Organizational leadership and management in Nursing

Organizational leadership and management in Nursing
Strong nursing leadership is required to solve problems and guide the transformation of healthcare systems today. The healthcare industry is evolving rapidly leading to changes in the way services are delivered including the incorporation of technology into routine patient care. Among the top priorities of leadership in healthcare are the improvement and the promotion of patient safety and quality care. Quality care refers to the provision of healthcare services according to the expectation of the patient while safety involves the prevention of errors and adverse effects associated with patient care. To address these issues, nurse leaders focus on enhancing the patient experience, reducing costs, improving the healthcare provider’s work life, and addressing population health concerns. This discussion identifies a healthcare problem that needs a practice change and highlights the role of nursing leadership in promoting quality and patient safety in the organization.

Clinical/Organizational Problem

The quality of communication interactions between nurses and patients has a huge impact on patient outcomes. Nurses are at the forefront of patient care and they are charged with communicating patient information to any healthcare providers available including the patient’s families. Poor communication among nurses is identified to be a challenge in my healthcare organization. There is a lack of clear channels of communication especially during shift handoffs leading to increased medication errors and poor patient satisfaction. To ensure quality improvement and the promotion of patient safety, a quality improvement program is needed to address the challenge of communication among nursing teams in the organization.

Description of the Problem

Failures of communication, especially those resulting from inadequate handoffs between nurses and other providers, are among the common causes of adverse events in healthcare. Shift report handover requires both technical and relational communication that can ensure information is accurately passed to other providers (Achrekar et al., 2016). Additionally, the handover process should incorporate aspects of questioning and the involvement of patients to promote understanding. The problem of communication among nurses in the organization can be attributed to several factors. The first cause of poor communication is the lack of organizational focus to communication barriers among healthcare teams. For example, recent quality improvement projects in the organization have focused on improving patient care with an emphasis on patient outcomes rather than addressing the root causes of the problems. Data obtained from the office of nursing education indicates that programs to promote communication among healthcare teams were last reviewed five years ago. Perhaps, changing the organization’s focus to addressing communication among healthcare workers can help solve the problem.

The importance of improving communication among healthcare team members is widely discussed by scholars. For instance, the primary reason for improving communication is to improve quality and patient safety in healthcare. The increasing competition in the healthcare sector requires healthcare organizations to be vigilant in matters of quality and safety. Poor communication hinders positive quality measures by increasing mortality rates, patient readmissions, and length of hospital stays (Dalky et al., 2020). Secondly, Improving communication in healthcare is identified as a step towards achieving patient-centered care. Patient-centered care involves the provision of care that is responsive to the individual preferences, needs, and values and ensuring that patient values guide all clinical decisions. The improvement of communication during handoffs will ensure that the patient needs are adequately addressed including an opportunity for patients to plan for their care. Lastly, addressing the issue of communication in the organization is likely to improve relationships between nurses and patients. Good relationships will ensure collaborative practice, teamwork, and reduce conflicts that could otherwise hinder quality patient care.

Explanation of Causes

There are paradoxes in communication during the exchange of shifts between nursing teams. The existence of this problem in the organization can be attributed to human and system factors. For example, some healthcare providers may portray poor communication skills leading to inaccuracy during shift handoffs. Other factors that are observed to contribute to the existence of the problem include poor documentation of written information in patient files and the lack of standardized communication media during shift exchange. Another reason for the existence of the problem in the facility is failure to document information in the electronic record system causing inaccurate delivery of information. Increasing evidence suggests that about 84.6% of the information shared during shift handoffs can be communicated using the EHR system (Achrekar et al., 2016). Availability of this information in the EHR will allow nurses to accurately reference information that can help during routine patient care.

The evolving healthcare environment and the increasing complexity of patient needs can contribute to communication challenges in healthcare. Lack of adequate time to present shift handover reports is among the identified contributing factors to the communication problem observed. Challenges are observed when nurses take care of large volumes of patients while accurately documenting patient information. The biggest challenge identified to cause communication breakdown among nurses is the lack of a well-designed process of handing over patient information. Instead of providing shift reports at the patient’s bedside, most providers prefer using shortcuts by sharing information at the nursing station. There is a need to use a standardized tool for communication together with training to ensure nurses communicate effectively.

Identification of Stakeholders

The implementation of change in healthcare organizations involves input from different stakeholders. These stakeholders include the administrators, patients, providers, policymakers, and payers who ensure that enough capital is available for process improvement. To address the issue of communication in the organization, the key stakeholders will include the registered nurses, hospital administration, and the information technology team.

Discussion of Stakeholders

Nurses

As the largest members of the healthcare team, nurses are crucial during the implementation of change in any healthcare organization. The nursing team will be directly involved in the implementation of change to improve communication in the facility. They will participate in education and training sessions to ensure understanding of the new communication tools to be implemented. The nurses have an interest in the project because it aims at improving patient safety and quality care. As advocates of the patients, nurses will be interested in improving communication to minimize medical errors and other adverse events related to poor communication. The nurses have the power to accept or decline the proposed changes leading to the improvement of communication in the facility. Regarding the aspect of influence, the acceptance of the proposed change by nurses will influence the adoption and support of the strategy by other healthcare members including the

Hospital administration

The hospital administration is responsible for making policies and designing processes to guide quality improvement in healthcare. These managers are in a position to mandate policy, systems, procedures, and organizational climates to promote quality and safety. To improve communication in the organization, the first step will involve seeking permission from the administrators. The hospital administration has the power to accept or decline the project. The hospital administration has influence in the project because their decision to support the new change will influence the acceptance and engagement of other stakeholders. Employees often look up to the administration for direction and guidance in matters of quality improvement. The hospital administration has an interest in the new change because it will improve quality and patient safety. The administration is interested in having employees who work collaboratively to improve patient care and achieve high-level patient satisfaction.

Information Technology Team

Health information technology presents numerous opportunities for improving and transforming healthcare today. The incorporation of technology into healthcare has led to positive outcomes like the reduction of medication errors and the facilitation of coordinated patient care. The IT team will be part of the stakeholders working to ensure the implementation of a strategy to improve communication in the organization. The team will work to ensure communication tools such as SBAR are effectively incorporated into the electronic health record systems (EHRs) to promote efficiency in handover report delivery. The IT team has little power over the implementation of the new change but their presence, support, and expertise will ensure the success of the project. The team has an interest in the new change because it will help in redesigning healthcare through process improvement. Their support for the project will influence the acceptance of the strategy by nurses and other healthcare team members.

Explanation of Project

Effective communication plays an instrumental role throughout a patient’s entire healthcare experience. Nurses are responsible for relaying information to patients, families and other providers largely compared to other healthcare providers. Effective communication in healthcare is observed to contribute to the ability to provide patients with individualized care while considering their values and preferences. Communication in healthcare does not only benefit the patients, but also the nurses as well. It allows the existence of good relationships between staff and promotes healthcare worker satisfaction. While every organization strives to improve communication, there is a need to use evidence-based strategies and best practices to guide process improvement in the facilities. The purpose of this project is to address the issue of communication among nursing teams, especially during shift handoffs. The problem of communication is observed to affect the quality of patient care and safety outcomes such as medication errors that have increased in the facility.

To address the issue of communication in the organization, this project will use current evidence to identify interventions that are most appropriate for the nursing profession. A literature review for best evidence-based practices will be done to ensure the selected approach is suitable for the organization and the nursing team. Apart from providing solutions to the communication problem in the organization, this project will promote my professional growth through the utilization of research to achieve key competencies of the profession. For example, completion of the project will demonstrate synthesis of professional competencies in areas of communication and building relationships, knowledge of healthcare environment, leadership, collaboration, and organizational business administration.

Proposed Solution

A recurrent theme observed in the handoff literature is the need to convey essential information to the oncoming shifts. To ensure information is accurately presented to other staff during handoffs, a standardized method of communication has been recommended. The SBAR communication technique is recognized as the most effective tool to improve communication between nurses and other healthcare teams (Shahid & Thomas, 2018). The tool provides a framework for communication between healthcare team members whereby a concise statement about the patient’s condition is given followed by background information, assessment of the patient, and final recommendation on possible interventions. To effectively implement the strategy, the Institute for Healthcare Improvement (IHI) provides a standardized SBAR checklist that outlines the key areas of communication for nurses, physicians, and other healthcare teams. The tool provides a concrete mechanism useful for framing any conversation, especially during critical events.

The implementation of SBAR communication in the organization aims at improving communication during shift handoffs. The new change will primarily focus on the nursing team because they are involved in multiple shift handoffs per day across all healthcare units. The project will involve the nursing educator who will help in educating nurses on how to use the IHI SBAR communication tool. Upon completion of the training, the nurses will use the tool to communicate patient data with the aim of improving communication that will translate to improved quality of care and patient safety.

Evidence Summary

Communication handoffs are critically important in creating a shared model around the patient’s condition. The SBAR technique is among the tools supported to improve communication in healthcare. This tool provides a concrete mechanism that is used to frame conversations around care transitions during routine nursing care and in emergencies (Dalky et al., 2020). The reason for selecting this tool is because it offers a practical strategy to assist nurses to implement a non-hierarchical communication model for improving clinical care outcomes (Bonds, 2018). Supported by various professional organizations, the SBAR communication tool is crucial for addressing communication issues among clinicians and other healthcare teams. A narrative review was conducted to assess the applicability of SBAR handoff in healthcare. The results from the review indicate that SBAR is a reliable and validated communication tool that has shown a reduction in adverse events in a hospital setting, improvement in communication among health care providers, and promotion of patient safety (Shahid & Thomas, 2018). The implementation of this strategy in the organization can greatly contribute to communication improvement among nursing teams.

There is a supporting array of evidence that indicates SBAR communication tool is crucial in improving patient safety and quality outcomes. A study conducted in the intensive care unit aimed at evaluating compliance of nurses to SBAR communication and the results of the compliance. Upon completion of the study, the researchers concluded that the use of standardized SBAR tools for bedside shift handover can improve communication and enhance patient safety (Achrekar et al., 2016). The results from this research are consistent with those from another study conducted to assess the impact of SBAR on patient safety. Upon the analysis of data from primary and secondary care and nursing homes, the systematic review concludes that SBAR communication can be used to improve patient safety, especially when used to structure communication over the phone (Muller et al., 2018). This SBAR strategy provides a clear structure that calls for the provision of relevant information in an organized and logical manner.

Plan of Action

The action plan for the proposed change can be described in four stages. The first part will involve meeting with the preceptor to identify a healthcare problem and the most appropriate approach. This discussion will focus on identifying a nursing issue that requires change and seeking guidance to proper implementation of the new change. The second part will involve conducting a literature review on the topic and the collection of evidence-based strategies to solve the identified problem. The materials for the literature review will be accessed from the WGU library and will include primary research studies that provide guidance for best practices.

Based on the results from the literature review, the next step will involve developing a plan to solve the identified issue. Evidence-based practices from the literature will guide the formulation of the most appropriate solution for communication challenges in the organization. The final step in the project implementation will involve the presentation of the proposed plan to the preceptor. Due to the current COVID-19 restrictions, actual implementation at the organizational level will not be required. The preceptor will go through the proposed plan and provide feedback.

Timeline

Full preparation and implementation of the project will take four weeks. Week 1 will involve meeting with the preceptor to identify a healthcare issue that requires practice change and discussion of the most appropriate strategies to address the issue. Week 2 will involve a search of evidence-based literature to support the identified problem and identification of a solution. The WGU library will be used to obtain primary research for the topic. Week 3 of the project will involve developing a plan based on the findings from the literature review. The plan will discuss the solution and how it will be used to address the healthcare issue. The last week will involve the presentation of the proposed plan to the preceptor for review and provision of feedback. Any corrections to the plan will also be carried out at this stage.

Required Resources and Personnel

Minimal resources will be required for the implementation of the project due to the COVID-19 restrictions. Human resources for the project implementation will include the MSN capstone student, WGU librarian, and the preceptor. The student will conduct a literature review aided by the librarian and will identify primary research to support the project. The preceptor will review the proposed plan and provide feedback to the student. Time will also be required to access the library, conduct the literature review, and discuss the project with the preceptor. No financial resources will be required due to the project implementation restrictions.

Proposed Change Theory

The proposed change theory to inform the project is Lewin’s change management model. Lewin’s model explains change management using the stages of unfreezing, moving/change, and refreezing. The first stage or unfreezing stage involves the creation of awareness among employees that change is required in the organization. During this stage, effective communication and seeking support from leadership is crucial to ensure employees accept the new change (Hussain et al., 2018). The second stage is the moving phase where the actual change is implemented. To effectively utilize this phase, Lewin emphasized the need for training and provision of support to employees (Hussain et al., 2018). The last phase is the refreezing stage whereby the change is already accepted and reinforcement is needed to solidify the new practice. Equally, communication and reinforcement are required to prevent employees from going back to old ways.

During the implementation of SBAR communication, the unfreezing stage will be demonstrated by presenting the proposal to the administration and nursing team. Data on the effects of ineffective communication in the facility will be presented to create awareness of the need for change. The involvement of the administration and other nurse leaders will serve to reinforce the need for a new change in the institution. The moving/change stage will be achieved through the education and training of nurses. Role-playing and simulation activities will serve to reinforce the new practice. Additionally, monitoring the implementation by nurse leaders will ensure the success of the project. During the refreezing stage, policies on the use of SBAR communication strategy will serve to reinforce the new change in the organization.

Barriers to Implementation

The problem of communication exists in many healthcare organizations despite the use of evidence-based strategies to improve the practice. One of the barriers that will be observed is changing the organizational culture to incorporate new strategies of providing shift handoffs. Many nurses are already used to the shortcut methods which are preferred by many healthcare providers. The new process may experience resistance due to the complexity of delivering shift reports using the SBAR technique especially in busy departments like the intensive care units. Another possible challenge will be the lack of enough training and education time for nurses given the busy nature of the nurses today. The COVID-19 pandemic will be a major hindrance to the conduction of research and interaction with the preceptor. Most of the communication will be conducted online and this will affect the student’s understanding of the project.

References

Achrekar, M. S., Murthy, V., Kanan, S., Shetty, R., Nair, M., & Khattry, N. (2016). Introduction of situation, background, assessment, recommendation into nursing practice: A prospective study. Asia-Pacific Journal of Oncology Nursing, 3(1), 45–50. https://doi.org/10.4103/2347-5625.178171

Bonds, R. L. (2018). SBAR tool implementation to advance communication, teamwork, and the perception of patient safety culture. Creative Nursing, 24(2), 116–123. https://doi.org/10.1891/1078-4535.24.2.116

Dalky, H. F., Al-Jaradeen, R. S., & AbuAlRrub, R. F. (2020). Evaluation of the situation, background, assessment, and recommendation handover tool in improving communication and satisfaction among Jordanian nurses working in intensive care units. Dimensions of Critical Care Nursing : DCCN, 39(6), 339–347. https://doi.org/10.1097/DCC.0000000000000441

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–A narrative review. Safety in Health, 4(1), 7. https://doi.org/10.1186/s40886-018-0073-1

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