WQT2 Performance Assessment Guidelines Consultative Change Recommendation

One of the key concerns in healthcare today is change management. Healthcare professionals are obligated to acquire skills and expertise to effectively manage change due to the increasing complexity of the healthcare environment. For instance, the change manager should be well informed about technology advancements, regulatory requirements, and the need to improve efficiency for proper change management. Nurse leaders are among the key players in evaluating, planning, and implementing operations that can improve quality and safety in healthcare. While planning for change, process analysis is required to determine areas that are performing well and those that need improvement. The focus of this discussion is to analyze the nurse leader’s role in influencing the change of a selected healthcare organization.

Purpose and Overview

Purpose

As a nursing consultant, I was assigned to analyze a healthcare organization to identify a change or improvement needed. Through the engagement of a nurse leader, the consultation aimed at identifying the organizational strengths and weaknesses. Additionally, the obtained information was used to recommend a practice change that could address the identified weakness in the organization.

Overview

Change in healthcare is important because it improves access to healthcare services, reduces costs, and enhances care coordination. The healthcare industry today can greatly benefit from change management to cope with technological advancements and the complex needs of patient populations. Recent data indicates that various factors such as fragmentation, access problems, healthcare disparities, and sub-optimal outcomes are the driving forces to healthcare transformation (Salmond & Echevarria, 2017). The nurses are not left behind in the change process because of their education, respect, and big role in healthcare sector management.

Nurse leaders are in a better position to influence organizational change because of their power and influence. For these reasons, I selected the clinical nurse educator for the consultation. Nurse educators are leaders that have various roles in an organization including the development of policies and procedures that can bring about change. The first step involved sending an email to the nurse leader to ask for permission for the interview process. Upon approval of my request, a face-to-face interview was scheduled to discuss the nurse leader’s roles and to obtain information about the strengths and weaknesses of the organization. Using structured questions, the discussion focused on the organizational performance, nurse leader’s roles, and the use of evidence-based practices and quality improvement projects. Apart from the nurse educator, additional sources of information about the facility included the organizational website and data from the medicare.gov hospital compare website. The information gathered was used to recommend a change that could improve the healthcare delivery process including aspects of quality and patient safety.

Description of Organization

Located in Weston, Broward County, Florida, Cleveland Clinic is a non-profit academic medical center that provides high-quality care to patient populations served. The mission of the organization is to care for life, research for health, and educate those served (Cleveland Clinic, 2021). The organization envisions to be the best place for care anywhere and the best place to work in healthcare. The organization highly values quality care for its patients and for this reason it employs a lot of staff. The institution has more than 205 physicians specialized in over 55 areas of care to ensure all populations are served effectively. Because of the high-quality services provided, Cleveland Clinic ranks top in the area of Miami-Fort Lauder dale and is among the top-ranking organizations in Florida.

Cleveland Clinic has made itself the best place for work by putting a priority on the community, healthcare workers, patients, and the organization. The facility provides both inpatient and outpatient services all through. As an organizational unit, Cleveland has nearly 60, 000 healthcare workers providing care to about 883, 839 patients yearly (Cleveland Clinic, 2021). The facility has an inpatient bed capacity of 1300 and a system-wise capacity of 6, 026 because of the many branches involved. Among the healthcare services provided in the organization include emergency care, gynecology, imaging services, orthopedic surgery, endocrinology, and plastic surgery among many others.

Cleveland Clinic provides healthcare services to diverse patient populations from all over Broward County. The nurse leader was not able to provide information about the specifics of patients served but demographics could be found at the US Census Bureau website. The latest data indicate that the county has a total population of 1, 952,778 people (United States Census Bureau, 2019). The majority of the people in the area are middle-aged with the elderly being the least population. Racially, the majority of the people seeking healthcare services in the institution are whites. Demographic data from the region indicates that 63.2% of the total population is made up of whites while the Blacks are the second largest with 30.1% (United States Census Bureau, 2019).

The nurse educator was able to breakdown the organizational structure whereby the CEO is at the topmost level of governance. The CEO together with his deputy and chief administrator make up the administrative unit of the facility. Below the administration are the nursing, medicine, finance, and human resource departments headed by respective chief officers. Information about the branches of the other departments apart from nursing was not provided. The nurse educator described the nursing department as a unit headed by the chief nursing officer, followed by the director of nursing services. Below the director are the nursing supervisor, nursing educator, and nurse managers in different nursing departments.

Primary Needs of Population

Health needs assessment uses a systematic approach to determine the health status of populations and to identify the healthcare concerns of people. Sometimes the health needs of individual patients coming through the outpatient departments may reflect the wider health needs of the community. According to the interviewed nurse educator, the majority of the people seeking healthcare services suffer from chronic conditions like diabetes, heart disease, obesity, and some forms of cancer. The nurse educator also stressed adolescent health-related issues such as sexually transmitted diseases that have recently increased in the facility. This information prompted a deeper search on the burden of chronic diseases in the region alongside adolescent health issues like STIs, teen pregnancy, and substance abuse disorders.

Heart disease is the leading cause of mortality in the United States resulting in about one in every four deaths in acute and long-term care facilities. Coronary artery disease is the most common of all and it has higher mortality in men than women. Broward county is faced with this healthcare problem just like other regions whereby it is the cause of about 3600 deaths yearly in the region (Florida Department of Health, 2020). Statistics indicate that heart disease is the leading cause of death for Whites and African Americans in Broward county and the US. The majority of the people affected by this condition are the elderly with only negligible values observed in the young generation.

Adolescent and school health have been on the headlines because of the increased risk behaviors contributing to the poor health of the young generation. For instance, the CDC Young Risk Behavior Surveillance System (YRBSS) identifies six common leading causes of death for youths. These causes include sexual violence, irresponsible sexual behavior leading to STIs and pregnancy, alcohol and drug abuse, tobacco use, unhealthy dietary behavior, and inadequate physical activity. Broward county reports high rates of STIs especially syphilis and chlamydia infections (Florida Department of Health, 2020). The high rate of drug and alcohol abuse is observed to be the greatest contributing factor to these outcomes with lack of enough sexual education being the area of focus today. Disparities are observed in the affected population whereby African Americans have the highest mortality rates.

The burden of disease does fall on the individual, family, and equally on the community. The identified health problems including chronic diseases, STIs, drug abuse, and violence lead to huge financial expenditure that cuts across the whole community. For example, chronic diseases account for 86% of all medical costs in the United States (Maresova et al., 2019). Community members have to contribute financially during the treatment of these patients. Secondly, there is reduced productivity because the majority of the people are sick. Productivity decreases when individuals miss workdays or when tasks are not completed due to sickness and sick leaves. Community development is affected greatly when these diseases affect the leaders and project managers. Lastly, healthcare expenditure for families and healthcare organizations increases yearly as more people continue getting sick. A lot of time is spent taking care of the old suffering from chronic diseases at home and in the hospital leaving less room for focusing on the young population.

Nurse Leader’s Roles

The nurse leader interviewed was an advanced practice nurse educator. As a leader in the organization, the nurse is charged with ensuring nurses and students adhere to the organizational policies. For example, the nurses are supposed to continuously improve their knowledge and skills through CMEs and other educational programs. The nurse educator explained that she regularly checks for compliance with such policies. The nurse educator also explained that she is charged with ensuring nurses practice with competency according to their qualifications. As the head of education and training in the institution, the nurse emphasized her expertise to draft and design curricula to fulfill the education requirements for other medical personnel.

Clinical nurse educators, like other advanced nurse practitioners, assume the role of advocacy for their patients and the nursing profession. The nurse educator explained that she actively participates in professional associations and speaks out in conferences regarding issues of policy and quality improvement. As a researcher, the nurse educator highlighted hr expertise in designing quality improvement projects using current evidence from research. Apart from these formal roles, she explained that she advises nursing staff on matters of education and work-related issues. As a leader, she acts as a role model for junior staff and mentors qualified and student nurses.

WQT2 Performance Assessment Guidelines Consultative Change Recommendation

Created by the American Association of Colleges of Nursing (AACN), the essentials of baccalaureate education for professional nursing practice describe what every RN should embody upon graduation day. The roles described by the nurse educator align with essentials III, VII, and IX in various aspects. Essential deals with quality improvement and safety whereby the nurse must be articulate in the methods, tools, performance measures, and standards related to quality, as well as prepared to apply quality principles within an organization (AACN, 2011). As described above, the nurse educator participates in quality improvement through education and research. Secondly, essential VII requires the nurse to be a member and leader of interprofessional teams that communicate and collaborate during care delivery (AACN, 2011). To align with this role, the nurse educator explained that she collaborates with patients and other nurses to identify areas of weakness. The nurse also collaborates with others to implement quality improvement projects in the facility. Lastly, the nurse educator’s roles align with essential IX which requires the nurse to practice Master’s level nursing. The nurse educator demonstrated alignment with this role through participation in policymaking, advocacy, and practicing with competence.

Characteristics of Organization

During the interview with the nurse educator, I was able to identify some of the strengths and weaknesses of Cleveland Clinic. Firstly, the nurse educator described the organization’s leadership as the key factor driving success in the facility. The organization has an extraordinary reputation and has managed to establish a strong cultural connection with the community members. For these reasons, the organization ranks number one nationally in providing adult specialty care. The nurse educator also explained that the facility has managed to incorporate innovative services that ensure effective management of patients seeking ICU services, emergency care, and gastroenterology.

One of the weaknesses identified by the nurse leader is discharge planning for patients where satisfactory scores have not been recorded. The hospital compare data indicates that this aspect has a score of 57% and is the lowest of all the other ten survey questions (U.S Centers for Medicare and Medicaid Services (CMS), n.d.). Regarding the aspect of QI projects and the use of EBP, the nurse educator was able to identify an ongoing project in the emergency department involving the use of debriefing and briefing sessions. This project aims at preparing nursing students to cope with adverse events especially after incidences of death in the department. A briefing is a short meeting between healthcare team meeting that ensures shared understanding of what is expected and the role of each team member. In the emergency department, briefing sessions serve to facilitate better coordination of patient care services, gain clarity of direction, and to create a culture of open communication (Agency for Healthcare Research and Quality (AHRQ), 2019). Debriefing, on the other hand, occurs at the end of sessions and it involves all healthcare team members. Debriefs serve to improve communication, improve practices and to support healthcare members that are overwhelmed by work, especially during critical events.

In the recent decades, the use of evidence-based practices has become a key component of exceptional patient care. Evidence-based practice use involves the integration of research, clinical expertise and patient preferences to guide the delivery of care (Uhm et al., 2019). One of the evidence-based practices identified in the organization is the use of the situation-background-assessment-recommendation (SBAR) communication tool to improve shift handoffs among the nursing teams. This strategy is observed to improve continuity of patient care through the promotion of information sharing, documentation of patient data, and the involvement of the patient/families in formulating care plans (Uhm et al., 2019). This evidence-based program is expected to improve quality care outcomes especially reduction in medication errors and cost of healthcare associated with adverse events. Additionally, the use of SBAR communication in the facility during handoffs aims at promoting collaborative patient care and coordination of services.

Recommendation for Organizational Change

Although many organizations use patient education as the key mechanism for discharging patients, understanding care upon leaving the hospital is dependent on several other factors. Evidently, there is a need to develop strategies that incorporate timely planning for discharge days before the actual day of leaving the facility. My recommended change in this aspect is to develop a proactive plan that involves timely planning of discharge, effective communication of the discharge process, and the use of a discharge checklist for patients.

Rationale for Recommended Change

Discharge of patients from acute care facilities is known to be challenging with the use of education being the most common approach. Evidence suggests that many patients do not understand their care upon leaving the facility even when thorough education is provided (Emes et al., 2018). For instance, most of the people seeking in-patient care services are the elderly and with this population, the use of education is less likely to take impact their understanding of care unless their family is present. The recommended approach will ensure that planning for discharge begins immediately after the admission of the patient. The discharge plan should be effectively communicated and reviewed by the patient each day until the last day in the facility. During this period, healthcare providers will stress the key facts about the patient’s condition and what is required upon leaving the facility. Lastly, the use of a discharge checklist will ensure all aspects of patient care including education are provided before the patient leaves the facility (Emes et al., 2018). I believe this approach will increase the patient’s understanding of care including the proper following of discharge information to reduce hospital readmissions.

Measures to Evaluate

To measure the effectiveness of the new change, the HCAHPS scores from the hospital compare will be used as the national benchmark. Currently, the survey question on ‘Patients who “strongly agree” they understood their care when they left the hospital’ has a score of 57% compared to 51% and 54% of the state and national average respectively (CMS, n.d.). Upon implementation of the new change, the scores are expected to improve gradually in the facility. If the scores will improve, the hospital will make it a policy to use the new discharge plan for all patients across all units. If the HCAHPS scores do not improve, reassessment of the new strategy will be done and additional changes made to ensure the identified area of weakness is addressed.

References

Agency for Healthcare Research and Quality. (2019). Debriefing for clinical learning. https://psnet.ahrq.gov/primer/debriefing-clinical-learning

American Association of College of Nursing (AACN). (2011). The essentials of master’s education in nursing. http://www.aacnnursing.org/portals/42/publications/mastersessentials11.pdf

Cleveland Clinic. (2020). About Cleveland Clinic: Cleveland Clinic overview. Retrieved from https://my.clevelandclinic.org/about/overview

Emes, M., Smith, S., Ward, S., & Smith, A. (2018). Improving the patient discharge process: Implementing actions derived from a soft systems methodology study. Health Systems (Basingstoke, England), 8(2), 117–133.                                                         https://doi.org/10.1080/20476965.2018.1524405

Florida Department of Health. (2020). Broward County: data and statistics. http://broward.floridahealth.gov/programs-and-services/community-health-planning-and-statistics/data-and-statistics/index.html

Maresova, P., Javanmardi, E., Barakovic, S., Husic, J. B., Tomsone, S., Krejcar, O., & Kuca, K. (2019). Consequences of chronic diseases and other limitations associated with old age–a scoping review. BMC Public Health, 19(1), 1-17. https://doi.org/10.1186/s12889-019-7762-5

Uhm, J. Y., Ko, Y., & Kim, S. (2019). Implementation of an SBAR communication program based on experiential learning theory in a pediatric nursing practicum: A quasi-experimental study. Nurse Education Today, 80, 78–84. https://doi.org/10.1016/j.nedt.2019.05.034

1. S Centers for Medicare and Medicaid Services (n.d.). Cleveland Clinic Hospital: Patient survey rating. https://www.medicare.gov/care-compare/details/hospital/100289?id=c829a7e5-253e-4bd8-976c-07b0691771bf&city=Pembroke%20Pines&state=FL&zipcode=33082

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12–25. https://doi.org/10.1097/NOR.0000000000000308

United States Census Bureau. (2019).Quick facts: Broward County, Florida. https://www.census.gov/quickfacts/browardcountyflorida