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    Using the paper written in Assignment 2 (in additional materials on a paper on FALLS) as a guide, incorporate feedback from your instructor (none) and write a 9-10 page paper expanding on your planned change initiative and devise an implementation plan on how to change FALLS in the hospital. Address the following points:
    -The change you wish to initiate
    -The rationale for the change, using supporting data
    -The outcomes desired from the change
    -The audience you need to convince
    -The benefits to the institution
    -Allocation of resources and potential budget requirements
    -The group to lead the initiative —why these members
    -The proposed timeline
    -Measures of success.
    *Includes all elements and incorporates feedback from assignment 2 (Really none) *its uploaded*
    *Clearly explains the rationale for the change and includes supporting data from the literature
    *Describes in detail the expected outcomes from the change
    *Describes in detail who is selected as the target audience that needs convincing
    *Describes in detail the benefits of the change to the institution
    *Describes in detail the resources needed and the potential budget requirements needed for the change
    *Identifies the group that will lead the initiative, who the group members are and why they are chosen



Subject Administration Pages 11 Style APA


Leadership and Strategic Planning

Proposed Change

Organizations change to ensure that they keep up with the current world trends, hence outdo their competitors in a race to become the best organization in their line of business. Falls in hospitals have become common in recent days, with an increased rate of between 3.3% and 11.5% per 1,000 patients daily. With the rate increasing, hospitals need to come up with ways to reduce hospital falls. Morris and O’Riordon (2017) add that 30-50% of falls among inpatient hospitals result in physical injuries, whereas 1-3% subject the patient to fractures. From the statistics, it is evident that hospitals in America continue to register high numbers of falls, contributing to a significant number of hospitalizations today. The falls defer with each department, hence addressing the issue differently according to the cause of falls in hospitals. Departments like neurology, neurosurgery, and medicine experience different falls, therefore registering different fall rates and effects.

To effectively initiate and implement the change, change managers must put a practical change layout for its success. Applying Kurt Lewin’s change model will ensure the success of the change. Kurt Lewin provides three steps in which change managers could use to ensure the effectiveness of the change. Marquis and Houston (2017) discuss the three steps, namely, unfreezing, movement, and refreezing. First, it is crucial that the organization and all its members, including stakeholders, see the need for change. Secondly, after the problem is identified and established that the change is inevitable, enforcement of the change takes place by outsourcing the desired behavior. At this stage, all the steps to actualize the transition occur, including initiating short-term wins for its success and, lastly, refreezing the change. The change must stick by making it part of the organization’s culture. Using Kurt Lewin’s three steps to organizational change, it is possible to initiate a change in in-hospital falls.

The Rationale for the Change

Falls have become a usual cause of prolonged hospitalization in hospitals today, resulting in the increase of hospitalization cost for the extra days. With increased rates of falls causing patients injuries and fractures, it is essential for a change in hospital falls to be put in place to reduce the number of fatalities. Gettens and Fulbrook (2019) report that patients who sustain injuries due to a fall pay more on hospitalization than patients with no falls hence the addition of $13,316 on their hospital bills. Apart from the increased costs, falls prolog patient’s stay at the hospitals compared to those who have no experienced falls. It is the length of stay that eventually increases the cost of hospitalization. Initiating a change in hospital falls would significantly improve the flow of services in and out of the hospitals, reducing unnecessary hospital bed shortages created by patients on bed rest due to hospital falls.

Depending on the department in which the patient is admitted, hospital falls register different effects on the patients. Compared to the Intensive Care Unit and surgery, the medicine and neurology departments experience high falls daily, which is a cause of worry to all medical practitioners and the patients (Gettens & Fulbrook, 2019). Although departments like intensive care and the surgery register lows cases of falls, preventing the falls would help medical practitioners deliver an almost excellent service to their clients. To reduce the number of falls that have adverse negative effects on both the patients and the hospital management, initiating the change is essential. Hospital setups should be safe for all its patients and medical practitioners, which form a basis for creating change on hospital falls. Since protecting and saving lives is one of the topmost priorities of health institutions, medical practitioners should avoid any chances of causing health havoc, including ensuring that hospital falls reduce.

Outcomes of the Desired Change

Every organization anticipates benefiting positively from any implemented change. Falls in hospitals associate with more prolonged hospitalizations, poor medical outcomes, and readmissions (Slade et al., 2017). Implementing change is meant to reduce any chances of under-quality medical services, which results in the patient’s hospitalization longer than expected. Moreover, implementing fall change ensures that patients’ costs due to prolonged hospitalizations are reduced due to decreasing cases of fractures and injuries.  The change has a high chance of providing evidence-based practice on the effectiveness of reduced hospital falls on delivery of medical services to patients and the success of the health institution. When the change sticks and becomes part of the organization’s culture, there should be a significant improvement in hospitals’ flow regarding bed availability and bill clearance. The success of the change is a motivation to other health institutions that, indeed, the falls could reduce and avoid inpatient acquired fractures and injuries.

Moreover, the provided channel in which the change would follow would offer a clear picture of the necessary procedure and the result of the change. Change managers should take time to explain the whole process to the hospitals’ members and ensure that the majority agree that the change is necessary. All concerned parties of the change would understand the impacts of the change and how it would positively benefit all stakeholders. Slade et al. (2017) add patient management and environmental modifications as part of the outcomes for the desired change. Patients would get an education and training thorough awareness on how to go about the hospital and take care of themselves when in the hospital premises. For patients to stay safe in the hospitals and avoid falls, the hospital would make some structural modifications to suit the purpose and reduce any hospital falls. The change is meant to bring out positive outcomes with little or no shortcomings for the god of all parties involved.

Audience to Convince

The change process requires the contribution of many parties for its success since one person is not enough to plan and execute; hence needs a team. Among people to convince to accept the change include managers, nurses, ancillary help, and doctors. Additionally, patients play a vital role in ensuring that the change is a success. For a successful change process, managers would provide the necessary equipment and facilitate the member roles (Chan et al., 2019). The facilitations would ensure that each member on the team plays their role hence avoid any confusion and the project completes on the stipulated time. Every member under managers can coordinate and integrate their skills and knowledge for the success of the change.

After the management, the change process includes the subordinates who include nurses, doctors, and ancillary help who are on the ground and could identify the points at which patients are likely to undergo falls. All the parties have different skills in which they are professionals; therefore, integrating their knowledge and skills comes in handy in actualizing the change through considering suggestions to better the project and do away with any limitations. Patients, on the other, hand play a vital role in implementing the change. To peacefully carry out the necessary activities in the hospital, patients need to understand that the process is essential hence create ample time and, in some cases, contribute in different ways to actualize the change. Convincing them means that the project is safe and accepted for its actualization.

To convince all the parties, the proposer needs to conduct thorough research and know the project, hence answering all the questions that may arise along the way as the change is actualized. Managers need to see the benefit it would do to the hospital for managers to finance the transition. Doctors, nurses, and ancillary help need to see how there would be ease after the problem is solved. With patients, the cost reduction and the cut of days they would stay under hospitalization in case of a fall is enough to make them see the importance of the change. All stakeholders play a vital role in the shift; hence none should be undermined.

Benefits to the Institution

Most of the time, change is essential and given priority when there are benefits to it. The hospital fall change bears a lot of benefits to the patients and the health institution. Changes like the integration of technology and diversification of the workforce, and management of ethics are some of the benefits the institution would enjoy. Shuldham (2018) term the changes as external and internal forces. One way to prevent falls is using technology to enable patients to call on nurses whenever they feel unable to facilitate their mobility. To reduce the effect, the hospital requires a purchase of modified beds that serve the purpose. Modern technology puts the institution a step ahead of other health institutions lucking the same resources. Diversification of the workforce requires that the employees undergo training to use the technology with ease and comfort. The training offers an opportunity for more professional personnel hence little or no cases of falls in hospitals.

Additionally, patients visit hospitals that offer the best medical services and are built on solid patient management ethics. To effectively prevent hospital falls, clinician training, patient education, environmental management, and staff behavior as essential (Slade et al., 2017). Services in the hospital get to improve since the personnel acquires additional skills to their knowledge. The education patients receive at the hospital enables them to be cautious even at home. The modification of the hospital environment makes it conducive to treating patients at risk of falling victims to hospital falls.

Moreover, the modification remains and adds to the hospital’s reputation hence become one of the best. The benefits of the change to the hospital also include a smooth flow of services with fewer cases of prolonged stay due to injuries and fractures. Excellent and reliable medical equipment attracts patients who are ready to receive quality medical services from qualified and professional medical personnel.

Allocation of Resources and Potential Budget Requirements

Implementing a change proposal requires many resources depending on the type of change and the period of actualizing the change. The external and internal forces related to change require a lot of adequate capital in equipment purchase and training. Considering that change requires the institution to be out of service for some time, the hospital needs to budget for the losses. New hospital smart beds would cost about $10,000 to $40,000. The number of beds should equate to the previous ones or even surplus the count.

Additionally, it requires finance and time to train the institution fraternity on how to use and respond to the technology, therefore, be available on time to prevent any unforeseen falls. Medicine and neurology departments, together with any other departments that register a high number of falls, should prioritize the supply of equipment and training, hence reducing the number of falls. All factors considered the cost of implementing change are expensive compared to modifying a change in place.

Training personnel also requires capital and time away from the regular hospital routine. The trainer needs finances as well as the training space. However, since the institution cannot run out of business, the training happens in phases to ensure that everyday activities remain on course. Depending on the level of knowledge of the hospital personnel, the trainer gauges their price. However, an average trainer would cost a hospital $1,296 on every employee each year. Since the departments require different skills and knowledge, the price per person may differ to fit the services needed. Training and educating patients on safety may take time and resources, too, since the administration of patients is different each day, with the hospital receiving and discharging different patients daily. Nevertheless, the hospital may find ways to cut down the cost of training by encouraging the first trainees to help the other person in embracing the change, although professional training to all is encouraged.

Initiative Leading Group

Change requires the contribution and input of employees and the support of stakeholders to ensure its success. In initiating the in-hospital change falls, like any other change, the hospital administration, through managers, takes part in approving, overseeing, and financing the change process. Managers here play the role of facilitating and providing the required change equipment for the change, like smart hospital beds (Chan et al., 2019). Employees work and respond to the manager’s orders, making it easy to convince the staff after the approval from the leadership board.  However, the junior team must get a say on the proposed change to avoid any hiccups after forcing a change on the employees. After a brief yet comprehensive report on the change, we select a small team to work on the particulars of the change since not all employees could work on the project. A team with different skills and knowledge would help make and incorporate the other employee’s ideas hence satisfying each member’s inputs and suggestions.

External forces also play a vital role in actualizing change ideas. Patients represent the external forces since they are the change’s recipients. During patient education, collecting their change ideas and opinion on the go about would ensure the love and commitment to the change’s success. Patients also play the role of marketing based on their services, hence making them an essential asset in the change initiation. To get enough funds and finance, including the hospital stakeholders is the next group to the change’s success. Other junior staff like cleaners and janitors require the training since they also interact one way or the other with the patients. Undermining the existence of the junior staff may mean a downfall for the project. Every other member of the hospital fraternity is important in actualizing the change to hospital falls; hence should receive recognition during the process.

Proposed Timeline

The change actualization should take a shorter time when all things are ready and put in place. However, the project’s duration entirely depends on the response from the three phases of the change process. Since change requires that all the three stages be followed without skipping any, the actualization of the change would depend on the rate at which all the phases play out; the freezing, movement, and re-freezing stages. The first phase involves convincing stakeholders to buy in the change idea, creating a team or teams to work on the change. This could prove challenging, especially when there is no adequate financial support to see to the project. Managers may deem it fit that the project waits until funds are available to work on the proposal. With all the other requirements in place and all the concerned parties aware and are convinced that the change is necessary, that gives room for the second phase to play out.

The actualization of the second phase determines whether or not the project lags or moves at a faster rate. During the movement phase, nurses, doctors, ancillary help, and managers need to work together and provide knowledge on actualizing and modifying the change. The second phase requires collecting knowledge on how hospital falls can reduce in the different hospital departments (Marquis & Huston, 2017). How fast this phase move determines the timeline of the project. After the change implementation is complete, change managers need to ensure that the change sticks and becomes part of the organization’s culture for better results at the re-freezing phase. The third phase is usually the most challenging as it takes a lot of effort and time to keep reminding employees and helping, especially the experienced doctors and nurses who are rooted in the traditional way of doing things to change their attitude towards the change.

Measures of Success

Measures of success ensure that the change process is smooth and runs from start to end with little or no shortcomings. However, defects are necessary for ensuring that the change is modified and turns out with its best version. Stouten et al. (2018) mention three levels of measures in which the change can attain success. The micro individual level, which is individual-based, Meso level findings that constitute cross-level effects, and macro findings are organizational measures. Individuals contribute a lot in ensuring the success of the changes. People tend to act on things they relate with, hence creating a good relationship between the change and employees by encouraging modification suggestions and buying in and convincing the stakeholders. Employees are the prominent architects to change success. Hence, ensuring that they are committed to the change by providing all the necessary information and offering help whenever a need arises would see that the change is successful.

Meso-level findings suggest that individuals play a vital role in ensuring that change sticks. Employee relationships establish the social influence and ties concerning the work. The readiness and response of employees bases on the level of trust and confidence they have in their peers (Stouten et al., 2018). Study shows that an average person makes decisions based on the opinion of others. Also, short-term wins in between the change process encourage employees to continue working towards the end product since they can already see some of the benefits of the change. Shared goals and beliefs provide a hint to the direction in which the change may take. Employees relate and grow to love what they do; hence it is wise to introduce a change close to the culture rather than presenting a different aspect. Concerning hospital falls, employees have a say in how they think the falls could reduce.

Micro-level findings base on the inter-organizational relationships and factors, which are primarily on leadership competency, employee trust, and the nature of the change idea. Leadership competency determines how well and effective employees act and stick to a change. A healthy relationship is likely to yield good results, while a bad and wretched employee-leader relationship equals a change downfall. Employees who trust their leaders have exhibited a readiness to change (Stouten et al., 2018). Leaders need to establish trust with their employees since it comes in handy in convincing them whenever a need for change arises. The nature of change determines how employees receive the change idea. Different people have different perspectives on things; hence all concerns must be considered with no intimidation or undermining anyone. Leaders need to lead by example by providing a conducive environment and mood for change and creating short-term wins to encourage employees to accept change ideas.


Chan, S., Wadsley, M., & Ferriere, S. (2017). Quality assurance of falls reduction in an orthopedic ward using a novel bedside trolley table set-up strategy. Australasian Journal on Ageing36(4), 318-323. https://doi.org/10.1111/ajag.12428

Gettens, S., & Fulbrook, P. (2019). Fear of falling: Association between the Modified Falls Efficacy Scale, in-hospital falls, and hospital length of stay. Journal of Evaluation in Clinical Practice, 21(1), 43-50.

Marquis, B., & Huston, C. (2017). Leadership roles and management functions in nursing (9th ed.). Wolters Kluwer Health.

Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine17(4), 360-362. https://doi.org/10.7861/clinmedicine.17-4-360

Shuldham, C. (2018). Leadership Roles and Management Functions in Nursing Bessie Marquis CarolHuston Leadership Roles and Management Functions in Nursing Lippincott

Williams and Wilkins, Philadelphia PA Sixth 752 £24.95 978-0781772464 078177246X.

Slade, S., Carey, D., Hill, A., & Morris, M. (2017). Effects of falls prevention interventions on falls outcomes for hospitalized adults: Protocol for a systematic review with meta-analysis. BMJ Open7(11), e017864. https://doi.org/10.1136/bmjopen-2017-017864

Stouten, J., Rousseau, D., & De Cremer, D. (2018). Successful organizational change: Integrating the management practice and scholarly literatures. Academy of Management Annals12(2), 752-788. https://doi.org/10.5465/annals.2016.0095




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