Change Initiative: Implementation, Evaluation, and Sustainability

Change Initiative: Implementation, Evaluation, and Sustainability
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Change Initiative: Implementation, Evaluation, and Sustainability
The Need for Change
At the 800-bed capacity multi-specialty hospital where the researcher works, the most critical issues that need change are the high rate of catheter-associated urinary tract infections (CAUTIs) andventilator-associated pneumonia (VAP). These two issues are posing a great challenge to the management of the healthcare facility as they adversely affect patient care outcomes. The need for change is driven by the fact that CAUTI and VAPs are the primary reasons behind the prolonged stay of patients in the hospital’s Intensive Care Unit (ICU). Though preventable, these nosocomial infections have been linked to high mortality and morbidity, and the runaway healthcare costs at the hospital. There is need for preventive intervention to manage and reduce these infection rates and hence change at the hospital’s ICU department based on Kotter’s 8 Step model will be implemented. This change initiative will reduce the rate of the two infections from the current 14 cases in 1000 patients to less than 5 cases. The outcome of the change will be a decline in morbidity and mortality rates, as well as a reduction in departmental costs. The general outcome will be improved patient care outcomes and healthcare quality.
Description of internal and/or external driving forces
The internal driving forces for the growing prevalence of CAUTIs and VAPs are poor sanitary conditions and especially, the sanitation of catheter gadgets. The primary cause of CAUTIs is bacteria and fungi that infiltrate the urinary tract through the catheter(Clayton, 2017). Once these bacteria get into the urinary tract, they begin to multiply and subsequently cause fatal infection. These infections happen in different ways. For instance, during catheterization, the catheter gets exposed to contamination, and as a result, bacteria and fungi enter through the insertion. The second driving force for the infection is prolonged use of drainage bags without emptying or replacement(Clayton, 2017). This is largely caused by the shortage ofcatheterization gadgets and the need to manage the ICU department costs. These infections also result from the entry of bacteria during a bowel movement, which eventually enter into the catheter. Furthermore, the backward movement of urine from the catheter into the bladder is to blame for the rising cases of CAUTI infections in the ICU. On the other hand, Ventilator-associated pneumonia (VAP) infection often results from prolonged mechanical ventilation procedures and is transmitted through an endotracheal tube(Kalanuria, Zai&Mirski, 2014). In the hospital ICU, VAPs is commonly caused by an invasion by micro-organisms in the lower respiratory tract and lung parenchyma.As a result, gastric secretions get their way into the lower airways thus causing triggering the infection.
Evaluation of stakeholders
The successful implementation of the proposed change at the department will require multi-stakeholder collaboration. Firstly, members of the multidisciplinary team that attends to patients in the ICU will be involved in the change process. The first people are intensivists who monitor and administer treatment to patients within the ICU department. The intensivists or critical care physicians will be affected by the change since they have the overall responsibility of administering and monitoring critical treatment. Besides, they will be affected since CAUTIs and VAPs adversely affect treatment and the duration of stay in the ICU. The second group will be the critical care nurses who provide patient care. These nurses will be affected by the change since they are the ones who are in charge of insertion and replacement of catheters.Besides, theyare generally charged with monitoring the patient condition. Still, they are responsible for ensuring that pneumonia patients get proper ventilation while in the ICU as this prevents ventilator-associated pneumonia. In addition, other multidisciplinary team members working at the ICU will be involved since they all constitute to the external driving forces.
The Role of the Leader in the Change Initiative
Leadership will play a key role in the execution and implementation of the proposed change initiative. Thus the choice of an appropriate change driven leadership style will be critical. Two leadership theories will be used namely transformational leadership and situational leadership. Transformational leadership was chosen due to its effectiveness in driving change. On the other hand, situational leadership theory was selected due to its efficacy in dealing with multiple situations since it involves the use of an ideal leadership style that suits a particular situation(Giltinane, 2013). This theory will come in handy when dealing with different scenarios during change execution and implementation. Transformational leadership will allow the change project manager to work with different teams in identifying the need for change, and in the creation of a change vision that can drive change while inspiring members of the change team to be committed to the change process(Flaming, 2014). Therefore, transformational and situation leadership theories will guide the change manager in defining the change vision and objective.
Discussion of necessary change agents and their respective roles
The success of the change process will require that certain change agents be used. These change agents will be the clinicians, physicians and nurses who provide treatment and patient care for patients in the critical care unit. During the change process, healthcare staff will either play the role of change agents or change targets ...