Change Strategy and Implementation

  • Analyze a professional environment and relevant data, and develop a change strategy (3-5 pages) and discuss how to implement it successfully.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, it is recommended that you complete the assessments in this course in the order in which they are presented.

Knowing the best practice for our patients is very important in providing safe and effective care. Understanding best practices can help nurses identify areas of care that need to be improved. To identify areas of need, nurses must use evidence from various sources, such as the literature, clinical practice guidelines (CPG), professional organization practice alerts or position papers, and protocols. These sources of evidence can also be used to set goals for improvement and best practices with an eye toward improving the care experience or outcomes for patients.

The challenge facing many care environments and health care practitioners is how to plan for change and implement changes. For if we cannot effectively implement changes in practice or procedure, then our goals of improving care will likely amount to nothing. This assessment focuses on allowing you to practice locating, assessing, analyzing, and implementing change strategies in order to improve patient outcomes related to one or more clinical goals.

This assessment will take the form of a data table to identify areas for improvement and to set one or more outcome goals, as well as a narrative describing a change plan that would help you to achieve the goals you have set.

Professional Context

One area in health care that it is necessary to consider is the environment in which nurses work. It is important that this environment evolves and changes so that all patients are adequately supported. For this assessment, you will develop a change strategy to improve the health care environment. These changes can be rooted in a desire to improve clinical outcomes and data related to assessment accuracy, drug administration, or disease recovery rates. A key skill for master’s-level nurses is to be able to evaluate clinical data and create a change plan to help drive improvements in the data to reach set goals.

Scenario

Consider a current environment. This could be your current care setting, the care setting presented in the scenario Vila Health: Using Concept Maps for Diagnosis, or a care setting in which you are interested in working. For the setting that you choose you will need to have a data set that depicts sub-optimal outcomes related to a clinical issue. This data could be from existing sources in the course, a relevant data set that already exists (a data set from the case study you used as a basis for your previous Concept Map assessment or from your current place of practice), or an appropriate data set that you have created yourself. (Note: if you choose to create your own data set, check with your instructor first for approval and guidance.)

After you have selected an appropriate data set, use your understanding of the data to create at least one realistic goal (though you may create more) that will be driven by a change strategy appropriate for the environment and goal.

Potential topics for this assessment could be:

    • Consider ways to help minimize the rate of secondary infections related to the condition, disease, or disorder that you focused on for your previous Concept Map assessment. As a starting point, you could ask yourself, “What could be changed to facilitate safety and minimize risks of infection?”
    • Consider how to help a patient experiencing traumatic stress or anxiety over hospitalization. As a starting point, you could ask yourself, “How could the care environment be changed to enhance coping?”

Once you determine the change you would like to make, consider the following:

    • What data will you use to justify the change?
    • How can the team achieve this change with a reasonable cost?
    • What are the effects on the workplace?
    • What other implementation considerations do you need to consider to ensure that the change strategy is successful?
    • How does your change strategy address all aspects of the Quadruple Aim, especially the well-being of health care professionals?
    • Once the change strategy is implemented, how would you evaluate the efficiency and effectiveness of the care system if the desired outcomes are met?

Instructions

Your assessment submission should include a data table that illustrates the current and desired states of the clinical issue you are attempting to improve through your application of change strategies. Additionally, you will need to explain the rationale for your decisions around your chosen change strategies, as well as how the change strategies will be successfully implemented. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your change strategy addresses all of them. You may also want to read the Change Strategy and Implementation scoring guide and Guiding Questions: Change Strategy and Implementation [DOCX] to better understand how each grading criterion will be assessed.

    • Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.
    • Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.
    • Justify the specific change strategies used to achieve desired outcomes.
    • Explain how change strategies will lead to quality improvement with regard to safety and equitable care.
    • Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.
    • Communicate the change plan in a way that makes the data and rationale easily understood and compelling.
    • Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

Example assessment: You may use the assessment example, Assessment 2 Example [PDF], to give you an idea of what a Proficient or higher rating on the scoring guide would look like.

Submission Requirements

    • Length of submission: 3–5 double-spaced, typed pages, not including the title and reference pages. Your plan should be succinct yet substantive.
    • Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that supports your goal setting, proposed change strategies, quality improvement, and interprofessional considerations. Resources should be no more than five years old.
    • APA formatting: The APA Template Tutorial [DOCX] can help you in writing and formatting your analysis. No abstract is required.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

    • Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes.
      • Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.
    • Competency 2: Develop change strategies for improving the care environment.
      • Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.
      • Justify the specific change strategies used to achieve desired outcomes.
    • Competency 3: Apply quality improvement methods to practice that promote safe, equitable quality of care.
      • Explain how change strategies will lead to quality improvement with regard to safety and equitable care.
    • Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired health care improvement outcomes.
      • Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.
    • Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
      • Convey purpose of the assessment narrative in an appropriate tone and style, incorporating supporting evidence, and adhering to organizational, professional, and scholarly communication standards.

Answer

Change Strategy and Implementation

Healthcare providers strive to utilize best practices to care for all patients, thus maximizing patient and organizational outcomes. The healthcare field is diverse, and new practice guidelines and best practices are developed occasionally. Therefore, nurses and other healthcare providers must be alert and ready to implement change in their practice settings as a need for change arises. Setting goals for improvement and best practice implementation is also essential in improving patient care outcomes and experience across all departments and units in a practice setting. Identifying a change and implementation strategy helps ease change adoption, plan to address resistance to change, and remain focused on achieving the expected outcomes. This essay presents change strategies and implementation aimed at improving outcomes in diabetes care in an institution. The proposed strategies, their justification, contribution to quality improvement concerning safety and equitable care, and the interprofessional considerations to ensure successful implementation will be discussed.

The reason for focusing on diabetes care is its impact on affected populations and individuals and its contribution to organizational performance. Inefficient diabetes care may drag organizational outcomes and performance down due to related hospitalization issues for diabetes complications, hospital readmissions, and increased operational costs. Additionally, diabetes significantly impacts the mental health of affected individuals due to its relationship to depression and diabetes-related stress. Therefore, diabetes care is a vital issue of consideration.

Diabetes and Depression

Research shows that depression is two to three times higher among people with diabetes (Chireh et al., 2019). The major reason behind the high prevalence is that diabetes is extremely overwhelming and exhausting since the individual has to keep up with a lifestyle that supports proper diabetes management and care. Many diabetic patients have episodes of feeling low and struggle with their mental well-being. Additionally, the Centers for Disease Control and Prevention (n.d.) note that despite the high prevalence and relationship between diabetes and depression, only 25% -50% of diabetic patients with depression get diagnosed and treated. The others mainly have adverse effects that impact not only the diabetes outcomes but also the overall quality of life. More so, depressed individuals are more likely to develop type 2 diabetes (CDC, n.d.). Diabetes and depression can be treated together, and diabetic patients with any depression symptoms should be assessed, diagnosed, and treated to enhance better care outcomes and improve their quality of life.

Diabetes-Related Stress

Even though stress does not cause diabetes, research evidence shows a link between stress and the risk for type 2 diabetes. High-stress hormone levels may affect the insulin-producing cells, limiting the insulin produced or stopping them from producing insulin completely. Additionally, Guerrero Fernández de Alba et al. (2020) note that diabetic patients are more likely to develop stress from managing the condition and coping with the demanding lifestyle, especially if they feel there are deficiencies in management, and end up blaming themselves for poor outcomes such as complications (Muktar & Muktar, 2020). These patients require support from support groups, care providers, and family. Therapy should be recommended for diabetic patients experiencing diabetes-related stress.

Data Table

Current Outcomes

Change Strategies

Expected Outcomes

Diabetes patients do not readily access mental health care services.

  1. Only 25%- 50% of diabetic patients who suffer from depression are diagnosed and treated.
  2. Patients with diabetes are more likely to suffer stress and depressive symptoms correlated with worsening diabetes outcomes and quality of life.
To ensure diabetic patients get mental health care services and achieve the desired health outcomes, several strategies will be implemented.

  1. Diabetic patients will be encouraged to join anonymous support groups.
  2. Nurses will be trained to offer care that includes mental health wellness to diabetic patients and encourage behavioral management.
  3. Patients will be provided with mental health care services to encourage diagnosis and treatment of depression and diabetes-related distress.
Diabetic patients will have access to the needed mental health care services and be able to avoid the adverse impact of depression and stress on diabetes management and outcomes

  1. Patients will understand the relationship between diabetes and mental health (Guerrero Fernández de Alba et al., 2020)
  2. Diabetes Patients experiencing stress or depression symptoms will seek mental health help
  3. Patients will appreciate the role of support groups and caregiver/family support in preventing diabetes-related mental health issues (Muktar & Muktar, 2020).

Change Strategies Proposed to Help Achieve the Desired Clinical Outcomes

Various change strategies can be used to lead to the improvement of clinical outcomes in diabetes care. Offering holistic diabetes care requires the incorporation of efforts from the entire interprofessional team, thus ensuring that all aspects related to diabetes are addressed. Therefore, one of the major change strategies proposed to improve diabetes care outcomes is enhancing interprofessional collaboration among the interprofessional team involved. According to Szafran et al. (2019), the diabetes care interdisciplinary team entails nurses, physicians, nutritionists, endocrinologists, dieticians, social workers, and community health workers.

The other proposed strategy is encouraging and training nurses to monitor behavioral management and include care that entails mental health aspects, such as offering mental wellness support to patients. Diabetes clinical outcomes like preventing diabetes complications, hospitalizations, and hospital readmission highly depend on the patient’s self-management practices and behavior. Thus, nurses need to encourage behavioral management among diabetic patients, hence preparing them to adhere to diabetes management best practices and guidelines. Additionally, deficiencies in diabetes self-management are known to lead to diabetes-related distress and depression (Guerrero Fernández de Alba et al., 2020). Therefore, change can be achieved by training nurses to include mental health wellness care for diabetic patients.

However, potential challenges may be encountered while implementing these strategies. These challenges include role conflicts between the interprofessional team members, slow action-taking following shared decision-making, and the inability of nurses to include mental health care aspects in diabetes care. These challenges will be overcome by enhancing interdisciplinary collaboration through open and free communication, sharing and communicating roles based on specialty areas, and ensuring nurses have the relevant training to include mental wellness in diabetes care.

Change Strategies Justification

The desired outcomes include having diabetic patients with depression diagnosed and treated and patients demonstrating an understanding of the relationship between diabetes and mental health. As mentioned earlier, the strategies that will improve these outcomes are interprofessional collaboration and the inclusion of mental support in diabetes care. According to Guerrero Fernández de Alba et al. (2020), diabetic patients are more likely to seek mental wellness support and care when they understand the relationship between mental health and diabetes and its impact on the overall outcomes and quality of life. Therefore, the change strategy of including mental wellness and support in diabetes nursing care will help achieve the desired outcomes. Some patients may be reluctant to seek support from family members and caregivers. However, Muktar and Muktar (2019) note that diabetic patients who receive adequate support from care providers, caregivers, and family members have better clinical outcomes. Other perspectives on improving diabetes clinical outcomes include Diabetes Self-Management Education and Support (DSME) and diabetes prevention and management programs offered by care institutions.

Proposed Change Strategies and Their Contribution to Quality Improvement with Regards to Safety and Equitable Care

One of the major reasons why healthcare institutions implement change is to ensure quality improvement with patient safety and equitable care. The proposed change strategies aim to promote patient safety and equitable care for diabetes patients. A study by O’Neill et al. (2019) showed that diabetes safety issues such as infections lead to increased diabetes-related costs, which are high and may not be afforded by most diabetic patients, especially the ones from poor socioeconomic backgrounds. Therefore, diabetes-related quality improvement initiatives should focus on the equitability and safety of care. The proposed change strategies will help prevent diabetes-mental illness comorbidities, thus reducing costs and enhancing care equitability. Additionally, the strategies will promote appropriate diabetes self-management behavior, thus improving patient safety.

Interprofessional Considerations

Implementing change strategies requires all the professionals involved in diabetes care to work together. The interprofessional considerations that will enhance the successful implementation of the change strategies include effective communication, shared decision-making, role clarity and communication, and openness in the interactions between the team. These considerations will help each team member know what is expected of them and the team goals, thus maximizing their contribution.

Conclusion

Diabetes care is one issue that significantly impacts organizational performance and outcomes. Among the clinical outcomes for diabetes patients is reduced risk for complications, achieved through proper diabetes management and preventing the impact of mental illness comorbidities. The proposed strategies to improve this outcome include providing mental health and wellness support, care services, and behavioral management. The discussion above has included the justification and interprofessional considerations to enhance successful implementation.

 

References

Centers for Disease Control and Prevention (n.d.). Diabetes and Mental Health. Accessed 21st April 2023 from https://www.cdc.gov/diabetes/managing/mental-health.html

Chireh, B., Li, M., & D’Arcy, C. (2019). Diabetes increases the risk of depression: A systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies. Preventive Medicine Reports14, 100822. https://doi.org/10.1016/j.pmedr.2019.100822

Guerrero Fernández de Alba, I., Gimeno-Miguel, A., Poblador-Plou, B., Gimeno-Feliu, L. A., Ioakeim-Skoufa, I., Rojo-Martínez, G., Forjaz, M. J., & Prados-Torres, A. (2020). Association between mental health comorbidity and health outcomes in type 2 diabetes mellitus patients. Scientific Reports10(1), 19583. https://doi.org/10.1038/s41598-020-76546-9

Mukhtar, S., & Mukhtar, S. (2020). Letter to the Editor: Mental Health and Psychological Distress in People with Diabetes during COVID-19. Metabolism: Clinical And Experimental108, 154248. https://doi.org/10.1016/j.metabol.2020.154248

O’Neill, K. N., McHugh, S. M., & Kearney, P. M. (2019). Cycle of Care for People with Diabetes: an equitable initiative? HRB Open Research2(3), 3. https://doi.org/10.12688/hrbopenres.12890.1

Szafran, O., Kennett, S. L., Bell, N. R., & Torti, J. M. I. (2019). Interprofessional collaboration in diabetes care: perceptions of family physicians practicing in or not in a primary health care team. BMC Family Practice20(1), 44. https://doi.org/10.1186/s12875-019-0932-9

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