Quality and Sustainability in Health Care

Implementation and Evaluation
Introduction
This is part 3 of the quality and sustainability paper. Part 1 outlined the descriptive method of assessing quality and safety measures in nursing science. It was concluded that administrative data could be used to determine the effectiveness of quality or safety program since safety is the most fundamental aspect of nursing science (Twigg, Pugh, Gelder, & Myers, 2016). In part 2, analysis and application of safety programs were explored and Kenneth E. Waldenberg Health Care facility was used as a model in the analysis. The findings of the paper was that leadership plays a key role in sustaining quality improvement programs in any health care organization (Stetler, Ritchie, Rycroft-Malone, & Charns, 2014). In this third part of the quality and sustainability paper, a change theory that will support the implementation of a quality and safety program will be discussed.
Change Theory
Healthcare facilitates are required to implement new process or technologies that improve patient safety and quality of care (Hughes, 2007). There exists a formula through which quality and safety programs such as telehealth services can be adopted and implemented in a health care facility. Health care managers should, therefore, consider the impact of quality and safety program changes before implementing a program change to ensure a smooth transition. Failure to assess the impact of quality or safety program may lead to unnecessary disagreements between various health stakeholders. So, healthcare managers should consider the various change theories that can be used to implement a quality or safety program successfully.
This paper will focus on John Kotter 8-Step change management model because it provides the most appropriate framework that Kenneth E.Waldenberg healthcare facility can use when introducing specialist care via telehealth services. The steps in this model are 1) create urgency, 2) form a powerful coalition, 3) create a vision for change, 4) communicate a vision, 5) remove obstacles, 6) create short-term wins, 7)build on the change, and 8)anchor the change (Campbell, 2008). Each of these steps is explained below.
Step 1: Create Urgency
Healthcare managers must create a compelling case for change. They must make people understand why the change is necessary. They must also encourage people to move from the current state to the future (Stetler et al., 2014)
To create a sense of urgency in Kenneth E. Waldenberg which is preparing to implement telehealth services, a healthcare manager can identify a facility that has successfully implemented telehealth services. The manager could then schedule times when Kenneth's staff (administrators, physicians, residents, and nurses) could visit the facility so that they could benchmark with their counterparts. During the visits, they could ask questions and share their experiences. In this way, Kenneth's staff will get the opportunity to see the program in action, interact with colleagues who are using telehealth on a daily basis, and gain firsthand knowledge on how telehealth services can benefit their facility. This visits will also help increase the sense of urgency among staff members and prevent negative attitudes that is usually associated with change (Campbell, 2008).
Step 2: Forming a Powerful Coalition
Within quality or safety programs, it is not possible for the health manager to do all the work and communication. A manager needs a team/coalition of people who will help drive the necessary change within an organization. So, a manager has to identify key people within the organization who can act as change leaders (change champions) because they will guide the telehealth program throughout the remaining steps (Hughes, 2007).
According to Kotter, change champions should have a well-defined skillset (Campbell, 2008). First, change leaders should have relevant knowledge about new technologies that are emerging in the health care industry. For example, a change leader should know the benefits of telehealth services, various quality and safety approaches, and measures of reducing health care costs and medical errors. Knowledge on these issues is crucial because it helps team members develop the vision of the telehealth program (Hughes, 2007).
Secondly, change leaders should be able to \\\"establish credibility with peers\\\" (Campbell, 2008). Various studies indicate that if employees trust the people in the leadership role, there are more likely to be motivated to take action and believe what is being communicated to them. Trust also promotes the team spirit.
Thirdly, change leaders are required to \\\"focus on the expertise that an individual has regarding the inner working of the department, division, or group\\\" (Campbell, 2008). By focusing on the strengths of team members, a leader will help remove obstacles that prevent peoples from embracing change within an organization. Obstacles to change can be attributed to mental, supervisors, lack of information, or even the system itself (Hughes, 2017)
Fourth, a change leader should have \\\"formal authority\\\" (Campbell, 2008). An effective leader should be in a position to identify procedures and tasks that will help Kenneth E. Waldenberg realize a series of short-term wins when implementing the telehealth services program. So, a leader should possess relevant managerial skills that is required when planning program tasks.
The fifth and last skill is leadership. A change leader should be able to \\\"develop and communicate a vision and motivate individuals to achieve the vision\\\" (Campbell, 2008).
Step 3: Create a Vision for Change
The vision for the organization must be short, clear, and understandable statement for it to be easily understood by the people who are affected by the change. It should also have an emotional and creative element because change can be very emotional and thus there is need to communicate it creatively to people who hear it.
To develop a vision statement for Kenneth's facility, Kotter recommends that change champions should start by identifying a minimum of six broad visions for the future. For each vision, the main element need to be identified because it helps a manager explore the options that are available in realizing the vision. From the health care point of view, a manager should consider the following elements: support staff, patients, health care professionals, action steps to be undertaken, care, competitors, and revenues (Campbell, 2008).
In general, when the change team identified in step 2 are discussing the vision of an organization, they need to provide a clear picture of what the future of an organization will look like. In the case of Kenneth hospital, which is planning to adopt telehealth services, the management can develop various pictures of the future. For example, picture one can be to fully implement telehealth services within all the departments in Kenneth' health care facility. This picture will then be fully discussed at team meetings so as to create a brief summary that will be shared with all the stakeholders of the hospital. Given these facts, Kenneth hospital should develop a service-oriented vision statement because it will inspire their staff to work hard to make telehealth services a reality. Below is an example of a vision statement:
\\\"To serve patients through the implementation of a comprehensive, technologically evolving electronic medical record that will provide reliable, efficient, and affordable health care services by enthusiastic, helpful, and qualified personnel who will strive for better disease management to improve patient outcomes\\\" (Campbell, 2008)
Step 4: Communicate a Vision
Once the vision statement has been created, change leaders are required to formulate strategies that will be followed in order to achieve the vision. Therefore, a manager should embed the vision in everything they do within the new program, be it verbal communication or written communication. Furthermore, the manager should showcase the vision by walking the talk, demonstrating the vision, and being the change they would like to see.
An effective way for Kenneth's health care facility to communicate its vision is to develop an engaging story that will capture the imagination to staff members. This step is crucial because it helps maintain the sense of urgency that was developed in step 1 of Kotter's change model. For example, Kenneth's management can create a short video whereby a diabetes patient describes his experience in using telehealth services. This video will help provide a concrete example of how the implementation of telehealth services can be used to offer specialized care.
Step 5: Remove Obstacles
Emotional or physical obstacles might exist in the change process. Obstacles prevent team members from achieving specific tasks. It is necessary for the change teams to step in and help people overcome those obstacles. They must listen to people fears and concerns and seek feedback. Feedbacks helps the management understand what is not working well hence provide solutions (Campbell, 2018).
The telehealth system itself can also prevent change within Kenneth healthcare facility. If individuals who are using the system are not adequately rewarded, they will not be motivated to try the new system. To overcome system barriers, Kenneth management should ensure that they reward nurses and physicians who adopt telehealth services. They can provide incentives such as bonuses, promotions, and raises. In doing so, the management will send a strong message to staff members who resist the implementation of telehealth services.
Step 6: Create Short-term Wins
When implementing change, it is very important to demonstrate the benefits at the beginning. For example, do not take two years to create a program and only deliver benefits then. A manager needs to come up with different phases of a program. At the end of each phase, they are required to demonstrate tangible benefits because they are examples of short-term wins.
Under this step, the goal is to win people early on by demonstrating what is in for them if they embrace change. Kotter recommends that change champions need to \\\"achieve visible, meaningful, and unambiguous progress quickly' if they are to proceed to step 7 (Campbell, 2008). It step also helps sustain the sense of urgency and momentum among the team members.
Step 7: Build on the Change
A manager needs to repeat steps 1 to 6 for a while for it to be embedded within the organization. It means that the management should keep communicating the vision, removing obstacles, and keep completing tasks. Change can only be realized if Kenneth's health care facility management maintains their consistency when implementing telehealth services.
Step 8: Anchor the Change.
This is the last step in Kotter's change management model. A manager must ensure that the change sticks. It means that it should be embedded into the organization procedures, operational models, and to people's day-to-day work (Lennox, Maher, & Reed, 2018)
Conclusion
Kotter change model is not a step-by-step approach to successfully implementing a new safety or quality program in a health care organization. It is an iterative model in that one step can be used to accomplish another step. For example, step 6 can be used to achieve the first step. That is a series of complete tasks which provides short-terms wins can be used to create a sense of urgency.
This model can also be categorized into three distinct phases. Phase one comprises of steps 1, 2, and 3, and it is popularly referred to as \\\"creating a climate for change\\\" phase (Campbell, 2008). Under this phase, Kenneth management has to provide a compelling case on telehealth services should be implemented. Phase two comprises of steps 4, 5, and 6, and it is known as \\\"engaging and enabling the whole organization\\\" phase (Campbell, 2008). The design of the quality program is presented in phase. It includes the vision statement of Kenneth health care facility as well as strategies to be used to achieve the vision. The last phase is \\\"implementing and sustaining the change\\\" and comprises of steps 7 and 8. In this phase, the expected outcomes of the telehealth program are outlined, which include improved specialist care.
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