Leadership Change Analysis Paper

Project Description

The project under review entailed developing new fasting guidelines that promote patient health for adult rehabilitation patients undergoing elective procedures requiring anesthesia. The need to introduce new fasting guidelines was influenced by the hospital’s current status quo, which is to order NPO at midnight regardless of the type of scheduled surgery/procedure time, type of anesthesia to be used, or current medical status. This practice exposes the patients to risks of malnutrition and discomfort before their elective procedures. Lengthy NPOs expose the patients to risks such as longer healing times because of malnutrition complications, and nutritional deficiencies for patients with existing malnutrition seeking surgical procedures.Leadership Change Analysis Paper

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Given these complications, there is a need to change hospital policy and clinician practice, where clinicians shorten the time NPO time depending on patient healthcare needs and existing health conditions. According to Xu, Zhu, Xu, & Zhang, (2017) shorter NPOs are important for patients because they reduce the probability and incidence of nausea and stress in the patient, which is caused by hunger and lack of proper nutrients in the body. Additionally, a pre-surgical period may be an anxious time for the patient; therefore, NPOs issued at midnight are likely to exacerbate patient stress and induce unpleasant feelings such as nausea as mentioned.  Therefore, the project entailed determining how healthcare providers could decrease fasting times and minimize the effects of prolonged fasting such as the pain and extended healing time.  As such, the team sought to develop a tool that tracks patient stress, vomiting, nausea, pain, and patient satisfaction, to measure the effectiveness of the new NPOs.Leadership Change Analysis Paper

Change Theory

Implementing change requires tact and skill, and the application of a theory proven to work numerous times. For this project, the main change required was the nurses and the rest of the clinicians to understand the importance of shorter NPOs for the surgical patients. Therefore, the best change theory to apply for this project was the empirical-rational model. This strategy refers to the idea that institutional change is possible to achieve when the concerned parties receive sufficient and convincing factual evidence (Huber, 2014). This change theory posits that changes are possible when people become motivated by reason. Reason should be sufficient to change an attitude towards a concept or an idea.

In this case, it was important to present the clinicians with facts about lengthy NPOs and their effects, as well as produce evidence-based information on the benefits of shorter NPOs for surgical patients. Therefore, an important consideration for this project was to conduct a literature review of empirical research conducted by other scholars, to compile the body of evidence required to appeal to the clinicians’ reason. For instance, we used the information found on the article by Xu, Zhu, Xu, & Zhang, (2017). This article is an investigation of the complications that arise in patients undergoing laparoscopic cholecystectomy, a surgical procedure. These patients were exposed to shortened NPOs, and the researchers explored the impact of these shortened periods. The researchers established that shorter NPOs are important for patients because they reduce the probability and incidence of nausea and stress in the patient, which is caused by hunger and lack of proper nutrients in the body.

Another body of evidence used to convince the clinicians of the importance of this change within the healthcare facility is the evidence in the research article by Mohan, Chakravarthy, George, Devanhalli, & Kumar (2018), who conducted a research study to explore the knowledge of nurses about pre-operative fasting in hospital. The researchers sent out 5,000 surveys to nurses, which revealed that 98% of the nurses were aware of the available fasting guidelines in the hospital, but about 80% had inaccurate knowledge about patients consuming clear fluids should not be consumed 6 hours prior to the surgical procedure. Only 6% of the nurses knew that pre-surgical patients should consume clear fluids 2 hours before an operation. This study indicates that nurses may understand fasting guidelines, but have limited information on the best practices with the best results that promote patient health outcomes.Leadership Change Analysis Paper

By presenting such knowledge and evidence to the nurses, applying the empirical-rational model would be more effective. Additionally this change theory is highly effective when there is least resistance from the target. In this case, since all nurses and clinicians are expected to prefer positive patient health outcomes, there was little expected resistance.

Facilitating Change

            One of the most effective strategies to facilitate this change was to expose the clinicians to the body of factual knowledge, obtained from a vast body of research. Empirical evidence was critical in facilitating this change considering the change model used for the intended change in the hospital. The meetings with the clinicians consisted of presentations made for the purposes of convincing the clinicians on the impact of the lengthy NPOs for the surgical patients.

The next step in facilitating the change was to establish new guidelines on the NPOs for the patients receiving adult rehabilitation care. Depending on the elective surgical procedure, the new guidelines included shortening the NPOs to 2 hours before the elective procedure, where the patients could take clear fluids up to two hours to the scheduled surgery. The goal is to ensure that patients meet their nutritional needs, shorten their healing time, and enhance their patient satisfaction levels. The new guidelines were implemented immediately, where the clinicians received directions on vetting the NPO length for patients depending on their status. Helping the clinicians understand the importance of this change was highly effective given the change theory used. Appealing to human reason is critical when implementing changes at personal, institutional, or societal level. Therefore, the most important strategy in implementing the changes was the use of facts to appeal to the clinicians’ reason, which ultimately inspired them to implement the changes without any form of resistance.

Another change implemented was the introduction of tools to measure the patient satisfaction levels after the shortened NPOs. Additionally, the clinicians were supposed to record the changes in healing length times, and overall patient health outcomes after implementing the shorter NPO guidelines for patients. Recording this information was critical for the change process, because it would add to the evidence presented from other studies. Compounding evidence with new information from the practical work clinicians do in the hospital setting was necessary to effect the change and make it permanent. Shorter NPOs enhance patient health outcomes. Gathering this information upon implementing the new changes was an effective implementation strategy because it provided proof that shorter NPOs are ideal for patients seeking elective surgeries. Leadership Change Analysis Paper

Barriers in Implementing Change

The first barrier was to develop a technological tool that would track important signs such as patient stress, vomiting, nausea, pain, and patient satisfaction. The idea was to design a platform where the nurses and other clinicians would obtain this information from the patients, and use it for analysis later, using a technological approach. Sourcing for a reliable and affordable application developer was challenging for the healthcare facility. Most of the application developers approached were pricey and would take longer periods to deliver the application. The least available deadline was in 6 months, which was not ideal for the change required. The change team aimed at implementing the changes as soon as the application was available, which was a month. Sourcing for an application that would deliver the application in such a short time was expensive. However, since positive health outcomes are a priority for the organization, the management invested in the application.

Another challenge the organization grappled with when implementing changes was that the nurses and physicians would forget about the new fasting policies and guidelines, and issue the NPOs at midnight, with some lasting for 8 hours. Implementing changes is challenging because people take time to accustom to new guidelines. People tend to forget new instructions because they are used to doing things and procedures in a specific manner. Therefore, it takes time for them to remember to implement new policies. To address this challenge, the management, including the lead nurses, conducted frequent meetings with the clinicians to remind them of the new expectations. A poster was placed in the nursing stations, doctors’ offices, and wards, to remind them of shorter NPOs. Constant reminders are effective in change processes because they remind the individual of the new expectations, until it becomes the norm. Leadership Change Analysis Paper

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            Lastly, the hospital encountered the challenge of uncooperative nurses and physicians who dismissed the new fasting guidelines. While the resistance to change was minimal, there were pockets of nurses and doctors who felt that these new changes endangered the patients’ health because of the risks associated with short NPOs. The two major risks of short NPOs include regurgitation and aspirating gastric content, according to Abebe et al., (2016). Given these risks, the nurses resisting the changes would still follow the older guidelines, hence, limiting the organization’s ability to track the effects of the new changes. Additionally, failure to follow the new fasting guidelines exposed the patients to additional risks such as longer healing times and patient discomfort (Njoroge, Kivuti-Bitok & Kimani, 2017). Longer NPOs are unnecessary, and to mitigate this challenge, the management suspended the clinicians who breached the new guidelines. The condition under which the clinicians would be allowed back to work was to follow the new guidelines under management supervision, to ensure that the change process was successful. Sometimes, negative reinforcement is important when implementing changes that have significant consequences when ignored (Gorman, 2018). Therefore, to avoid termination, the clinicians complied with the new fasting guidelines.

Empirical Rational Model as a Change Theory 

            This model of change requires that the persons supposed to implement a change use reason to make the changes. To appeal to reason, one should use facts (Kearney-Nunnery, 2019). The change process in the organization began with the issuing of facts during a presentation to the clinicians and other staff members in the healthcare facility. This model is critical because it reduces any form of resistance, especially when facts are presented to the target audience (Garret, 2018). The use of evidence in this change process included the presentation on the facts based from evidence-based research articles, and the new information derived from the tool used to track patient satisfaction levels, patient stress, vomiting, nausea, and pain. The shortened NPOs should yield positive results such as shortened healing time, reduced incidence of regurgitation and aspirating stomach contents, as well as enhanced patient satisfaction levels. These results should serve as important facts and evidence to the practitioners, to motivate them to continue implementing the changes.Leadership Change Analysis Paper

Project Impact

            The most noteworthy impact on the project made was enhanced patient health outcomes. One of the main challenges that the hospital encountered before the change was patients who were unable to meet their nutritional needs, and were exposed to long NPOs. The situation was that, on admission, 13% of patients were malnourished, and of these patients, 17% experienced a nutritional decline and did not meet their nutritional needs. Therefore, the longer NPOs for the surgical patients worsened their health outcomes and increased risk of regurgitation and aspirating stomach contents, which is life-threatening (Gray, Ferris, White, Duncan & Baulme, 2018).

The project entailed instituting new fasting guidelines that recommended shorter NPO periods for the patients, and introduction of a tracking tool to evaluate the impact of shorter NPOs on patient satisfaction, nutritional needs, and other side effects after surgery such as nausea and vomiting. The new guidelines that require shorter NPOs impacted the project by revealing a reduced incidence of regurgitation and aspiration during surgery, hence a lower patient mortality rate, enhanced patient satisfaction levels, and manageable side effects. Therefore, the reduction of NPO period had positive effects on the project, which enhances the publicity of the healthcare facility.

References

Abebe, W. A., Rukewe, A., Bekele, N. A., Stoffel, M., Dichabeng, M. N., & Shifa, J. Z. (2016). Preoperative fasting times in elective surgical patients at a referral Hospital in Botswana. The Pan African medical journal, 23, 102. https://doi.org/10.11604/pamj.2016.23.102.8863

Garrett, B. (2018). Empirical nursing: The Art of Evidence-Based Care. Emerald Group Publishing,.

Gorman, L. (2018). Neeb’s fundamentals of mental health nursing. F A DAVIS.

Gray, S., Ferris, L., White, L., Duncan, G., & Baulme, W. (2018). Foundations of nursing. Cengage.

Huber, D. (2014). Leadership and Nursing Care Management. Saint Louis: Elsevier Health Sciences.Leadership Change Analysis Paper

Kearney-Nunnery, R. (2019). Advancing your career. Sage.

Mohan S., Chakravarthy M., George A., Devanahalli A., Kumar J.(2018). Knowledge of Nurses About Preoperative Fasting in a Corporate Hospital. The Journal of Continuing Education in Nursing, 49(3), 127-131. https://doi.org/10.3928/00220124-20180219-07

Njoroge, G., Kivuti-Bitok, L., & Kimani, S. (2017). Preoperative Fasting among Adult Patients for Elective Surgery in a Kenyan Referral Hospital. International Scholarly Research Notices, 2017, 1-8. doi: 10.1155/2017/2159606

Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration*. Anesthesiology 2017, 126(3), 376-393. https://doi.org/ 10.1097/ALN.0000000000001452

Xu, D., Zhu, X., Xu, Y., & Zhang, L. (2017). Shortened preoperative fasting of complications associated with laparoscopic cholecystectomy: A meta-analysis. Journal of Internal Medical Research, 45(1), 22-37. https://doi.org/10.1177/0300060516676411

Leadership Change Analysis Paper