Impact Of Innovative Change On Healthcare Environment: Leadership Theories, Innovation, And Change Management

Discussion

Discuss about how an initiated innovative change by the author’s organization impact on our healthcare environment, associated with various leadership theories, innovation and change management.

According to Ashcroft et al (2015), medicines or drugs are the most commonly employed clinical interventions under the healthcare settings. However, the use of drugs towards the successful treatment of the patients is at times associated with sudden degree of error. Berdot et al. (2012) argued that medication error can occur during, dispensing, prescribing and administration of drug. The results of this medication error are fatal which may lead to the development of chest aspiration, pneumonia or worse intracarnial haemorrhage. In relation of medication management, Berdot et al. (2012) is of the opinion that the drug error is the single most avoidable cause behind the subsequent patient’s harm. In order to reduce the medication cost subsequent harm to patients electronic medication administration records are gradually gaining importance (eMARs). According to Guo Iribarren, Kapsandoy, Perri and Staggers (2011), eMARs can be used to support medication management in order to decrease the rate of medication errors, while promoting patient safety along with the improvement of the overall workflow efficiency.

Leadership

According to Scully (2015), nursing is challenging yet dynamic profession which demands engaging and inspiring leaders and role models. In present day ever changing yet extremely demand healthcare environment, proper identification along with development of appropriate nursing leadership is one of the biggest challenges experienced by the individuals in the nursing profession. The overall concept of the nursing leadership is complex and has multi-dimensional approach. Hutchinson and Jackson (2013) is of the opinion that effective nursing leadership is regarded as one of the essential factor towards achieving optimal patient centred outcomes along with proper workplace enhancements. There are numerous nursing leadership theories however, not all the nursing leadership theories align with all the successful change implementation in the healthcare domains (Scully, 2015). According to Grossman and Valiga (2016), transformational and transactional leadership are the two most well-studied leadership theories in nursing professionals. Both the transformational and transactional leadership theories span both the organisational and cultural boundaries and have been critically validated and accessed in numerous studies.

Transformational leadership is akin to visionary and charismatic leadership. Leaders who abide by the transformational leadership inspire, motivate their followers in manners that extends beyond rewards and exchange. Transformational leadership executes expectionally well under close supervisory relationships in comparison with more diverse relationships and this closer supervision is more typical in order to implement certain administrative change like the use of the eMARs in nursing health care settings. This integrated relationship may be typical of a supervisee-supervisor relationship and is also captured under the notion of “first level leaders” who are thought to be important due to their effective functional proximity with their supervisees under a particular healthcare setting (Hutchinson & Jackson, 2013). Hutchinson and Jackson (2013) argued that transformational leadership increases the overall intrinsic motivation via expression of the importance along with the values of the leader’s goals and thereby helping to implement the change. Transformational leadership will be best suited in order to implement change in medication management via eMARs because transformational leader has been described as an engaging leader who develops the followers via creating a proper vision that generates meaning towards the change along with proper motivation. Via stating a promising vision along with proper enthusiasm and accurate confidence, transformative leaders are said to develop a firm sense of identification within the organisation thereby persuading individuals to transcend their own self-interest. However, transformational leadership model has certain form of limitation like dichromatic interpretation of the leadership while keeping the focus upon the heroic or charismatic leaders and providing minimal insight into the leader integrity (Hutchinson & Jackson, 2013). Nevertheless, these limitations can be overcomed via the human-capital-enhancing resource management style of transformational leaders. This particular style will motivate the members of the team beyond their own expectations and thereby helping them to inherit and successfully implement the change in the medication management under nursing care (Hutchinson & Jackson, 2013).

Leadership

In contrast to the transformational leadership, transactional leadership model is based on “exchanges” between the follower and leader under which the follower is rewarded for satisfying specific performance criteria or goals. Though transactional leadership is more practical in nature as it give importance towards meeting specific targets or objectives, it has certain level of limitations (Dumdum, Lowe & Avolio, 2013). Dumdum, Lowe and Avolio (2013) is of the opinion that transactional leaders are said to achieve performance when required via contingent rewards or via negative feedbacks. The focus of the transactional leaders is to focus mainly upon the structures while clarifying the tasks along with providing valid rewards only for extra efforts or satisfying the requirement of the team members only when they meet or comply the expectations. This specific pattern of achieving performance of the followers via contingent reward has been conceptualized as much lower order leadership function. Thus the transactional leadership model might not be suitable for the implementation of fresh new change in the nursing practise. Clarke (2013) is of the opinion that while implementing any advanced technological change in the nursing practise like in the case of eMARs, it is the duty of a nursing leader to acknowledge each and every initiative taken by a nursing professional towards effective medication management through eMARs. Rewarding only added efforts will only create a disgust or unwillingness to implement the change and thereby creating failure towards successful utilization of the eMARs in reducing medication error and management (Clarke, 2013).

However, Frankel and PGCMS (2018) are of the opinion that a given nursing leader may exhibit a varying percentage of both the leadership that is transformational or transactional leadership. These two theories of leadership models or theories are not mutually exclusive and few combinations of both might increase effective leadership and overall change management outcomes.

In the concerned organisation (the main organisation of interest in this assignment), leadership traits are also taken into special considerations apart from abiding by one specific leadership model. According to Stanley and Stanley (2017), these specific leadership traits are an important determining factor behind the clinical leadership in nursing professional. Stanley and Stanley (2017) further argued that clinical leadership in nursing is a special practise domain that employs interpersonal communication skills in order to support nurses to procure high quality patient care. According to Gesme and Wiseman (2010), effective and frequent communication is important during the change implementation at strategic, operational and at individual level. When promoting a transformative change, Gesme and Wiseman (2010) argued that effective communication is extremely important in order to communication few basic question lying behind a particular change and this includes “who”, “what”, “where”, “why” and “how”. Other level of clinical leadership after communication that must be displayed in all level of nursing is fostering a team culture. Under this leadership trait, a nursing leader with manage the change process via encouraging the participation of the individuals involved in the change. This emphasizes the importance of the team culture where everyone will be motivated enough to work towards the common goal (change implementation). Moreover, an efficient nursing clinical leader must also provide feedback along with positive reinforcement to the team members in order to motivate them to work effectively towards the change. According to Gesme and Wiseman (2010), individuals want to know how are they performing or whether their efforts are making any difference towards the change. Thus providing periodic feedback to the team members will help to document the entire process of progression along with the reinforcement of the new behaviours. Another trait if a nursing leader that must be reflected in order to implement the change is identification and empowerment of the champions. Gesme and Wiseman (2010) argued that all changes demand visible champions who are devoted towards the goals and can lead other members of the team. It is the role of a nursing leader to know the strength of his or her team members. Here strength signifies to recognise the individuals with natural leadership skills who will in turn convince the peers towards optimal implementation of the change.

Clinical Leadership

Effects of working environment on planned change via SWOT analysis

Strength:

The main strength of the eMAR is related to quick and timely access of the medication related information for the patient by the nurses (Shahmoradi, Darrudi, Arji & Nejad, 2017). According to Moreland, Gallagher, Bena, Morrison and Albert (2012), the use of the eMARs enable the nursing professionals to access the medication related information of the patients whenever and wherever required. This greater access to information will help to improve patient care and at the same time the concerned nursing professionals will be able to communicate with each other remotely.

Weakness:

The main weakness of the implementation of the eMARs is mainly associated with the lack of proper hardware and compatible infrastructures (Shahmoradi et al., 2017). The amount of investment required to perchance and simultaneously install eMARs is the main barrier towards the optimal adaptation of the eMARS. Apart from significant amount of capital investment, another weakness of implementation of eMARs is high demand of the information-technology workforce in order to link, store and handle the data encryption (Staggers, Iribarren, Guo & Weir, 2015).

Opportunity:

The main opportunities behind the implementation of the eMARs under hospital settings for proper medication management is proper sharing of the information between the doctors and the nurses and thereby helping to increase the quality of care along with decreasing the gap of information exchange between both the groups of health care professionals (Moreland et al., 2012). Moreover it will ensure semantic co-ordination and communication between the external and internal system along while maintaining integrity (Shahmoradi et al., 2017).

Threats:

The main threats arising behind the optimal implementation of the eMARs under hospital settings is the unwillingness of the healthcare professionals to spontaneously adopt this electronic software. The reluctant is learning the technical specificities required for handling eMARs may create a disturbance within the entire synchronization of the work-process. Moreover, lack for proper stringent privacy regulation in the technicalities of the eMARs have lead to unauthorised access of the patient’s medical information leading to bridging of the ethical issue of privacy and confidentiality (Middleton et al., 2013). According to Shahmoradi et al. (2017), the limited awareness among the healthcare professionals about the entire concept of the eMARs might create a gap in proper handling and implementation of the latest technical advancement.

Table 1: SWOT

(Source: Shahmoradi et al., 2017)

According to Al-Balushi et al. (2014), change management is defined as an application of a set of tools, skills, processes and principles for effective management of people side of change in order to obtain the needed outcomes of a change initiative or project. Al-Balushi et al. (2014) is of the opinion that change in healthcare is progressing with a rapid phase as the practises strive to implement new regulator and policy guidelines. Under this environment of change the implementation of eMARs is extremely a path-breaking steps as this change is taking place under some circumstances where healthcare providers are still attending patients and at the same time trying to maintain a healthy work life-balance. For obvious reasons these are stressful times for the healthcare providers and adapting to change has become a part of their professional life. Fortunately, change management is well-developed domain with prominent evidence and evidence and adequate learning practices on how to successfully manage the overall change process.  One of the leading notable tinkers in managing organisational change and delivering applicable strategies for navigating change is John Kotter (Hornstein, 2015). According to Kotter, change has both situational and emotional components for proper optimal implementation of change Kotter has proposed a multi-step change model. This model is arranged in three main phases in order to assist the leaders to effectively manage the challenges that are inherent under any initiative of change (Hornstein, 2015). Another change management model is Lewin’s change management model. Lewin’s change management model is based in three stages of change management and this includes unfreezing, change or transition and re-freezing (Shirey, 2013).

Innovation and Change Management

Lewin’s change management model

(Source: Shirey, 2013)

For the optimal implementation of the eMARs, Kotter’s change management model will be extremely effective. The below mentioned diagram attempts to illustrates how Kotter’s three-phase approach can be employed while planning a change from the present way of executing business and caring for patients with a vision of future practise that optimizes the application of technology to deliver high-quality, safe and effective patient care services while adequately satisfying the regulatory requirements (Boonstra, Versluis & Vos, 2014).

Figure: Kotter’s Change Management Model for the implementation of eMARs

(Source: Boonstra, Versluis & Vos, 2014)

The phase 1 of the model, the practise leaders are required to create a climate for change via establishing a sense of emergency, establishing a guiding coalition and via creating a vision for the future state of state. For creating a future state or vision the leaders are required to communicate the priorities and goals of successful implementation of eMARs. This can be done via organising interactive meetings so that the stakeholder of the eMARs clearly understands the future goals and success provision of eMARs (Hornstein, 2015). According to Cresswell and Sheikh (2013), soliciting and employing input from interdisciplinary sources can make cultural change from small practices. Communication of the vision of change will be followed by the identification of champions or multiple champions in order to lead the guiding team. Here the champions should be nursing professionals along with administrative who are essential for the success in implementation of eMARs. Selection of champions will be followed by the establishment of the project plan that will cover all aspects of EHRs implementation. However, Cresswell and Sheikh (2013) argued that the vendor-supplied project plans generally need to be adapted in order to include all aspects of project along with unique needs of practise.

Phase 2 deals with communicating the future state; empowering others to take necessary actions towards satisfying the future state and plan for short-term wins. In the domain of implementing the change practise through eMARs, communicating the future state of plans will mainly deal with the engaging nursing staffs in the process of system selection and implementation. This will help them to compare the practise’s clinical and business needs under the specification of eMARs. In order to empower nursing professionals to take required actions in the future state, specific trainings are required to be conducted followed by evaluation of the usability of the training. This training will mainly deal with the education of the nursing professionals towards optimal use of eMARs in medication management along with reporting of the medication error (Kuo, Liu, and Ma, 2013).

Implementation of change can be achieved via engaging staffs in all stages of implementation process. The staffs, those who perform better or found to be taking extra initiatives towards the effective implementation of this technological advancement in healthcare will be rewarded and recognised. According to Gottesman et al. (2013), celebrations bring individuals together under an informal or relaxed settings and thereby helping to inherit the entire change process. Gottesman et al. (2013) argued that towards the implementation of the change, staffs were required to address the entire domain in the eMARs. This will eventually help to determine which particular fields will be important for quality reporting and thereby significantly reducing the number of fields. This will in turn promote the sustainability of the overall process.

Evidence based practise in nursing is defined as special conscientious and judicious application of current best evidences along with the clinical expertise and values of patients to guide the overall healthcare decisions (Stevens, 2013). The change is need to be based on evidence based practise because research findings, basic science, clinical knowledge and opinions of the experts are all considered “evidence”, however, the evidence based practice based on the findings of the research are more likely to produce desired patient outcomes under myriad settings. The main impetus of evidence-based practice generates from health care settings pressures for financial constraints, increase availability of information and increased service user’s savvy towards care and treatment options. Moreover, evidence-based practise procures new opportunities for nursing practise while maximizing the effects of clinical judgement (Stevens, 2013).

The evidences supporting the effectiveness of the eMARs have been obtained from the journals and the peer reviewed articles obtained by brainstorming through the databases of the Cochrane, JBI and the World Health Organisations (WHO). Such a level of evidence is required for determining the effectiveness of a particular intervention. These databases provide a rich quality of medical journals having high levels of evidence supporting the interventions. Apart from critiquing the evidence regarding eMARs, it also provides with the possible recommendations to improve the future scope of practice.

The eMARs have serious implications on the safety care delivery of the patient. It not only improves the patient safety but also reduces the amount of time spent on manual documentation of the health records. They can also contribute to less medication errors and the 45 % reduction in the time of documentation (Qian & Hailey, 2015). Other benefits that have been discovered are that it improves the nurse’s compliance with the requirements of the documentation, freedom from the error of signing more than twice and reduction in the possibility of forgetting to administer medications to a patient.

Hence it can be said that although electronic medication administration cannot reduce the nursing time spent by the caregivers in providing care to the patient or modify the medication administration process, but can definitely avoid the adverse consequences or can generate adverse consequences (Moreland, Gallagher, Bena, Morrison & Albert, 2012). Future researches may investigate how to prevent the adverse consequences.

Conclusion

Thus from the above discussion, it can be concluded that in order to reduce the rate of the medication error and effective medication management implementation of eMARs is a must. In order to implement new technology (eMARs) under healthcare settings, the main model of leadership that must be taken into consideration is transformational leadership in comparison to transactional leadership. Moreover, a prospective leader is required to execute effective clinical leadership skills into the implement this technological advancement at the grass root level. The assignment also highlights that the main change management model that should be used in order effectively manage the threats and the weakness of the eMARs system implementation in healthcare is Kotter’s change management model. Lastly, proper evidence based approaches are required to be source from WHO and other peer-reviewed journals in order to effectively backup the overall process of optimal implementation of eMARs

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