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 You will collaborate with two of your classmates to share ideas and offer feedback and suggestions to one another in an informal setting. This collaboration within your group will assist you in further developing your Change Proposal to be submitted for feedback from your instructor next week. 

Peers submission attached below.. please provide feedback and suggestions individually!!

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Peer 1:

Victoria Lyons posted 
IV. Implementation Plan

Assess the factors that are likely to affect the implementation of your recommended activities
Many stroke patients require rehabilitation after their hospitalization and many patients get readmitted from post-acute care facilities, educating these facilities could decrease the readmission rate however rehabilitation facilities are often short-staffed and may not have money for education amongst the staff
 

Identify evidence-based rationales to propose how you will address them, incorporating your identified change theory. Your plan should encompass the following with evidence to support your rationale:
Technological challenges
Stroke patients require adequate follow-up care with their health provider team, tele-health is a great way to provide these follow-up appointments however stroke patients may not be able to navigate computers to be able to do these appointments as they frequently have deficits.

Stroke health care providers would have to learn how to use tele-health and there may be push back to using it due to health care providers typically using hands on assessment skills, they may not find assessing patients this way adequate. Finding a group of health care providers that are willing to start treating patients this way is the first step.

 

Institutional structures
Changes in hospitals do not happen overnight. At my state run hospital it seems to take forever to get any changes made. Implementing education regarding how to reduce stroke readmissions would require research and then approval from many different committees to even be approved for implementation. Once approved then it has to be sent all to all hospital staff involved. Examples of committees that a hospital will have and that any changes would have to go through are finance, safety and quality, strategic planning, and audit and compliance committee (Price, 2018).

Strategies for building buy-in-among different stakeholders, including nursing
Doctors, nurse practitioners, physician assistants, physical therapists, social workers, and case managers will need to be on board with the change process. Historically nurses have a hard time with change.

Financial trends and anticipation of the availability of human resource and project funding
Implementing tele-health and training to decrease stroke readmission, mostly education and new ways to check that everything a patient needs, will cost money which the institution will have to be prepared to put into their budget. Institutions get penalized financially for readmissions so increasing efforts to decrease these would be a financial benefit (Kripalani, Theobald, Anctil, & Vasilevskis, 2015).

Hospital or governmental policy constraints
It may be tricky for patients that have strokes that are on Medicaid or Medicare and    working around their insurance policies. Within hospitals it takes time to get a policy

set into place.

Regulatory requirements
Some regulatory acts that would have to be taken into consideration would be The Health Information Technology for Economic and Clinical Health Act (HITECH) (Maryville University, 2020) and the Medicare Access and CHIP Reauthorization Act of 2015 (Maryville University, 2020). The MARCA works with a payment model for quality of care, reducing readmissions would help with reimbursements (Maryville University, 2020).

Patient diversity
Educating patients on ways to decrease their admission will have many different considerations. Reading levels, language spoken, family support, use of technology, what disability they have after their stroke. Understanding why groups of people tend to get readmitted over others is an important way to decrease admissions. Individuals less than 80 years of age had a less chance of being readmitted over individuals over 80, this was related to statin use (Poston, 2018).

 

References
Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E. (2015). Reducing Hospital Readmission: Current Strategies and Future Directions. Annu Rev Med, 1-18.

Maryville University. (2020). 5 Important Regulations In United States Healthcare. Retrieved from Maryville University: https://online.maryville.edu/blog/5-important-regulations-in-united-states-healthcare/

Poston, K. (2018). Reducing readmissions in stroke patients. American Nurse Today, 9-15.

Price, N. (2018, August 24). Board Structure of a Healthcare Institution. Retrieved from Board Effect: https://www.boardeffect.com/blog/board-structure-healthcare-institution/

Peer 2:

Zachary Erickson posted 
Victoria and Lisa, 

   My apologies for late submission this week. I know it doesn’t leave you much time for feedback and I will try to be more prompt in the future. 

   My implementation plan is coming together but I look forward to your thoughts on what to add and what to clarify. Let me know what you think.

-Zak

Change Proposal: Work-Related Bullying

Implementation Plan Utilizing Lippitt’s Phases of Change, (Mitchell, 2013)

Raising Awareness of The Need for Change

Create buy-in for the change process by appealing to direct and indirect victims of WRB. Build enthusiasm by drawing attention to commonalities and shared experiences.
Multimedia approach incorporating;
Visual printed media to spark collaboration and create a dialogue
Initial email surveys to gain baseline data and identify areas of greatest need
Opening anonymous reporting channels to increase communication and involvement
Overcome technological hurdles is essential during this phase. Identifying and utilizing existing resources within the organization starts by reaching out to internal research, quality management, and information technology departments to secure support and time commitments for the development of infrastructure changes that facilitate reporting and data collection. This ties into the next phase of change.
Building a Relationship with The System

Presentation of a completed Change Proposal to nursing leadership and members of administration.
Clearly stating the evidence-supported physical, psychological, and financial costs to patients, staff members, and the organization at large
Accurately estimating the time and resource commitment necessary for program development and ongoing success
Building buy-in on an administrative level
Reaching out to unit managers to identify their perception of WRB and its prevalence on their individual work environments
Involvement of employee health/occupational medicine staff as partners in the reduction of workplace stressors through larger behavioral changes.
Further promotion of the WRB reduction initiative among staff members and identification of staff champions passionate about these changes.
Defining the Problem

What does WRB look like?
Where is WRB occurring in this work environment?
What is the direct impact to staff members?
How does WRB impact our patients?
What are the long-term ramifications of allowing WRB to go unaddressed?
Are there policies in place that address WRB? If so, do they need to be modified?
Setting Goals and Action Planning

Time sensitive goals create milestones and improve evaluation of program success. Program phases will be rolled out quarterly, with the relationship building and collaborative planning happening in the first quarter after program approval, followed by the initial campaign to raise awareness in the second quarter, and full program implementation on select units slotted for six months after approval. Evaluation of successful change will occur quarterly thereafter to measure program effectiveness, make changes, and incorporate new work areas.
Action planning should be interdisciplinary and tailored to the needs of individual work environments. Buy-in and early adoption of the program is essential to the success of this phase.
Implementation

The operational model will be relationship-based and involve several components
Psychodynamic education based on cognitive behavioral models
Cognitive rehearsal training, i.e. role-play, universal anti-bullying phrases, resilience training
Policy enforcement training: building awareness and support for new or changed policies
Coaching: using the established reporting system to identify WRB trends and address areas of highest incidence                                                               (Balevre, Balevre & Chesire, 2018)
Weekly program updates with core program supporters and monthly meetings with staff champions will identify areas of success and areas in need of reevaluation.
Stabilization/Acceptance

Change program success depends on acceptance and sustainability
This means consistent administrative support through the enforcement of zero-tolerance policies that directly address WRB events in a timely and supportive fashion.
Ongoing evaluation of staff awareness and involvement in initiative. Monthly review of staff feedback and yearly retraining as part of core safety measures.
Maintaining program flexibility and changing delivery of training and monitoring strategies to best suit each work environment.
Redefine the Role of the Change Agent

Once the change process is initiated, the change agent works to keep others on track with program support and involvement.
Coordinate the feedback review efforts and continue to recruit interested staff members to act as program champions.
Liaise with administration members and continue to “bridge the gap” between program results and the impact on staff and patients.
Share program successes both within the organization and with the community.
 

References

Balevre, S., Balevre, P., & Chesire, D. (2018). Nursing professional development anti-bullying project. Journal for Nurses in Professional Development, 34(5), 277-282. doi: 10.1097/nnd.0000000000000470

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37. doi: 10.7748/nm2013.04.20.1.32.e1013

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