Theory of Change and the Effective Use of Management Science, Essay Example

Identified Quality Improvement

There is a need to improve communication between employees at health care organizations in order to help improve patient care. It is important for nurses to have a better understanding of the needs of the patient at the end of each shift. As a consequence of building communication between workers, nurses will be notified of important information regarding a patient more quickly and therefore be able to address problems that pertain to their care. In addition, communication between nurses in different shifts is primarily verbal in nature. However, communication will become effective if it is documented. It is likely that requests that occur as a result of communication between nurses will be performed a larger percentage of the time due to the instant nature of the message in addition to the      fact that the message has been recorded for reference. In addition, accountability of nurses will increase due to enhanced record keeping. Therefore, it is important to enhance the communication of nurses to facilitate an improvement of the quality of care that patients receive.

Relevant Members of the Health Care Team

All nurses, independently of experience or education level, would benefit from participating in a program that aims to increase communication between members of the department. Since different nurses work with the same patients, all members within an individual unit should be involved in this communication enhancement program. Although this quality improvement initiative was conducted using nurses, it would be beneficial for future studies to incorporate analysis of communication improvement methodology focusing on additional members of the medical staff. The results of this pilot study will influence this decision within the department.

Review of Minutes and Discussions of the Health Care Team

The health care team agrees that implementing smartphone technology in the department will improve upon the current level of patient care that is provided. Since paper record and electronic health records are not designed to allow for complete communication between employees, members of the team agree that texting will allow for supplementary communication and these messages may effectively serve as reminders for the specific next steps that nurses need to take to help their patients. Members of the meeting agreed that this practice would be made more widespread if the pilot study is successful.

Data Collection Tools and Current Data

Current institutional data reveals that there are a moderate number of medical errors being made. It is possible that these mistakes could be avoided by enhancing communication between members of the medical team. Electronic health records are effectively utilized to keep track of a patient’s record, but they do not always allow for the provision of adequate instruction to the next employee. Furthermore, studies have shown that nurses tend to not formally report medication errors, but may be willing to communicate errors to other members of their staff. Enabling a less formal form of communication between nurses will enhance their ability to send messages that pertain to the health of particular patients in a manner that will allow them to deliver care effectively and efficiently.

Measurable Outcomes and Quality Indicators

Measurable outcomes will include a qualitative assessment of the fluidity of care that patients receive when their nurses change shifts. In addition, they will be asked to assess their quality of care. Nurses will be asked to reflect upon the quality of care they believe their patients are receiving as a consequence of this intervention as well.

Implemented Plan to Meet the Outcomes

Surveys will be issued to the patient to ask them to assess the quality of care that they are receiving at baseline, prior to the smart phone messaging implementation, and following the smart phone messaging implementation. Nurses will be issued surveys as well to determine their assessment of the messaging intervention.

Evaluation of Plan Implementation and Outcomes

Out of the 10 patients surveyed, 6 reported that they believed their care improved compared to their reports at baseline, 3 believed that care had stayed the same, and 1 reported that care decreased. 9 out of 10 nurses reported that they believed the system contributed to their ability to contribute to effective patient care. The remaining nurse believed that the need to check text messages from co-workers interfered with her ability to positively contribute to quality care. Overall, it was shown that the perception of quality improvement generally increased as a consequence of the smart phone messaging system in terms of both patient and nurse opinions.

Quality Improvement Process and the Nursing Process

The quality improvement process is related to the nursing process because it is important to carefully consider goals, create plans of action to address aims, and then to determine whether the decided intervention is appropriate or if another plan needs to be created. In the quality improvement process, these steps refer to nursing actions in terms of general practice, while the nursing process is used to address the needs of a particular patient or patients. To improve both the quality improvement process and the nursing process, it is reasonable to incorporate the opinions of not just nurses, but patients as well (Mitchell & Koch, 2007). When implementing the nursing process, nurses are required to follow set procedures to identify clues to reveal the symptoms the patient is experiencing in addition to the potential causes of these symptoms. Through the examination, patient feedback is a beneficial part of the process because it allows symptoms and disease states to be identified more readily. Patient involvement is also important to the quality improvement process for this purpose. Patients can help nurses and other health care professionals more readily understand the flaws that exist in their practices in addition to the practices of the institution, which could then be incorporated as the basis of quality improvement initiatives to help patients more effectively.

Discussion of Change Theory

Lewin’s theory of change is applicable to this quality improvement initiative because for continued implementation of this practice to be successful, many nurses will need to relearn how they communicate with others (Zand et al., 1975). Even though one nurse reported that she was frustrated with the need to look at text messages for the purposes of communication, it would be beneficial for her to “unfreeze” her current understanding of communication practices to be able to implement this new practice more readily. Therefore, in the future, it would be reasonable to spend more time with participating nurses to implement Lewin’s theory of change during a training seminar prior to implementing the smartphone messaging intervention. This may contribute to a greater perception of quality improvement among both the patients and the nurses.

References

Mitchell, P., Koch, T. (2007). An attempt to give nursing home residents a voice in the quality improvement process: the challenge of frailty. Journal of Clinical Nursing, 6(6): 453–461.

Zand, D.E., Sorensen, R.E. (1975). Theory of Change and the Effective Use of Management Science. Administrative Science Quarterly, 20(4): 532-545.