Introduction
In the modern clinical world, patient experience is the primary determinant of the efficiency of clinical practice delivery. Henceforth, clinal governance demands progressive clinical audits to inform on these essential practices. This paper discusses a small change project to enhance the patient’s experience based on clinical audit data where the theatre pressure injury prevention audit scored 92%. It entails planning and implementing the small change project while considering the impact of organizational culture and climate.
The change processes integrate the aspect of leadership and the role played by the leaders. The analysis also covers various concepts, including theories and models of change, resistance to change and how to overcome it, and critical evaluation of the audit process. The slight change project focuses on documenting appropriate pressure ulcer prevention equipment in recovery to improve the quality of care delivered to vascular and trauma patients.
The Audit Process
An audit is a clinical process to measure provided services and care against evidence-based standards and minimize the gap between existing practices and best practices. This practice ensures that service users and patients receive the right services from the right personnel and in the correct way (The Victorian Quality Council, 2005). The purpose of clinical audit is to improve the quality of care systematically and collaboratively, thus enabling reviewing the quality of services from an angle of support, development, and improvement. In other words, the audit enables clinicians to detect inconsistencies in the quality of care and highlight the need for improvement.
The four-stage audit process includes preparation and planning, measuring performance, implementing change, and sustaining improvement. In the first stage, the auditor selects a topic agreed upon by all the audit stakeholders and measures it against evidence-based practices (The Victorian Quality Council, 2005). The second stage entails data collection and analysis using correct statistical measurements. In the third stage of the cycle, the action plan is developed to implement and monitor the change process (The Victorian Quality Council, 2005). Finally, a re-audit is done to ensure that the implementation process has resulted in continuous improvements of the services.
The Purpose of Audit and Small Change
The purpose of the audit is for clinical care services to align with those evidence-based standards. The clinicians ensure the alignment by evaluating their daily care delivery practices compared to the evidence-based practices (The Victorian Quality Council, 2005). If the audit finds any inconsistencies, a proper change plan is developed to implement improvement strategies.
The available audit data shows a need for change through inconsistencies in the documentation of appropriate pressure-relieving equipment in recovery (The Victorian Quality Council, 2005). According to the audit findings, the five patients’ vascular and trauma records did not provide a response regarding the proper pressure-relieving devices during their recuperation (The Victorian Quality Council, 2005). The absence of a document directing this process makes the clinicians ignore the right equipment to prevent pressure injuries during recovery (The Victorian Quality Council, 2005). Organizational culture, which entails rules, structures, and norms that guide and restrict behavior, works towards forming a workplace climate.
A favorable climate is a result of a friendly organizational culture and vice versa. According to The Victorian Quality Council (2005), employees behave concerning organizational beliefs and values, reflecting the top leadership’s expectations. Consequently, if the workers realize that the top management has no problem with neglecting a particular issue, they will equally neglect it (The Victorian Quality Council, 2005). In the audit case, care delivery clinicians might have noticed the absence of a document guiding the relevant pressure injury prevention procedures. Although they knew its importance, they ignored it, just like the top management neglected it.
The intended small project entails providing a guide to appropriate pressure-relieving equipment in recovery. This guide will discuss the right pressure injury prevention equipment for vascular and trauma patients. The most obvious equipment is support surfaces, including cushions, pillows, and mattresses used to distribute the pressure to avoid sores adequately (The Royal Children’s Hospital, 2022).
The decision on which support service to use should be based on the overall patient pressure ulcer risk score and weight. The effectiveness of support surfaces is integrated with minimal layering between the device used and the patient (The Royal Children’s Hospital, 2022). The addition of pads, sheets, towels, and dry flows should be avoided to prevent pressure injuries.
The choice of support mattress should be considered in light of the patient’s risk of developing injuries. A patient’s risk increases when they become immobile (The Royal Children’s Hospital, 2022). These are amongst the many aspects this small change project will include in the guiding documentation (The Royal Children’s Hospital, 2022). An essential factor to consider is that different patients will have varied needs depending on their level and location of the surgery, hence requiring different equipment to prevent pressure ulcers in recovery.
The Process of Change Linked with the Healthcare Leadership Model
The healthcare leadership model provides nine dimensions of leadership behavior during the change process. The first dimension, inspiring shared purpose, requires the leader to make courageous challenges for the advantage of the service (The Victorian Quality Council, 2005). The next dimension of leading with care requires exemplary leaders to share a caring environment beyond the workplace (The Victorian Quality Council, 2005).
The leaders should also evaluate information to develop new concepts and connect services by working across the strategic system. The dimension of sharing vision demands leaders to inspire confidence in the future through employees (The Victorian Quality Council, 2005). The leaders should engage the team by stretching them for innovation and excellence and holding them accountable. Developing capability for employees requires creating succession systems for key roles and influencing results through building sustainable commitments.
The Process of Change and Implementation
A critical change process entails five key steps, including preparing the organization for change, crafting a change plan, implementing the changes, aligning the changes with company culture and practices, reviewing the process, and analyzing the results. In the first stage, preparing the organization for change involves introducing the issue of change (Lewis, 2019).
In this phase, the manager helps the employees to recognize and understand the need for change. They create awareness regarding the existing challenge in the organization and how it generates dissatisfaction (Lewis, 2019). In this case, the top clinical manager should discuss with other clinicians how the lack of procedures to use appropriate pressure injury prevention equipment affects the care delivery. That way, the worker can understand the need to align this procedure with the evidence-based standards and will be part of the change.
The second stage requires developing a vision and a plan for the change. Managers must develop the most realistic approach to bring about change (Lewis, 2019). In this case, the clinical manager must draft a plan using various pressure ulcer prevention tools and devices. The plan must also account for different patients, surgery locations, and intensity of involved pressure (Lewis, 2019). Henceforth, the workers will use the most suitable equipment based on the intensity of the patient’s condition.
In the third stage, all the involved persons will follow the steps or procedures outlined to implement the change. The managers must continuously empower employees to take the necessary steps to achieve the change (Lewis, 2019). In this case, the management should provide all the equipment for the clinicians to use in pressure injury prevention. Small wins should be celebrated during this stage to encourage continuing implementation (Lewis, 2019). While working as a team, the members must also anticipate roadblocks they should prevent or mitigate when detected.
The phase of embedding changes with company culture and practices entails considering all the factors involved in the organization. The implementation phase must incorporate the impact of organizational culture and climate, as well as professional, political, social, and environmental factors. The culture and climate of a company can enable or prevent the implementation of a change (Bejaoui, 2020). Therefore, the top management must revise its values and beliefs to create a change-friendly climate. The plan must align with various professional ethics and standards to ensure the change actions do not interfere with expected professional behaviors (Bejaoui, 2020).
Politically, the acquired approach should be within legal limits. The available equipment and consideration should be within legal limits and prevent pressure injuries that deviate from clinical laws (Bejaoui, 2020). The action plan must be formulated to consider the social needs, values, and beliefs of the patient and the healthcare institute. Finally, the approach should preserve the environment by applying the proper temperatures to affect the patient positively (Bejaoui, 2020). In the last stage, conducting an analysis and review of the progress helps to determine whether the change meets the intended purpose.
Leadership Styles
There are a variety of organizational leadership styles, including transformational, participative, and delegation. Transformational leadership emphasizes transformation and change, where leaders inspire followers to achieve more effectively than imagined by tapping into team members’ potential (Demirtas, 2020). This style is the most effective in change because the leaders explore qualities such as freedom from conflict, emotional expressiveness, self-confidence, and self-determination (Demirtas, 2020). Transformational leaders are people-focused and can effectively work with other professionals and collaborate to achieve goals. The leaders are aware of their ability to inspire and drive change, thus combining all these abilities to implement the change.
The second and third styles are participative and delegation, respectively. Participative leaders listen to their employees and include them in decision-making. The leaders have self-knowledge, determination, and resilience (Demirtas, 2020). Following their inclusive ability, participative leaders can easily collaborate with other professionals to drive change. They know the power to consider other people’s opinions and formulate them into the best, inclusive decisions to develop the most effective action plan (Demirtas, 2020).
Delegative leaders practice hands-off or less-involved norms where the employees can formulate an action plan and implement it without supervision (Demirtas, 2020). These types of leaders are driven by self-confidence, resilience, and trust and entrust their employees to deliver the best. Delegative leadership is ineffective in driving changes in a firm because the leader cannot collaborate with other professionals to develop and implement changes (Demirtas, 2020). Furthermore, they are least self-aware of their leadership abilities because they are rarely involved in driving changes.
Theories and Models Related to Change Management
Several theories and change management models explain the aspects involved in effectively achieving a change. One of the theories is life cycle or linear non-dynamic, where a new effect is influenced by the previous change being implemented (Lewis, 2019). These change processes are accurate, orderly, causally, and statistically represented. The problem with this theory is that it lacks feedback, yet it is a significant aspect of change.
Another theory is dialectical or linear dynamic, where the concept’s initial, immediate, and end states keep changing (Lewis, 2019). The end of the state can only be predicted and not determined. The lack of predictability is a problem or a weakness because changes must be predicted to estimate the right action plan.
Finally, a teleological theory involves unproportioned cause and effect aspects (Lewis, 2019). A small effect can trigger significant consequences, and a considerable effort can result in insignificant yields (Lewis, 2019). Teleological, like dialectical, makes it difficult to predict the end state of a change.
Lewin’s and Kotter’s Eight-Step Plan are the most common change management models. The first Lewin’s change management model stage is unfreezing, where the firm’s status quo should create awareness of why the change is needed (“Which Change Management Model,” 2020). The changing stage is the implementation phase, where preparation and communication are essential. The next phase, freezing, involves strengthening new processes and structures to include organizational culture and sustainability of the change (“Which Change Management Model,” 2020).
The first step of Kotter’s model is creating a sense of urgency by informing the organization members about the effect of the problem (“Which Change Management Model,” 2020). Top management should converse honestly with employees to convince them to participate adequately in change. The next step involves creating a guiding team by forming a group of suitable people for the change (“Which Change Management Model,” 2020). Depending on the company’s size, the team should contain at least one member from each department (“Which Change Management Model,” 2020). This is to build support and inclusion-based trust amongst all employees.
Everyone should be on the same page when developing a vision and strategy. The change coalition should foresee the future and explain the vision in simple words (“Which Change Management Model,” 2020). The team should also have specific directions about what needs to be done.
The next issue is to involve everyone in the change and create a volunteer team (“Which Change Management Model,” 2020). The change management should communicate more regarding their vision and organize a team of volunteers willing to work on the change as role models to other employees. Next, the possible barriers to change must be removed, and the focus should be on short-term wins (“Which Change Management Model,” 2020). Barriers can be removed by ensuring that the vision aligns with organizational structures, job compensation, and performance.
The management must recognize and celebrate small wins to motivate employees. The last two steps are keeping the momentum going and accepting new approaches in the organizational culture (“Which Change Management Model,” 2020). Strategies to sustain the change are needed, and all stakeholders must be willing to accept new approaches to doing things (“Which Change Management Model,” 2020). Starting the change process with the most achievable strategies regardless of what change model is in place matters to motivate workers.
An example of a model that could be applied to the slight change plan is Lewi’s change management model. In the first refreezing stage, the clinical managers should help other clinical employees understand the problem of not using pressure injury prevention equipment. Once the employees understand the urgency of the change, it is the right time to commence it.
Stage two is implementing the change; preparations and communication are vital (“Which Change Management Model,” 2020). As the employees learn about the new processes and expected behaviors, they might develop negative perceptions and rumors that must be mitigated immediately. The managers should ensure that employees minimize gossip and have the correct perception about applying preventative measures. The freezing stage entails the stiffening of premium processes and structure (“Which Change Management Model,” 2020). The use of preventative equipment is made the organization’s culture, and the managers develop ways of sustaining these practices.
Resistance to Change and Overcoming Strategies
An organization might experience resistance from a few stakeholders during the change process. Resistance is the unwillingness to adapt to new concepts or ways of behaving. There are several reasons why employees may resist change in a business (“Which Change Management Model,” 2020). These reasons are the fear of the unknown, poor organizational culture, lack of awareness of reason to change, lack of trust or support from leaders, and change of job role. Employees may also resist changes if their opinions are not considered during the action plan formulation (“Which Change Management Model,” 2020). Therefore, an organization must streamline its culture to be employee-friendly and overcome such possible resistance.
An accommodating culture includes the employees’ opinions in their final decision (Lewis, 2019). The clinical manager, in this case, should improve the firm culture to be positive. They must also clear employee doubt or fear by becoming trustworthy and adequately explaining the need for change (Lewis, 2019). If the change requires a change in primary employee roles, the change must also be explained in a way that all the employees understand.
Evaluation of Audit
Using audits as a tool to inform and improve clinical practices is effective. The audit process ensures the analysis of all clinical practices of a specific field, for example, in this case, the recovery process for trauma and vascular patients. Through the four audit stages, auditors can detect various care delivery practice problems (The Victorian Quality Council, 2005).
The audit is also essential because it matches the current practices with existing evidence-based care quality standards, thus identifying the needed improvement actions. The audit process provides an action plan to follow during the implementation of change, thus ensuring efficiency (The Victorian Quality Council, 2005).
Furthermore, an audit is critical for ensuring a sustainable strategy for continuously improving patient care. For example, in implementing the change, the managers must develop permanent strategies to guide clinical workers during continuous change. The clinicians will eventually align the practice issues with evidence-based guidelines.
Conclusion
The audit data brings the need for a small change project where strategies to prevent pressure injuries must be implemented. The small change entails documentation of needed procedures in using various pressure ulcer prevention equipment to improve the care of vascular and trauma patients. Clinical leaders, especially managers, must practice the best leadership qualities to implement this change effectively.
A transformational leadership style is the best for implementing the audit change. The clinical leaders will be employee and change-focused, can collaborate with other professionals, and explore their unique attributes to implement change using this style. Theories and models of change management explain various aspects of the change process. Lewin’s change management model can be applied to the audit data to ensure change. Finally, using the audit as a tool to inform and improve clinical practice proves compelling because it puts the patient’s needs first.
References
Bejaoui, A. (2020). Corporate leadership and its role in shaping organizational culture and performance. IGI Global.
Demirtas, O. (2020). A handbook of leadership styles. Cambridge Scholars Publishing.
Lewis, L. (2019). Organizational change. Routledge.
The Royal Children’s Hospital. (2022). Clinical guidelines (Nursing): Pressure injury prevention and management. Web.
The Victorian Quality Council. (2005). Developing the clinical leadership role in clinical governance. Healthcare Quality Improvement Partnership, 1-135.
Which change management model is the best for your organization? (2020). SafeStart. Web.