Evidence Centered Patient Safety Initiative

Abstract

In order to gather the challenges, it is necessary to rehabilitate organizations into learning institutions at the first step, so as to make them superlative. To make a change from a traditional to a learning organization, the main factor is leadership, which brings to light the goals and the main insights of the organization, assists workers to achieve their aims and helps them put up a learning condition which is inventive (Diab, Safan & Beeker, 2017). In the most recent proposal, an outline of an organizationâ€™s assessment on how ready they are to adopt evidence-based practice in the healthcare sector is presented. This project will be carried out in hospital environments with the respondents being healthcare professionals. The study will employ the Prevention Program Assessment tool to check their preparedness for change and thereafter get into a training period of 25 weeks. The outcomes will be analyzed qualitatively and quantitatively and finally highlight the drawbacks and future implications.

Introduction

We are living in a century which requires us to speed up the rate of progress in healthcare. Nowadays, advancements in healthcare organizations are not constant. Therefore, it is very critical for the success of an organization that it has an ability to change the usual ways of practice. Change comes under different attributes either in political, social or financial frameworks. The success of an organization is revealed by its tendency to change (Diab, Safan & Bakeer, 2017). When an organization progresses from its current state to some forward and desirable state, this is said to be organizational change. Organizational change management consists of preparation and application of positive and negative changes in the organization. This has to be done in such a way so that there is a decrease in employee resistance and cost to the organization along with strengthening of tolerability of change exertion. Therefore, it is advisable for people to get ready for change in order to reduce resistance to change (Vakola, Oreg & Armenakis, 2013). Change is more likely to take place if those that embrace it are more than the ones opposed. This is observed in the model for individual and organizational change. The willingness of an individual to pursue therapy change informed the transtheoretical model in psychotherapy. In an effort to prepare the stakeholders to prepare for change, the transtheoretical model emphasizes the need to remove obstacles to the change initiative and fan the urge for change by introducing motivators for the same. The motivators may be either psychological or structural (Howley, 2012). The guidelines below could help to pick out the best approach for change: It breaks down from the status quo to the future state in five stages:

1. Craft the change

2. Plan change

3. Put change into effect

4. Manage change

5. Sustain and maintain change (Cavarec, 2014).

Failure by the top management to support nursing staff at lower levels could be one of the barriers to change. Poor pay and lack of rewards, including poor facilities, equipment and resources, lack of clear information about the need for change and failure to provide training programs for the staff for their development constitute a raft of factors that impede change. Consequently, there is likely to be lack of commitment, dissatisfaction and lack of motivation among the nursing fraternity to inspire them to take part in change (El-Sayed, Seada & El-Guindy, 2017).

Managing change is, clearly, a complex process. It is also hard to characterize and initiate in a world that is changing fast, and full of diversity among people. There are varied cultures, ecologies and organizational missions. Since leaders have an obligation to make the right decisions and implement their conclusions, the guidance provided by theories of change is, undoubtedly, useful to them. Leaders can make use of models of change to prepare their organizations to embrace fresh methods of adopting change and achieving their objectives. Change management could be a more intricate skill than conventional science. The fact that there is ambiguity in the current research on change underscores the fact. Thus, insights about practice are invaluable to such leaders (Howley, 2012).

Literature Review

According to Jones et al (2005), the perception of employees to an organizational culture is strong according to their human way of seeing things. Therefore, an open relations values will be linked to increased levels of preparedness for change which would predict the success of implementing change. Analysis disclosed that pre-implementation levels of preparedness for change brought a positive impact on the satisfaction of employees, given that the system is error free and user friendly. In another research by Ingersoll et al (2000), the relationship between organizational commitment, organizational culture, and organizational preparedness in a number of employees taking part in a hospital-wide redesign process were determined. Results showed that when change is taken positively, employees might put in more effort and commit themselves to the institutionâ€™s work. According to Treuer et al (2018), the preparedness of the organization as a whole for change will depend on how much they modify their organizational climate and style of leadership.

Problem Statement

The research was conducted to assess the following problem statement: â€œWhat is the level of readiness of my organizationâ€™s staff for evidence-based practice?â€ In order to determine how ready, the organization was for incorporation of evidence into practice in the organization, this study sought the opinions of nurse managers and staff nurses regarding the implementations of EBP changes. It also looked into the barriers that deter the incorporation of practice changes.

Methodology

Instrument. Change readiness assessment seeks to examine the level of readiness three main items: the circumstances; individual approach; and possible resources in a system. This is done at all levels (Diab et.al, 2017). The Prevention Program Assessment tool will be used to evaluate how ready the healthcare employees are to implement evidence-based practice. The major goal of developing this tool was to assess the preparedness of organizations for evidence-based interventions in programs related to prevention of chronic diseases, including asthma, obesity, and diabetes, among others. The tool can be very useful to public health practitioners who may want to know how ready their organizations are for kicking off evidence-based programs. The tool comprises 23 questions under four categories, i.e. awareness, adoption, implementation and awareness). These are meant to guide the user on evaluation of the preparedness of a given organization to apply evidence-based practice for both private and public health sectors. The Prevention Program Assessment tool employs 4 basic stages for the readiness assessment (Stamatakis et al, 2012).

1. Awareness: Assessing community awareness and organizational awareness, recognizing the availability and need of sources of EBIs

2. Adoption: Analyzing the level of evidence use in decision making

3. Implementation: Implementation and adaptation of the intervention to fulfill community needs

4. Maintenance: Availability of resources and activities for continuing support of the innovation

The four stages herein outlined make the Prevention Program Assessment Tool a worthwhile tool to use. The tool caters for both the senior and junior staff, and thus very appropriate for the project. It is good to use the tool both at the beginning of the training (pre-intervention) and after the training (post-intervention). The training will cover among other things: division of labor, discipline, decision making, leadership with fairness, sustainable employment, comprehensive instructions, remunerations and performance appraisals. The four stages cover a period of 6 months, after which the preparedness for change is evaluated using the Program Assessment tool (Cavarec, 2014).

The tool has been tested by interviewees sampled to represent study areas in prevention of chronic diseases. The degree of readiness was measured using the confirmatory factor analysis (CFA). The CFA was first tried out on the initial four-factor approach to organization preparedness. It was thus adapted several times, using a number of indices used to examine model fit. These include comparative fit index, chi-square/degrees of freedom, associated 90% confidence interval, and root means square error of approximation. CFA was the most appropriate for the 5-point scale of adoption and implementation. Its use considerably improved the awareness and maintenance scales. The maintenance scale was further divided into four and five item scales. The four-point scale represents the evaluation maintenance, whereas the five-point scale represents resource maintenance. The final scales managed to exhibit a good fit, with factored loadings between 0.6 and 0.4. The readiness scale was also found to be a good one, with ranges from 0.47 to 0.71 (Stamatakis et.al, (2012).

Subjects. This undertaking will be performed within healthcare centers and hospitals. Potential participants in the venture are hospital managers and RNs (registered nurses). Convenient sampling will be used for sample selection. Participants will have to sign a consent form before appearing for data collection.

Procedure. A non-randomized sample of registered staff nurses and nurse managers from acute and critical care units will be included in the sample. The objectives of the study will be explained to the managers, who will then be asked to give consent for me to conduct the research. A cover letter will be included with the survey in order to provide additional information to the staff about the study. Approval will be sought from the hospitalâ€™s Human Subjects Research Committee. The researcher will take care of informed consent. Confidentiality of the participants will also be maintained. The Prevention Program Assessment tool will be administered to the respondents before the commencement of training. 6 months training will be conducted. As the baseline period of 6 months ends, the tool will be again administered to the similar subjects to record their responses. The difference in the responses on the tool at the start of the training and end of the training will provide the information related to readiness to change.

Training. The effort by nurses to improve education in nursing, the profession, or even just patient care for the transformation of healthcare in general is described with the term: leading change (Nelson-Brantley & Ford, 2016). Many interventions meant to change the situation for the better are likely to succeed if they tackle the core practice determiners for betterment in the setting targeted. Studies on implementation have previously been focused the professionals at individual level (Bosch et al, 2016). It is possible to do post and pre-evaluation with intervention that is effective. The readiness to change, by the nursing staff, can be checked with the Prevention Program Assessment Tool (Stamatakis et al, 2012) at the onset of such an intervention.

Performance is basically measured by gathering some relevant data which can be used to tell how well a program is doing. One strategy normally employed for performance measurement is the pre-post analysis. This involves the assessment of the participants both as the program starts and as it comes to an end. If there be a notable difference between these two assessments, it can then be concluded that the program has helped the participants in some great way (Tatian, 2016). This research will use a more or less similar approach. The participants will be questioned both before and at the end of the training. The differences for these two are normally a good indication whether the company goals and objectives have been adequately met. The strategies below could prove useful in the training session:

Authority and discipline. The tiered relationship between managers and employees within and organization with delegation flowing from the top, downwards.

Centralized decisions. The main decisions are taken at the top. The model is such that the head directs while the hands and legs execute what the head has directed. If there is a disagreement, it is settled by the manager.

Division and standardization of tasks. Assignments are split into smaller and doable parts while the employees specialize on tasks that are standardized.

Fair leaders. It is the hallmark of a good manager to understand the strengths and weaknesses of their employee. They are therefore enabled to assign tasks to those who can accomplish them as expected.

Secure employment. The moral contract between employees and their employer is that they will remain humble and execute tasks as directed by their bosses, show respect to their bosses in exchange for security of their pay and employment, in general.

Detailed instructions. No employee will be blamed for implementing or accomplishing a task the way they are directed to.

Reward and blame. Blame can only be apportioned for oneâ€™s mistake and not for following instruction given by a senior. Promotions are based on experience and not work outcomes

Salaries. The performance index is influenced by the marginal productivity of a company. A company will employ until the point when there is equilibrium between marginal productivity and the cost of employing. After 6 months, a review can be done (Cavarec, 2014)

A good number of the most important factors can be modified. Consequently, we shall use them to decide the intervention modalities. The result is that here will be factors of intervention that target such factors. One incidence is when there are no sufficient clinical leaders to take charge of professional groups so as the lead the tools and offer practical examples is a major impediment; deployment and recruitment of clinical and nursing opinion shapers to take charge of the workshops, locally, and accounting for their trait characteristics. In the same way, lack of resources can be overcome in the meantime by offering reimbursements and passing the relevant information at the recruitment onset (Bosch et al., 2016).

Discussing the factors that are believed to determine innovation uptake, values compatibility and needs perceived seems to be a central factor of influence. Many agree, generally, that using guidelines helps nurses more in their line of duty that in the medical practice culture. Equally, it is widely thought that healthcare personnel with vast experience in the practice do not need guidelines. They are, nevertheless, considered critical for junior personnel, especially at the time when senior staffs arenâ€™t around for responding to questions. Changes made should be observable so as to encourage the change initiative. Physicians underpin the fact that evidence should drive the change agenda (Bosch et al., 2016).

Change Model

The concept â€˜evidence-based practiceâ€™ (EBP) may be defined as a process of joint decision-making on the part of healthcare providers, patients and their family members, using research-grounded evidence, individual patient preferences and experiences, clinical skills and other sound information sources on hand.

Elementary nursing interventions, including activity and sleep promotion and oral care, prove challenging in spite of proofs of improvements in patient outcomes (Choosing Wisely, 2014). Hand hygiene also has suboptimal adherence in spite of the presence of sound evidence, practice applicability and regulatory standards. Numerous models direct project and company leadership across EBP stages (Melnyk & Fineout-Overholt, 2015). A majority of these process paradigms share similar over-arching issue resolution stages including issue identification; critiquing evidence; implementation of proper recommendations; evaluation of patient outcome changes; and result dissemination. Supplementary frameworks and theories concentrate on adoption (Cullen, 2015).

Iowa Model of EBP

This EBP model commences with urging practitioners to determine practice triggers or questions, a few of which have extant information, underlining opportunities for improvement. Meanwhile, other triggers arise out of fresh knowledge such as scientific updates. This model has effectively dealt with even those practice traditions that are hard to alter (Cullen, 2015).

Clinical issue. This paper will expound on a clinical issue linked to TCM which is referred to as Traditional Chinese Medicine. It is normally known as nursing in TCM or TCM nursing. It is a very important element in the profession of nursing in China. There is a complication known as Diabetic Foot Ulcer (DFU) associated with Diabetes Mellitus (DM) which can hardly be avoided. This complication does not cause a long-life disability. However, it affects the Quality of Life (QOL) of the patient. According to Wagerâ€™s wound classification system, the pre or post-ulcerative lesion is classified as Grade 0 DFU. In western medicine, the most popular nursing involvement activities are health education, consistent examination and strengthening protection of food.

The TCM nursing method for foot bath requires institutionalized nursing procedure and an evidence based clinical rule despite the fact that it is termed as efficient. The time required to soak feet in water, the temperature of the water, and the type of Chinese medicine to be prescribe are details which should not be left out. These details motivate healthcare professionals to develop proof-based care protocol in nursing which will help in the treatment grade 0 DFU using TCM foot bath (Zhao et al, 2016).

Formation of team. This step involves bringing together stakeholders like

Clinical nurses, hospital managers, nursing leaders, epidemiologist, and nursing researchers to form an interdisciplinary team which will help in accomplishing the projectâ€™s implementation (Zhao et al, 2016).

Research and evidence-based literature. Searching the evidence is the next step after pointing out the issue of concern and forming a team. In this context, a period of brainstorming will be put in place in order to identify the main terms which will aid in search for evidence and identification of the resources which are available. With the help of a medical librarian, searching and retrieving research studies can be achieved and it can go a long way to help in finding a solution to a question which requires a lot of knowledge or choosing an intervention (Brown, 2014).

The tested interventions in the current studies need critical evaluation. The team should do a critical evaluation to establish whether the intervention is scientifically right for the problem in concern. Every research paper has some drawbacks. There are issues like studies using a tool which are not known whether they are reliable or valid or studies with a sample size which is small eventually leading to generalization. Therefore, it is very key to do a critical evaluation on the screened-out research studies before putting into consideration their outcomes for implementing practice change. It is also very key to ensure that enough research is available in relation to the issue before making a decision to implement the change. How should researchers make a decision on whether there is enough evidence or not? According to Titler et al, this is the criteria which should be followed (a) Multiple studies have developed consistent discoveries that back up the change (b) The studies should be looked in to and their quality and type should be established (c) The results should have a clinical importance (d) The sample features and the studies with similar sample features (e) How efficient it is to put the samples to practice (f) The risk-benefit ratio. If the aforementioned criteria are met, promoting the change into practice can be put into consideration. If that is not the case, research studies must be carried out (Zhao et al, 2016).

As a result, EMbase, VIP, MEDLINE, CNKI, and Wanfang Data and comprehensive literature will be recovered. The main terms to search will be Chinese herb/Chinese medicine, Chinese herbal medicine, diabetes foot/diabetic foot, foot bath/foot soak and all the related terms. The next step would be identifying relevant papers meet the criteria for inclusion. There will be an addition of papers in the review after they undergo screening as well as critical appraisal. A meta-analysis will be carried out to establish how effective TCM on foot bath is on patients with 0 grade DFU.

Piloting. This involves implementation of the change in a singular minute unit. In this unit, it is practical to notice whether the change has an effect to patients. The procedure followed here is: making a decision on the outcomes to be achieved, collecting baseline data, and producing a written guideline on EBP. This is used in units which contain smaller number of patients. The outcomes of the trial and the procedure are then taken through an evaluation and the guidelines are formed according to the outcomes (Zhao et al, 2016)

In conclusion, the Iowa EBP model offers a practical EBP process guide. The model encompasses feedback loops which underscore the nonlinear and complicated nature of support teams and EBP progress. It aims at supporting evidence-grounded patient care provision on the part of interdisciplinary care teams by offering step-wise directions. However, a few steps necessitate meticulous planning and consideration (Cullen, 2015).

Implementation Plan

Within the domain of nursing literature, â€˜leading changeâ€™ is a phrase which describes attempts, on the part of nursing staff, at improving the overall nursing profession, nurse education, and patient care, in addition to transforming healthcare delivery systems and facilities (Nelson-Brantley & Ford, 2016). Initiatives targeted at affecting change will probably prove most successful if they are able to deal with the most salient practice determinants for improvement within the context targeted (Palinkas et al, 2016). Implementation researches have historically and chiefly concentrated on individual practitioners (Bosch et al, 2016).

The growing emphasis and effort towards implementing evidence-based practices within practical community settings is accompanied by an acknowledgment of the difficult nature of the endeavor, entailing planning, quality assurance, training, and interactions between developers, users, system heads, and frontline employees. The general belief is that sites take at least a couple of years for completing implementation, which is impacted, to a great extent, by implementation techniquesâ€™ effectiveness (Saldana, 2014; Jacob et al, 2014).

Timeline

Milestones for individual phases of the project will ensure the evidence-based practice team remains on track. The preliminary study and design phase are expected to be accomplished after twelve weeks of project commencement; the implementation and EBP tool planning stage is expected to be finished in another twelve weeks. The following six months will be meant for extensive rollout across the institution, performance feedback, and process alterations and improvements as required. Process stability, which is determined through consistent period-by-period performance information which corroborate goal attainment, indicates the start of â€œhard wiringâ€. The project team confirms sound, error-proof plans for the process, adopting a reduced performance data analysis frequency for verifying long-run institutional implementation (Mark, Kuklinski & Cacchione, 2016).

Resources

No resource-related changes are needed. The same healthcare professional sample will be utilized. Pre- as well as post- sample assessment will be performed following successful intervention. During the start of intervention, nursing practitionersâ€™ acceptance of the change proposed will be gauged using the Prevention Program Assessment (PPA) instrument (Stamatakis et al, 2012; Gagnon et al, 2014; Jacob et al, 2014).

Akin to Fixsen and BlasÃ©â€™s key elements, which they claimed were critical to effective implementation, all 8 phases delineate major and salient milestones (for instance, training completion). Activity adaption in individual phases for targeting particular tasks pivotal to completing the implementation has been planned. A few activities are anticipated to differ from evidence-based practice, whereas a few others, like fidelity monitoring, are anticipated to be universal. The choice of novel practice implementation has been grounded, for the most part, in community need. This view is probably impacted by the service sector that the population has access to (Saldana, 2014).

Data Analyses

The techniques utilized for outcome data collection will basically be derived using prior researches and will incorporate quantitative techniques. Information will be gathered from healthcare facilitiesâ€™ nurses and management following acquisition of their consent to participate in the research. The research projectâ€™s nature will be described to them. The PPA instrument will be utilized before as well as subsequent to training. Research personnel at EBP facilities will be provided training on information acquisition techniques in every site of fresh implementation. A point individual has been isolated in all facilities for monitoring when fresh sites get in touch with purveyors for considering EBP adoption (Stage 1), besides commencing tracking of activity data within the facilities. These purveyors will receive training with regard to taking note of resources required for task completion (person hours as well as fees) and implementation tasksâ€™ completion by sites. Information will encompass every new facilityâ€™s demographics. For guaranteeing information reliability, in all purveyor organizations, evidence-based practice coordinators as well as information acquisition assistants will record ten percent of information separately (Saldana, 2014).

While corporate atmosphere, culture and other institutional elements have, time and again, proven that they impact effective implementation, not much information exists with regard to implementation failures and what, according to the facility, was the reason behind such failures. Considerable insights may be obtained from facilities which initiate evidence-based practice adoption and subsequently find themselves unsuccessful at completing a few of the milestones like sustainability or start-up, besides successful ones. Until recent times, researchers retrospectively employed sites or banked on recruitment plans in which evidence-based practice champions chose sites for implementation, thus failing to reflect actual conditions that sites typically face when initiating the process. A natural design wherein a site self-selects to implement a practice has been proposed. This enables potential monitoring of distinct obstacles considered overwhelming by sites during distinct implementation phases, and the distinctions between sites which can and cannot surmount them. A standardized measure will be utilized for ascertaining whether it is possible to detect obstacles leading to failure (Saldana, 2014).

Awards are solely in case of evidence-based practice project-associated tasks. Investigator time wonâ€™t be funded and no support will be given for costs associated with conference attendance and related traveling. Every other EBP-connected expenditure is allowed (for instance, transcription services, research assistants, communications, copying, supplies, and travel to collect data). The budget as well as the justification provided for it will be analyzed for appropriateness; this may be followed by recommendations for budget modifications (CGEAN, 2018).

A process of change evaluation has been incorporated as well. This phase will entail assessment of the effectiveness of prompt EBP intervention and evaluation. Screening may be discontinued if it is deemed ineffective. On the whole, it is hoped that providers will receive requisite education for identifying elements facilitating EBP.

Given the results of the study are negative, this is enough reason to conclude that the employees are rigid and resistant to change. Their readiness may also have been too minimal to be observed. The 6 months proposed for the program may sometimes prove too little to observe the readiness among the employees. Another contributing factor is the fact that the leaders may not have had time to show how ready they are for EBP, especially if their particular team started late in the implementation process (Aarons, Erhart, Farahnak & Hurlbut, 2015).

Conflicting results will be avoided by re-evaluating the training method. First and foremost, the researcher can conduct some reconnaissance to learn what aspects the hospital staff hold important, for example, capacity to manage change, communication skills, responsiveness, strategic planning and flexibility.

Conclusion

The healthcare sector requires a continuous focus on leadership traits even as they endeavor to implement other things such as climate change concerns. For instance, implementation of leadership training could be done hand in hand with implementation of climate policies. This way, the leaders are able to uphold FRL behaviors, even as they use their implementation leadership capabilities, and thus they can come up with strategic climates for consideration.

Limitations and Suggestions

As this research has not covered all aspects of evidence-based practice, future researchers should look into the degree to which less formalization of Leadership and Organization Change for Implementation would greatly improve leadership standards. Past researches were able to show how organizational development interventions can make the workplace better and improve overall patient experience. Future researchers may also consider looking into how strategic climates can be tailored to uphold implementation of EBP (Aarons et.al., 2015).

References

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Appendix A

The Prevention Program Assessment Survey

Date:…………………….

Sex:………………………

Age:………………………

Instructions: By answering the questions that follow, you will enable us to understand how well you are versed with evidence based practice. A scale of 1 to 7 is provided against each question to make your work easier. Choosing 1 means you do not agree with the statement, whereas choosing 7 shows you fully agree with statement. You are required to circle only one number on the scale depending on your level of agreement or disagreement.

Community awareness

The community upholds involvement as a way out of problems

1 2 3 4 5 6 7