FIP2 — FIP Task 1: Final Chapters of Capstone Report C824 Nursing Leadership and Management

Chapter 3: Implementation

Description of Steps

Various steps were taken during the implementation of the new change to promote participation and feedback from the administration, nurses, and other essential stakeholders. The first step involved drafting the proposed change and submission to the administration for approval. The draft explained how the use of the SBAR technique could improve communication in the facility and how the SBAR checklist could serve to ensure the success of the plan. The second step involved designing the SBAR checklist to ensure all aspects of the situation, background, assessment, and recommendation were included. The checklist put into consideration the activities carried out in the emergency department and the admitting unit to promote effectiveness.

Clinical nurse educators are important personnel that guides the implementation of evidence-based practices in healthcare organizations. The third step involved the sharing of the proposed SBAR checklist to the nurse educator for evaluation and approval. The nurse educator helped in redesigning a few elements in the proposed checklist and a final draft including all aspects of communication in the two departments was made. The next step involved the identification of key stakeholders, the definition of roles, and planning for education before the implementation of the new change. The key stakeholders that were involved in the project included the nurses, physicians, hospital administration, and the patients.

Education and training are critical during the implementation of change in healthcare organizations because it prepares employees for the new change. The fifth step involved collaboration with the nurse educator to design educational elements for each stakeholder regarding SBAR communication. The nurses and physicians were educated about the new strategy including the importance of the change in the emergency department and the inpatient admitting unit. The charge nurses were also guided on the routine collection of the SBAR checklists, filing, and weekly submission of the reports to the implementation team. The final step involved the dissemination of the final SBAR checklist draft to the nurse managers and the start of the pilot. During the four weeks, the charge nurses and the nurse educator monitored the communication process and bound the completed checklists into a file that was submitted weekly to the implementation team. Additionally, weekly discussions involving key stakeholder members were held to identify barriers and evaluate the progress of the new change.

Discussion of Changes

The initial plan involved the use of education and training for ED and admitting unit staff on the importance of SBAR communication. However, the nurse educator considered the involvement of external stakeholders to address the issue of communication and its relevance to patient satisfaction. The nurse educator in collaboration with hospital administration managed to bring in board representatives from the CMS who enlightened staff about communication and its influence on the HCAHPS scores. Secondly, there was a challenge in creating time for staff education because of the different shifts assumed by nurses and physicians. To ensure every member got an education opportunity, sessions were recorded and sent on online groups to ensure easy access to information. There was also a need to create an extra education program for night shift staff who found it difficult to engage in the day time education and training activities. Additionally, an extra week was added to ensure all activities including the new changes were incorporated into the program.

 

Discussion of Barriers

Implementation of major change initiatives presents various challenges in healthcare organizations. However, understanding these challenges forms a solid background to effectively manage change. The first challenged experienced was the reluctance of the hospital administration to accept the proposal. Other quality improvement processes were likely to be given priority and this led to a delay in acceptance of the project. However, it did not take much to convince the administration how important the new change was to the two departments and the organization at large.

The second challenge was resistance from the nursing and the physician team regarding the incorporation of the SBAR checklist. The new checklist was a modification of the previously used tool and it had additional aspects that according to the nurses and physicians, made it more complicated to use. The team also argued that the busy nature of the ER and the inpatient admitting unit made it difficult to report all the information included in the tool within the shortest time possible. Lastly, time was a challenge during the implementation of the new change because of the delayed education and training for staff. The inclusion of external educators also meant that more time was needed to discuss the importance of the new change to the organization and patients/families.

Overcoming Barriers

The first barrier was the reluctance of the administration to accept the proposal because of other underlying hospital projects. To ensure the support of the administration, I contacted the nurse educator because I believed he influenced the acceptance of the new change. I presented facts about the errors that were observed in the ER due to communication breakdown and how the new change was supported by evidence to bring about patient satisfaction. Additionally, I engaged the research team in digging the positive effects of SBAR communication in the ER and how focusing on this department could be an achievement to the organization. Eventually, the administrators were pleased with the approach and realized how important the new change was to improve patient satisfaction and organizational performance.

The second barrier experienced was resistance from the nursing and physician teams regarding the complexity of the new SBAR tool. To overcome this barrier, the education and training program enlightened staff on the importance of each included aspect. The staff was able to see that the use of the new checklist could potentially decrease errors in the ER through the inpatient admitting unit. The charge nurses for the two departments were also urged to take strict actions against staff who declined to follow protocol regarding the implementation of the new change.

The third barrier was the lack of enough time to implement the new change, especially during training and education. To overcome this barrier, online education and sharing of the material were introduced to ensure employees got to listen and watch all training sessions at their convenience. The second approach involved the incorporation of education and training for night duty staff because they had limited access to daytime training. An additional week was also included in the program to ensure comprehensive education and training for staff. There was also pushing of weekly meetings to weekends when the time was not available to discuss the progress of the new change.

 Identification of Interprofessional Relationships

Modern healthcare is a team sport that involves a team of healthcare professionals working together to deliver quality care to patients. This practice is observed to increase data sharing and to improve communication between healthcare teams. Emerging evidence suggests that effective collaboration promotes the active participation of each discipline in patient care including the patients and their families. During the implementation of the new change, the nurses, physicians, information technology (IT), and the administrators formed the interprofessional team that ensured the success of the project.

Discussion of Relationships

Nurses form the largest group of healthcare professionals in healthcare organizations making them crucial during the implementation of change. The emergency department and inpatient admitting unit nurses were responsible for communicating with physicians during patient are. The team worked closely with the physicians to ensure effective communication using the SBAR technique and reported any aspects that did not go as planned. Additionally, a good relationship between nurses and other stakeholders ensured the plan was carried out with accuracy leading to the realization of good results.

The physician team was an important stakeholder during the project implementation because they actively engaged in the use of the SBAR technique during patient care. The team worked with nurses and the administration to ensure the checklist was followed while addressing any problems that were observed. The physicians were active during education and their professional relationship with nurses ensured effective communication throughout the implementation period.

Part of the project implementation required the incorporation of technology which was coordinated by the IT team. The IT team ensured that all education and training events had visual aids to promote understanding. Secondly, the recorded videos were shared in groups to ensure dayshift and night duty staff had access to discussed information. The administration, on the other hand, collaborated with the nurses, physicians, and other stakeholders to ensure the success of the program. Good relationships between these teams ensured that challenges such as time and resistance were addressed effectively.

Chapter 4: Post-Capstone Project Considerations

Discussion of Successes

The implementation of SBAR communication in the organization was a success because of teamwork and support from the administration. The new strategy greatly promoted teamwork and interprofessional collaboration through the improvement of communication between nurses and other healthcare providers. The nurses, physicians, IT team, and the administration worked closely to ensure the SBAR communication implementation plan was followed. The collaborative practice also ensured that barriers such as time and resistance were easily overcome.

The project was able to demonstrate how evidence-based practices can be used to improve quality and organizational performance in healthcare. For instance, the use of the SBAR checklist ensured accountability among healthcare teams during the sharing of information. The result of the implementation saw the ER and inpatient admitting unit reduce communication errors that had a huge impact on patient satisfaction. There was a significant improvement in departmental performance as a result of improved communication. For example, patient satisfaction scores improved because of minimized errors and faster delivery of services in the ER.

How Successes Will Inform Future Projects

The success of this project demonstrates that the use of evidence-based practices can transform care delivery in healthcare organizations. The use of evidence-based practices is observed to inform nurses about their practice and allows patients to have a proactive role in their own healthcare. In future projects, it will be important to implement change that is evidence-based for the realization of results. The success of the project also demonstrates that interprofessional collaboration is a tool for improving care delivery. Future projects should involve multiple healthcare teams to promote teamwork and faster realization of set goals. The success of this project also demonstrates that barriers in healthcare should not impair the implementation of evidence-based practices.

Aspects That Did Not Go Well

The implementation of evidence-based practices can be difficult due to challenges such as organizational culture and lack of support. During the implementation of SBAR communication in the ER, there was poor reception of the change by the nurses and physicians which led to delayed adoption and acceptance of the change. The new checklist seemed to be more detailed than the previously used tool and it became challenging to fulfill all required aspects during communication.  There was also a challenge of gaining support from the administration initially because of various underlying projects in the facility. I had to take an extra step to involve the clinical nurse educator and the research team to convince the administration of the importance of the project in the institution. There was also the challenge of creating time for staff in the ER because of the different shifts which led to poor delivery of education and training.

Understanding What Did Not Go Well

Understanding what did not go well has helped me realize the importance of early preparation before project implementation. Early preparation can ensure that enough support is available before beginning projects and that the required time-frame is maintained. In the future, I will make sure to use individuals with power and influence while presenting projects to institutional managers. I believe this practice will help in promoting acceptance of the project because of support from influential leaders. Additionally, I will need to make project proposals early so that enough time is available to do research and present facts before other stakeholders. Time allocation is another factor that I will need to work on in the future to ensure every step is completed within the required time-frame.

Explanation of How the Gap Was Bridged

Communication is an important tool that helps to achieve quality care that translates to patient satisfaction. This aspect is stressed and supported by research because it minimizes errors and promotes good relationships between healthcare providers and patients (Wang et al., 2017). In my organization, ineffective communication during hand-offs in the ER through the inpatient admitting unit had led to poor coordination of care, increased medical errors, and poor patient satisfaction. There was a gap between nurses’ communication and communication with physicians when reporting cases, especially during emergencies. To bridge this gap, an evidence-based practice change that involved the use of an SBAR checklist was proposed.

The use of the SBAR checklist to improve communication was proposed because it provided an opportunity to involve multiple healthcare teams. The strategy bridged the communication differences between nurses and physicians and led to collaborative care which improved patient outcomes. The other aspect that was improved involved the delivery of comprehensive patient history during communication which helped in guiding patient care. For instance, the checklist ensured that pertinent patient data such as drug history, allergies, and pain assessment were included during SBAR communication. The use of the checklist ensured that nurses and physicians in the two departments communicated about mediation which minimized medication errors. This outcome corresponds with evidence-based practice which strongly indicates that SBAR communication reduces errors and improves patient satisfaction. Lastly, the checklist promoted patient-centered care by allowing patients to be part of the communication and allowing the family to ask questions or recommend change during patient care.

Supporting the Plan

The sustainability of projects can be challenging if clear goals are not set and enough support is not provided. For example, pragmatic sustainability which includes support of the project in the absence of the donor can be a problem due to financial problems. To ensure support of the new change, the ER and admitting unit charge nurses will provide regular reports on communication and perform a periodic assessment of the change. Secondly, the departments will continue using the checklist for a few weeks until the staff can communicate all aspects without reference. Long term plan for sustainability will involve the formulation of policies governing communication using SBAR in the unit. For example, disciplinary action can be taken against those found to use shortcuts during the communication of patient information.

 Resources for Post-Implementation

Post-implementation support for the project will require meeting rooms for continuing education and training of new employees. There will be a need to discuss weekly reports on the strategy as a short term plan for sustainability. The IT department will continue to disseminate and communicate findings of SBAR communication to healthcare providers. Financial assistance will be required to ensure checklists are available in the units and to facilitate training and education for new staff.

Chapter 5: Reflection

Integrated Outcomes

Masters prepared nurses should apply research and use evidence-based practices during the implementation of the new change. One of the program outcomes dictates that a master’s prepared nurse should utilize applied research outcomes within the practice setting by navigating and integrating care services across healthcare systems (Moss et al., 2016). This outcome was integrated through the utilization of research to identify SBAR communication as an evidence-based strategy to improve communication in healthcare. The second program outcome utilized was interprofessional collaboration whereby a master’s prepared nurse should see the construction of interprofessional teams to communicate, coordinate, collaborate, and consult with other health professionals to advance a culture of excellence (Moss et al., 2016). The new change involved collaboration between nurses, physicians, the IT team, and the administrators to ensure the success of the project. The multidisciplinary approach also ensured that the central focus was the patient which helped in improving patient satisfaction.

Abstract

Evidence-based practice (EBP) is now widely recognized as the key to improving patient outcomes and healthcare quality. Communication in healthcare is among the practices that require interventions using EBPs because communication breakdown leads to errors and poor patient outcomes. In the organizational emergency department, there was an issue with communication that necessitated research and the implementation of change to improve patient outcomes. The problem identified was poor communication of patient information during handoffs in both the nursing and the physician teams in the emergency and inpatient admitting units. To improve communication in these departments, the proposed solution was to design an SBAR handover checklist to serve as a tool for improving communication for nurses. The initial plan involved the development of the checklist, submission to the clinical nurse educator, and refinement of the aspects included in the final SBAR checklist draft. The second step involved education and training of staff from the two units regarding SBAR communication, how to use the tool, and the relevance of the project to patients and the organization. The implementation process took five weeks and the results indicated that the SBAR communication checklist was an important tool in improving communication among nurses and other healthcare teams.

References

Moss, E., Seifert, P. C., & O’Sullivan, A. (2016). Registered nurses as interprofessional collaborative partners: Creating value-based outcomes. OJIN: The Online Journal of Issues in Nursing, 21(3). DOI:10.3912/OJIN.Vol21No03Man04

Wang, Y. Y., Wan, Q. Q., Lin, F., Zhou, W. J., & Shang, S. M. (2017). Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International Journal of Nursing Sciences, 5(1), 81–88. https://doi.org/10.1016/j.ijnss.2017.09.007