Physician Resistance to Change, Capstone Project Example

Nursing: Capstone Project – Physician Resistance to ChangeEvidence-based solution to the identified problem/concern; anticipatedor actual outcomes to the implementation of the project

There is evidence supporting ways providers and facilities can improve patient satisfaction. The meaningful use of Electronic Health Records (EHR) offer supporting evidence to improve caregiver decisions and patient outcomes.  Blumenthal & Tavenner (2010) agrees   that these are areas that contribute to overall patient satisfaction as there is an overlap.  Once patients experience the benefits of this technology, they will demand nothing less from their providers. Hundreds of thousands of physicians have already seen these benefits in their clinical practice(Blumenthal & Tavenner, 2010)

One major Urban Facility experimented with measuring patient satisfaction with pain management in their ER using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control), the evidence confirmed that this methodology can be used successfully when measuring patient satisfaction with pain management. Subsequent evidence are reveals that facilities are looking at different data to determine if patient satisfaction is associated within this instance,  improved mortality rates and patient adherence(Glickman, Boulding, Manary, Staelin, Roe, Wolosin, & Schulman, 2010).

Glickman et.al (2010) advanced evidence to prove this correlation after conducting an analysis of patients with acute myocardial infarction. Patient satisfaction was positively correlated with performance measures. The authors further suggest that patients are good discriminators of the type of care they receive. Thus, patients’ satisfaction with their care provides important incremental information on the quality of care they receive(Glickman et.al, 2010).

The aim of this capstone project is to improve patient communication and collaboration during an elective inpatient admission. Longtin(2010) and colleagues state that having the right information and providing the information to the patient creates an environment where the patient is satisfied and the medical staff can make the best decisions necessary for the patient.  Inherently, the hospital is in a discomforting and unnatural environment for the patient and providing the key information they need, immediate status on their care and enabling reliable communication with their medical staff and family increases the overall quality of the visit and improves the hospital stay. This in turn is expected to improve the patient’s satisfaction (Longtin, Sax, Leape, Sheridan, Donaldson & Pittet, 2010).

Consequently, further evidence reveals that as an Informatics Nurse leveraging technology to bring together patients and their caregivers into collaboration some providers view this advanced use of technology as both celebration and apprehension. According to Boucher (2010) practitioners see the advantages of efficiency and accessibility, but often feel concerned by how each tool may overwhelm them as patients seek care or gain access to misinformation. As a result of some of these concerns, healthcare has been among the slowest to embrace advances in communication and information technology(Boucher, 2010).

Ultimately,there is over whelming evidence to prove that adequate information dissemination creates an environment where the patient is satisfied and the medical staff can improve quality of care. The hospitalusually promotes an uncomfortable environment culture for the patient. Therefore, in making available access to key information helps improve communication among staff and quality of care (Boucher, 2010).

Identification and inclusion of a change theory

Peplau change theory.

Peplau (1909-1999) emphasized nurses’ ability of understanding their personal behaviors in helpingidentify perceived difficulties in others. The interpersonal process and therapeutic relationships between and among nurses, staff and clients was the focus of her assumptions. Four phases of nurse-patient relationships were projected along with six primary/secondary roles the nurse must execute.  These roles and phases are depicted in the diagram below. This theory is considered useful in arriving at a resolution regarding physicians’’ resistance to change.

Comprehensive and measurable planUtilization of new modalities of scholarship (i.e. innovative teaching methods, simulation)

This comprehensive resolution plan will utilize new modalities of scholarship offered by patient care satisfaction experts. According to (Boucher 2010) health care practitioners acknowledge the efficiency and accessibility of electronic health records, but often feel concerned by how each tool may overwhelm them as patients seek care while clarifyingmisrepresentation of personal data. Due to these concerns, healthcare has been among the slowest to embrace advances in communication and information technology (Boucher, 2010).

Consequently, the plan entails measuring data outcomes utilizing tools such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) model. HCAHPS is a CMS-driven process that was initiated in 2006. This method seems to be the method of choice when hospitals are looking to measure data outcomes.  In a pilot study, the HCAHPS was used to measure physician communication and overall hospital care with the use of face cards.  Using this method was able to provide the data that was being measured. Gan (2013) described the HCAHPS survey tool as a well-designed survey instrument that direct patients to report their experiences rather than their general feelings. Another quality of the HCAHPS according to Simons (2013) was the timeliness the data is collected using this tool , survey questionnaire is collected no later than 42 days after the patient’s discharge. Waiting much longer to complete a patient survey can introduce considerable recall inaccuracies and bias(Gan, Habib, Miller, White & Apfelbaum, 2013) (Simons, Caprio, Furiasse, Kriss, Williams, & O’Leary, 2013).

Another survey tool for data analysis is the Consumer Assessment of Healthcare Providers and Systems (CAHPS). A program led by the Agency for Healthcare Research and Quality (AHRQ). Clancy (2012) states that in addition to asking  consumers and patients to report on their experiences with health care services. The CAHPS surveys reports quality information for accountability and consumer decision-making. The CAHPS program develops the survey instruments, and   has provided instructions for analyzing the data and constructing composite measures, as well as formats for reporting the data. Another important purpose of CAHPS is to serve as a tool for quality improvement (Clancy, 2012).

Utilization of thesenew modalities adapted by scholars in the science these data measurements tools are sure to give Providers and Facilitiesalike the available data to improve areas based on the analysis derived after application of the foregoing tools.

References

Blumenthal, D., Tavenner, M. (2010). The “meaningful use” regulation for electronic health record. New England Journal of Medicine, 363(6), 501-504

Boucher, J. (2010). Technology and patient-provider interactions: improving quality of care, but is it improving communication and collaboration? Diabetes Spectrum, 23(3), 142-144.

Clancy, C.,  Brach, C., & Abrams, M. (2012). Assessing patient’s experiences of providers’ cultural, competence, and health literacy practices: CAHPS® item sets. Medical Care, 50, S1-S2.

Glickman, S., Boulding, W., Manary, M., Staelin, R., Roe, M., Wolosin, R., & Schulman, K. (2010). Patient satisfaction and its relationship with clinical quality and inpatient mortality, in acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 3(2), 188-195.

Gan, T., Habib, A., Miller, T., White, W., & Apfelbaum, J. (2013). Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. CurrentMedical Research & Opinion, 30(1), 149-160.

Longtin, Y., Sax, H., Leape, L., Sheridan, S., Donaldson, L., & Pittet, D. (2010). Patient participation: current knowledge and applicability to patient safety. In Mayo Clinic proceedings 85(1), 53-62,  Elsevier.

Peterson, S. (2009). Interpersonal Relations. Middle range theories: Applications to nursing research. Philadelphia, PA: Lippincott Williams & Wilkins

Simons, Y., Caprio, T., Furiasse, N., Kriss, M., Williams, M.,  & O’Leary, K.  (2013). The impact of facecards on patients’ knowledge, satisfaction, trust, and agreement with hospital physicians: A pilot study. Journal of Hospital Medicine.