Transition to Leadership Summative Assignment Guidance
3000 words + references (at least 30) 100% weighting
Assignment Brief
Students are required to submit a 3000-word appraisal. The essay should include a discussion of the leadership approach required to implement a successful quality improvement project, which the student is required to identify.
Structure: Introduction
+ Set the scene – introduce your work – say what you will be discussing
+ What are you going to be discussing and why?
+ What is Quality Improvement?
+ Why is this important?
+ What is leadership and why is this important?
+ Use your formative work
+ outline of your chosen Quality Improvement Project/ change in practice.
+ Include whether you chose this based on service user feedback or observation.
+ Detail how this will improve service user experience in your clinical area.
+ Evidence what Quality Improvement and quality improvement methodologies are and the importance of this in health care.
+ Evidence you have thought about managing change (including any barriers and enablers and change models).
+ Evidence regarding the leadership approach you have chosen with regards to your project – from here you lead into the main body.
Main Body
+ Critically analyse the leadership approach you have used
+ How have you/would you lead on this quality improvement project???Consider your role as a leader in this project (even if you do not think you are specifically a leader in your role).
+ Demonstrate your leadership approach to this project and its implementation.
+ Show specific discussions about leadership, including barriers and enablers to change and how you would work with these.
+ Critically discuss how this project and your leadership approach will improve patient care and/or services and how these will be evaluated.
+ You must demonstrate the importance of service user involvement and co-production in health care
Conclusion
+ No new information
+ A summary of the arguments/discussions (nothing new should be introduced during your conclusion).
+ How will the understanding you have gained influence your practice.
+ Relate this back to the NMC code.
Key considerations
+ Ensure confidentiality
+ Look at the rubric to see what we’re marking on
+ Ensure you are writing in the third person.
+ Follow Harvard Referencing Guidelines.
+ One of the main components of nursing assignments is recognising how your learning will impact your nursing practice.
+ Analysis – when you delve deeper into a topic and begin to, based on your knowledge and evidence suggest what might be going on.
+ Good grammar and spelling. Take time to read your work through carefully. Does it make sense to you? Will it make sense to another reader? Use available tools to check spelling and grammar.
+ Logical flow and well organised work.
+ Critically analyse within the work. You will need to have read a range and depth of literature around the topics you are discussing.
+ Include a good range and depth of literature. It is not enough at this stage to only use webpages and internet sources. You need to show that you have read around the topics in depth. Look at the Moodle reading list as a starting point and the blended learning and additional resources within the meta-site.
A Reduction of Catheter Insertion to Prevent Associated Urinary Tract Infection
Introduction
The aim of the study is to reduce catheter insertion to prevent associated urinary tract infections (CAUTIs) among hospitalized adult patients. The use of indwelling catheters among hospitalized adult patients is a common therapeutic intervention in healthcare settings. However, misuse of catheters occurring in diverse circumstances such as wrong fitting, poor hygiene maintenance, and poor risk assessment by the healthcare team, and delayed catheter removal has been associated with infections that threaten the safety of the patients (Cudjoe & Heidelberg-Horton, 2019; Parker et al., 2017). According to Gomila et al. (2019), an estimated 20 percent of hospitalized patients get a catheter admission and their risk of acquiring CAUTIs is between 3 and 7 percent every day. Some of the risk factors associated with CAUTIs among patients include being female and having a longer hospital stay (Li et al., 2018). Catheter-associated urinary tract infections have been documented to result in morbidity, mortalities, high hospital costs for both the patients and the healthcare organizations as well as an increased length of hospital stay (Mitchell et al., 2017; Van Decker et al., 2021).
This quality improvement project will lower catheter insertion to prevent catheter-associated infections; it will address the role of the organizational leadership, service user involvement and coproduction and will talk about the barriers and facilitators of the proposed change to improve the quality and safety of care among patients put on catheters. Quality improvement project refers to a process whose goal is to improve the quality and safety of the care provided to patients. It facilitates the improvement and standardization of hospital processes to improve patients’ health outcomes. Marquis and Huston (2017) define leadership as a management skill that focuses on the development of mission, vision, strategy and providing motivation to the employees. The chosen leadership approach for the quality project is participative leadership, which allows for consultative decision-making and open-communication between the leadership and the subordinates (Chan, 2019). Through leadership, the leaders get the opportunity to positively influence and guide the employees’ opinions and activities to achieve the desired goal. The report recommends that the nurses use evidence-based guidelines during catheter insertion to minimize catheter-associated infections. This continuous quality improvement project was chosen based on observation of catheter insertion practices in the patient wards. This change project will improve the service user experience among the patients as a reduction of catheter insertion has been associated with improved health outcomes, a decrease in the length of hospitalization, and improved patient’s satisfaction (Yatim, 2016). Some of the barriers identified include employee perceptions and attitudes towards change, lack of organizational support, lack of resources and lack of readiness. Facilitators of the change would include employee training, effective leadership and open-mindedness among the employees.
Background
Hospitalized adult patients are put on catheters for different reasons including diagnostic, convenience, and therapeutic reasons (Srisatidnarakul et al., 2021). The presence of a catheter increases a patient’s risk of acquiring bacteriuria, which can either be benign or could progress to an infection. Nursing literature indicates the lack of a consensus approach on the CAUTIs apart from the non-use of the devices were no longer necessary (Thekete, 2022). In the UK, urinary tract infections are the second most common infections with 50 percent of the infections being present in patients fitted with catheters. The link between catheter-associated urinary tract infections has been established with the main causes being unnecessary catheter use and wrong catheter insertion technique (Yatim et al., 2016).
Tenke et al. (2017) assert that the use of systemic antibiotic prophylaxis is not recommended for the management of catheter-related symptomatic bacteriuria since it may result in resistance to antibiotic treatment. It is for the above reason that nursing literature recommends the prevention of infections rather than the use of antibiotics for infection management and control. Healthcare professionals play an important role in catheter use and care which makes them an appropriate audience for a change related to catheter care. Smith et al. (2019) assert that the UK government was committed to halving Gram-negative bloodstream infection (GNBI) by the year 2020. The commitment by the government to lower the prevalence of the infections was attributed to the burden imposed by the infections on England’s National Health Services (NHS).
Catheter-associated urinary tract infections can only be prevented through the implementation of multi-modal quality care programs, which range from behavioural interventions, and the use of medical devices, to staff education (Busbee et al., 2020). Behavioural interventions include the utilization of catheter insertion checklists (Wanat et al., 2020). Medical devices could involve the use of ultrasound bladder scanners while staff education could involve educating the staff on the evidence-based guidelines related to catheter use and maintenance. Assadi et al. (2018) claim that a reduction of catheter-associated urinary tract infections improves the patient’s health outcomes, lowers the patient’s length of hospital stay, and at the same time reduces hospital bills.
The collaboration of healthcare workers with the organizational leaders is likely to facilitate a culture of safety and accountability within the clinical settings (Auten, 2021). A reduction of catheter-associated urinary tract infections is likely to positively affect the patient’s health outcomes and the hospitals’ rating (Meir & Wittich, 2019). Hospitalized patients have diverse health needs, which communicates the need for the nurses to conduct a comprehensive patient assessment to identify the patients in need of catheters. Equally, the healthcare professionals should go through the necessary training to enhance their knowledge and skills regarding catheter insertion to lower the patient’s vulnerability to acquiring infections.
Change Management
Marquis & Huston (2017) assert that healthcare organizations go through continual change which is directed towards the promotion of quality, organizational structuring, and employee retention. The changes are in most cases planned, which means that the leaders apply a deliberate application of knowledge, and skills to bring out the change as desired. Due to dynamics in the healthcare sector, the healthcare leaders need to initiate change processes to meet the populations’ changing health needs, upcoming health laws and policies, and the need to provide a safe practicing environment. Healthcare leaders can utilize several change models like Kotter’s change model or Lewin’s change model. Kurt Lewin’s change model emphasizes the need for the change stakeholders to demonstrate readiness to change to make the proposed change a status quo (Mahmood et al., 2018). Kotter’s change model on the hand emphasizes the need for creating a favourable environment for change.
The most appropriate change management model, which would facilitate the success of the quality improvement project, would be Kurt Lewin’s change model. Lewin’s model of change has three phases, which the change agent must go through before the planned change becomes the status quo of the system. The three phases of the change model are discussed below.
Unfreezing
Unfreezing is the first phase of Lewin’s change model. At this stage, the change agent must convince the team members about the intended change. Lewin claims that for change to take place, the people involved must believe that the change is needed (Marquis & Huston, 2017). The change agent therefore ought to have made an accurate assessment of the extent of change as well as the interest in change. The leader also needs to assess the nature and the level of motivation among the employees and the environment in which the change will occur. At this stage, the leader acting as a change agent must serve as a role model to the subordinates by viewing the change as both a challenge and an opportunity for growth. On the needed change in the reduction of catheter insertion, the employees need to understand and believe the need for change based on observation of poor health outcomes among patients with catheters in the ward. The leader should share the vision, and most importantly communicate the benefits of implementing the change not only to individual patients but also to the healthcare organization.
Movement
The second phase of the change is movement entails planning and the implementation of proposed new practices while influencing behaviours and thoughts about change (Marquis & Huston, 2017). During this phase, the change agent should ensure that the driving forces exceed the restraining forces. It is important to understand that change is a complex process that requires planning and timing. Similarly, identifying, addressing, and overcoming employee resistance poses as a changing and lengthy process. Therefore, a change process must allow enough time for the stakeholders to fully get assimilated into the change. In this stage, the team members should be educated about the need to reduce catheter use.
Refreezing
The last step of Lewin’s change is refreezing. During the refreezing phase, the change agent at this step focuses on assisting the employees in stabilizing the change so that it becomes the status quo (Marquis & Huston, 2017). For the refreezing step to take place successfully, the change agent must be supportive and most importantly reinforce the individual efforts of those directly affected by the change. The change agent must ensure that he/she is available until the change process is complete. During this stage, the change agent should provide necessary information about the importance of reducing catheter insertion while giving feedback to enable solidify the change.
Leadership Approach
There are various leadership approaches such as autocratic leadership, transformational leadership, participative leadership, and transactional leadership among others. The most suitable leadership approach for this continuous quality project is the participative leadership approach. A participative leadership approach is an approach to leadership where the subordinates are empowered to participate in the decision-making process (Chan, 2019). The leader uses the subordinates’ input to make organizational decisions, which makes it an inclusive leadership approach. This type of leadership aims at increasing employee empowerment and motivation making, them feel valued and appreciated. Participative leadership would ensure that the change agent and the subordinates collaborate to reduce catheter-associated urinary tract infections to improve the patient’s health outcomes and lower the length of hospital admission and costs of care. The leadership process will allow both the leadership and the employees to provide valuable feedback to each other to support the successful implementation of the intended change.
Co-production and Service User Involvement
Co-production in healthcare refers to the involvement of the patients in the provision of healthcare services as partners of the healthcare professionals (Vennik et al., 2016). Co-production in healthcare has been seen as a method of quality improvement since the involvement of both the staff and the patients fosters collaboration (Batalden et al., 2015; Fusco et al., 2020). Co-production not only involves designing a healthcare service or product but also an interaction with the user on their first-hand experience. Engaging patients in their care usually increases their confidence, and willingness to control their health, which ultimately could result in healthier behaviours as well as the ability to take control of their health (Turakhia & Combs, 2017). Service user involvement refers to an involvement process entailing a partnership between patients, the public and the health professionals (Ocloo & Matthews, 2016). Service user involvement ensures shared decision-making resulting to improved service delivery and better health outcomes. The collaboration of various stakeholders in the healthcare setting such as the nurses, nurse leaders, and physicians to ensure that the correct catheter protocols are followed is likely to facilitate patient safety and ensure the achievement of positive healthcare outcomes.
Continuous Quality Improvement
In the healthcare setting, continuous quality improvement (CQI) is a process, which aims at improving the quality and safety of the processes offered. Nursing studies have associated continuous quality improvement with a reduction in mortality rates, improved health outcomes, safety in the clinical settings, and a reduction in hospital admissions (Hill et al., 2020). During continuous quality improvement projects, the leaders use decision-making tools and input from the subordinates to make the desired change. It is vital to note that continuous quality improvement allows changes in work processes and operations, compliance with laws and regulations in the healthcare sector, and an improvement in the work environment. The continuous quality improvement tool that will be used for this project is the Planned Approach to Continuous Quality Improvement (PDCA) whose cycle consists of four steps, which are plan, do, study, and act as discussed below.
Plan
Planning is the first step in the PDCA cycle. During this step, the change agents identify opportunities for change. From the project, the identified change in reducing catheter-associated urinary tract infections was identified through observation of the clinical settings. After identifying the change, the leader should pool personnel and resources and set a time-frame to achieve the set goals and objectives. The leader should create a vision, set goals and facilitate a support system. Similarly, the leader should plan on employee training to sensitize them on safe catheter placement and maintenance protocols.
Do
The second step is the execution stage where the proposed change should be piloted. At this step, the leadership and the change steering team. The leadership will document any observations and problems noted. Similarly, the team will gather data that will likely shape the project and inform future changes and improvements.
Study
The third stage of studying requires that the change team analyses and uses the obtained data from the project to determine if the change made a difference or not. At this point, the team is required to carry out audits at different levels of the piloting. The team handling the change will assess whether a reduction of catheter-associated urinary tract infections will result in better health outcomes among the patients, improve the patients’ satisfaction and reduce their length of stay in the hospitals. If at this stage the team finds that the change is not facilitating the achievement of the set goals and objectives, the team will make some modifications and restart the piloting process.
Act
The last step of the CQI cycle is acting. This last phase entails assessing whether the change achieved the set goals and objectives and if it did, should be implemented on a wider scale. In case the change did not, the cycle should be started again with the leadership and the team proving important input. A reduction in catheter-associated urinary tract infections has not only been associated with lowering the burden on individual patients but also the NHS.
Potential Barriers
The adoption of an organizational change is likely to face potential barriers, which could not only delay the process of change management but also cost the organization more resources. Therefore, the organizational leadership should largely rely on employee input and feedback throughout the change process. Some of the potential barriers that could hinder the implementation of include but are not limited to employee perceptions and attitudes towards change, lack of resources, lack of organizational support, and lack of readiness. Negative perceptions and attitudes towards the proposed change could see employees being unwilling to make changes to their routines. According to Menegueti et al. (2019), a major obstacle in the removal of indwelling catheters is the perception among healthcare workers that patients with severe health conditions automatically need catheters. This barrier can be removed through the implementation of protocols ensuring that the healthcare workers use a defined and standardized criterion for indications on when to use the catheters.
The second barrier concerns the lack of organizational support. Lack of organizational support is likely to hinder the successful change process. Marquis & Huston (2017) claim that organizational leaders must play the role of change agents to assist their subordinates to assimilate the desired change. The change of catheter placement and maintenance protocols would require that the leaders show support, motivate the employees, and probably provide training on recommended guidelines. Rehman (2021) claims that when employees perceive organizational support, they are likely to demonstrate a sense of responsibility, which will be shown in their behaviour and attitudes towards achieving the introduced change.
The third barrier is the lack of readiness for change among the employees. Organizational readiness refers to a shared psychological state that involves the organizational members getting involved while at the same time showing their commitment to implementing proposed organizational changes (Alolabi et al., 2021). Lack of readiness towards change among the employees has been associated with poor leadership practices such as lack of employee involvement, organizational complexity, and poor communication strategies. Therefore, it is the leadership’s responsibility to keep the employees involved and engaged in the change process to prepare them for change and assure them that the change process is for the benefit of everyone (Roos & Nilsson, 2020).
Potential Facilitators
The potential facilitators of the intended change include effective leadership, employee training, and open-mindedness among the employees. Effective leadership is of paramount importance in facilitating change. Effective leaders should prepare the employees, align the intended change with the vision, and set realistic goals and objectives while at the same time pool resources and personnel with the ultimate goal of preparing the employees for change (Shehab, 2017). The chosen leadership model for this continuous quality improvement model is participative leadership, which allows the leaders need to interact with the subordinates in-depth, engage them in decision-making and consider their input throughout the change process.
The second facilitator is employee training on the recommended catheter placement, maintenance, and removal protocols. Employee training is an effective facilitator, which is likely to result in the acquisition of new skills and knowledge about the intended change (Shehab, 2017). The employees need to understand when to use a catheter, and the protocols used in both placement and removal to minimize the prevalence of CAUTIs.
The third facilitator is open-mindedness among the employees. While it is important to acknowledge that change results in the disruption of the status quo, in the organization, planned change is usually planned for and aimed at benefitting the stakeholders. Therefore, when the employees show open-mindedness to the change, they are likely to be receptive, accept the change, and most importantly incorporate it into the organizational system.
Evaluation
The evaluation process is of paramount importance in determining whether the piloting of the project yielded the expected results. The proposed change of reducing catheter-associated urinary tract infections among hospitalized adult patients would be an indication of the project’s success. A reduction of CAUTIs would indicate proper risk assessment, appropriate catheter placement, and removal practices as well as catheter care. The healthcare practitioners who are the target audience for this project need to demonstrate their willingness and commitment to changing practices related to catheter care. During the patient’s hospital stay, they need to show positive health outcomes, a reduction of CAUTIs, and overall improved well-being. It would be necessary to collect data from the team members as well as the patients involved in the change process, as the data would facilitate a comprehensive evaluation of the project’s success, gaps, and the transition from the piloting stage to the actual execution.
Conclusion
Change is an inevitable process in an organization. Organizations engage in change implementation as a way of improving their operations, systems, and overall performance. Nursing literature as highlighted in this project shows a correlation between misuse of catheters and the prevalence of catheter-associated urinary tract infections. The studies have emphasized the need for nurses to adopt better catheter care and maintenance protocols to minimize patients’ exposure to infections. Appropriate catheter care has been linked to better health outcomes, a reduction in hospitalization length, and better patients’ outcomes during their hospital stay. The healthcare practitioners should therefore be trained on safe catheter practices to improve care and ensure patient safety. The proposed change will require organizational support, the pooling of resources and personnel, employee training, employee readiness, and openness to change and the involvement of the relevant parties to eliminate possible barriers that could impede or even delay change implementation.
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