The Institutional Assessment For Change In A Policy/Procedure
Description of Institution
Thomas Hospital has services for every healthcare need on the Eastern Shore and surrounding communities in Baldwin County. With consistently high patient satisfaction rates and an award winning cardiac program, the hospital offers outstanding medical service and compassionate care. Thomas Hospital has 129 suites and is an acute care hospital. An affiliate of Infirmary Health, the average employees amount to more than 1,100 people and they have more than 200 physicians. Thomas Hospital offers a full range of services including a state of the art birth center, radiology, endoscopy, inpatient and outpatient surgery facilities and a cardiac program that places it as a Thomson Reuters "Top 100 Cardiovascular Hospital" four consecutive years. Thomas Hospital offers non invasive diagnostics including nuclear tests, stress tests and EKGs. Coronary interventions, such as stents and balloon angioplasty, are administered in the hospital’s heart catheterization labs. Dedicated open heart surgery rooms are available for bypass, heart valve replacement and coronary artery grafts. The hospital delivers the highest quality healthcare for the communities and neighbors in Baldwin County.
Description of Unit
The unit description described will be the cardiac catheterization lab but this will not be the only unit that will foresee this project implemented. This proposed project will be introduced to radiology, endoscopy, inpatient and outpatient surgery department by the departmental administration. The Thomas Hospital institution currently has no policy/procedure for the routine testing of an urinalysis for patients coming from other hospitals, nursing homes and into the hospital for routine procedures. This is not a standard procedure test for the south,
unless something is going wrong with the patient. This standard urinalysis test needs to be in place because of all the government mandates as well as the fact that the insurance companies are not reimbursing the hospitals. The fact is that the hospital is not getting reimbursed when they are at fault. If a patient enters with a urinary tract infection during a routine visit, the hospital is held responsible for the cost. There are ways of helping the hospital recoup their cost by starting off with a small urinalysis screening performed on every patient that is admitted to the hospital. This would eliminate unjust costs to the hospital.
Assessment
An assessment will examine the population that the project intends to target in order to see whether the need as conceptualized in this project actually exists in the population and whether it is a problem, and if so, what is the best way for the problem to be dealt with. This assessment is about the hospital needing to implement a screening of an urinalysis test for all patients that are admitted. Oftentimes, one is aware of the news about new laboratory tests being developed to detect or manage conditions or diseases that effect our lives as well as someone else. Why is the hospital not using urinalysis screening routinely? As with other products and services, new laboratory tests are meant to satisfy a need, to help us and our healthcare providers screen for, diagnose, or monitor conditions faster, easier, and with more confidence (Block, 2012). How does a particular test that shows promise in the research stages actually get to the point where it is available for use at the doctor's offices, clinics or hospitals? How is ones healthcare needs met with the advancement of new tests and how is ones health protected from new tests that might misinform or mislead their doctor? The urinalysis test discussed in thispaper has been around since the beginning of healthcare screenings and will hopefully help the facility understand the importance of this procedure.
Assessment Theories
The Stetler Model will be the structure used for this proposed project and the research conducted will create a vehicle for changing policies and procedures. Individual nurses, such as practitioners, educators and policymakers, summarize research and use the knowledge to influence educational programs, make practice decisions and impact political decision making. In the next section one can see how the Stetler Model combines with the proposed project to make a solid working project (Stetler, 2001).
In the first phase of the proposed project comparing and contrasting the pros and cons, the urinalysis screening is one of most economical methods available to test people for urinary tract infection. Urine testing is an affordable and suitable method for urinary tract infection within the organizations and is easy to implement. Some of the advantages of urinalysis testing includes being less expensive, easy to perform and provides reliable results. The specimen collection process is debatable and is one of the major disadvantages of urine culture testing. Another disadvantage could be that the patient thinks they will be held responsible for the cost of this procedure. The second phase of the proposed project is using a dipstick. The advantages of using dipsticks would be for convenience, easy to interpret and cost-effective. An analysis can be obtained within minutes of collecting the patient's urine when they come into the doctor's office or the emergency room. However, the information gathered from a dipstick can be limited by its design. The information may not be very accurate as the test is time-sensitive and this can be considered a disadvantage. Obtaining a urinalysis test on each individual that is admitted tothe hospital is the third phase of the proposed project. This is the most important phase of the institutional assessment and could be very beneficial to the hospital. However, who will pay for this standard procedure? The hospital should absorb this cost because it will benefit them in the long run. The cost of diagnosing one urinary tract infection ahead of time could save the hospital money versus having to absorb major dollars incurred after the fact. To make matters worse, reimbursements from the insurance companies could also be forfeited.
Assessment
The Stetler Model theory was developed as a prescriptive approach designed to facilitate the safe and effective use of research findings. The organization may choose not to be involved in the individual's utilization of the project. Utilization may be instrumental, conceptual and/or symbolic (Stetler, 2001). Types of evidence and or non-research related information are likely to be combined with research findings that facilitate decision making. If one does not present enough evidence on a project, this could be the deal breaker. Internal and external factors can influence an individual or a group's view on the evidence used. This would be an example of a resistor that could make the project fail, which is not good. In reviewing the internal and external factors, cost can play a major role in the proposed project being continued. Research and evaluation provides us with probabilistic information, not absolutes. Lack of knowledge and skills pertaining to research utilization and evidence-based practice can inhibit appropriate and effective use. This project is one that will hopefully move forward in the near future. One can understand that there is cost associated with a urinalysis test but the initial cost is minute and there are more benefits to performing the test than not. In the end, the hospitals are having to absorb cost associated with urinary tract infections that have already been occurring in the patient before they were admitted to hospital.
Importance of the urinalysis test.
At this time within the healthcare institute, it is important to prove that the patient is free of any kind of bacterial infection upon arriving at the hospital. This procedure is currently not being performed. The only procedure that is in place at the present time is a urinalysis that is being taken only from a transfer patient who comes from another hospital with a foley catheter or from a nursing home. This particular policy needs to be addressed. If the hospital has to assume responsibility for their actions and be held accountable for infections, then the hospital personnel should start screening everyone that comes through the doors of the hospital (Adukauskiene, 2006). Becoming familiar with how the urinalysis tests are navigated through the development, validation and approval stages, along with being placed into practice, may help one understand the answers to these questions. It possibly could take years for a new test to pass through the many phases, research, testing, clinical evaluation, development of manufacturing processes and be reviewed by regulatory authorities before the test would be available for use, but we are looking at an old test (Cronin, 2008). It is an intensive process with no assurance that the test, once developed and validated, will actually be adopted by the healthcare providers. This is why the first step is usually determining whether the proposed test will be beneficial for the patients and their doctors. Urinalysis is a very important test and this is why the urine is inspected for blood, particles or pus. It is then inspected for microscopic ingredients like proteins, white blood cells, sodium, bilirubin and glucose. It is then analyzed for osmolality or how diluted it is. The specimen can contain certain hormones that are only excreted during a pregnancy, when tumors or other serious conditions are present, so analyzing the urine during a diagnostic workup becomes valuable. All of these results are part of the bigger picture of your overall health (Shajari, 2009). The results of a urinalysis can inform the physician as to whether the kidneys are working to filter correctly. A urinalysis can also confirm if there is an infection in the kidneys or the bladder, whether the patient is hydrated, dehydrated or has sustained an injury to the bladder or the kidney. A urinalysis can indicate a possible concern for diabetes, kidney disease, kidney stones, abdominal trauma and muscle breakdown from too much exercise or trauma. A urinalysis can also advise the physician whether an illness is benign, adequately hydrated and the virus will pass (Cronin, 2008). It is hard to imagine that all this information can be obtained from less than a tablespoon of urine. Understanding the importance of this data will make obtaining the specimen all the more important and will help the individual understand the importance of the procedure.
National interest.
There is an interest at the national level. Much can be learned from this proposed project. Research shows that scientists are working on developing a vaccine that can prevent urinary tract infections from reoccurring. Researchers are testing injection and oral vaccines to see which one works the best. Another method being considered for women is to apply the vaccine directly as a suppository in the vagina. Other scientists are working on identifying ways to prevent urinary tract infections using probiotics. The urinalysis should be a standard set of screening tests that can provide a general overview of the patient's health. Doctor's could correlate the urinalysis results with the patients symptoms and clinical findings and search for the causes of abnormal findings with other targeted tests, such as a comprehensive metabolic panel, complete blood count or urine culture to look for a urinary tract infection (Latini-Keller, 2009).
Institution interest in urinalysis.
This institution does not mandate having a urinalysis performed when a patient is admitted to the hospital but what benefits could be derived with one being performed? Being able to get the staff on board will require more work than the actual implementation process. There will always be staff members that do not like change, but this is the path moving forward and this will require change! The nursing staff did not like electronic computer charting when the hospital moved in this direction either, but they work with it every day and change is no longer an issue. The negative effect of this change occurs when the computer malfunctions or has to have upgrades installed, which can occur daily in the working world. If the patient contracts a urinary tract infection while in the hospital, the insurance companies do not reimburse the charges for the visit. These particulars are holding the hospital accountable for their actions.
Summary of Analysis
It would be in huge factor for the hospital if they were able to implement the upcoming changes within the facility. By implementing the urinalysis screening process the hospital will be reimbursed for a patient being admitted that already has a urinary tract infection. Now the hospital has evidence that the patient already had the infection prior to being admitted. Can one imagine a patient arriving at the hospital for an emergency open heart surgery and having a foley catheter put in and then getting a urinary tract infection while being in the hospital? Is this the hospitals fault? Should they have to absorb the cost of a hundred thousand dollar surgery? The chances are great that the patient could have had the urinary tract infection before being admitted to the hospital.
Implementation
The first thing needing to be implemented within the facility would be to educate the staff members on the symptoms of a urinary tract infection. Examples of the symptoms consist of abdominal pain, back pain, and frequent or painful urination. Prevention can include a pregnancy check-up, hospital admissions or a pre-surgical work-up. A routine urinalysis usually consists of the visual and chemical examinations. These two phases may be completed in the laboratory or the doctor’s office. A microscopic examination is then performed if there is an abnormal finding on the visual or chemical examination; this is also a learning curve (Tworek, 2008). The second concern would be the need to discuss the importance of the urinalysis culture test that detects and identifies bacteria and yeast in the urine. Urine is generally sterile, but sometimes bacteria or more rarely, yeast can move from the skin outside the urethra and migrate back up into urinary tract causing a urinary tract infection. With a urine culture, a small sample of urine is placed on one or more agar plates and incubated at body temperature (Steggall, 2007). Any microorganisms that are present in the urine sample grow over the next twenty four to forty eight hours as small circular colonies. The size, shape and the color of these colonies help identify which bacteria is present and the number of colonies indicates the quantity of bacteria originally present in the urine sample (Wilson, 2005). The third important concern is for the hospital to not get entrapped for something that the facility or nursing staff had nothing to do with. The proposed project has not had any major problems. The only foreseen problem would be the staff obtaining the specimen from the patient since this proposed plan has not been approved by the hospital administration. This will be addressed in due time, because the higher this proposed project is elevated within the hospital the better the chance the hospital will not have to absorb costs associated with blame. This is a huge step for the hospital because the better the patient outcomes within the hospital, the better the reimbursements are for the hospital.
Change Theories
The management theory of change model discussed will be the Lewin proposed theory which entails three different theories of change commonly referred to as the unfreeze, change and the freeze phase. The unfreezing stage is probably one of the more important stages within our society of change that one lives in today. This stage consist of getting ready for change. It involves moving to a point of understanding that change is necessary and moving away from our current comfort zone. Transition is the inner movement phase or journey that consist of one's reaction to the change within the facility. The second stage known as the change phase, occurs as one makes the change that is needed. The third stage is the freezing phase, which consist of establishing stability once the change has been made. Once change is accepted it becomes the new normally environment. New relationships between people form and they become comfortable with their new environment. This can take time and one must have patience.
Implications in Initiating Change
The implication of this change within the facility chosen could utilize all the phases within the Lewin theory. The more one feels change is necessary, the more urgent it is and the more motivated one becomes to developing the change, such as the urinalysis test in the Thomas hospital facility. The changing phase is simply that. Why should one remain doing something wrong when they can make it right. It is also useful to keep communication open between each other with a clear mind of the desired change so it could benefit people not to lose sight of where they are headed. Knowing the direction one is heading could help the proposed project to become implemented.
Stakeholders involved.
The stakeholders involved are the departmental administration which includes the Cardiovascular Manager, Catheterization Lab Manager and other middle departmental administrations which include the Patient Safety Officer and the Research Coordinator. Everyone that has been involved with this proposed project has been instrumental and are in agreement to the change. "Team urinalysis" has assembled the hard evidence to make this particular project move from conception to realization so the hospital administration can successfully implement the project in the future. The urinalysis test is a significant issue and the screening is important because there must be a way to determine how the hospital can recover their losses. The society will become healthier when everyone makes a difference. It could be as simple as a urinalysis screening that helps with the long term effects. The least it can accomplish for the hospital is for them to get reimbursed for the charges incurred by the patient while they are in the hospital.
Resistors.
Change is necessary and inevitable. The quality movement, continuous improvement, action learning organizations and the advancing of technology is going to happen now and in the future. Unfortunately, as change is inevitable, so is the tendency for workers to feel the change as a measure of inadequacy in their performance or an unnecessary whim of management. The resistant forces are employees or nurses who do not want the proposed change. For the change theory to be successful, the driving force must dominate the resistant force. The staff members within this particular facility are aware of the situation and are in agreement with the change because they realize the hospital will benefit the most. This reaction to change was not anticipated due to the tenure of the staff members have been working within this facility. When employees have been at a place of employment for a substantial period time, they are quick to place blame on management for the loss of comfortable roles and tasks, seniority, income and sometimes jobs, rather than take up the challenge of change. As agents of change, we are held responsible by our employers and the other major stakeholders within the healthcare organization to undertake these changes in as thoughtful and integrated way as possible. Managing any change in process is never easy and is a continual part of organizational life.
Drivers.
Transitions are journeys that each one needs to come to terms with. There are events or situations that occur that affect the way an organization operates, either positive or negative. The driving force behind the change are the change agents that push employees in the direction of change. Drivers of this project would be the staff members, departmental administrators and middle management departmental administrators mentioned above as stakeholders involved. The advocates for this project are the ones that work in the field and not behind a desk. This gives the workers a chance to speak in favor of a topic that is important for the facility. This particular project should be positive! There were no non-human resources used within this project.
Evaluation
Evaluation theory serve several purposes and perhaps the most important guide to the practice. Learning the latest advances whether it is some new statistical adjustment for selection bias or the most recent technique to facilitate stakeholder without knowing the relevant theory is a bit like learning what to do without knowing why or when. First, evaluation theories are a way of consolidating lessons learned within the proposed project. Second, comparing evaluation theories is a useful way of identifying and better understanding the key areas of debate within the proposed project. Third, reason for studying evaluation theory is that theory should be an important part of our identities as evaluators, both individually and collectively (Smith, 2012). The theory played out for this proposed project was received as a positive note from the middle departmental managers and in time upper management may possibly be on board. The educational, investment and interest for this project was adopted by the departmental administration, middle departmental administration, along with the nursing staff. The educational opportunity was a great experience. The proposed project worked well for the institutional change for policy even though no one could initially see the project being implemented. This was a negative for the project, but one can only hope that it will be implemented with time. Projects like this could save the hospital thousands of dollars in reimbursements.
Conclusion
In conclusion, the stakeholders were easy to work with and exerted a lot of positive thoughts and efforts into this particular project. The time frame for this project was not long enough to see if upper management buys in and implements the project. One of the changes of this project would be to educate the staff, get the employees on-board with diagnosing patients with urinary tract infection by performing a urinalysis on every patient. The proposed project would be to have every patient that enters the hospital for a routine procedure have a urinalysis test performed. This proposed project will be presented by the middle departmental administrators to the chief administration board for their approval at the next meeting scheduled. The only hope is that the board recognizes this project as a benefit to the hospital and successfully implements it in the near future.
Description of Institution
Thomas Hospital has services for every healthcare need on the Eastern Shore and surrounding communities in Baldwin County. With consistently high patient satisfaction rates and an award winning cardiac program, the hospital offers outstanding medical service and compassionate care. Thomas Hospital has 129 suites and is an acute care hospital. An affiliate of Infirmary Health, the average employees amount to more than 1,100 people and they have more than 200 physicians. Thomas Hospital offers a full range of services including a state of the art birth center, radiology, endoscopy, inpatient and outpatient surgery facilities and a cardiac program that places it as a Thomson Reuters "Top 100 Cardiovascular Hospital" four consecutive years. Thomas Hospital offers non invasive diagnostics including nuclear tests, stress tests and EKGs. Coronary interventions, such as stents and balloon angioplasty, are administered in the hospital’s heart catheterization labs. Dedicated open heart surgery rooms are available for bypass, heart valve replacement and coronary artery grafts. The hospital delivers the highest quality healthcare for the communities and neighbors in Baldwin County.
Description of Unit
The unit description described will be the cardiac catheterization lab but this will not be the only unit that will foresee this project implemented. This proposed project will be introduced to radiology, endoscopy, inpatient and outpatient surgery department by the departmental administration. The Thomas Hospital institution currently has no policy/procedure for the routine testing of an urinalysis for patients coming from other hospitals, nursing homes and into the hospital for routine procedures. This is not a standard procedure test for the south,
unless something is going wrong with the patient. This standard urinalysis test needs to be in place because of all the government mandates as well as the fact that the insurance companies are not reimbursing the hospitals. The fact is that the hospital is not getting reimbursed when they are at fault. If a patient enters with a urinary tract infection during a routine visit, the hospital is held responsible for the cost. There are ways of helping the hospital recoup their cost by starting off with a small urinalysis screening performed on every patient that is admitted to the hospital. This would eliminate unjust costs to the hospital.
Assessment
An assessment will examine the population that the project intends to target in order to see whether the need as conceptualized in this project actually exists in the population and whether it is a problem, and if so, what is the best way for the problem to be dealt with. This assessment is about the hospital needing to implement a screening of an urinalysis test for all patients that are admitted. Oftentimes, one is aware of the news about new laboratory tests being developed to detect or manage conditions or diseases that effect our lives as well as someone else. Why is the hospital not using urinalysis screening routinely? As with other products and services, new laboratory tests are meant to satisfy a need, to help us and our healthcare providers screen for, diagnose, or monitor conditions faster, easier, and with more confidence (Block, 2012). How does a particular test that shows promise in the research stages actually get to the point where it is available for use at the doctor's offices, clinics or hospitals? How is ones healthcare needs met with the advancement of new tests and how is ones health protected from new tests that might misinform or mislead their doctor? The urinalysis test discussed in thispaper has been around since the beginning of healthcare screenings and will hopefully help the facility understand the importance of this procedure.
Assessment Theories
The Stetler Model will be the structure used for this proposed project and the research conducted will create a vehicle for changing policies and procedures. Individual nurses, such as practitioners, educators and policymakers, summarize research and use the knowledge to influence educational programs, make practice decisions and impact political decision making. In the next section one can see how the Stetler Model combines with the proposed project to make a solid working project (Stetler, 2001).
In the first phase of the proposed project comparing and contrasting the pros and cons, the urinalysis screening is one of most economical methods available to test people for urinary tract infection. Urine testing is an affordable and suitable method for urinary tract infection within the organizations and is easy to implement. Some of the advantages of urinalysis testing includes being less expensive, easy to perform and provides reliable results. The specimen collection process is debatable and is one of the major disadvantages of urine culture testing. Another disadvantage could be that the patient thinks they will be held responsible for the cost of this procedure. The second phase of the proposed project is using a dipstick. The advantages of using dipsticks would be for convenience, easy to interpret and cost-effective. An analysis can be obtained within minutes of collecting the patient's urine when they come into the doctor's office or the emergency room. However, the information gathered from a dipstick can be limited by its design. The information may not be very accurate as the test is time-sensitive and this can be considered a disadvantage. Obtaining a urinalysis test on each individual that is admitted tothe hospital is the third phase of the proposed project. This is the most important phase of the institutional assessment and could be very beneficial to the hospital. However, who will pay for this standard procedure? The hospital should absorb this cost because it will benefit them in the long run. The cost of diagnosing one urinary tract infection ahead of time could save the hospital money versus having to absorb major dollars incurred after the fact. To make matters worse, reimbursements from the insurance companies could also be forfeited.
Assessment
The Stetler Model theory was developed as a prescriptive approach designed to facilitate the safe and effective use of research findings. The organization may choose not to be involved in the individual's utilization of the project. Utilization may be instrumental, conceptual and/or symbolic (Stetler, 2001). Types of evidence and or non-research related information are likely to be combined with research findings that facilitate decision making. If one does not present enough evidence on a project, this could be the deal breaker. Internal and external factors can influence an individual or a group's view on the evidence used. This would be an example of a resistor that could make the project fail, which is not good. In reviewing the internal and external factors, cost can play a major role in the proposed project being continued. Research and evaluation provides us with probabilistic information, not absolutes. Lack of knowledge and skills pertaining to research utilization and evidence-based practice can inhibit appropriate and effective use. This project is one that will hopefully move forward in the near future. One can understand that there is cost associated with a urinalysis test but the initial cost is minute and there are more benefits to performing the test than not. In the end, the hospitals are having to absorb cost associated with urinary tract infections that have already been occurring in the patient before they were admitted to hospital.
Importance of the urinalysis test.
At this time within the healthcare institute, it is important to prove that the patient is free of any kind of bacterial infection upon arriving at the hospital. This procedure is currently not being performed. The only procedure that is in place at the present time is a urinalysis that is being taken only from a transfer patient who comes from another hospital with a foley catheter or from a nursing home. This particular policy needs to be addressed. If the hospital has to assume responsibility for their actions and be held accountable for infections, then the hospital personnel should start screening everyone that comes through the doors of the hospital (Adukauskiene, 2006). Becoming familiar with how the urinalysis tests are navigated through the development, validation and approval stages, along with being placed into practice, may help one understand the answers to these questions. It possibly could take years for a new test to pass through the many phases, research, testing, clinical evaluation, development of manufacturing processes and be reviewed by regulatory authorities before the test would be available for use, but we are looking at an old test (Cronin, 2008). It is an intensive process with no assurance that the test, once developed and validated, will actually be adopted by the healthcare providers. This is why the first step is usually determining whether the proposed test will be beneficial for the patients and their doctors. Urinalysis is a very important test and this is why the urine is inspected for blood, particles or pus. It is then inspected for microscopic ingredients like proteins, white blood cells, sodium, bilirubin and glucose. It is then analyzed for osmolality or how diluted it is. The specimen can contain certain hormones that are only excreted during a pregnancy, when tumors or other serious conditions are present, so analyzing the urine during a diagnostic workup becomes valuable. All of these results are part of the bigger picture of your overall health (Shajari, 2009). The results of a urinalysis can inform the physician as to whether the kidneys are working to filter correctly. A urinalysis can also confirm if there is an infection in the kidneys or the bladder, whether the patient is hydrated, dehydrated or has sustained an injury to the bladder or the kidney. A urinalysis can indicate a possible concern for diabetes, kidney disease, kidney stones, abdominal trauma and muscle breakdown from too much exercise or trauma. A urinalysis can also advise the physician whether an illness is benign, adequately hydrated and the virus will pass (Cronin, 2008). It is hard to imagine that all this information can be obtained from less than a tablespoon of urine. Understanding the importance of this data will make obtaining the specimen all the more important and will help the individual understand the importance of the procedure.
National interest.
There is an interest at the national level. Much can be learned from this proposed project. Research shows that scientists are working on developing a vaccine that can prevent urinary tract infections from reoccurring. Researchers are testing injection and oral vaccines to see which one works the best. Another method being considered for women is to apply the vaccine directly as a suppository in the vagina. Other scientists are working on identifying ways to prevent urinary tract infections using probiotics. The urinalysis should be a standard set of screening tests that can provide a general overview of the patient's health. Doctor's could correlate the urinalysis results with the patients symptoms and clinical findings and search for the causes of abnormal findings with other targeted tests, such as a comprehensive metabolic panel, complete blood count or urine culture to look for a urinary tract infection (Latini-Keller, 2009).
Institution interest in urinalysis.
This institution does not mandate having a urinalysis performed when a patient is admitted to the hospital but what benefits could be derived with one being performed? Being able to get the staff on board will require more work than the actual implementation process. There will always be staff members that do not like change, but this is the path moving forward and this will require change! The nursing staff did not like electronic computer charting when the hospital moved in this direction either, but they work with it every day and change is no longer an issue. The negative effect of this change occurs when the computer malfunctions or has to have upgrades installed, which can occur daily in the working world. If the patient contracts a urinary tract infection while in the hospital, the insurance companies do not reimburse the charges for the visit. These particulars are holding the hospital accountable for their actions.
Summary of Analysis
It would be in huge factor for the hospital if they were able to implement the upcoming changes within the facility. By implementing the urinalysis screening process the hospital will be reimbursed for a patient being admitted that already has a urinary tract infection. Now the hospital has evidence that the patient already had the infection prior to being admitted. Can one imagine a patient arriving at the hospital for an emergency open heart surgery and having a foley catheter put in and then getting a urinary tract infection while being in the hospital? Is this the hospitals fault? Should they have to absorb the cost of a hundred thousand dollar surgery? The chances are great that the patient could have had the urinary tract infection before being admitted to the hospital.
Implementation
The first thing needing to be implemented within the facility would be to educate the staff members on the symptoms of a urinary tract infection. Examples of the symptoms consist of abdominal pain, back pain, and frequent or painful urination. Prevention can include a pregnancy check-up, hospital admissions or a pre-surgical work-up. A routine urinalysis usually consists of the visual and chemical examinations. These two phases may be completed in the laboratory or the doctor’s office. A microscopic examination is then performed if there is an abnormal finding on the visual or chemical examination; this is also a learning curve (Tworek, 2008). The second concern would be the need to discuss the importance of the urinalysis culture test that detects and identifies bacteria and yeast in the urine. Urine is generally sterile, but sometimes bacteria or more rarely, yeast can move from the skin outside the urethra and migrate back up into urinary tract causing a urinary tract infection. With a urine culture, a small sample of urine is placed on one or more agar plates and incubated at body temperature (Steggall, 2007). Any microorganisms that are present in the urine sample grow over the next twenty four to forty eight hours as small circular colonies. The size, shape and the color of these colonies help identify which bacteria is present and the number of colonies indicates the quantity of bacteria originally present in the urine sample (Wilson, 2005). The third important concern is for the hospital to not get entrapped for something that the facility or nursing staff had nothing to do with. The proposed project has not had any major problems. The only foreseen problem would be the staff obtaining the specimen from the patient since this proposed plan has not been approved by the hospital administration. This will be addressed in due time, because the higher this proposed project is elevated within the hospital the better the chance the hospital will not have to absorb costs associated with blame. This is a huge step for the hospital because the better the patient outcomes within the hospital, the better the reimbursements are for the hospital.
Change Theories
The management theory of change model discussed will be the Lewin proposed theory which entails three different theories of change commonly referred to as the unfreeze, change and the freeze phase. The unfreezing stage is probably one of the more important stages within our society of change that one lives in today. This stage consist of getting ready for change. It involves moving to a point of understanding that change is necessary and moving away from our current comfort zone. Transition is the inner movement phase or journey that consist of one's reaction to the change within the facility. The second stage known as the change phase, occurs as one makes the change that is needed. The third stage is the freezing phase, which consist of establishing stability once the change has been made. Once change is accepted it becomes the new normally environment. New relationships between people form and they become comfortable with their new environment. This can take time and one must have patience.
Implications in Initiating Change
The implication of this change within the facility chosen could utilize all the phases within the Lewin theory. The more one feels change is necessary, the more urgent it is and the more motivated one becomes to developing the change, such as the urinalysis test in the Thomas hospital facility. The changing phase is simply that. Why should one remain doing something wrong when they can make it right. It is also useful to keep communication open between each other with a clear mind of the desired change so it could benefit people not to lose sight of where they are headed. Knowing the direction one is heading could help the proposed project to become implemented.
Stakeholders involved.
The stakeholders involved are the departmental administration which includes the Cardiovascular Manager, Catheterization Lab Manager and other middle departmental administrations which include the Patient Safety Officer and the Research Coordinator. Everyone that has been involved with this proposed project has been instrumental and are in agreement to the change. "Team urinalysis" has assembled the hard evidence to make this particular project move from conception to realization so the hospital administration can successfully implement the project in the future. The urinalysis test is a significant issue and the screening is important because there must be a way to determine how the hospital can recover their losses. The society will become healthier when everyone makes a difference. It could be as simple as a urinalysis screening that helps with the long term effects. The least it can accomplish for the hospital is for them to get reimbursed for the charges incurred by the patient while they are in the hospital.
Resistors.
Change is necessary and inevitable. The quality movement, continuous improvement, action learning organizations and the advancing of technology is going to happen now and in the future. Unfortunately, as change is inevitable, so is the tendency for workers to feel the change as a measure of inadequacy in their performance or an unnecessary whim of management. The resistant forces are employees or nurses who do not want the proposed change. For the change theory to be successful, the driving force must dominate the resistant force. The staff members within this particular facility are aware of the situation and are in agreement with the change because they realize the hospital will benefit the most. This reaction to change was not anticipated due to the tenure of the staff members have been working within this facility. When employees have been at a place of employment for a substantial period time, they are quick to place blame on management for the loss of comfortable roles and tasks, seniority, income and sometimes jobs, rather than take up the challenge of change. As agents of change, we are held responsible by our employers and the other major stakeholders within the healthcare organization to undertake these changes in as thoughtful and integrated way as possible. Managing any change in process is never easy and is a continual part of organizational life.
Drivers.
Transitions are journeys that each one needs to come to terms with. There are events or situations that occur that affect the way an organization operates, either positive or negative. The driving force behind the change are the change agents that push employees in the direction of change. Drivers of this project would be the staff members, departmental administrators and middle management departmental administrators mentioned above as stakeholders involved. The advocates for this project are the ones that work in the field and not behind a desk. This gives the workers a chance to speak in favor of a topic that is important for the facility. This particular project should be positive! There were no non-human resources used within this project.
Evaluation
Evaluation theory serve several purposes and perhaps the most important guide to the practice. Learning the latest advances whether it is some new statistical adjustment for selection bias or the most recent technique to facilitate stakeholder without knowing the relevant theory is a bit like learning what to do without knowing why or when. First, evaluation theories are a way of consolidating lessons learned within the proposed project. Second, comparing evaluation theories is a useful way of identifying and better understanding the key areas of debate within the proposed project. Third, reason for studying evaluation theory is that theory should be an important part of our identities as evaluators, both individually and collectively (Smith, 2012). The theory played out for this proposed project was received as a positive note from the middle departmental managers and in time upper management may possibly be on board. The educational, investment and interest for this project was adopted by the departmental administration, middle departmental administration, along with the nursing staff. The educational opportunity was a great experience. The proposed project worked well for the institutional change for policy even though no one could initially see the project being implemented. This was a negative for the project, but one can only hope that it will be implemented with time. Projects like this could save the hospital thousands of dollars in reimbursements.
Conclusion
In conclusion, the stakeholders were easy to work with and exerted a lot of positive thoughts and efforts into this particular project. The time frame for this project was not long enough to see if upper management buys in and implements the project. One of the changes of this project would be to educate the staff, get the employees on-board with diagnosing patients with urinary tract infection by performing a urinalysis on every patient. The proposed project would be to have every patient that enters the hospital for a routine procedure have a urinalysis test performed. This proposed project will be presented by the middle departmental administrators to the chief administration board for their approval at the next meeting scheduled. The only hope is that the board recognizes this project as a benefit to the hospital and successfully implements it in the near future.
the_institutional_assessment_for_change_in_a_policy_powerpoint.pptx | |
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