Organizational Culture and Readiness Assessment

Abstract
Health care facilities experience various challenges in the quest to provide efficient medical services to patients. One of the most common challenges is the occurrence of hospital-acquired infections (HAIs) amongst the patients. The act of finding solutions to such infections such as CAUTI is crucial owing to their significant contribution to the mortality rate amongst hospitalized patients. The existence of HAI proves to be costly not only to patients but also to the healthcare facility administration. This paper provides a proposed methodology on how to tackle the relationship that exists between effective nurse management and HAI cases. The evidence-based practice proposal covers the proposed plan for an EBP project that is designed to provide a solution to the HAI problem within patient rooms at the hospital organization. Despite the availability of several types of evidence capable of providing the required solution, there is a need for compelling and evidently sufficient support from peer-reviewed studies that act as the basic component of the proposed evidence. The proposal comprises of seven different sections starting with organizational culture and readiness assessment, problem statement, literature review, solution description, change model, an implementation plan with the seventh section providing the evaluation process.
Table of Contents TOC \o "1-3" \h \z \u Section A: Organizational Culture and Readiness Assessment PAGEREF _Toc39682362 \h 4Introduction to Evidence-Based Practice PAGEREF _Toc39682363 \h 4Barriers to Implementation of EBP PAGEREF _Toc39682364 \h 5The survey PAGEREF _Toc39682365 \h 5Section B: Problem Description PAGEREF _Toc39682366 \h 7Background of the Problem PAGEREF _Toc39682367 \h 7Stakeholders PAGEREF _Toc39682368 \h 8PICOT Question PAGEREF _Toc39682369 \h 8Purposes and Objectives of the Project PAGEREF _Toc39682370 \h 8Importance to Nursing PAGEREF _Toc39682371 \h 9Section C: Literature Support PAGEREF _Toc39682372 \h 10Description of the Search Method PAGEREF _Toc39682373 \h 10Summary of Evidence PAGEREF _Toc39682374 \h 11Section D: Solution Description PAGEREF _Toc39682375 \h 13Solution Description PAGEREF _Toc39682376 \h 13Organization Culture and Viability PAGEREF _Toc39682377 \h 14Measurements and Outcomes PAGEREF _Toc39682378 \h 14Limitations PAGEREF _Toc39682379 \h 15Outcome Impacts PAGEREF _Toc39682380 \h 15Section E: Change Model PAGEREF _Toc39682381 \h 15Roger’s Diffusion of Innovation’s Model PAGEREF _Toc39682382 \h 15Conclusion PAGEREF _Toc39682383 \h 17Section F: Implementation Plan PAGEREF _Toc39682384 \h 17Section G: Evaluation of Process PAGEREF _Toc39682385 \h 20References PAGEREF _Toc39682386 \h 23Appendix A: Critical Appraisal Checklist PAGEREF _Toc39682389 \h 26Appendix B: Evaluation table PAGEREF _Toc39682390 \h 30Appendix C: Conceptual Models (Theory of Planned Behavior Model) PAGEREF _Toc39682391 \h 31Appendix D: Timeline PAGEREF _Toc39682392 \h 32Appendix E: Resource List PAGEREF _Toc39682393 \h 34Appendix F: Proposal Instrument PAGEREF _Toc39682394 \h 35Appendix G: Data Collection Tool PAGEREF _Toc39682395 \h 39Appendix H: Budget PAGEREF _Toc39682396 \h 40
BENCHMARK - EVIDENCE-BASED PRACTICE PROPOSAL FINAL PAPER
Section A: Organizational Culture and Readiness Assessment
Introduction to Evidence-Based Practice
The modern business environment is shown to be dynamic as well as unpredictable in nature, therefore, demanding the necessity of organizations to always be ready for change. It is mandatory that employees have the capability of accepting change initiatives within their respective workplaces for the purposes of enabling constructive contributions. This is a result of the need to match the high level of competition, making quick decisions alongside the will and competency towards coping with constant change. In the current business environment, the ability of the organization to succeed requires that it be responsive to the various needs of the perpetually evolving business environment. Some of the factors that lead to effecting the necessary changes within an organization may include but not limited to changes in legislation as well as the increase in organizational efficiency. However, one of the impediments that challenge the implementation of change projects within organizations entails the nature of resistance as posed by the employees. In effect change readiness becomes one of the most points of interest discussed in organizational change. The ability to create readiness for change requires an adequate understanding of the antecedents as well as factors that are capable of influencing change readiness. In this case, organizational culture represents one of the antecedents that influence the way things are done within the organizational set-up. The nature of the reaction of employees towards any form of change strongly depends on the existing organizational culture.
Barriers to Implementation of EBP
The EBP helps in the provision of solutions to clinical issues that focus on patient care through the integration of well-designed evidence that contains preferences of the patients, their assessments as well as health professionals. However, there exist some barriers that challenge nursing in the implementation of EBP. The identification of such barriers could easily enable health facilities to avoid such issues through the formation of solutions, therefore enabling robust execution of health care services. Some of the barriers entail lack of supervision, lack of adequate training, time restriction as well as limited resources. Further, individual barriers include lack of adequate knowledge amongst nurses, deficient skills, and awareness as regards the use of EBP, lack of professionalism, language barrier as well as attitude and experience of the nurses.
It is essential that the process of implementing EBP be critically considered owing to the high scrutiny alongside the high profiled regulations that govern patient outcomes. The concept of implementing the EBP enables effective change within the organization’s culture due to the fact that new practices, as well as behaviors, should be adopted. The EBP plays a very critical role in the mission as well as the philosophy of any organization and demands the commitment of all stakeholders that include the administration, support, the nurses, and also physicians. The organization’s readiness assessment tool is key in helping healthcare organizations to evaluate their intended readiness towards implementation as well as the sustainability of organizational improvement. The tool applicable in this case focuses on the infection and control intervention.
The survey
The organization readiness assessment tool developed by Austin and Claassen (2008) will be used to measure the readiness of MedStar Washington Hospital Center (MWHS) in implementing an infection control intervention. The tool utilizes organizational capacity, organizational culture, staff capacity, and implementation plan to measure organizational culture and readiness. The score of these parameters ranges from 4 to 20, 4 being the lowest, and 20 being the highest.
The results indicate that MedStar has an organizational capacity score of 16. This reveals that the organization has enough financial and human resources to facilitate the successful implementation of EBP. The hospital has an organizational culture score of 15. This indicates that the hospital’s culture is moderately accommodative of change. The staff capacity score for MedStar is 12. This reveals that there lacks sufficient capacity for the staff to implement these changes. This low score can be attributed to nurses’ limited awareness of research activities and resources (MWHS, n.d.). This is a barrier to the implementation of an EBP project and Medstar needs to invest more in promoting nursing research. Medstar scored 18 in the implementation plan. This indicates that Medstar is well-prepared to implement an EBP, which is attributable to the fact that the hospital has a team of implementers who work together, such as a clinical specialist who ensures that the hospital is using current and evidence-based clinical nursing practice (MWHS, n.d.). This will facilitate the implementation of the evidence-based project.
By establishing a nurse residency program as part of clinical inquiry integration, this would ensure that any nurse who comes to work for MedStar after graduation completes an EBP project. This will promote a culture of clinical inquiry and nursing research.
Summary of the Results
Parameter

Score

Organizational capacity

16

Organizational culture

15

Staff capacity

12

Implementation plan

18

Section B: Problem Description
Background of the Problem
The aspect of evaluating the relevancy alongside the efficiency and competencies of the tool as well as ensuring the function ability and usability of the tool helps in ensuring its usefulness within healthcare for the assessment of their readiness for organizational improvement. Preventing hospital-acquired infections (HAIs) is essential in ensuring patient safety. HAIs are infections that patients get while receiving healthcare services (Haque, Sartelli, McKimm, & Bakar, 2018). HAIs are one of the most common causes of health complications in hospital settings. According to the Centers for Disease Control and Prevention (CDC) (2017), in every 25 American inpatients, 1 is diagnosed with at least one HAI, every year. HAIs can cause sepsis or even death of patients. For instance, the CDC (2019) indicates that in 2017, about 119,000 patients acquired bloodstream staph infection, and about 20, 000 of them died as a result. Some of the factors that increase the risk of a patient acquiring HAIs include communicable diseases that pass from patients to healthcare workers, who then pass them to other patients (U.S. Department of Health and Human Services (HHS), 2020). Also, poorly disinfected and cleaned healthcare settings increase the risk of HAIs. Therefore, infection control within a hospital setting is important, especially at a time when the world is experiencing the Coronavirus pandemic. Nurses and other healthcare workers need to wash their hands regularly to reduce the spread of infections within the hospital. 
Stakeholders
Successful implementation of an infection control EBP project requires collaboration between different stakeholders. This project will be beneficial to hospitals and other healthcare organizations that provide healthcare services to patients. Also, nurses and other healthcare workers will be a crucial part of this project. As revealed by HHS (2020), healthcare workers play a very big role in passing communicable diseases from one patient to another. This group will also be responsible for implementing the EBP project. Hospital administrators will also provide the necessary resources to ensure that the project goes through all the phases successfully (Storr, et al., 2017). Patients, especially those in admission, will benefit from this project because they are the ones with the highest risk of acquiring HAIs.
PICOT Question
In a healthcare setting (P), what is the impact of handwashing using antimicrobial agents (I) among healthcare workers compared with handwashing using soaps (C) on reducing hospital-acquired infection (O) within twelve months (T)?
Purposes and Objectives of the Project
This project’s main purpose is to examine whether hand washing using antimicrobial agents among healthcare workers can decrease HAIs within a hospital setting. The main objectives will be:
* To control the transmission of communicable diseases and infections within a healthcare setting
* To ensure that vulnerable patients do not acquire HAIs
The progress of the program will be checked every three months and by the end of one year, the outcomes of the project will be analyzed. The rate of HAIs is expected to reduce and the containment of HAIs should be evident. The main indicators, which will also be used to measure the effectiveness of the program, will be as follows:
* Outcome Indicators- These will reveal the number of new infections within the healthcare setting, as well as the rate of infection. The number of infected patients will be taken before and after the program is introduced.
* Compliance Indicators- These will measure how well the healthcare organization is following the evidence-based guidelines. Healthcare workers’ access to the antimicrobial agents will be measured in terms of availability and ease of use. The number of handwashing points as well as drying towels will also be recorded (Hansen, Schwab, Zingg, & Gastmeier, 2018).
Importance to Nursing
Nurses play a very crucial role in enhancing patient safety, in ensuring recovery, and in preventing illnesses. Yet, HAIs negatively impact patient recovery by putting their safety at risk as well as adding more diseases to an already sick person. Nurses can enhance infection control through leadership and by providing patients, caregivers, and families with education on the issue (Carrico, Garrett, Balcom, & Glowicz, 2018). This is especially important because nurses interact with patients on a day-to-day basis. Therefore, they have an opportunity to impact the greatest when it comes to infection control, through communication, and through maintaining standard precaution practices and guidelines (Burnett, 2018). Also, according to Rebmann and Carrico (2017), observing appropriate infection control procedures is one of the most crucial nursing practices. Infections pose a great threat to the health and well-being of nurses. It is an occupational health risk and nurses should be in the frontline of enhancing infection control. Further, infection control is of particular importance to nursing during the Coronavirus pandemic because other than taking care of infected persons, nurses have to ensure that the disease is contained to prevent more infections
Section C: Literature Support
Understanding the relevance, preciseness, and validity of literature is crucial for any research. It ensures both the researcher and his readers that the conclusion reached by the study is firmly established on top of substantial pieces of evidence. In this research, the primary literature collected in 'Section B: Problem Description' is evaluated based on its merits. The subsequent analysis includes a description of the search method used, a summary of the studies, as well as a general description of the validity of the internal and external research conducted. Based on these, the author believes that analyzing the validity of the literature collected is essential for the assurance of the validity of the research's findings.
Description of the Search Method
In order to find literature that would support the PICOT question for this research, the author initially used the keyword "Healthcare-Associated Infections (HAIs)" in the searching through EBSCOhost. However, upon using the keyword, the search results provided 2,881 results, which necessitated a narrower and more precise search. Thus, the subsequent search was limited from the period of 2017 to 2020 and that it only includes peer-reviewed articles, as well as those that grant access to the 'full text'. This yielded a result of only 94 articles, which further limited the literature that was used in this research. After this, another general and specific search was conducted using the keywords "antimicrobial agents in a healthcare setting" which yielded 2,980 and 83 results, respectively.
Despite the number of available resources found during the search, it was apparent that additional data is needed especially for general statistics and information about HAIs. To ensure that the information can still be taken from reliable sources, the author conducted a general search in Google's search bar and then sifted through the available sources until only those from valid government websites (i.e., U.S. Center for Disease Control and Prevention and U.S. Department of Health and Human Services) were included.
Summary of Evidence
Generally, all the sources collected contributes to a specific aspect of the research's outline. Initially, the reports of CDC (2019) and the US DHHS (2020), describes the statistics of HAI patients (i.e., infection rate and mortality rate) in the United States as well as other pertinent facts such as the common types microorganisms and the modes of transmission and contamination for such kinds of infections. For instance, the CDC (2019) study revealed that in 2017, about 119,000 patients acquired bloodstream staph infection, and about 20, 000 of them died as a result. In line with the validity of these researches, the author found that the fact that this information was taken just a few years before the writing of this paper as well as that it is an official count taken by government agencies, making it valid for this research.
In contrast to this, studies conducted by Burnett (2018) and Hansen et al. (2018) describes some of the common reasons for HAI and provides technical knowledge about these kinds of information. One the one hand, Hansen, et al. (2018), suggested the use of healthcare-associated infection (HCAI) surveillance in the research settings determine baseline data and post-intervention results to determine the efficacy of the procedures. Accordingly, the strength of this research is the employment of 297 hospitals with established procedures (i.e., regular handwashing) against HAI infections. On the other hand, Burnett's (2018) work described technical terms such as infection control and prevention, cross-infection, and gram-negative bloodstream infections, among others. This systematic review of some of the challenges in treating HAIs provides some of the best practices based on an analysis of several peer-reviewed journals and reports in the United States.
Lastly, it is also essential to consider that proper implementation of EBP practices should always be considered in implementing an intervention similar to this study. Thus, other studies collected provides for specific nursing practices and guidelines that would allow for more effective implementation of EBP research. One example of this is Carrico et al.'s (2018), work about the essential nursing guidelines against HAIs include the processes that should be done in order to reduce healthcare to patient infection. This roadmap includes the "eight-core practices" that the author was able to take and provide a more in-depth analysis of the CDC's implementation guidelines. Another critical study in terms of EBP implementation is Rebmann and Carrico et al.'s (2018) study about routinary procedures to mitigate nosocomial infections. This includes some of the gaps between theory and implementation that causes the failure to mitigate nosocomial infections in the healthcare setting. For example, his systematic review of implementation procedures and staff practices regarding hand hygiene shows that staff are washing their hands less often than they should have. This contributes to the research by showing that implementation procedures for the intervention should be stricter in order to lessen errors.
All in all, the author finds that the current list of literature gathered in section B is essential in contributing to the whole research. In addition to this, each of them was reviewed for their validity and was found to be technically updated and valid. However, it seems that one of the pitfalls for the current list is the need for literature that correlates handwashing with antimicrobial agents and HAI rates directly.
Section D: Solution Description
Creating a viable, effective, and efficient intervention for any problem requires an understanding of the different circumstances surrounding the workplace. This includes, not only how it would improve patient satisfaction and well-being, but also how it would reduce costs, improve adherence, and reduce human reluctance, among others. In this article, the author would like to discuss his solution regarding the PICOT question proposed in the previous sections of this research. This includes its applicability in the healthcare setting where the study is to be conducted, as well as the expected outcomes of this research.
Solution Description
In order to achieve the reduction of Healthcare-Associated Infections (HAIs) in this research, the author would like to propose the use of antimicrobial agents (i.e., antiseptic agents) for 12 months, in order to reduce the rate of HAIs within long-term care facilities where the EBP will be applied. Burnett (2018) described that one of the most common types of HAIs is caused by gram-negative bloodstream infections, especially for those who are under long-term care. In this study, the main population is patients who are confined in long-term care facilities, which increases their risks of HAIs brought about by the said bacteria (Hansen et al., 2018). Thus, as presented by the CDC recommendations (2019) as well as from the study of Carrico et al. (2018), then HAI prevention would be better achieved with the use of antimicrobial infections rather than only using soap and water.
Organization Culture and Viability
Generally, there are two things to consider in the implementation of this intervention in a particular healthcare setting where this will be applied. On the one hand, the facility does not have enough budget to implement costly addition to procedures since it is a low-cost public care facility. This means that the intervention must also be cost-effective in reducing HAI infections. Nonetheless, an interview with the hospital director revealed that the addition of the use of antimicrobial solutions is viable.
On the other hand, the possible reluctance (conscious and unconscious) of the workers to the intervention could lead to false results. Thus, aside from the shift in using antimicrobial agents, the intervention would also include the proactive use of 'roadmaps,' 'signs,' and regular 'lectures' in order to ensure that adherence to the intervention is met (Rebmann & Carrico, 2017).
Measurements and Outcomes
By adhering to the intervention proposed in this EBP, the author believes that the long-term care facility would experience about 10% to 15% reduction in HAIs after 12 months (Haque et al., 2018). However, in order to measure this, a baseline measurement of the average rate of HAIs before the intervention should be made using Healthcare-Associated Infection (HCAI) Surveillance Systems that would help assess if there is a significant different between pre- and post-i...