Change Initiative: Implementation, Evaluation, and Sustainability

Change Initiative: Implementation, Evaluation, and Sustainability
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Change Initiative: Implementation, Evaluation, and Sustainability
The virtual ICU or tele-ICU is a new concept that seeks to tap into the technological boom in the world today. Many people die while in the ICU, and in an effort to try and reduce mortality rates in the ICU, virtual ICUs were developed. Hoonakker and Carayon (2018) provide an explanation of virtual ICUs and note that in “tele-ICUs, clinical teams monitor ICU patients remotely and support clinicians in multiple ICUs.” So, this means that there has to be a team of virtual ICU nurses ready to pass on the message to the intensivists on call. However, while monitoring several ICUs, there are bound to be problems. Currently, the virtual ICU nurses work 12-hour shifts and I believe this is an area that needs change. Below is a description of the issue, its effects, and the change initiative that can help ensure efficiency.
Discuss the issues in this area and the current outcomes as a result of the issues.
While working 12-hour shifts, virtual ICU nurses or tele-ICU nurses are bound to experience instances of burnout. Often, because their work is to monitor ICUs, their workload is deemed manageable. However, as many tele-ICU nurses claim, the 12-hour shifts and the mental luggage of dealing with more than 30 ICU patients at a time often induces burnout. The ICU requires a workforce that is vigilant, keen, and fresh at all times. The expectation that a virtual ICU nurse can stay fresh, keen and maintain their focus and vigilance for 12 hours is flawed. Additionally, dealing with a large number of patients at a go makes it incredibly difficult for them to keep track of a patient’s history and be assets.
The current outcomes of the above have been a group that is dealing with stress, fatigue, conflicts in the workplace, and a department that is dealing with high turnover rates. The team is also emotionally drained, and hence the increased rates of absenteeism. One other outcome as a result of this issue is the reduction of the usefulness of virtual ICU nurses. As already stated, the lives of ICU patients are highly dependent on the keenness of virtual ICU nurses. So, it is highly likely that some nurses will miss readings or signs of distress from some patients. This is indeed a major issue that can help save a few lives.
Describe the external and/or internal driving forces, contributing issues, and the people affected.
One external driving force that the virtual ICU nurses have no control over is the fact that they monitor patients from different ICU units. So, one nurse will be expected to monitor patients from the medical, special, cardiac, or the neurological unit. Additionally, nurses are expected to monitor patients from different hospitals which may differ in their protocols and processes.
An internal driving force involves the fact that it is standard policy for tele-ICU nurses to work for 12-hour shifts. Having such a standard policy makes it incredibly difficult for nurses to effectively do their job. It is crucial that this policy is changed to help the nurses avoid instances of burnout that eventually result in high turnover rates and increased instances of medical errors.
A contributing issue would be having a single nurse deal with more than 30 ICU patients from different ICU units and hospitals. It is true that virtual ICUs ought to make things better and enhance response time, however, overworking the nurses while expecting excellence is not the answer.
Evaluate the stakeholders involved and discuss how they will be affected by your change initiative.
The change initiative involves changing the 12-hour shifts to 8-hour shifts. Additionally, the virtual ICU nurses will have to be trained and to specialize in the ICU units and hospitals they will be monitoring. The expectation is that with reduced hours and specialization, productivity will be increased.
The stakeholders involved include tele-ICU nurses, intensivists, and patients. For the tele-ICU or virtual ICU nurses, the change initiative will reduce their number of working hours, help them specialize, and reduce instances of burnout. The goal is to have a team that is not overworked and fatigued. When it comes to the intensivists, there will be improved communication and response time because of the changes affecting the tele-ICU nurses. For the patients, enhanced outcomes should be expected. Having nurses specializing in particular ICU units and taking 8-hour shifts will enhance productivity and patient outcomes as well.
Clarify your role and responsibility as a change leader. Discuss the leadership theory (or theories) you will use to guide the change process.
My role as a change leader is to bring about a change initiative that is agreeable to the stakeholders and making sure it succeeds. Even though my goal is to see enhanced productivity, I would also like to see instances of medical errors within the virtual ICUs reduce. Instances of burnout within an ICU unit or any hospital unit often lead to an increase in medical errors. Medical errors in the ICU translate to death, and if this is an issue that can be dealt with, then it is only right that it is.
The leadership theory that will guide the change process is the transactional leadership theory. With transactional leadership theory, a leader seeks change by orchestrating a transaction with the followers. So, I intend to communicate my goals with the change initiative and then offer the 8-hour shift solution as well as the idea of specializing as what I am offering the virtual ICU nurses. My intention is to develop a mutually reinforcing environment and make sure my followers are in sync with my goals and vision for the virtual ICU unit. ...