STRATEGIC PLAN FOR CHANGE

Reflect on the topics you are examining in this course and consider how they relate to your selected problem.

Plan to analyze the problem using principles, theories, and concepts related to leadership and management, as well as other pertinent course themes.

• Review evidence-based literature for data related to your selected problem. You will need to use at least five current (not more than five years old), peer-reviewed articles. Your Instructor may provide some guidance for your literature search.

• Synthesize findings from the research literature and/or drawn from other sources of evidence.

• Develop evidence-based recommendations for addressing the problem.

Write a 5- to 6-page paper (not including title page, references, or any appendix) that addresses the following:

• Introduction/Statement of the problem (1/2 page)

• Review of the literature for potential solutions to the identified problem

• Synthesis of the evidence as applied to the stated problem.

• Strategic plan for suggested courses of action based on your evidence and including application of a change theory.

• Conclusion/Summary Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

Attach is the outline to follow along with problem statement.

needs to be perfect APA format with citations

ANY QUESTIONS PLEASE EMAIL: 

Strategic Plan for Change

 

Walden University-

 

Improving Patient Experience who are Undergoing Chemotherapy from an Outpatient setting to an Inpatient Setting

1. Introduction and Statement of the Problem

1.1. What is the problem?

Outpatient chemotherapy sessions are sufficient in most organizations, especially for those receiving curative intent chemotherapy (Davidoff et al. 2013). The patients who meet the set criteria end up receiving supportive care post induction chemotherapy, as well as different cycles as other outpatients. Outpatient management can be made safe and the transition to inpatient more efficient, which is considered a challenge for most healthcare organizations. The problem at hand in this section has been adequately analyzed, which involves the transition of patients receiving chemotherapy from outpatient to inpatient in healthcare facilities.

1.2. Why is it important enough to warrant a change?

Outpatient care especially for most patient has become a familiar concept that is driven by increased healthcare costs and more so, the increased demand for existing inpatient resources in different organizations (Joana et al. 1987). Improved supportive care in inpatient is also another reason for the need to embrace the transition, and patient wishes to spend the least amount of time, especially in waiting for service delivery in the outpatient setting. With these concepts in mind, it is important enough to warrant a change. Patient satisfaction ought not to be ignored in different healthcare organizations. There is a need to, therefore, be on the forefront in enhancing adequate care, and embracing inpatient plans for the chronically ill patients.

1.2.1. Scholarly Reference #1

Joana, L., Mary, H., Alan, M., Andrew, B., & Steven, C., (1987). Case Mix and Changes in inpatient and outpatient chemotherapy. PubMed 8(4): 65-71.

In most healthcare settings, the therapy provided in outpatient has been associated with substantial tumors, chemotherapy involving high doses, and then followed by autologous stem cell transplantation. Outpatient administration of consolidation cycles has been reported, which emphasizes the major problem in this scholarly soured. According to the authors, the transition to inpatient to outpatient care should be considered and priority to solve the efficiency problems at hand.

1.2.2. Scholarly Reference #2

Hayes, J. (2014). The theory and practice of change management. Palgrave Macmillan.

This source deals with theory and practice of change management. Change management is an adequate practice in the healthcare setting. There is a need for all healthcare organizations to be at the forefront to ensure that healthcare, both inpatient and outpatient are realized. The source provides and explains outpatient inefficiency for chronic patients as the worst problem in the medical profession. The problem under consideration should not be shunned, hence the need to oversee such transition professionally.

1.2.3. Scholarly Reference #3

Michael, E. P, & Thomas, H. L, (2013). The Strategy That Will Fix Health Care. Harvard Business Review.

This source provides a recommendation on what should be done, to solve the most intensive problem in the healthcare fraternity. The source provides a common strategy that can be implemented to deal with the problem at hand. Chemotherapy patients and other chronically ill patients should be given the most effective care, through enhancing efficiency in service delivery. The transition, which is considered a problem, will be beneficial only if correct measures are put in place, to ensure that outpatient to inpatient transition does not affect service delivery and patient satisfaction.

2. Review of Literature

2.1. Research Reference #1

Davidoff, A. J., Zuckerman, I. H., Pandya, N., Hendrick, F., Ke, X., Hurria, A., Lichtman, S. M., Edelman, M. J. (April 01, 2013). A novel approach to improve health status measurement in observational claims-based studies of cancer treatment and outcomes. Journal of Geriatric Oncology, 4, 2, 157-165.

Davidoff et al. (2013) provide relevant information regarding the issue of chemotherapy in outpatients, and the transition of patients to inpatient care. The research is quantitative and aims at describing the aspects which need to be considered, to improve health status measurement especially in cancer treatment and outcomes. The population under consideration includes all chronically ill patients. Cancer treatment and outcomes have also been identified, as well as the strategies that can be used by healthcare organizations to increase efficiency in the management of cancer treatment.

2.2. Research Reference #2

Fisher, M. D., Punekar, R., Yim, Y. M., Small, A., Singer, J. R., Schukman, J., McAneny, B. L., … Malin, J. (January 01, 2017). Differences in Health Care Use and Costs among Patients with Cancer Receiving Intravenous Chemotherapy in Physician Offices versus in Hospital Outpatient Settings. Journal of Oncology Practice, 13, 1, 37.

Fisher et al. (2017) describe the basis of healthcare use and the costs which are incurred by different groups of patients. The focus population includes all patients with cancer, specifically those than receive intravenous chemotherapy in physician offices, versus in hospital outpatient settings. This source helps identify the different cost-effective measures and weigh the benefits which are realized by receiving efficient care especially for the terminally ill patients in different organizations.

2.3. Research Reference #3

Foster, A. E., & Reeves, D. J. (June 01, 2017). Inpatient antineoplastic medication administration and associated drug costs: Institution of a hospital policy limiting inpatient administration. P and T, 42, 6, 388-393.

This is a quantitative study which aims at identifying the associated drug costs for different patients in healthcare organizations. The population under consideration includes administrative departments of organizations, where the policies limiting inpatient administration have been analyzed. This source is credible for the research topic under consideration. The authors have managed to utilize the evidence as provided in different healthcare organization policies regarding inpatient medication administration and service delivery, as compared to outpatient service delivery.

2.4. Research Reference #4

Mathews, M, Buehler, S. & West, R. (2009). Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket cost for cancer care. PubMed Central, 16(4): 3-8.

Mathews et al. (2009) aim at describing the prosecution of different healthcare providers. This is in regards to the patient and healthcare provider strategies that are present, to limit out of pocket costs, especially for cancer care. This is a quantitative research, which relies on information from semi-structured data collected, from interviews. The population under consideration includes twenty-one cancer care providers. Examples include nurses, social workers, surgeons, and dieticians. The areas under consideration include; Labrador and Newfoundland.

2.5. Research Reference #5

Vegunta, R. K. R., Blue, B. J., Fernandes, H. D., Upadhyayula, S., Burhanna, P., Rodin, M. B., & Poddar, N. (January 20, 2016). Impact of an inpatient palliative consultation in terminally ill cancer patients. Journal of Clinical Oncology, 34, 77.

Vegunta et al. (2016). Examines how patients respond to the high costs of treatment, primarily related to subscription drugs. This source examines the strategies which patients and their providers use especially in cancer care. This qualitative article is based on a more extensive study of cancer patients. The collection method used includes surveys and qualitative interviews with care providers.

3. Synthesis of the Evidence

3.1. Summary of potential actions derived from your evidence review.

All the studies which were conducted based on the consulted sources are all inclined to the treatment of chronic infections, as well as patient management in both outpatient and inpatient departments in different healthcare organizations (Fischer et al. 2017). Risk factors also need to be noted, for the sake of maintaining credibility and efficiency in service delivery. Transitional care involves a wide range of services and environments. These are precisely meant to promote the safety and timely passage of patients (Foster & Reeves, 2014).

Different levels of healthcare in different settings are put into consideration. The high quality of care is expected and considered important especially for patients with multiple chronic conditions. Family caregivers are also in the picture because a lot of quality and professional care needs to be discharged at all times. A growing range of evidence suggests the importance of noting the patient groups that are vulnerable to breakdowns, especially in care. There is a great need for transitional care services, especially from outpatient units to inpatient care in different organizations (Hayes, 2013).

Poor handover of patients’ needs to be discouraged at all costs. Low satisfaction with care and the high hospitalization rates should be controlled for improved efficiency in medical and healthcare organizations (Michael & Thomas, 2013). The option of exercising specialized handover for patients should thus be consulted for efficient service delivery and improved rates of satisfaction among patients in different healthcare organizations. Patients need to be treated most efficiently, and the continuum of care emphasized.

3.2. Recommendations to improve the problem.

A lot of factors are responsible for contributing to gaps in care, especially during specific critical transitions in healthcare organizations (Mathews et al. 2009). Fundamental problems which need to be considered during the process include poor communication, inadequate education of family caregivers, incomplete transfer of information in the process, limited access to services which are essential to the patients, and the lack of a specific person delegated to a patient, to enhance continuity of care.

Other aspects which exacerbate the problem includes cultural differences and health literacy issues. The best recommendation, in this case, is to suppose the adults especially during hospitalization, and after their discharge is effected (Numico et al. 2015). There is a need to have family caregivers educated and made aware of the importance of paying attention to their patients. Emotional needs should be studied during this form of transition.

3.3. The best action for your organization and make a succinct statement of your recommended plan.

The best action is educating family caregivers, especially during patient transition, and the whole problem under consideration (Shirley, 2013). Family caregivers play a significant role especially in supporting adopts during the transition and hospitalization process. The level of engagement in decision making especially about transition and is charge plans should be communicated to patient relatives. With this in place, it will be easier to ensure that quality preparations are made, for the next stage of care. Caregiving both to family and professionals can be rewarding, but can also be considered as a burden.

Episodes of illness need to be treated from a professional level. Hence the continuum of care is very important. Nurses and social workers need to be on the forefront primarily in attending to emotional needs. If this recommendation is implemented, assessment of emotional needs will be more efficient. At the same time, it will be easier to minimize the negative impacts and experiences of outpatient-inpatient transitions for different groups of patients. A lot still needs to be done, to care for the terminally ill patients.

4. Suggested Courses of Action

4.1. Restate the action you want to occur

Frequent transitions within an organization can have devastating effects primarily on the health of the patient. For example, medication errors may occur, which are common during such periods inpatient care (Vegunta et al. 2016). The best models of care should be embraced at this point, where the best course of action is to educate the family members, on the importance of the transition from outpatient to inpatient, empathizing with their situation, and provision of professional advice while in the facility.

4.2. Outline how you will implement the change

Change is inevitable, but most likely to be faced with a lot of reluctance and opposition if not well implemented an introduced. I will implement the change through organizing with different professionals, on how to initiate the transition from outpatient to inpatient for the chemotherapy patient. Liaising with the involved parties is bound to ensure that everyone is on board, the importance of the process realized, and coordination realized in the process (Vaunt et al. 2016).

4.3. Change theory or Leadership strategy to guide the change process.

A successful change process needs to begin by the development of understanding, of why the change should take place in every organization. Lewis change theory will help guide the change process in the healthcare setting. The unfreeze stage involves preparation of the involved parties to accept that the change is necessary. This will be done through explaining the importance of the transition for the benefit of the patient (Vaunt et al. 2016). The change itself takes place when people begin to resolve all forms of uncertainty and look into newer and better ways of doing things. Transitioning from the outpatient to inpatient is initiated in this phase, which is effective. The refreeze stage in this model helps embrace the change that has taken place. Consistency is achieved, and internalization is also embraced. Comfort is at this stage, realized by the patient and relatives.

4.4. Who, what, when, and where?

The involved parties include the relatives of the patient, the family as a whole, and the patient in the hospital setting as well. Primary and secondary caregivers are present in this case, especially the nurses, practitioners, physicians and medical service providers. This transition will only be valid after proper information transfer is initiated and in a compatible healthcare organization setting.

5. Summary or Conclusion

5.1. Summarize the main ideas and arguments, pulling everything together to help clarify the thesis of the paper.

Most patients try their best especially in minimizing the costs related to healthcare, including rationing medications, and choosing to be part of radical treatments. Lengthening the time between appointments is also considered an option, or choosing inpatient care (Vaunt et al. 2016). Healthcare providers, on the other hand, respond to different financial concerns of patients, through assisting them to access the best services, and by changing the supportive chemotherapy programs and drug prescriptions. Other aspects include shortening the treatment protocols involving radiation. Most healthcare service providers have resulted in admitting patients to the facilities, to follow up more closely with physicians on their conditions. The best option is to offer out of pocket services, which result from cancer care. Cancer treatment is considered to be expensive primarily due to the different phases of treatment follow-up sessions (Vaunt et al. 2016). Transitions from outpatients to inpatients should be handled most effectively. The best strategy which should be prioritized is to deal with the education of family caregivers, for enhanced service delivery.

References

Davidoff, A. J., Zuckerman, I. H., Pandya, N., Hendricks, F., Ke, X., Hurried, A., Littman, S. M., Edelman, M. J. (April 01, 2013). A novel approach to improve health status measurement in observational claims-based studies of cancer treatment and outcomes. Journal of Geriatric Oncology, 4, 2, 157-165.

Joana, L., Mary, H., Alan, M., Andrew, B., & Steven, C., (1987). Case Mix and Changes in inpatient and outpatient chemotherapy. PubMed 8(4): 65-71.

Fisher, M. D., Punker, R., Yam, Y. M., Small, A., Singer, J. R., Schulman, J., Canny, B. L., … Malign, J. (January 01, 2017). Differences in Health Care Use and Costs among Patients with Cancer Receiving Intravenous Chemotherapy in Physician Offices versus in Hospital Outpatient Settings. Journal of Oncology Practice, 13, 1, 37.

Foster, A. E., & Reeves, D. J. (June 01, 2017). Inpatient antineoplastic medication administration and associated drug costs: Institution of a hospital policy limiting inpatient administration. P and T, 42, 6, 388-393.

Hayes, J. (2014). The theory and practice of change management. Palgrave Macmillan. Mathews, M, Buehler, S. & West, R. (2009). Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket cost for cancer care. PubMed Central, 16(4): 3-8.

Michael, E. P, & Thomas, H. L, (2013). The Strategy That Will Fix Health Care. Harvard Business Review.

Numico, G., Cristofano, A., Mozzicafreddo, A., Curcio, O. E., Franco, P., Courthod, G., Trogu, A., … Silvestris, N. (January 01, 2015). Hospital admission of cancer patients: avoidable practice or necessary care?. Plos One, 10, 3.

Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72.

Vaunt, R. K. R., Blue, B. J., Fernandes, H. D., Upadhyayula, S., Burhanna, P., Rodin, M. B., & Poddar, N. (January 20, 2016). Impact of an inpatient palliative consultation in terminally ill cancer patients. Journal of Clinical Oncology, 34, 77.