Practical Application Of Lewins Force Field Analysis Change Model Nursing Essay

Practical Application Of Lewins Force Field Analysis multifariousness exemplar Nursing EssayThe aim of this paper is to to describe practical coating of Lewins (1951) force field abridgment compound model in reduce Intensive caution Unit ( intense carry off unit of measurement) longanimouss aloofness of repose (LOS) in a Tertiary dispense University Hospital.IntroductionThis paper reports on a dislodge from 6.5 old age to 4 days reduction in Intensive Cargon Unit (intensive cargon unit) patients length of stay (LOS) in a Tertiary Cargon University Hospital. The compound was em hit the sackded with systemic assessment, planning and implementing standardized strategies for all intensive care unit long stay patients and finally evaluating the efficiency and effectiveness of ICU bed utilization with multidisciplinary squad approach. multifariousness is inevitable for the reason that it ingrained homophile lives, core moti angiotensin-converting enzymes and system refo rms. Day by day m either shifts beget been observed in wellness vex associated with disease bear upones explicitly from measure to rehabilitation, health safekeeping norms and nomenclature, infra structures modifications, policy matters, reengineering and system transformation. Different components of health c are depends on one an opposite for assembling such alternates in localize to produce work like from providers to payers, hospitals to suppliers, education to regulatory bodies and explore to pro associations all these are interlinked to perform function. Many of the above say happening are planned however at clips temperament takes its own turn to act as a catalyst for permute for example natural occurrences like tsunami, some crucial system analysis like break through reports from Institute of Medicine (IOM) on patient safety and the quality of care provided to all the health care customers. These were unsloped simple examples of revolutions in health care take n place on an ongoing institution. Traditionally it is believed that win overs are al ways for the betterment however at times it has been observed that this phenomenon is proven to be cynical and challenging particularly when it is not do in a haphazard manner, without pursuing mixture management principles. Addressing the challenge of swap Fetherston et.al (2009) press outd thatManaging changing in the health care setting is always challenging, especially when it involves transforming entrenched habits grounded in professional expectations (p.2581).Despite change involves resources like human, material and cost and therefore whatever is proposed for change exact to be evaluated for its effectiveness and efficiency, applicability, and consequences. It also depends on the team we are working with and there are times when the team construction is so strong and the conversation between the team is such that adopting to a youthful concept is very easy versus if the team memb ers are not on same wavelength and have a lot of differences of opinions failure to hap to a simple consensus. Coch and French (1948) concluded that rate of recovery when teaching a new task is directly proportional to the amount of participation. To change understanding of change dynamics Armenakis and Harris (2011) recommends that readiness for change is distinguished from tube to change and readiness is described in terms of the organizational members beliefs, attitudes, and intentions. Change agent is a very important contributor to make change happen constructively and productively. The personal and professional characteristics, interpersonal competency all these aspects are dependent to an outcome of change. Another factor involved in change process seems to be very crucial is the timeframe require for change. Is it a short term or a long run change which is going to measure and monitor, what more or less the sustainability of the proposed change etc. In purchase order to have successful change Kotter and Schlesinger (2008) recommends and put idea in consecrate (Appendix) and suggested that analyze situational factors, determine the optimal speed of change, and consider methods for managing resistance (p1, 2). jibe to Lippincott-Raven Publishers 1986 Crucial to facilitating change is selecting a dodge that is likely to produce the craved change with minimal time and resistance.BackgroundIn todays health care setting, organizational change is essential for growth and development to keep up with the market competition Although health care continues to be enmeshed with ongoing challenges of cost, technologies, access to health care, human resources, quality inconsistent with an arena where actus reus rates are too mettlesome there are manifold growing opportunities to improve client care management and service economy components. Changes have been observed in clinical practice based on evidence based research resulting in office of new techn ology, diagnostics, drug regimes, treatment profile, care monitoring and finally the patient outcomes. All these are direct provision to a customer and perhaps if we look at the wider base it heavily involves all support functions available for patient care and employees of the organization. How all these are managed with patient flow and activities? Who is accountable? Change has both(prenominal) individual and institutional significance and addressing its enormousness Watwood et al. (1997) shared that changes bring fortune for personal and institutional growth and development (p 162). When it comes to an institutional change it has emphasised that it should complement the philosophy, mission and vision of the organization. Therefore Heller Arozullah (2001) identified 4 key factors for successful computer program development and achievement and those werealigning the program with the strategic goals of the organization obtaining active senior leadership commitment, includi ng allocated resources securing the appropriate understructure to facilitate integration of recommended actions into effortless practice and setting up opinionated communions with all involved stakeholders (p551)Several challenges exists in system when it comes to a revolution however factors define by Heller Arozullah (2001) would help in embarking change in a more structured manner.ICU is a consolidated commonwealth of a hospital where patients with life-threatening afflictednesses or injuries feature round the clock specialized medical checkup and nursing care. Intensive care is one of the hospitals most complex and expensive medical systems. As medical care has improved, the type of patients treated in circumstantial care units has changed from those with tart illnesses to those suffering from complications of chronic diseases. While better technology and better ways of taking care of patients has improved longevity and general health, the patients in the intensive c are units of hospitals are getting sicker and globally these beds have a high demand based on the critical needs of patients and it doubles the need in an arena where these resources are very scare and inadequate This would join on medical care required, cost of care and excess use of resources when they are not required. Long stays in the intensive care unit are associated with high costs and burdens on patients and patients families and in turn carry on society at large. Williamss et.al (2010) states thatIt has been estimated that between 2% and 11% of critically ill patients require a prolonged stay in ICU, accounting for 25-45% of congeries ICU days, and a significant proportion of resources(p 459)The cost of caring for patients in ICUs in the United States has been estimated to account for 1% to 2% of the gross interior(a) product shared by (Miller et al. 2000, Seeman David 2004) ) whereby Haugh (2003) verbalize that 15% to 20% of US hospital costs represents 38% of total US healthcare costs. correspond to Miller et al. (2003)the total number of hospitals, hospital beds, and inpatient days decrease during the years 1985 to 2000, the number of critical care beds and days in critical care add-ond dramatically during the same periodWhereby Stricker et al (20037) base that only 11% of patients admitted to the ICU stayed for more than 7 days, these patients utilize more than 50% of ICU resources. Furthermore, in several studies (cited in Ryan et al 1997, Wong et al 1999) the mortality of patients with ICU admissions lasting 14 days or yearlong was estimated to be n primordial 50%. Rosenberg et al. (2001) shared that Mortality rates are higher in ICU than in any other area of the hospital due to the complexity of patients medical condition. Fakhry et al (1996) found that 70% of patients with stay all-night than 2 weeks reported less than 50% operational recovery. Esserman e t al (1995) found that 32% of ICU resources were variationed out caring f or patients who survived less than 100 days after put down from the hospital.In a tertiary care university hospital where I am currently working patients were found to be stuck in the ICU and have longer stays and in the month of January 2009 it was found to be 8.4 days and afterward in the following quarter 1 it was 6.5 days (refer appendix 1). When explored, eight-fold factors aroused (refer appendix 2) and therefore to address this concern a multidisciplinary team was formed. It was proposed to undertake the work of reducing patients length of stay in ICU and therefore it the goal was to reduce patients length of stay from 6.5 days to 5.5 days in the second quarter for the year 2009.Rogers and Shoemaker (1971) framework was used to appraise the various component of the proposed change in order to distinguish its strengths and weaknesses.Team assessed its relative advantages to current situation and felt that it is worth expenditure the time and effort for the wedded scenar io, change seems to be appropriate and congruous with existing philosophy of the clinical area, easy to be understood and relevant by all bedside staff. Moreover the project was trialable to a pilot originally going the whole way and relevant to organizational goals.DiscussionChanges pull up stakes continue as an adaptation and at times mandatory in order to survive. Lot of literature is available when it comes to the change management in health care setting. There are models available to address organizational change, system revolution, and human transformations which address many other aspects of successful death penalty of reforms.Change process follows the same function as of nursing process and problem solving approaches.According to Christensen a Christensen b (2007) Lewins (1951) theory of transitional change is the most used form of change implementation strategies. The change we were supposed to undertake this theory appeared to address many aspects of it and theref ore the weapon for identifying the social system within organization for selecting, developing and implementing the strategies to serve as a solution was done by application of this model. According to course notes Lewins widely cited, classic model of the change process, the three changes areUnfreezing, where set about with a dilemma or disconfirmation the individual becomes aware of the need to change changing where the situation is diagnosed and new models of behaviour are explored and tested and finally, refreezing where the application of new behaviour is evaluated and adopted. (p53)Huber (2006) states thatThe basic concept of the change process was draw by Lewin A successful change involves three elements unfreezing, moving and refreezing. (p810)Fetherston et.al (2009) emphasise the importance of major change like this and endorsed thatWhere a major change is implemented, models such as Lewins (1951) model of unfreezing, changing and refreezing can be a useful guide Baul comb (2003) states that This theory places emphasis on the driving and resisting forces associated with any change, and to achieve success the importance lies with ensuring that driving forces outweigh resisting forces. movement forces tilt to initiate change or keep it going whereas curbing forces act to restrain or decrease the driving forces. The intention to reach a state of equilibrium (p277).UnfreezingLewins change approach fall within three travel and this is the first one where the process of thawing out the system to give motivation for change. Its like getting the team warming up to play their cards getting everybody on the same wavelength and organizing. Huber (2006) shared that the first exemplify is cognitive exposure to the change idea, diagnosis of the problem, and work to generate preference solutions. (p811). Though it was a great challenge for the team however the process of systemic assessment and unfreeze stabilizing the team readiness was initiated for th e give tongue to change. Different strategies were brain stormed in a multidisciplinary team.ICU patients length of stay was self-possessed prospectively. Potential predictors were analyzed for possible association with prolonged ICU stay. Driving and restraining forces were studied (Appendix )MovingThen we proceeded with the second stratum of Lewins theory i.e., moving and changing. It involves moving a target system to a new direct maintaining equilibrium viewing the problem from a new perspective, situation is diagnosed and new models of behaviour. This stage was determine through formation of ICU long stay committee with terms of reference, notification of long stay patients stayed in ICU for more than 7days or earlier if deemed necessary to all concerned, holding see with primary team everyday to discuss next course of action, acknowledgement of patients difficult to wean, patient requiring early tracheotomy to maximize discharge process, initiating daily rounds by multid isciplinary team with primary team. Furthermore, introducing expected admission discharge time (EADT) to facilitate bed identification. According to Hoda (2008) length of stay (LOS) may be influenced by the availability of appropriate high dependency units to discharge patients. criticism on daily basis the need for bed for inpatients and emergency. Admission /discharge policy was reinforced through multidisciplinary approach. Alternate accommodation in other units like CICU and CCU which has same bed accessories and uniform care provision were identified. archeozoic tentative beds are booked in wards before rounds in order to facilitate early bed arrangement and patient transfer.RefreezingThe final stage is refreezing. In this stage new developments are incorporated and improvements are made to stabilize the selected strategies to ensure the sustainability of the project. Daily check at unit and divisional level by bed management coordinator and ICU team. Monitoring on shift base s by charge nurses and nursing supervisors. Interventions involving palliative care, ethics consultations, and early decision about patient transfer and orders writing, family willingness and readiness and other methods to increase communication between healthcare personnel, patients, and patients families were helpful in decreasing length of stay in the intensive care unit. Thus, interdisciplinary communication contend a vital role in improving ICU patients LOS whereby its importance is being defined by Pronovost et al (2003) and point out that communication failures lead to increased patient harm, length of stay (LOS), and resource use (p71). Hence to a major extent the daily communication strategy worked out very well and the team was successful to bring about this change. ICU length of stay was 6.5 days in quarter one and it was reduce to 5.6 days in the second quarter for the year 2009 and so to 4.8 and 4 day in third and fourth quarter of 2009. Fetherston et.al (2009) stated thatWhen change is managed in systematic steps with adequate evaluation and communication throughout the process, it is more likely to result in successful outcomes. (p 2582)Evaluating the Change Project s took place and was received very positively. Following are the most important attributes I have experienced for this successful change like it was logical, efficient, and planned not haphazardthen it was based on explanation of reason for a change so that individuals understand it. after(prenominal) that it was very informative and staff supported change when they were involved in assessment and planning. Change agent interpersonal competency and expertise (knowledgeable) of the given task was outstanding and hence the monitoring feedback on timely basis -to ensure that all team members is on same wave length wa carried out in a very sposticated manner.