This Summative Assignment is the continuation of the Formative Assignment Order number 121705. Please follow the Assignment Guidance well.
The Topic is Improving Nurse Responsiveness to Patients
QUALITY IMPROVEMENT IN TRANSITION TO LEADERSHIP IN ADULT NURSING: IMPROVING NURSE RESPONSIVENESS TO PATIENTS
By (name)
Course name
Professor name
Institution
Date
Introduction
Nurses, unlike other healthcare professionals, spend a lot of the time with patients in hence they have a direct impact on patient satisfaction, safety, and outcomes. Responsiveness refers to provision of care in a manner that considers the needs and values of patients and includes the ability to meet patients’ expectations regarding the non-health aspects of care. The rationale for discussing responsiveness is that healthcare systems on a global level are always seeking for strategies that enhance the responsiveness of their services to both patients and members of the community (Hompashe et al., 2021). The NHS mentions nurse responsiveness as a concept that ensures that patients have a positive experience of the care process (NHS, n.d.). Responsiveness is also a key component of patient satisfaction and includes two main components: respecting the rights of patients including autonomy, dignity, and confidentiality and client orientation especially giving prompt attention to the patients’ needs. Greater responsiveness facilitates access to timely care which may be life saving for critically-ill patients (Shaqura et al., 2021). The purpose of this paper is to present a quality improvement project that focuses on improving nurse responsiveness to patients’ needs.
Quality Improvement
Quality improvement within the healthcare system refers to the use of systematic change management methods to improve quality of care and patient outcomes (Backhouse and Ogunlayi, 2020). The main significance of quality improvement is that it facilitates measurable improvement to specific healthcare aspects (Braithwaite, 2018). The dimensions considered during quality improvement processes include safety, person-centred care, timeliness, efficiency, equitability, and effectiveness of care (Islam and Li, 2019).
Leadership
Leadership refers to individual behaviour when guiding group activities towards a specific shared goal. Leaders share visions, direct others, and inspire them to achieve organizational goals. The main role of leaders in healthcare is to promote development of skills, knowledge, and abilities among the staff in order to promote quality healthcare (Figueroa et al., 2019). Effective leadership is necessary in quality improvement processes since leaders identify areas of improvement, set direction, and motivate employees to take part in the improvement process (Drew and Pandit, 2020). The selected leadership approach for the current quality improvement project is the transformational approach which will be used to direct and motivate employees in the change process.
Outline of the Chosen Quality Improvement Project
The current quality improvement initiative focuses on improving nurse responsiveness to patients. As identified in the formative assessment, the quality improvement project was selected based on observations made in the workplace. Patients complained of delayed responses from nurses when they were in pain or needed help moving around even after using call lights. The negative implications of poor nurse responsiveness include reduced satisfaction with the care process and increased risk of negative events such as patient falls. The main focus of the quality improvement project is to increase nurse responsiveness to patients. The project will improve service user experience by ensuring that nurses respond to their needs promptly and reducing the risk of adverse events that negatively impact patient safety.
Quality Improvement Methodologies
Quality improvement methodologies are systemic methods that lead to improved quality through changes in organizational strategies and provider behaviour (Adams, 2018). In healthcare, these methods are important because they facilitate the achievement of successful improvement that can be sustained on a long-term period (Backhouse and Ogunlayi, 2020).
The change management process requires identification of change models, barriers, and facilitators to change. For the current quality improvement project, the main barriers that may arise include competing demands, scarce resources, lack of support from organization’s leaders, and poor communication. The enablers for the project include support from both internal and external stakeholders and effective leadership. The change model to be used is Lewin’s change model, while the quality improvement method to be used is the PDSA model (Plan-Do-Study-Act). The selected leadership approach is transformational leadership which will be applied during the implementation of the change model. As per Specchia et al. (2021), using a transformational leadership approach facilitates effective change management by enhancing employee involvement. This paper will critically analyse the transformational leadership approach and illustrate how the change project will be implemented using the change model and quality improvement method.
Critical Analysis of the Leadership Approach
Transformational leadership refers to a form of relational leadership which entails exerting positive influence on followers. The main components of transformational leadership include influence, inspirational motivation, individual consideration, and intellectual influence. Idealized influence describes leaders who gain the trust and confidence of their employees by acting as a role model, developing an extraordinary code of conduct, and establishing a clear organizational vision. Inspirational motivation entails the ability of a leader to enhance the employees’ desire to achieve organizational goals and their commitment to the organization. Individual consideration entails assessing employee differences and using the assessment results to provide effective support, training and guidance in order to improve performance. Intellectual stimulation refers to strategies used by transformational leaders to challenge their followers by encouraging and stimulating creativity and innovation (Asif et al., 2019).
In healthcare organizations, transformational leadership has been associated with the development of empowering work environments. Transformational leadership is also associated with better job satisfaction, commitment to the organization, and reduced nurse turnover rates (Iqbal et al., 2019). Khan and Tidman (2021) also link transformational leadership to improved safety and quality of healthcare since it encourages the development of a safety culture. In a systematic review that assessed the impacts of leadership style on the job satisfaction rates for nurses, Specchia et al. (2021) determined that the transformational approach enhances job satisfaction and has the greatest impact in improving nurse performance when compared to other approaches.
In change management, transformational leadership is associated with improved commitment to and readiness for change, effective communication, and employee involvement (Faupel and Sub, 2018; Farahnak et al., 2019).
Leadership in the Quality Improvement Project
The leadership process in the current project would begin by evaluating the organizational context, conducting a comprehensive assessment on the need for change, and developing a clear change management plan including the desired outcome. It would be important to focus on communicating with the nurses in the unit and all other units in the organization about the need for change. This process would make it easier to seek for their perspectives about change and ask them to provide suggestions that would help meet the desired outcomes. Additionally, the leader would provide evidence on the impacts of poor responsiveness to patients including issues regarding increased risk of adverse events, reduced patient safety, and poor patient outcomes. This information would help convince the nursing staff that change is necessary. The leadership process will also entail using specific change management and quality improvement models to guide the change process and assess the effectiveness of change.
Proposed Solution
Most healthcare institutions rely on call lights to help nurses know when patients need help. Regardless of what nurses are doing, they are expected to respond to patients promptly which may not always be the case especially if there are many patients to attend to. Additionally, some patients, especially those who have been admitted for long time periods, demonstrate eagerness to be more independent hence they may be reluctant to use call bells. Such patients may opt to use call bells only when their needs are urgent and any delays may result in negative safety implications. Therefore, multifaceted approaches are essential when improving nurse responsiveness. Purposeful hourly rounding may be used to help deal with predictable patient needs and reduce the need for using call lights (Shaqura et al., 2021). According to Mulugeta et al. (2020), hourly rounds refer to planned nursing visits to hospitalized patients where nurses assess the patients’ comfort, needs, and safety. Nurses also perform routine care that includes checking for vital signs, bedside documentation, pain management, patient positioning, checking IV pumps, feeding, and toileting.
Several studies illustrate the significance of purposeful hourly rounding in improving patient experience and satisfaction with care. Savage (2020) assessed the impact of hourly rounding and determined that healthcare facilities which implement the strategy experience a significant reduction in inpatient fall rates. Gliner et al. (2021), Saul (2018), and Sun et al. (2020) obtained similar findings regarding reduction of patient falls after evaluating the impacts of hourly rounding on adult care patients. Ryan et al. (2018), in an integrative review on intentional rounding, determined that the approach improves patient satisfaction and safety. However, Francis et al. (2019) add that the effectiveness of the approach is based on factors such as ward layout, formal rounding education, leadership, staffing levels, workload, and nurse experience. Based on this information, the current change management project should include formal rounding education as part of the implementation process.
Change Model
Change models refer to methodologies that provide organizations with a guide to change including how to navigate the change process, how to eliminate or reduce resistance, and effective implementation (Harrison et al., 2021). The selected change model for the current research project is Kurt Lewin’s model which follows three steps: unfreezing, change, and refreezing. As per Karasvirta and Teerikangas (2022), the unfreezing stage focuses on creating awareness on the need for change. Resistance to change is often expected because people are often used to old processes and structures. Therefore, it is necessary to communicate with all stakeholders affected by the change process and provide the rationale for change. In the current change project, the nursing staff will be informed about the need for change by explaining the impacts of poor responsiveness on patient satisfaction and outcomes.
The changing stage is where the organization transitions to new processes and structures. The main activity conducted during this stage is implementation of the change and is usually characterized by uncertainty as people learn new behaviours. Factors that determine the effectiveness of the changing stage include access to support, constant communication, and access to training to familiarize employees with the change (Karasvirta & Teerikangas, 2022). In the current change project, the changing stage will entail provision of hourly rounding training for the nurses and implementing it as part of the care process in the unit.
The final stage is the refreezing stage where the new state is stabilized and reinforced as part of normal organizational processes. Refreezing is essential since it ensures that employees do not go back to old processes and structures. Leaders may utilize strategies such as rewarding the efforts made by employees to further reinforce change (Karasvirta & Teerikangas, 2022). After implementing hourly rounding, it will be necessary to stabilize and reinforce it as part of
Quality Improvement Tool
The quality improvement process will be conducted using the PDSA tool which will help assess the effectiveness of the change. The model includes four steps: Plan, Do, Study, and Act.
Planning
The planning stage entails recruiting a change team, defining the objectives and predictions for quality improvement, describing the current context and process, identification of the causes of the current problem and alternatives, and selecting the best alternative (Knudsen et al., 2019). In the current change management project, nurses and patients are the most significant stakeholders since they will be directly affected by the change. The patients in the unit will be asked to provide information regarding nurse responsiveness to their calls and how it has affected their healthcare experience. Nurses and patients will be asked to provide their opinions on hourly rounding as a solution to the issue. The information obtained will be used to inform the quality improvement initiative.
Doing
The next stage in the PDSA cycle is to implement the action plan. For the current change management project, the implementation process should begin with providing formal rounding education to the nurses. The nurses’ knowledge and experience on hourly rounding should be assessed and the information obtained used to develop an effective training curriculum.
After training, the nurses will be expected to begin the hourly rounds. Throughout the implementation process, any observations, unexpected impacts, and problems must be documented.
Study
This stage in the PDSA cycle entails determining if the plan resulted in improvement including whether the change was worth the investment. The studying stage also entails examining the unintended side effects (Knudsen et al., 2019). For the current project, the studying stage will begin as soon as the action plan is implemented. The main observations that will be assessed include changes in various quality measures including patients’ perspectives about their experience especially with regard to nurse responsiveness, any adverse events such as patient falls that may have occurred during the implementation period, and patient outcomes. The nurses’ perspectives regarding the experience will also be assessed. Any issues such as high workloads, insufficient resources, and inflexible work schedules must be assessed to determine the impact of the quality improvement among the nursing staff. The data obtained during the studying stage will be compared to the predictions made during the planning stage. Any lessons learned will be summarized and put into account to be utilized in the next stage.
Act
If the action plan is determined to significantly improve patient experiences and satisfaction with care and reduce the risk of adverse events, then the improvement will be standardized for regular use within the unit.
Barriers and Enablers
The anticipated barriers to the change process include competing demands and scarce resources. As per Tappen et al. (2017), competing demands occur when there is another change initiative being implemented at the same time. In the hospital where the current change initiative is to be implemented, there is an on-going change initiative where the technological systems are undergoing complete transformation to improve their efficiency and effectiveness and to reflect current technological changes. Therefore, it is likely that the on-going initiative may be viewed as more important. This barrier can be overcome by writing a report about the importance of nurse responsiveness and support it using sound evidence. The report should also include expected monetary benefits to the organization to justify the implementation costs and submitted to relevant stakeholders.
Scarce resources may also be a significant barrier because the nursing staff may not be sufficient to effectively accomplish intentional hourly rounding. It will be necessary to seek for additional nursing staff after considering factors such as the number of patients in the unit and patient acuity. This barrier may be addressed by convincing the hospital’s administration of the need for additional staff using evidence from the unit. It may be necessary to seek the help of other nurse leaders and healthcare professionals who fully understand the significance of sufficient staffing.
The main enabler to change would be the leadership process. As per Faupel and Sub (2018), the transformational approach to leadership is mostly effective in change management since it helps create a culture that values change and improvement and promotes team building and collaboration among the staff. Transformational leadership is also essential for promoting communication with internal and external stakeholders including patients, staff, the administration, and investors. Apart from leadership, other enablers to change may arise when there is adequate support from the administration and external stakeholders that will ensure availability of resources required for implementation.
The Significance of the Project and Leadership Approach in Improving Patient Care
The project will improve patient care by increasing nurse-patient interactions and improving patient experience with care. As per Shin and Park (2018), hourly rounding reduces patient anxiety since they know that nurses are readily available when they need them. For instance, Rahmawati (2021) explains that for patients who suffer from chronic or acute pain, it becomes easier to access pain medication thus leading to effective pain management. Hourly rounding also facilitates the development of nurse-patient relationships that improve the patients’ experience and increase the likelihood of positive outcomes. Furthermore, hourly rounds promote patient safety by minimizing adverse events such as patient falls. Nurses also engage in actions such as patient repositioning which reduce the risk of hospital-acquired infections such as pressure ulcers. Hourly rounding is also associated with reduced length of stay and reduced risk of readmission for patients due to better nurse responsiveness and improved timeliness of care. The transformational leadership approach will be used to ensure success of the project by enhancing staff motivation for change, ensuring involvement of patients and other stakeholders, and facilitating effective communication.
Co-production and Service-User Involvement
Co-production is where patients are regarded as partners in healthcare provision and make significant contributions to the care process (Elwyn et al., 2019). In the current project, co-production is illustrated by gathering more information about the patients’ experiences with nurse responsiveness and using it to inform the change process. Additionally, patients are involved when gathering their opinions on hourly rounding as a solution to nurse responsiveness and when assessing the effectiveness of the intervention.
Service-user involvement entails active participation of patients in the healthcare process which is essential for the development of services and healthcare processes that align with patients’ needs (Berzins et al., 2018). In the current change project, service user involvement is essential to ensure that the proposed intervention reflects the preferences and needs of the patients and that it improves patient safety.
Conclusion
The change management project focused on improving nurse responsiveness to patients. In inpatient units where patients have various needs, timely responses promote patient safety and improve patient satisfaction with care. The described initiative focuses on the implementation of intentional/purposeful hourly rounding. The rationale behind the selection of hourly rounding is that research evidence illustrates that it improves nurse-patient interactions, reduces patient anxiety, improve quality of care, and enhance patient satisfaction. The transformational leadership approach is used to inform the quality improvement process. Additionally, Lewin’s change model and the PDSA method were used to guide the implementation process.
Completing the paper enhanced understanding of the significance of listening to patients’ concerns and engaging in actions that promote their best interest. Therefore, in practice, it is important to always seek the perspectives of patients regarding the quality of services provided and how they can be improved. One of the principles described by NMC (2018) is to always prioritize people by listening to them, attending to their needs, and acting in their best interests. Nurses are also expected to engage in actions that preserve patient safety. This paper demonstrated the principles of the NMC code since the initiative focused on improving patient safety and enhancing patient involvement in care.
References
Adams, D., 2018. Quality improvement; part 1: introduction and overview. BJA Education, 18(3), pp.89-94.
Asif, M., Jameel, A., Hussain, A., Hwang, J. and Sahito, N., 2019. Linking Transformational Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care: Assessing the Role of Job Satisfaction and Structural Empowerment. International Journal of Environmental Research and Public Health, 16(13), p.2381.
Backhouse, A. and Ogunlayi, F., 2020. Quality improvement into practice. BMJ, 368, pp.865.
Berzins, K., Louch, G., Brown, M., O’Hara, J., & Baker, J. (2018). Service user and carer involvement in mental health care safety: raising concerns and improving the safety of services. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3455-5
Braithwaite, J., 2018. Changing how we think about healthcare improvement. BMJ, 361, p.k2014.
Drew, J. and Pandit, M., 2020. Why healthcare leadership should embrace quality improvement. BMJ, 368, p.m872.
Elwyn, G., Nelson, E., Hager, A., & Price, A. (2019). Coproduction: when users define quality. BMJ Quality &Amp; Safety, 29(9), 711-716. https://doi.org/10.1136/bmjqs-2019-009830
Farahnak, L., Ehrhart, M., Torres, E. and Aarons, G., 2019. The Influence of Transformational Leadership and Leader Attitudes on Subordinate Attitudes and Implementation Success. Journal of Leadership & Organizational Studies, 27(1), pp.98-111.
Faupel, S. and Sub, S., 2018. The Effect of Transformational Leadership on Employees During Organizational Change – An Empirical Analysis. Journal of Change Management, 19(3), pp.145-166.
Figueroa, C., Harrison, R., Chauhan, A. and Meyer, L., 2019. Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC Health Services Research, 19(1).
Francis, K., Kurtsev, A., Walter, D., Steele, C. and Staines, C., 2019. Nurses’ Experiences and Perceptions of Hourly Rounding: A Private Australian Catholic Hospital Single Case Study. International Archives of Nursing and Health Care, 5(2).
Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D. and Frazier, C., 2021. Patient Falls, Nurse Communication, and Nurse Hourly Rounding in Acute Care: Linking Patient Experience and Outcomes. Journal of Public Health Management and Practice, 28(2), pp.E467-E470.
Harrison, R., Fischer, S., Walpola, R., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. Journal Of Healthcare Leadership, Volume 13, 85-108. https://doi.org/10.2147/jhl.s289176
Hompashe, D., Gerdtham, U., Christian, C., Smith, A. and Burger, R., 2021. ‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa. BMJ Global Health, 6(4), p.e004360.
Iqbal, K., Fatima, T. and Naveed, M., 2019. The Impact of Transformational Leadership on Nurses’ Organizational Commitment: A Multiple Mediation Model. European Journal of Investigation in Health, Psychology and Education, 10(1), pp.262-275.
Islam, M. and Li, Y., 2019. Quality improvement in healthcare: the need for valid, reliable and efficient methods and indicators. International Journal for Quality in Health Care, 31(7), pp.495-496.
Karasvirta, S., & Teerikangas, S. (2022). Change Organizations in Planned Change – A Closer Look. Journal of Change Management, 1-39. https://doi.org/10.1080/14697017.2021.2018722
Khan, A. and Tidman, D., 2021. Impacts of Transformational and Laissez-Faire Leadership in Health. International Journal of Medical Science and Clinical Invention, 8(09), pp.5605-5609.
Knudsen, S., Laursen, H., Johnsen, S., Bartels, P., Ehlers, L. and Mainz, J., 2019. Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Services Research, 19(1).
Mulugeta, H., Afenigus, A., Wagnew, F., Haile, D., Tadesse, A. and Kibret, G., 2020. The effect of hourly nursing rounds on patient satisfaction at Debre Markos Referral Hospital, Northwest Ethiopia: A non-randomized controlled clinical trial. International Journal of Africa Nursing Sciences, 13, p.100239.
NHS, n.d. The NHS Patient Safety Strategy. [online] Available at: <https://www.england.nhs.uk/patient-safety/the-nhs-patient-safety-strategy/> [Accessed 3 April 2022].
NMC, 2018. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. [online] Available at: <https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf> [Accessed 3 April 2022].
Rahmawati, I., 2021. Implementing nursing round to deal with unresolved nursing problem on patient with acute pain: A case report. Journal of Public Health Research, 10(2).
Ryan, L., Jackson, D., Woods, C. and Usher, K., 2018. Intentional rounding – An integrative literature review. Journal of Advanced Nursing, 75(6), pp.1151-1161.
Saul, T., 2018. C6 Purposeful Hourly Rounding Positively Impacts Pain Management, Compassion, Teamwork and Rounding Survey Scores. Pain Management Nursing, 19(2), p.107.
Savage, A., 2020. Reducing Patient Falls through Purposeful Hourly Rounding. Student Scholarly Projects.
Shaqura, I., Jaafaripooyan, E., Hosseini, M., Shagora, A. and Sari, A., 2021. Nurses’ Perspectives on Inpatient Care Responsiveness at the Gazan Public Hospitals. Ethiopian Journal of Health Science, 31(4), pp.847–856.
Shin, N. and Park, J., 2018. The Effect of Intentional Nursing Rounds Based on the Care Model on Patients’ Perceived Nursing Quality and their Satisfaction with Nursing Services. Asian Nursing Research, 12(3), pp.203-208.
Specchia, M., Cozzolino, M., Carini, E., Di Pilla, A., Galletti, C., Ricciardi, W. and Damiani, G., 2021. Leadership Styles and Nurses’ Job Satisfaction. Results of a Systematic Review. International Journal of Environmental Research and Public Health, 18(4), p.1552.
Sun, C., Fu, C., O’Brien, J., Cato, K., Stoerger, L. and Levin, A., 2020. Exploring Practices of Bedside Shift Report and Hourly Rounding. Is There an Impact on Patient Falls?. JONA: The Journal of Nursing Administration, 50(6), pp.355-362.
Tappen, R., Wolf, D., Rahemi, Z., Engstrom, G., Rojido, C., Shutes, J. and Ouslander, J., 2017. Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program. The Health Care Manager, 36(3), pp.219-230.