Addressing Complexes Issues in Healthcare

Introduction

In order to improve care quality and optimize resources, the American Recovery and Reinvestment Act (ARRA) that prescribes using the Electronic Health Records (EHRs) was introduced in 2015. The employees of Home Health Aides (HHAs) are largely resistant to implement electronic documentation in their practice due to a lack of technology knowledge, which limits the effectiveness of care, costs, and time.

As reported by Sockolow, Bowles, Adelsberger, Chittams, and Liao (2014), their study shows that “90% of notes were completed within the 1-day compliance interval (n = 56,702) compared with 30% of notes completed within the 7-day compliance interval” (p. 459). This problem makes a negative impact not only on the healthcare system but also a patient’s life, impeding his or her recovery and causing preventable hospitalizations. If no action is taken, care providers would experience low workplace satisfaction, patients would suffer from longer treatment periods, and costs would not be reduced.

Healthcare Professionals Needed to Make a Positive Change

The interprofessional team is necessary to address the complex issue of electronic documentation resistance that often occurs in nurses, physicians, administrators, and other staff members. Communication is the universal tool to ensure that all the persons engaged in care are reached regardless of settings and internal factors (Kruse, Kristof, Jones, Mitchell, & Martinez, 2016). A leader is the first responsible team member, whose role is to understand the roots of resistance and identify several possible solutions. Nurses, home health aides, and social workers are the persons who directly interact with patients, and their contribution to stabilizing the tracking process is essential.

Technologists should be contacted, for instance, to design a training program for staff to make it easily comprehensible and apparently advantageous. The accomplishment of a meaningful change depends on the cooperation of the mentioned team members. For example, in case a nurse received education, yet she or he considers it useless, it is likely that resistance would remain (Sockolow et al., 2014). Therefore, the leader is expected to explain the significance of EHRs for both the organization and its employees.

Possible Difference in Point-of-Views/Concerns

While elaborating on overcoming resistance to change, the leader should consider how team members perceive the introduction of EHRs. The recent research specifies the fear of additional control that is experienced by many physicians (Safi, Thiessen, & Schmailzl, 2018). In their turn, the responses of nurses are marked by feelings of insecurity and uncertainty, which are noted as the issues that affect their day-to-day practices. It is important to note that nurses also perceive EHRs as a cumbersome and unclear system that threatens their daily routine, for example, communication with patients and procedures.

Technical professionals who are not fully aware of care services may deliberately or unintentionally ignore their needs and provide less detailed instructions (Safi et al., 2018). The most feasible anticipatory measure that can be applied by the leader is to prepare preliminary training specific to the professional scope of the target audience. Another measure is associated with conducting brief conversations with several staff members representing various disciplines to reveal any problems.

Improving Synergy and Collaborative Approach

Transformational leadership is connected with mutual commitments between leaders and employees in an organization. This style implies that leaders are expected to engage people in the change process and arouse their enthusiasm (Weng, Huang, Chen, & Chang, 2015). In case of the given problem of addressing resistance to electronic documentation use, it is critical to understand the key barriers and opportunities, which is consistent with the principles of transformational leadership. The leader should reawake the interest of stakeholders in achievement and development through applying a set of strategies, including simulation and Watson’s Caritas Processes.

Simulation in nursing refers to the thinking of people, namely the patterns and perceptions they use to make conclusions about one or other phenomena. In doing so, the leader encourages followers to use their imagination and challenge the accepted ways of performing their work and increase self-awareness (Morin, 2017; Weng et al., 2015). The leader reconsiders the assumptions, creates a broad picture, and is willing to consider all the ideas suggested by employees. By this, he or she shows that followers should not hesitate to think critically, use imagination, and act as active members of the change progress.

Watson’s Caritas Processes is a humanitarian and inclusive approach that can be used to create collaboration in the team. A vivid characteristic of this strategy is in-depth attention to a person and recognition of the leading role of consciousness, kindness, and authenticity in interaction, as well as the indispensable joy of teamwork as the goal (Gomes, Hash, Orsolini, Watkins, & Mazzoccoli, 2016). The leader using Caritas Processes should master the skills of attention, expectation, succession, recognition of any behavior as an act of communication. In addition, the team principle of work is to be emphasized.

The entire team should master the key principles of the method and use them in everyday interaction (Gomes et al., 2016). Thus, this strategy can be attributed to environmental approaches that are primarily aimed at creating a supportive communicative environment that allows developing proper relationships.

As for my personal strengths as a leader and communicator, I can focus on my abilities of interacting with people and inspiring them to change by clear explanations of potential benefits. At the same time, I am good at recognizing people’s emotions and feelings, which helps me to select proper words to speak to them. However, I consider that I should work more on expressing my ideas and setting clear goals so that my employees would effectively achieve them within the deadlines set. While the majority of staff I work with trust me and communicates openly, there are still some employees who evidently hesitate to share their thoughts.

Adopting a Patient-Centered and Relationship-Based Approach

A relationship-based care delivery system will be applied to ensure patient-centered and relationship-based approaches. Fitzpatrick (2014) states that a healing and caring environment should be created to involve patients and their families. There are six key components that need to be taken into account to deliver proper care and promote employee satisfaction, including teamwork, professional practice, leadership, care delivery, resources, and outcomes (Fitzpatrick, 2014). The use of this method is likely to allow facilitating the expected behavior and addressing errors in care processes. Thus, relationship building will be utilized as a way to achieve patient wellness and technology adoption.

In Summary

The complex problem of overcoming resistance to technology in HHAs is associated with feelings of uncertainty experienced by staff. It was found that different health care professionals may be more concerned with their area of interest, which should be taken into account by the leader and the strategies to be introduced. The transformational leadership style was regarded as the one that meets change needs in this case due to its focus on vision, inspiration, communication, and commitment. In terms of the ethic of care, interpersonal relationships will compose the basis for nursing practice.

References

Fitzpatrick, J. J. (2014). Relationship based care and the psychiatric mental health nurse. Archives of Psychiatric Nursing, 28(4), 223.

Gomes, M., Hash, P., Orsolini, L., Watkins, A., & Mazzoccoli, A. (2016). Connecting professional practice and technology at the bedside: Nurses’ beliefs about using an electronic health record and their ability to incorporate professional and patient-centered nursing activities in patient care. Computers, Informatics, Nursing, 34(12), 578-586.

Kruse, C. S., Kristof, C., Jones, B., Mitchell, E., & Martinez, A. (2016). Barriers to electronic health record adoption: A systematic literature review. Journal of Medical Systems, 40(12), 252-259.

Morin, A. (2017). The “self-awareness–anosognosia” paradox explained: How can one process be associated with activation of, and damage to, opposite sides of the brain? Laterality: Asymmetries of Body, Brain and Cognition, 22(1), 105-119.

Safi, S., Thiessen, T., & Schmailzl, K. J. (2018). Acceptance and resistance of new digital technologies in medicine: Qualitative Study. JMIR Research Protocols, 7(12), 1-9.

Sockolow, P. S., Bowles, K. H., Adelsberger, M. C., Chittams, J. L., & Liao, C. (2014). Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes. Applied Clinical Informatics, 5(2), 445-462.

Weng, R. H., Huang, C. Y., Chen, L. M., & Chang, L. Y. (2015). Exploring the impact of transformational leadership on nurse innovation behaviour: A cross‐sectional study. Journal of Nursing Management, 23(4), 427-439.