Answer

  Planned Change in a Department/Unit

Change in nursing practice has become an essential component especially because of the development of new technologies, advances in science, staff shortage, and an aging population. However, according to Marquis & Huston (2009), leading change has been an uphill task due to the complexities and challenges which arise in the continually evolving health care environments geared towards the provision of improved patient care. As such, being successful in the change process requires the adoption of the most appropriate theory as well as the application of various leadership skills which can decrease resistance to change and hence make it successful (Yoder-Wise, 2014). Additionally, the changes should be designed to address a specific problem and be aligned with not only the mission and vision of the organization but also the relevant professional nursing standards. This paper provides a planned change in the Elderly Care Unit (ECU) to address the problem of patient falls.

Identification of Problem/Inefficiency/Issue

                In the Elderly Care Unit (ECU) of Mayo Clinic, the rates of falls have been on the rise. In specific, at least one older adult in the department falls each day (Mayo Clinic, 2019). The falls have resulted in not only physical and mental injuries to the elderly but also in increased rates of rehospitalizations. Additionally, the medical costs of falls in the hospital’s healthcare system have increased. Moreover, some of the families of the victims of the falls have brought up litigations to recover damages for the injuries caused to their family members due to the falls (Mayo Clinic, 2019). One of the primary reasons for the falls is the inefficiency of bedside call bell in alerting nurses about any incidences in the Unit. Notably, whereas some of the elderly populations cannot access the bedside call bell, others use it when it is too late. Various instances of deaths arising from the falls have also been reported. As such it is vital that changes are adopted to address this problem and ensure the safety and wellbeing of the elderly in the Elderly Care Unit.

Change to Address the Issue

                In addressing the problem of patient falls for the elderly in the Elderly Care Unit, the most realistic change which could be made by the hospital is the implementation of hourly rounding. In specific, in every hour, a nurse or nursing assistant should enter the elderly patient’s room and assess his/her needs (Goldsack et al., 2015). In the day shift, hourly rounding should be done every one hour whereas, in the night shift, it will be done every two hours. During the hourly rounds, the 5’ps of pain, potty, position, proximity, and personal needs should be assessed. It is expected that the adoption of hourly rounding will result in reduced rates of falls. Additionally, the rate of satisfaction of the patients will increase (DuPree, Fritz-Campiz, & Musheno, 2014). Moreover, the quality of care would be enhanced which would result in better patient outcomes.

Alignment of Change with Mission

                The proposed change of implementing hourly rounding will be in tandem with the mission and vision of the organization as well as the professional standards. Notably, the purpose/mission of the hospital is to inspire hope via the maintenance of health and wellbeing through the provision of best care to the patients (Mayo Clinic, 2019). Hourly founding will ensure the attainment of this mission as it will contribute to better health for the patients whereas their wellbeing will be catered for through increased monitoring. Moreover, the organization seeks to provide an unparalleled experience and become the most trusted healthcare partner. The adoption of the proposed change will make the patients satisfied and hence trust in the quality of care provided by the facility. Moreover, hourly rounding will be in alignment with standard 5 of the American Nurse Association (ANA) which requires nurses to use various systems aimed at leading effective change (American Nurses Association, 2010).

Change Model

The model which will be used in guiding the planning and implementation of the proposed change is Kurt Lewin’s Unfreezing-Change-Refreezing Model. In specific, Lewin devised a model of change which follows three steps in the identification and examination of the forces which influence change. In the first stage of unfreezing, a method is found to assist individuals in letting go of their old patterns and behaviors and adopting new behaviors (Marquis & Huston, 2009). However, in the second stage of change/moving, the thoughts, feelings, and actions are changed. Such a change can be achieved through persuading stakeholders on how why the status quo should be replaced with a new order. In the last step of refreezing, the change is established as a new habit (Hussain et al., 2018). In specific, the change implemented in the change phase is optimized to ensure maximum benefits.

Rationale for Selection

                The choice of Lewin’s three-stage change model was pegged on the various benefits that it brings out when used in change implementation. One of those is that it is the simplest model which only involves undertaking three steps. As such, according to Marquis & Huston (2009), it makes change easier to plan especially in organizations who are more focused on the science of change management. The fact that the model allows for the resistance to change to be addressed before the actual changes are done makes it result in effective and successful change implementation (Hussain et al., 2018). Additionally, it allows for the stakeholders to be convinced of the importance of the changes especially through the examination of the benefits of the changes compared to the status quo (Yoder-Wise, 2014). Such gains and advantages compared to other models with many steps led to the choice of Lewin’s change model.

Steps to Facilitate the Change

The three steps which will be used in the implementation of hourly rounding in the ECU unit will follow Kurt Lewin’s three stages of change implementation. In the unfreezing stage, the stakeholders including the nurses and the hospital administration will be informed of the need for change by highlighting the issues of falls in the Elderly Care Unit and the various adverse effects that they have brought to the patients, the nursing professionals, and the entire hospital. However, in the second step of the change phase, arguments will be made to the stakeholders about why the status quo (use of bedside call bells) is inefficient and why there is a need to adopt the hourly round strategy. Any fears in the stakeholders will then be alleviated by demonstrating how the proposed change will be beneficial. In this case, a cost-benefit analysis will be conducted. The change agent will then seek the necessary resources such as finances and human resources for the implementation of the changes (Yoder-Wise, 2014). Afterward, the staff members will be trained on how to conduct hourly rounding. In the last step of freezing, the key stakeholders will be encouraged to stick to the new strategy of reducing falls and ensure that they do not fall back on the old ways. Finally, the change impact will be evaluated to establish its effectiveness.

Initiating and Managing the Change

Various stakeholders will be involved in the initiating and management of the change. In specific, the change agent, charge nurses, nurse leaders, and the hospital administration will be vital in the management of the changes. The change agent will be responsible for directing and guiding the change (Yoder-Wise, 2014). The skills that he/she must have are those of vision, leadership, effective communication and persuasive skills (Marquis & Huston, 2009). The charge nurses will implement the hourly rounding as they will be tasked with the assessment of the 5P’s of hourly rounding. They will need the skills and competencies to implement the changes. The nurse leaders will ensure that their followers are well distributed and assigned to provide the hourly rounds. However, according to Goldsack et al. (2015), the hospital administration will provide the resources to be used in change implementation such as the hiring of additional nurses and training them.

In sum, advancements in technology and the evolving nature of the healthcare environment has made change an inescapable element of nursing practice. The issue identified in the Elderly Care Unit is that of patient falls which has resulted in increased care costs due to hospitalizations, injuries, and even fatalities. Hourly rounding is the proposed change which can be adopted to address patient falls. Using the Lewin’s model of freezing, change, and unfreezing hourly rounding will be implemented in the Unit. The proposed change aligns with the mission of the organization which is on providing improved health and wellbeing. The change agent will initiate and manage the change and should have leadership, persuasive, communication, and visionary skills.