210. 

Kleinman, C. S. (2003). Leadership roles, competencies, and education: How prepared are our nurse managers? Journal of Nursing Administration ,  33 (9), 451-455. 

Marquis, B. L., & Huston, C. J. (2009).  Leadership roles and management functions in nursing: Theory and application . Lippincott Williams & Wilkins. 

Nagelkerk, J. (2005).  Leadership and nursing care management . Elsevier Health Sciences.