Reducing UTIs in Hospice: Foley Catheter Change Strategy

Introduction

The comedian Billy Crystal once quipped that "Change — it's such hard work!" Nowhere is this remark more valid than in managing change in the healthcare setting. Effective change requires expert planning, and this paper discusses the strategy of change, its organizational effects, and the impact of restricting Foley catheter use to medically necessary situations in the hospice setting. This change will contribute to a lower frequency of urinary tract infections (UTIs). The most appropriate theory of change for this purpose is Lewin's (1951) Force Field Model. This strategy centers on the problem identified, the key personnel involved, proposals for change, analysis of what might actually occur, and the evaluation tools available.

Through a thorough understanding of the strategy of change, healthcare providers can more effectively address problems in their work and deliver superior care to their patients. One such problem is the unnecessarily high rate of urinary tract infections in hospice care. Urinary tract infections can be understood as infections of the ascending urinary tract, beginning at the urethra and progressing to the bladder and kidneys. In the hospice setting, rates are significantly higher when dealing with immobilized patients, a rate further compounded by the frequent use of Foley catheters. The Foley catheter is often inserted without medical necessity because it makes caring for an incapacitated patient considerably easier for the attending nurse. In addition, catheters are used in situations where they are not absolutely medically necessary, such as simple fluid monitoring.

This prevailing culture of Foley catheter use is dangerous, as it predisposes patients to UTIs, which in turn leads to greater antibiotic use and the development of resistance. This resistance endangers not only the individual patient's life but also the lives of other residents in the facility who may become colonized with resistant bacteria. Developing new management protocols for the use of Foley catheters is therefore critical, and it provides an excellent avenue for examining change management in the healthcare setting.

Lewin's Force Field Model and the Case for Change

The most appropriate and practical theory of change for a large-scale adjustment of this kind is Lewin's theory. This theory operates on three key stages: Unfreeze, Move, and Refreeze (Lewin, 1951). In the unfreezing stage, individual staff members must be selected to implement the change. It may be beneficial to schedule an orientation program on the new protocols in order to improve the quality of work performance and achieve better patient outcomes. This will upgrade the hospice's level of care as well as uphold the professional reputation of its nurses.

Furthermore, as Gardner noted in Marquis and Huston (2006), retaining the same personnel during periods of change is one way of preserving organizational continuity. It is important to introduce changes to how new staff members are oriented, enabling them to work confidently and efficiently to meet the desired expectations. Lewin's model provides a clear and structured path for achieving this kind of sustainable organizational transformation.

Driving and Restraining Forces in Foley Catheter Reform

In the process of implementing this change, two categories of forces must be considered: driving forces and restraining forces. Marquis and Huston (2006) defined driving forces as those that propel the system toward change, while restraining forces divert the system away from it. They further emphasized that the balance between these forces must shift — either by increasing the driving forces or decreasing the restraining forces — for change to occur.

The driving forces in this context include improving the hospice's reputation, achieving better patient outcomes, and the potential for professional recognition or promotion. The restraining forces include an attitude of conformity to existing norms, which can lead to outright refusal to adopt change, as well as an unwillingness to take risks and a fear of the unknown (Marquis & Huston, 2006).

After accounting for both sets of forces, the next task — as proposed by Marquis and Huston (2006) — is to create an imbalance within the system. Driving forces can be maximized and restraining forces minimized by appointing a chairperson from nursing management who has the authority to support and advocate for the change. The best candidate for this role is the nursing manager of the hospice. As Marquis and Huston (2006) noted, one factor that prevents planned change from being realized is a lack of power among those leading it. Additionally, driving forces can be strengthened while restraining forces are suppressed by allowing sufficient time for the change to take hold. Because this change involves shifting staff attitudes, adequate time is necessary to allow all involved to fully embrace the new approach.

Conclusion

Change is necessary and at times critical in any organization for successful leadership and management. In order to excel and keep pace with today's challenging environment, an organization can only be sustained through ongoing change; without it, the organization will stagnate and fail to provide safe and effective healthcare. However, change alone does not guarantee an effective result without skillful leadership and management by the change agent. For a successful planned change to occur, the manager of change must thoroughly understand the planning process and its standards, and must be able to apply both to real working situations.