The Freederm Project: eliminating decubitus in Veterans Hospital patients

Business Plan I

The Freederm Project is a training and best practices development project that is designed to eliminate the occurrence of decubitus in patients in the Veterans Hospital in [insert location]. Increased privatization of healthcare services has resulted in a more competitive market, and for more contract with external suppliers. The project is well placed to establish a business relationship with the Veterans Hospital and to extend the project after a successful pilot year. The scope of the project is for a three months pilot that introduces the training and implementation of the new practice at the hospital. Follow-up will be provided for nine months after the completion of the three-month training and observation phase of the project. Certified Nursing Assistants will be trained to implement the evidence-based best practices in their workplace, using the SODOTO training methodology. Project performance will be measured in terms of the number of staff trained, the incidence rate of new decubitus, and the recovery rate of decubitus extant at the beginning of the pilot project.

Purpose

The Freederm Project is designed to eliminate the problem of decubitus (bedsores) from hospitalized patients. The project pilot will be launched at the Veterans' Association Hospital in [insert location]. Decubitus is a preventable condition that is associated with lengthy confinement to bed of people who are not able to manage changes in position on their own, such as mobility-compromised patients or spinal-cord injury patients. The project will provide training to Certified Nursing Assistants on updated best practices to prevent and treat bedsores. Certified Nursing Assistants are the hospital staff who are most likely to be available for -- and assigned to -- the task of assisting patients to change their positions in a manner and on a schedule sufficient to prevent the development of decubitus.

Market and Competition Analysis

The project is needed to change the culture of care in the participating Veterans Association hospital. The changes required of staff are not innovative, but are instead recommended evidence-based best practices. In any medical facility, changing practice and procedures can take a longer implementation time than is acceptable. By working with the project manager, the hospital establishes official endorsement of the recommended practices, and can put the full weight of the hospital administration and quality groups behind the training and implementation of the new practices. As Rogers has demonstrated, the strength and speed by which a change (or innovation) proceeds through an organization and is embedded in practice is related to the approval and escalation that officials in the organization provide (Rogers, 1995).

Table 1. SWOT Analysis

INTERNAL

EXTERNAL

POSITIVE

Strengths

-- the practices are derived from evidence-based best practices

-Hospital administrative staff want the training to take place

-Reductions in the incidence of decubitus in the hospital may result in higher scores (or even awards) in published hospital status reports

Opportunities

-Reductions in decubitus will bring long-term savings in the costs of care

-Hospitals are increasing seeking smaller non-profits and for profits for external suppliers (see Red Cross loss of market share to smaller companies)

NEGATIVE

Weaknesses

-Staff resistance to change

-Funding for new projects may not be available

-Administration may view the project as a bid for more staff

-Project could compete with current or ongoing programs

Threats

-Some competitors, such as the Red Cross, already include a unit on decubitus in their CNA curriculum

_Reductions in the incidence of decubitus in the hospital will raise the hospital to a more competitive level, which will gain the attention of competitors

-Performance may not clearly indicate the effect of the training on the prevalence and incidence rates of decubitus

Effective management of decubitus and eliminating all new instances of the preventable condition will result in substantial savings in the cost of care and valuable contributions to improved quality of life for patients. Over a million people in the United States are affected by pressure ulcers each year, with substantive impact on the general health and morbidity rates in people who are mobility-compromised and/or hospitalized ("Healthcare Inspection," 2006). Overall costs of treating people with pressure ulcers in hospitals exceeds $3.6 billion each year, with all associated costs reaching well over $55 billion ("Healthcare Inspection," 2006).

Project Management

The PRINCE method of project management will be followed in order to establish the greatest opportunity of success for the pilot. The acronym stands for: Projects IN Controlled Environments (Marshall & Huges, 2008). The project management approach delineates four critical phases: 1) Starting up a project; 2) initiating a project; 3) directing a project; and, 4) closing a project (Marshall & Huges, 2008). Project performance will be measured in terms of the number of staff trained, the incidence rate of new decubitus, and the recovery rate of decubitus extant at the beginning of the pilot project (Schaffner, 2009).

Key Personnel

The project manager will be a Registered Nurse who has experience training other nurses and supervising Certified Nursing Assistants in routine patient care. Beyond the project manager, no new staff will be required for the training project. The system used to train the project participants will ensure that the project receives support and is sustainable. The training plan follows the See One | Do One | Teach One or SODOTO method (DeGraff, 2013). In this process, See One (Emerge) is a data gathering (research and observation), and sense making (analysis) stage (DeGraff, 2013). The training will include an earlier phase in which the research will reveal evidence-based best practices that are a good fit for the situations that are encountered in the Veteran's Hospital.

Trainees will also follow a curriculum that provides information about the etiology, prevalence, and incidence of the decubitus condition. Do One (Converge) is the stage when ideas converge with actions, and direct feedback from individual and collective experience and supervision alerts the practitioners to what is working and what is not working (DeGraff, 2013). Teach One (Diverge) is the stage during which the practitioners' knowledge and experiences allow the expansion of the conception of the practice and the formulation of new ideas and ways of doing things that can codified and taught (DeGraff, 2013; Sare & Ogilvie, 2010).