Critiquing a Change Effort Sample Essay

Critiquing a Change Effort Sample Essay

To prepare:

Review Chapters 7 and 8 in the course text. Focus on the strategies for planning and implementing change in an organization, as well as the roles of nurses, managers, and other health care professionals throughout this process.
Reflect on a specific change that has recently occurred in your organization or one in which you have worked previously. What was the catalyst or purpose of the change?
How did the change affect your job and responsibilities? Critiquing a Change Effort Sample Essay.
Consider the results of the change and whether or not the intended outcomes have been achieved.
Was the change managed skillfully? Why or why not? How might the process have been improved?

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Post a summary of a specific change within an organization and describe the impact of this change on your role and responsibilities. Explain the rationale for the change, and whether or not the intended outcomes have been met. Assess the management of the change, and propose suggestions for how the process could have been improved.

Please references should be within the last five years, all in text citation should have page or paragraph number. please there should be and introduction and summary.

Post (1) a summary of a specific change within an organization and describe the impact of this change on your role and responsibilities. (2) Explain the rationale for the change, and whether or not the intended outcomes have been met. (3) Assess the management of the change, and propose suggestions for how the process could have been improved.
Readings

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application(8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Review Chapter 7, “Strategic and Operational Planning”
Chapter 8, “Planned Change”

This chapter explores methods for facilitating change and the theoretical underpinnings of implementing effective change
McAlearney, A., Terris, D., Hardacre, J., Spurgeon, P. Brown, C., Baumgart, A., Nyström, M. (2014). Organizational coherence in health care organizations: Conceptual guidance to facilitate quality improvement and organizational change. Quality Management in Health Care, 23(4), 254-267 doi: 10.1097/QMH.0b013e31828bc37d Critiquing a Change Effort Sample Essay.

An international group of investigators explored the issues of organizational culture and Quality Improvement (QI) in different health care contexts and settings. The aim of the research was to examine if a core set of organizational cultural attributes are associated with successful QI systems.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32-37. doi: 10.7748/nm2013.04.20.1.32.e1013

Abstract: Planned change in nursing practice is necessary for a wide range of reasons, but it can be challenging to implement. Understanding and using a change theory framework can help managers or other change agents to increase the likelihood of success. This article considers three change theories and discusses how one in particular can be used in practice. Critiquing a Change Effort Sample Essay.
Shirey, M. R. (2013). Lewin’s Theory of Planned Change as a strategic resource. The Journal of Nursing Administration, 43(2), 69-72. doi:10.1097/NNA.0b013e31827f20a9

Abstract: This department [manuscript] highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author explores the use of the Lewin’s Theory of Planned Change as a strategic resource to mobilize the people side of change. An overview of the theory is provided along with a discussion of its strengths, limitations, and targeted application.
Media

Laureate Education, Inc. (Executive Producer). (2012g). Organizational dynamics: Planned change and project planning. Baltimore, MD: Author.

Note: The approximate length of this media piece is 9 minutes.

In this week’s media presentation, experts discuss how today’s health care organizations can capitalize on the strengths of nurse leaders to plan for and navigate change effectively.

Critiquing a Change Effort

One of the largest changes that I have seen over the years of working in the emergency department (ED) is that of triage. First it was triage up front then bring to a room, then it was to bring a patient to any available bed and triage at the bedside, and now it is pull until full rules and triage has been left up to the primary nurse. They even went as far as to drop the triage nurse from the schedule as an “unnecessary expense.” Critiquing a Change Effort Sample Essay. Now that worked all well and good until someone finally died in the front lobby and there was no nurse to find or a room to put the patient in, because the nurses were all in the full rooms that seemed like such a good idea at the time, according to management. Yes, this was an actual scenario from the hospital I was previously working at about ten years ago. The reason it failed? There was zero input from the nursing staff who actually worked in the environment, and management refused to listen.

Impact of Change on Roles and Responsibilities

According to Marquis and Huston (2015), the change agent can make the difference between a successful implementation and a failure when it comes to a change effort. This is where the process failed in my opinion, because there was no input, just a bunch of brash decisions being made by a governing party that had no idea of the process and the way they worked. The process of triage is to manage patient flow, and that responsibility fell to the triage nurse and then the charge nurse to decide what level a patient was designated based off subjective and objective data, and which was the most appropriate plan of action for the patient at that time (Ovens, 2016). Critiquing a Change Effort Sample Essay.

Due to the changes made and removing the triage nurse the duty of triage fell to the charge nurse, which was fine until the department became busy. This new method of pulling patients to an open room and triaging them at the bedside became an overwhelming nightmare, because it left everything full, no crash bed available, and the main ED congested with level four and five patients while level two and three patients were waiting in the now overcrowded ED waiting area. This made it difficult for the charge nurse to manage flow, maintain order, and balance the work load of the nurses, which were all responsibilities that went by the way side because the charge nurse was also the triage nurse now, too.

Change as a Necessity

Change, especially in the ever advancing world of medicine, is expected and needed in order for facilities to survive. As outlined in The Institute of Medicine and the Robert Wood Johnson Foundation iconic 2011 report (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2011), changes in healthcare are needed and most of them immediately. So the idea of change is not a new one and has recognized importance that anyone can see.

The idea of changing the triage process was to cut out the time lag from door to doctor. As Dr. Oven presented in his posting, triage has become viewed as a waste of time (Ovens, 2016). To patients, it may feel this way, but with due respect to medical necessity and limited space, the nursing staff may feel differently. With this change, due to poor implementation and planning overall, the outcomes were not met. In fact, the triage numbers became much worse and the process actually slowed through times and increased the number of patients who left without treatment. Since that time the process has been changed back and the triage nurse added back to the scheduled nurses for each shift. Critiquing a Change Effort Sample Essay.

Assessment and Propositions

Management did a very poor job of implementing this change when it comes down to it. They rushed in, without proper planning, input, preparation, or implementation strategies in place. Because of this gung-ho approach the idea, which could have worked and has in other facilities now, the plan failed and patient care ultimately suffered because of it. Now it was noted earlier that a change agent can make or break these types of efforts. This is where a strong nurse manager would come in to play. With good leadership and commanding presence, the ideas set forth by administration could have still been implemented but in a manner that would not have strangled the process to dysfunction and death.

At the time the nurse manager blindly went along with these changes with immediate implementation and zero thought process. When it failed, who do you think administration blamed? You guessed it, the nurse manager, when in reality it was their own faults as well. Now ideally, the way this should have been handled is through using a model for change like what was outlined in Marquis and Huston (2015, p167), and used the adapted Lewin’s Model of Change. This is a five step outline starting with precontemplation, then contemplation, preparation, action, and finally maintenance Critiquing a Change Effort Sample Essay.

The idea to change could have been considered in precontemplation, then heavily discussed in the contemplation stage to avoid any possible scenario in which a problem might arise. The plan could then be prepared for and change could come on a time table versus immediate change, allowing for adjustments or any concerns to be voiced and considered prior to implementation. Action is of course the start day and can be used to evaluate the process and changed as needed to allow for a better function. Critiquing a Change Effort Sample Essay. Once all has been ironed out and a working process is in place, all one would have to do is maintain it, and avoid any return to old methods.

 

References

Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). Chapter 7: Recommendations and Research Priorities. In The Future of Nursing: Leading Change, Advancing Health (pp. 269-284). http://dx.doi.org/10.17226/12956

Marquis, B. L., & Huston, C. J. (2015). Chapter 8: Planned Change. In Leadership roles and management functions in nursing theory and application (8th ed., pp. 162-180). Philadelphia, PA: Wolters Kluwer Health. Critiquing a Change Effort Sample Essay.

Ovens, H. (2016, April 12). Is triage obsolete [Blog post]. Retrieved from https://emergencymedicinecases.com/is-triage-obsolete/

 

Week 4 Main Discussion Post

Critiquing a Change Effort

“Planned change is the deliberate application of knowledge and skills by a leader to bring about a change” (Marquis & Huston, 2015). Management must be knowledgeable in change theories to be able to apply such methods appropriately. Leaders must be able to identify where change is needed within the facility and be flexible in adjusting to the change they initiated.  Kurt Lewin developed the change theory that includes three phases for planned change: unfreezing, movement, and refreezing (Marquis & Huston, 2015). Unfreezing occurs when change is needed, movement takes place when change is initiated, and refreezing happens when equilibrium is established (Mitchell, 2013). Critiquing a Change Effort Sample Essay.

Recent Change

A recent change that was implemented throughout the facility where I work is bedside shift report on all patients. The purpose of bedside shift report is to create accountability between both nurses, to keep the patient informed and educated on their care, increase patient safety, and improve patient and family satisfaction scores. “The benefits of bedside reporting are numerous and include increased patient involvement and understanding of care, decreased patient and family anxiety, decreased feelings of “abandonment” at shift changes, increased accountability of nurses, increased teamwork and relationships among nurses, and decreased potential for mistakes” (Rush, 2012).

Effect on Job

In the intensive care unit, the charge nurse gives a brief report to oncoming nurses about all the patients in the unit. The oncoming charge nurse will then divide up the patients based on acuity, drips, ventilator, etc. Once the charge nurse has assigned the patients, the oncoming nurse and the departing nurse will go to the bedside and give a detailed report on their visit. This has affected my job positively and negatively in some instances. It is great to keep patients involved in their care, but it’s a lengthy process, and sometimes you don’t want to disclose certain information in front of a patient or their family. For instance, I was caring for a suicide attempt patient the other day, and he was very depressed and tearful when his situation was brought up, so giving bedside report made him very agitated and eventually combative because he did not want us talking about what happened. He said it was a violation of his privacy because everyone could hear what we were talking about, even though we were behind closed doors. The patient’s family was asked to leave the room while we gave report, but the patient was still upset because he said it “seemed suspicious.” Although it keeps patients involved in their care, report often gets interrupted with questions, causing report to take a lot longer than before.

Intended Outcome

This change was implemented within the past three weeks, so it’s hard to say whether we’ve reached the intended outcome or not. So far, the feedback has been positive, for the most part, from patients and nursing staff. Critiquing a Change Effort Sample Essay. I have seen a change in how nurses, patients, and family members interact throughout the day. Multiple patients have verbalized their appreciation for being kept up-to-date on procedure results and feeling like they’re involved in their care.

Management of the Change

This change was initiated through a democratic leadership style. “Democratic leadership is useful when co-operation and co-ordination between groups are necessary, so it is therefore a more appropriate style for implementing change” (Mitchell, 2013). I believe the staff was provided with the proper education to apply this change efficiently and the managers are frequently giving us feedback from patient and family members. The staff was given plenty of notice before the change was implemented, and although some nurses were resistant at first, it seems like everyone is participating in the process.

References

Marquis, B. L., & Huston, C. J. (2015). Leadership Roles and Management Functions in Nursing (Eighth ed.). Philadelphia, PA: Wolters Kluwer Health.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management- UK, 20(1), 32-37. Critiquing a Change Effort Sample Essay.

Rush, S. K. (2012). Bedside reporting: Dynamic dialouge. Nursing Management, 43(1), 40-44. Retrieved from http://journals.lww.com/nursingmanagement/fulltext/2012/01000/Bedside_reporting__Dynamic_dialogue.11.aspx Critiquing a Change Effort Sample Essay

 

 

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