NURSING 6: University Dissertation: COPD Patient Service Innovation

This assignment delves into patient service innovation within the context of COPD, focusing on a community-based intervention designed to reduce hospital readmission rates. The report begins with an introduction to patient service innovation and its importance in healthcare, particularly within the NHS framework. It explores the challenges faced by the NHS, including funding, staffing, and evolving healthcare demands. The report then outlines a project plan for a community-based intervention, a change management strategy to facilitate its implementation, and a leadership theory suitable for guiding the project. It highlights the significance of clinical governance principles and their role in improving patient care. The assignment also examines the role of nurses in this innovation, emphasizing their contributions to patient outcomes and service improvement. Furthermore, the assignment presents a theoretical background on the NHS, challenges faced, and clinical governance, which will be followed by how change management model will help to put the innovation into practice. Time management will also be explained in this essay, which will predict how long it will take to plan, realize and assess the innovation. Finally, the role of the nurse in innovation will also be explored in the essay.

Running head: NURSING
Patient Service innovation – Dissertation
Name of the Student
Name of the University
Author Note

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Part 1
Introduction
Patient service innovation refers to strategies that are adopted by the
healthcare organization and health department for continuous enhancement of
patient satisfaction and are generally promoted with the aim of enhancing patient
health outcomes. Furthermore, public sponsored healthcare has also been identified
as a crucial aspect of health innovation on a national and local level. Time and again
it has been proved that bringing about improvement in patient care has been
identified as a major priority for different healthcare providers who have the chief
objective of enhancing patient satisfaction (Dandoyet al. 2017). Furthermore, an
increase in awareness among the public, snowballingmandate for better care,
profound competition, increase in number of health care regulation, the growth in
medical misconduct litigation, and anxiety about poor health outcomes are some of
the factors that significantly contribute to patient service innovation.
The patient service innovation that will be discussed in the assignment
focuses on reducing the recurrent hospital admissions amid patients who suffer from
COPD.
The patient innovation program focuses on making the COPD affected
individuals use community service for lowering their admission rates. There are
several community services available for patients suffering from COPD that focus on
altering their behaviour, helping them deal with the physical and emotional impact of
the disease, and medication management. However, it has been found that not
many patients seek help from these community services, thus calling for the need of
implementing patient service innovation. Therefore, the service that will be discussed
in this assignment focuses on a community-based intervention that will address the
healthcare needs of patients who are suffering from COPD, thus lowering their
admission rates in healthcare settings. This assignment will contain a project plan,
followed by a suitable change management strategy, and leadership theory that fits
the intended project. Furthermore, the assignment will also elaborate on the role of
nurses in service innovation. This assignment will be divided in to two sections. The
first section will elaborate on the theory and include the general idea of the NHS and
contemporary challenges. The major principles of clinical governance and their role

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in service improvement, quality improvement and clinical excellence will be also ne
discussed in this section. Part two will talk about how change management model
will help to put the innovation into practice. Time management will also be explained
in this essay, which will predict how long it will take to plan, realize and assess the
innovation. Finally, the role of the nurse in innovation will also be explored in the
essay.
Theory
The National Health Service (NHS) was created in England and refers to
a publicly subsidisednation-wide healthcare system and is one of the four NHS that
have been formulated for each constituent nation of the United Kingdom. The
foundation of this organisation can be associated to the enforcement of the National
Health Service Act 1946 on 5 July 1948 (Grimes 2016). Presence of a
national health service had been identified as an important expectation in
the Beveridge Report(Siddall2018). In addition, the establishment of the Emergency
Hospital Service in 1939 provided a clear overview of what the NHS would comprise
of. The initial structure of the NHS encompassed three crucial aspects namely, (i)
hospital services, (ii) primary care, and (iii) community services. The core principles
of the NHS that govern the delivery of healthcare facilities in England are based on
the long-held assumption that excellent quality healthcare must be available to every
resident, regardless of prosperity and socioeconomic condition (Guest et al. 2015).
Furthermore, some additional principles that also govern the work of NHS, in relation
to delivery of optimal healthcare services are namely, (i) care, (ii) communication, (iii)
compassion, (iv) competence, (v) commitment, and (vi) courage to be inadequate
(Lancet 2018). Furthermore, an early COPD diagnosis is often challenging for the
healthcare professionals, since patients who are affected with mild COPD, in
addition to smoker’s cough are not diagnosed properly (NHS England 2013).

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Figure 1- 7 pillars of clinical governance
Source- (Routes Healthcare 2019)
Nonetheless, the NHS is facing several challenges in recent times. Some of
the key challenges that the NHS is currently facing are namely, (i) lack of adequate
funding, (ii) shortage of staffing, (iii) exit of the British from the European Union, (iv)
increase in social care costs, (v) evolving healthcare demands and needs, (vi)
centralisation drives that are causing closure of local health services, and (vii)
increased reliance of the public on privatised healthcare services (Mossialos et al.
2016). During the launch of the NHS in 1948 it had a financial plan of £437 million
(approximately £9 billion according to current price), which eventually increased to
£122.5 billion in 2016-17 (Burch 2019). Furthermore, the health spending was an
estimated 11.2% during 1955-56 that increased to a massive 29.7% during 2015-16
(Triggle 2017). Evidences also highlight the fact that the NHS performs well while
protecting individuals from huge monetary costs at the time of their illness (Pitchforth
et al. 2017).
As per the Griffiths Report outline, clinicians were expected to be more
involvement in patient management (Klein 2019). This report resulted in a major
change in the managerial culture in NHS. The organisation underwent several
changes in the past seven decades and is under the process of continuous evolution
(Ham 2018).The Berwick Report was another essential step in identification of the
significance of constant watchfulness, watching and knowledge acquisition to make

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sure that the patients were kept distant from any kind of avoidable harm (Gov.UK
2013).
The NHS Reorganisation Act also resulted in setting up of local NHS bodies
that had the responsibility of managing all community and general health services
(Lale and Temple 2016). Moreover, health disparities are still on the plan and
continue as a key precedence for public health services. This has eventually resulted
in the ‘Forward View’ assessment where some of the future strategies of the NHS
have been highlighted such as, (i) better health, (ii) better care, and (iii) financial
sustainability (NHS 2017). Furthermore, the King’s Fund is an independent public
health thinktank that focuses on health-related work in England. Moreover, efforts
are also been taken by the organisation for shaping practice and policy through
analysis and research (Ham 2018). According to the King’s Fund (2013) the national
leaders must be given credit for addressing quantifiable developments in health
outcomes.The King’s Fund has some values that underpin the work towards
excellence of care. It displays a commitment for maintaining independence, while
promoting collaborative practice and striving for excellence. The King’s fund also
states that management of care for individuals suffering from long-term health
complications must be holistic, preventive, proactive, and patient centred. Taking into
consideration the fact that there are almost 15 million individuals in England who
have been diagnosed with one or more long-term health condition, it is imperative to
implement personalised care planning where the patients and clinicians work
together for identifying the support needs and reaching a consensus (The King’s
Fund 2013).
Some of the chief principles of clinical governance that have been associated
with high quality patient care are (a) training, education, and continuous professional
development, (b) evidence-based care, (c) patient and carer involvement and
experience, and (d) staff management (Donaldson 2018). It came into effect after the
Bristol heart scandalof 1995 and is defined as the framework through which NHS
organisations are answerable for repeatedlyrefining the quality of their care services,
while protecting high care standards by creating a setting in which superiority in
clinical care will display (Fox 2001).If clinical governance is to really function
successfully as a methodical approach to upholding and enhancing the excellence of
patient care in a health organisation, it necessitates advocates (Walshe and

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Chambers 2017). Furthermore, the NHS Outcomes Framework (NHS OF) has also
been developed in the form of several indicators by the Department of Health and
Social Care, with the aim of monitoring health outcomes of children and adults in
England (Roland and Guthrie 2016).
This in turn can be accomplished by implementing the NHS Healthcare
Leadership Model that states that professional skills, technical competence, and
managerial brillianceunderwrite good management, nonetheless the
actualassessment of what divides those individuals, in NHS, is the compassion,
care, and sincere investment in workers that great leaders identify as being the
importantvariance between satisfactory technical medical care and successful
healthcare service (NHS 2018). Another similar initiative that has been developed by
the NHS is the Leading Change, Adding Value (LCAV) that focuses on midwifery,
nursing and other care staff. According to this framework, efforts will be taken by the
NHS to address the target areas of health and wellbeing, care and quality, and
funding and efficiency (NHS 2016).
Background
The quality of care delivered to the patients is fundamentally determined by
the excellence of arrangement, worth of training, capability of staffs and competence
of the operational systems (Allan et al. 2017). The Keogh Review related to patient
safety was conducted, in relation to the Francis Inquiry that was based no poor care
NHS
outcomes
framework
Domain 1:
Preventing
people from
dying
prematurely
Domain 2:
Enhancing
quality of life for
people with
long-term
conditions
Domain 3:
Helping people
to recover from
episodes of ill
health or
following injury
Domain 4:
Ensuring that
people have a
positive
experience of
care
Domain 5:
Treating and
caring for
people in a safe
environment
and protecting
them from
avoidable harm

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at Mid Staffordshire Hospitals NHS Foundation Trust (NHS 2013). This review
resulted in incorporation of six NHS Foundation Trusts and five NHS Trust
Development Authority. The Francis Inquiry report was formulated and enforced on
February 2013 and scrutinised the reasons behind the failure associated with patient
care at Mid Staffordshire NHS Foundation Trust from 2005-2009 (NMC 2013). This
report was a significant step towards developing 290 recommendations, which
comprised of better-quality support for empathetic, caring and dedicated care, and
resilient healthcare leadership (Francis 2013).
Government reports provide evidence for the fact that an estimated 1.2 million
individualshave beendiagnosed with COPD, which is noticeablygreater than the
835,000 people, as projected by the Department of Health in the year 2011 (Snell et
al. 2013). Roughly 2% of the entire population, and around 4.5% of all individuals
aged more than 40 years are living with confirmed diagnosis of COPD ( British Lung
Foundation 2018). Furthermore, a 2.03% prevalence was observed among people
living in Scotland, and this number is also expected to be more than 2.20% by 2030
(McLean et al. 2016). Additionally, COPD is occasionally reported by people aged
less than 40 and nearly affects 9% of people aged more than 70 years (Snell et al.
2016).
On evaluating the impacts of a multi‐site community pharmacy-based service
for COPD improvement, Wright et al. (2015) found that an estimated 306 patients
accessed the community service. On analysing the data obtained from 137 patients,
the researchers found significant enhancements in patient reported compliance,
quality of life, use of rescue packs, and a decrease in routine visits by the general
practitioner (GP). Reports from another qualitative study that compared the
perception of patients in relation to early stage COPD specialist and telehealth
interventions supported the fact that though COPD recipients of the telehealth
service obtained 50 % less home visits from clinicians, when compared to patients
who were subjected to out-dated community-based nursing interventions, they
demonstrated enthusiasmabout the service, with some of them considering it
effective for the management of COPD. This in turn provides the indication that there
is lack of acceptance of community-based services among COPD, even though it
would facilitate direct communication and interaction with clinicians. Rather, the
patients demonstrate a likelihood of accepting telehealth service where they will be

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remotely governed by a healthcare professional (Fitzsimmons et al. 2016). The need
for increasing patient acceptance of community-based service for COPD was further
elucidated by Cope, Fowler and Pogson (2015) who postulated that on developing a
COPD in-reach service, the average length of hospitalisation for the patients reduced
significantly by 2.53 days, which in turn was concomitant with reduction in
readmission rates by a mean value of 4.5 per month. Furthermore, the service lead
to early discharge of 17% of patients, and also brought about an increased
preparedness and readiness among them for discharge from hospital. Thus, the
findings helped in illustrating the effectiveness of community-based service in
reducing COPD admission.
These findings are in accordance to those published by Hermizet al. (2002)
who stated that on subjecting randomised patients to a community-based COPD
intervention, no significant differences were observed in the rate of hospital
presentation, admission, or general functional status, Nonetheless, patients
subjected to community-based interventions were able to demonstrate improved
activity scores, while the control group manifested deterioration of their health
symptoms. Visits from the community nurses also increased patient satisfaction, in
comparison to general practitioner visits, and the patients in the intervention group
also reported improved awareness and knowledge about their health status, thus
highlighting the role of community-based care program in reducing COPD admission
to hospitals. This calls for the need of implementing changes where patients
diagnosed with COPD will be subjected to education and advice on different lifestyle
modifications that can help reduce their COPD symptoms.
Hall (2016) have also elaborated that on implementing Chronic Respiratory
Disease Nurse Practitioner (CRD NP) Model of Care (MOC) among patients, a
statistically noteworthyupsurgefrom 7.7% in 2009 to 45% in 2011was noted in the
number of patients, who had beenevaluated with arterial blood gas examination for
eligibility of STOT. Creating provisions for accessing the facility of STOT on patient
discharge also augmented from 26.7% to 44.4%. Furthermore, this MOC was also
associated with a reduction in the hospital re-admission rates, within 28 days of
release for the patients with STOT, from 25% to 12.5% (2009 and 2011,
respectively). Strategies to avoid hospital admission of COPD patients were also
illustrated by Cox et al. (2017) who stated that professionalexpertise of respiratory

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nurse specialists were an importantinfluential factor in the accomplishment of the
objective, predominantly the capability to commence and understand CBG
assessments amid patients, while initiating emergency oxygen upon them. It was
also suggested that providing a holistic and individual assessment, besides making
patient referral to community service also creates a longer-term influence on the
COPD related health outcomes.
According to the NICE guidelines (2018) it is essential to review COPD
patients at least once in a year, and if necessary, more often, to keep a track on their
health status. The guidelines highlight that for most individuals suffering from severe
COPD, consistent hospital review is not essential, nonetheless there must be locally
decided mechanisms to permit quick access to hospital examination, as and when
desired (NHS 2018). These guidelines also emphasise on the need for specialists to
frequently review individualsdiagnosed with severe COPD who require the
administration of interventions such as, non-invasive ventilation. Further reports from
the Care Quality Commission (2019) also elaborated on the fact that of all people
who are diagnosed with long-term health ailments, 88% patients who experienced
poor health did not complain since they were concerned about making trouble.
Nonetheless, 81% of patients with COPD lamented for not registering a complaint
about receiving poor care. Hence, this calls for the need of implementing a patient
innovation service that will address the concern of recurrent hospital admission that
patients suffering from COPD.
Rationale/aims and objectives
The fishbone diagram has been used for categorising the possible causes of
the health problem in order to classify its root causes, based on their hierarchy and
level of importance. It also facilitated identification of bottleneck in the entire
procedure, thus highlighting the strategies that can be adopted to address the
problem (Coccia 2018). It has been identified that not all patients who have been
diagnosed with COPD are able to utilise the community-based healthcare services
that are able to address their healthcare demands. Furthermore, patients have also
been found to demonstrate lack of adequate understanding and knowledge on the
available community service, and the potential health benefits that they can gain, by
using them. Hence, the primary aim of this patient innovation program is to create
and disseminate leaflets to patients, containing exhaustive and comprehensive

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information on different respiratory health ailments namely, COPD, pneumothorax,
type 1 and type 2 respiratory failure, pulmonary embolism, their symptoms, causative
factors and treatment options. The leaflet will also provide the patients with
necessary information on when and whom to contact under emergency situations
such as respiratory specialist nurses and other healthcare personnel.
The major objective of distributing leaflets to patients is to increase their health
literacy, which will help the patients to understand and utilise the information
provided in a manner that prevents exacerbation of COPD symptoms, helps in
effective management of the condition, thereby reducing hospital readmission rates.
Contrary to verbal information, the difficulty of interpretation of any written material is
permanent and consequently must be prepared in a manner that is understood by
the patients (Schmitz et al. 2017). Patients will therefore gain benefit from this
innovation program since it is in accordance to two indicators of the NHS Outcomes
Framework that are given below:
 1.2 Under 75 mortality rate from respiratory disease
 3b Emergency readmissions within 30 days of discharge from hospital (NHS
2019)
Owing to the fact that respiratory diseases, when left untreated, have been
associated with high mortality and morbidity rate, the patient leaflet will prove
effective in ensuring that health outcomes of COPD diagnosed patients aged under
75 will improve, thus decreasing their mortality. In addition, readmissions are
generally used by the NHS in the form of an indicator for determining the efficacy
and success of healthcare amenities, in relation to recovery of the patients. Thus,
leaflet dissemination will also help in increasing awareness among the patients,
thereby improving their health outcomes, and preventing emergency readmissions,
after discharge from the hospitals. The SMART goals for the patient innovation
program are given below (Bjerke and Renger 2017):
S (Specific) Increase patient awareness on COPD and
reduce recurrent hospital admission
M (Measurable) Conducting clinical audit for determining
readmission rates
A (Achievable) Increase in patient health literacy

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R (Realistic) Dissemination of leaflets
T (Timely) 6 months
Table 1- SMART goals for the patient innovation program

Running head: NURSING
Figure 2- Fish bone diagram for root cause analysis

Running head: NURSING
Part 2
Change management strategy
Change management refers to a systematic method to dealing with the evolution or
alteration of an organization's objectives, procedures or machineries. The
determination of change management is to apply approaches for effecting alteration,
monitoring change and assisting individuals to adapt to modification (Hayes 2018).
According to Doppelt (2017) change management also inspires future growth of the
organisation by permitting it to maintain a dynamic nature.As vicissitudes to work
befall, change management aidsstaffs to understand their novel roles and shape
more process-driven principles. In other words, the purpose of initiating change in
the healthcare organisation was to encourage the individuals to adopt novel
strategies for enhancing health outcomes of patients. Time and again it has been
found that if the hospital leaders elucidate why the association is making a change, a
coherent and clearer rationale becomes visible that helps in identification of the
potential benefits of change management, for the betterment of the clients (Van
Rossum et al. 2016). The stakeholders involved in the project are the general
practitioner, specialist nurse, respiratory nurse, COPD affected patients, family
members, hospital administrators, and the community members.
Organisational transformation is problematic in this healthcare scenario owing to the
fact that major changes regarding utilisation of community health services by the
patients who suffer from COPD will take long time to be implemented. Moreover, the
administrative and clinical staff working in the hospital generally consider their work
as a vocation, almost like their profession, and it has been found that these
healthcare workers are often suspicious of the senior administration, and their motive
to bring about the change. Despite the fact that the primary objective of this patient
service innovation program is to increase the awareness and number of patients who
use COPD community health services, besides decreasing the rate of recurrent
hospital admissions, the healthcare staff working in this organisation generally view
the premise as being essentially flawed. Moreover, though the healthcare
organisation has strong operational standards, there are a variety of effective and
fiscal problems that impede its success in delivering treatment to COPD patients,

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and also demeans its reputation. There is non-existence of a well-defined strategic
path in the hospital, towards increasing familiarity and awareness of patients about
COPD prevention and management. This calls for the need of implementing change
management, with the aim of building coordinated healthcare delivery system, which
will address the needs of the COPD patients. Hence, the change management will
be predominantly geared towards modification in the context of caring for COPD
patients (By, Hughes and Ford 2016). With the aim of facilitating healthcare reform in
the organisation, the decision makers and healthcare managers must demonstrate
an adequate understanding of how the change can be initiated in the hospital, in
order to develop an environment that is favourable to innovation. Hence, change
management will be implemented in the hospital, with the aim of enhancing the
health outcomes of the COPD affected patients.
While managing change and implementing the change approaches, it is imperative
to avert implementation of random or irrelevant strategies, and more focus must be
placed on feasible plan of action. The change management in the hospital would
take considerable dedication, time, expertise and efforts to get accomplished.
Hence, appropriate involvement of staff is necessary for the same. Prior to adopting
any one particular change management model, it is imperative to figure out the
advantages and potential drawbacks (if any) of the different models. The table given
below highlights the pros and cons of different change management models:
Model Description Benefit Limitation
Kotter’s change
management model
Steps for
encouraging novel
behaviour for
effective
organisational
change
Offers an 8-step
checklist that is
actionable
Absence of
evaluation process
and is time
consuming
ADKAR model 5-step procedure
based on
awareness,
knowledge, desire,
reinforcement, and
ability
Rewards distinct
changes in
organisational
process
Process is
cumbersome for
large companies
Lewin’s change 3-step model for Easy to comprehend No discussion of

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management model helping leaders to
facilitate transition
and offers a visual
language
strategies that can
be adopted by
leaders for dealing
with individuals who
are resistant to
change
Bridges Transition
model
Techniques for
management of
emotional transitions
related to change
Contains a step-by-
step guideline for
fostering expressive
acceptance of
change
No outline for
operational change
Action-Centred
Leadership model
3-element model
based on task
accomplishment,
task development,
and individual
development
Simple and easy to
understand
Conflicts present
within the three
elements
According to Hornstein (2015) John Kotter developed a ‘8 step change model’
with the aim of improving the ability of an organisation to change, besides increasing
the opportunities for success. The steps of this change management model are
namely, (i) developing a sense of urgency, (ii) fostering a powerful coalition, (iii)
creating a definite vision for change, (iv) communicating the vision, (v) removal of
obstacles, (vi) creating short-term motivations, (vii) building on the change, and (viii)
anchoring the variations in the corporate culture (Lamé, Jouini and Stal-Le Cardinal
2017). Another model that focuses on leadership and management is John Adair's
‘Action-Centred Leadership model’ that makes it easy to recall and apply any
change, and to acclimatise for a particular situation (Harding 2017).According to
Cordell and Thompson (2019) goodleaders and managers must have complete
command of the three chief areas of the model that are namely, (a) achieving the
task, (b) managing a group or team, and (c) managing individuals, and must be able
to utilise thecomponents according to the state of affairs. Hence, this model proves
imperative in striking a balance, building morale, obtaining results, improving quality,
and developing teams and productivity.

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Figure 3- Kotter’s 8 Steps for Leading Change
Source- (Lamé, Jouini and Stal-Le Cardinal 2017)
According to the ‘Process of Transition model’ there are eight stages that
people follow in series through a change development namely, anxiety and denial,
happiness, fear, threat, guilt and disillusionment, depression and hostility, gradual
acceptance, and moving forward. This model highlights the fact that leading change
necessitates a clear objective and operative organisation to attaindefinite results.
Another significant model in this regard is the ‘ADKAR Model’ that encompasses a 5-
step framework that facilitates the process of dealing with the individual-aspect of
change management. The five goals of this framework that needs to be reached for
accomplishing a successful change are awareness, desire, knowledge, ability and
reinforcement (Dorrofield 2017). Though all of these models have been found
effective for change management, the Lewin model of change management will be
used for the patient innovation program.The major components of the project are the
patients and the healthcare personnel. This change would occur at the community
service that delivers care to patients diagnosed with COPD. One nurse specialist
and one pulmonologist will be entitled with the role of disseminating the leaflets.

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The three main stages that are present in this change management model
encompass unfreeze, change and refreeze. The first stage of unfreezing focuses on
enhancing the readiness and the readiness of the healthcare personnel to the
change, by nurturing a comprehension for moving from the prevailing comfort zone
to an altered situation. The second stage of change comprises of approval of the
new manners of doing things (Hussain et al. 2018). During the second stage, the
healthcare staffwill beunfrozen, and the tangible change will be implemented that will
comprise of distribution of the leaflets. These leaflets will be distributed to the
patients affected with COPD, at the time of home visits by the specialist nurses.
These home visits will generally be conducted in order to review the patients after
regular intervals, which in turn will be accomplished by conducting thorough physical
assessments. The third stage of refreezing will involve the staff moving from the
transition stage to a more stable stage that is generally considered as the stage of
equilibrium. This phase is typically considered as the ultimate stage and during this
phase the healthcare professionals and members of the administration will have to
internalise or accept the novel ways of working through dissemination of leaflets, in
order to increase health literacy among them, and making the accept it as an
essential part of their life (Cummings, Bridgman and Brown 2016).
Figure 3- Lewin change management model
Source- (Hussain et al. 2018)

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With the aim of making the innovation successful, it must be ensured that
adequate information is provided in the leaflets that will increase literacy and
awareness of the patients. Nonetheless, some common barriers that might be
encountered are absence of employee involvement, lack of effective communication,
and organisation complexity might make the nurse and pulmonologist question the
reason behind the change. Identifying the root cause for resistance, engaging senior
leaders as visible and active sponsors of change, and communicating the need for
change will help in addressing the barriers (Lewis 2019). In addition, a green paper
will also be formulated. This generally refers to the first draft of a document that is
related to anissue or policy. It will be disseminated among the key stakeholders who
will be invited to participate the debate and consultation on the change management.
The primary objective of having a green paper is that it will facilitate arriving at a
common consensus, prior to the draft of the original document.
Features of patient service innovation (leaflet)
Some of the most essential elements of the leaflet would be as follows:
 Tri-folded piece of A4 paper
 On-brand design that has a blue colour scheme with text in white
 Presence of a consistent and clear theme about COPD
 Emotive headlines with a clear purpose. The headlines are one of the most
essential elements of a leaflet, while promoting the usage of a particular
product or service.
 Appropriate spacing between lines
 Directly addressing the target audience
 Statement in active voice
 Compelling imagery and necessary information about the community health
services available will help in showcasing credibility and will increase
engagement with the audience (Salahieh et al. 2018)
 Focusing on the benefits of using the community COPD services will increase
audience awareness
 Large headline positioned at the top
 Balance between text and images
 Perfect grammar and spelling

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Leadership theory
Effective leadership focuses on driving the team members for
facilitating change management, by utilising the human resources.
Arrangingteamwork around a predetermined objective forms an essential aspect of
change management (McCaffery 2018).This can be accomplished by ensuring that
all team members have the essential skills required for performing their roles and
responsibilities, besides addressing the gaps thatare likely to create an impact on the
performance of the organisation. With change management arises the inevitability of
training and expansion to authorise the team members with novel and relevant
abilities, precise to the change intentions. Development of relationships among the
person who are involved such that they are not subjected to any form of stress
ortension during change is imperative, and it can be achieved by creating provisions
forengagingfairly about their apprehensions in a relaxed setting (By, Hughes and
Ford 2016).
Democratic leadership can work best at the time of team building since this
approach typically provides equal rights to unequal individuals in making essential
decisions. According to Iqbal, Anwar and Haider (2015) this leadership style will be
applied in this scenario where it will focus on collaboration and free flow of opinions
and ideas. This in turn will make the leaders encourage shared responsibility among
all healthcare staff, in relation to leaflet preparation and distribution, with the ultimate
objective of enhancing the health outcomes and preventing recurrent hospital
admissions. One of the most crucial facets of any leadership pattern is developing a
sound understanding of thecircumstances in which it benefits the organisation to
excel (McKeown and Carey 2015).Democratic leadership does not unavoidably have
an association to a stressful or thought-provoking occasion, rather it is a style that is
recognised to comprise of as many opinions and expressions as possible, for making
important choices.
One of the main advantages glorified by individuals who generally favour
democratic leadership highlight the impact that it creates on employee engagement.
In order to demonstrate a positive work culture, a democratic leader will envoy
responsibility amid associates of his or her team to enable member contribution in
making pronouncements. It is obligatory for such leaders to authorise their team
members such that the latter will be appropriately equipped to achieve their tasks

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(Khan et al. 2015). Encompassed in the procedure of empowerment is the
establishment of necessary education and training, mandatory for the achievement
of delegated tasks. A noteworthy role played by the democratic leader is
safeguarding that democratic discussion are occurring when group verdicts are
being made. This designates that the leader is thought to serve the role of an
arbitrator and expediter between affiliates of the group, thereby ensuring that all
associates are psychologically well, besides ensuring the presence of a courteous
workplace environment (Petrou, Demerouti and Schaufeli 2018). Some strategies
that can be adopted to motivate change among the employees are namely, (i) setting
clear goals and expectations, (ii) providing autonomy to the team members, (iii)
adorning the role of an active listener, (iv) establishment of short-term goals, and (iv)
celebration of success. If done appropriately, the change initiative identified for this
project (leaflet development and distribution) will provide the seamless occasion to
positively impact employee insights and participation (Conrad, Ghosh and Isaacson
2015).
Time management
Making the best use of time forms a crucial aspect of change management
process by facilitating the accomplishment of a particular goal. Presence of a well-
organised timeline or Gantt chart will help the healthcare professionals learn to
identify the circumstances when a predetermined change is necessary (Bolden
2016). Presence of a time management plan will also ensure that the concerned
healthcare professionals are more organised, thus reducing the time they
unnecessarily spend while searching for relevant documents, stationery items and
information that are required for preparation and dissemination of the leaflet. It will
also facilitate accomplishing the project within stipulated time that will help in rapid
evaluation of its impact, and will also increase confidence of the team members. The
timeline for this project encompasses a span of six months. During the first month,
the project shall be planned. The following four months shall encompass
implementation of the three steps of change management model, followed by
development and dissemination of the leaflet to the target audience. The final month
shall encompass a clinical audit (that will be conducted prior to the project
commencement as well), to determine the efficacy and success of the patient

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innovation project. During the final month, responses will also be collected from the
patients to determine their understanding and awareness.
Evaluation
Change evaluation is essential for assessing the major impacts of the change
management that have been brought about to an existing service in a healthcare
organisation. Organisational success has been identified as the cumulative outcome
of discrete individual alterations, thus in order to determine efficacy of change
management, it is imperative to place due focus on examining the success of
individual transitions, in relation to the intended change (Gohari, Mirchi and Madani
2017). Quality assurance will be accomplished and the organizational benefits will be
comprehended if a “critical mass” of the persons who formed the target population,
adopted and made use of the change (Cookson et al. 2018). Hence, change
management evaluation is closely interlinked to clinical excellence since it will help in
evaluating if the healthcare professionals have been successful in demonstrating a
satisfactory performance, in relation to increasing health literacy among COPD
patients, eventually reducing their hospital readmission rates. Therefore, this
evaluation will ensure that the concerned healthcare professionals have
demonstrated adequate competency and proficiency to promote the wellbeing and
health of all patients, by providing them adequate information on COPD signs and
symptoms, its management, and referral services.
The two methods that I intend to use for change management evaluation are
namely, pre and post clinical audit and patient survey. According to Rubio et al.
(2017) the aim of a clinical audit is to shed light on the inconsistencies between
actual practice and the change management, with the aim of assessing the clinical
competence of the healthcare professionals and the impact of change management
on the health outcome of the patients.Prior to implementing the change, the rate of
hospital admission for patients for COPD treatment will be recorded. This will be
followed by implementation of the change management. Three months after the
leaflet has been distributed, the rate of readmission for patients suffering from COPD
will again be evaluated, thus facilitating the determination of patient health outcomes.
The likert scale, commonly referred to as psychometric scale will be used for scaling
responses of the patients that will determine whether there has been any
improvement in their awareness and understanding about COPD (Joshi et al. 2015).

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Commonly found in different survey forms, a likert scale helps in measuring
the feelings and perceptions of people about a particular event or object and
includes a sequence of questions that need to be answered. The scale will comprise
of preferably 5-7 balanced answers individuals can select from. It will also
encompass a neutral midpoint.This likert scale will be administered one month after
the dissemination of leaflet (Harpe 2015). Observing a decrease in the rate of
recurrent patient admission to hospitals for COPD management will help in
understanding that the change management that focused on dissemination of leaflet
has been successful. In addition, obtaining positive survey responses will also
suggest that the information provided in the leaflet has been successful in increasing
health literacy of the patients. These outcomes can be sustained by fixing regular
appointments with the patients even after their discharge from the hospital, providing
guidance over telephone, and scheduling home visits for keeping a follow-up.
Role of nurse in service improvement and innovation
Awareness about disease and its signs and symptoms is imperative for
screening the health status of a target population, which in turn facilitates early
detection and management of health ailments. An analysis of the information
presented in the previous section suggest that if individuals of a community are
made aware of COPD, the presenting complaints, management techniques, and
community services that they can utilise, they will demonstrate an increased
likelihood of taking actions for preventing deterioration of health outcomes. On the
other hand, it was also realised that if individuals are not aware of COPD and the
community service healthcare options that they can utilise for enhancing their health
outcome, they will not take necessary efforts for taking preventative measures, and
will be repeatedly admitted to the hospitals, thus increasing healthcare expenditure.
The literature discussed in the previous section advocated that absence of
awareness about the community service for COPD treatment in the target population
could be accredited to inaccessibility, which in turn is governed by several fear,
taboos, and lack of familiarity about the health consequences (Boehm et al. 2019).
The change management process has enhanced and informed the capability to
change, lead, direct and assess innovation, while adorning the role of a registered
nurse. It has increased understanding on the fact that managing any kind of change
involves accurately handling complexity of the healthcare environment and also

10NURSING
requires ensuring that the change that has been brought about is relevant and
worthwhile to the existing scenario. The lone sustainable reasonable advantage in
the present day is the capacity to change, familiarise, and grow, and to perform it in
a better manner, when compared to the competitors (Shanks 2016). Disappointment
rates are related to a plethora of diverse factors such as,non-existence of
visualisation and obligation from senior management, inadequateincorporation with
additional systems and procedures in the institute, and ill-conceived operation plans.
In other words, the change management process discussed above suggested
that if the healthcare organization intends to reduce the rate of readmission of COPD
patients, by increasing their health literacy and utilisation of community health
services, the executives and managers need to have a enhanced framework for
formulating the change. The process also enhanced the understanding of major
issues or challenges that will accompany change management. It was also
understood that delivery of excellent patient care is dependent on the strategy that
treats each patient as unique individual (Smeds-Alenius et al. 2016).
It has often been realised that stay of patients in the hospital is frequently a
problematic or trying time, which emphasises on the role of healthcare professionals,
including registered nurse to take all possible efforts for making patient experience
as enjoyable and pleasant as possible. Hence, the statements discussed in the
previous sections provided an explanation for the need of promoting change
management, which in turn will help in enhancing patient health and safety. Delivery
of excellent patient care is also imperative since it helps the patient to assess the
willingness to treat the health complaints, thus increasing their trust on the
healthcare professionals. In addition, providing care services that is responsive to,
and respectful of the individual preferences and needs of the patient will also ensure
that the treatment program is in alignment with his values and principles, thereby
facilitating the concerned healthcare professionals to arrive at a shared decision
(Swetz 2019).
Furthermore, the change management process and intended goals of this
project also helped in gaining a sound understanding of the fact that dissemination of
leaflet would prove an effective strategy for realising the objectives since it would
help COPD patients and their family members understand about the health ailment.

11NURSING
It would also foster communication with the healthcare professionals about the
community services that could be accessed by them. In addition, it was also
assumed that patient education forms an integral component of the role of a nursing
professional.
Therefore, the leaflets must be prepared in an easy-to-understand and
approachable manner, which would present the facts about COPD, without being
excessively clinical. Patient education material that is precise and systematic is
imperative to permit patients recognise their illness and community treatment plan.
Hence, application of Lewin theory of change management will prove effective in
increasing understanding among the managers and executives regarding the
importance of imparting health education in order to improve COPD patient health
outcomes, through increase in health literacy and utilisation of community service,
thus preventing readmission rates.
Conclusion
Thus, it can be concluded that showing similarity to different organisations
and firms, it is necessary for the healthcare industry to demonstrate adherence to
having the information of allowing for changes and modernisation to safeguard that
the administration continually adapt to the up-to-date trends and advancements that
are associated with the delivery of high quality healthcare. Hence, patient innovation
is imperative in healthcare organisations since it will provide assistance to the
management team of the organisation to investigate its contemporary situation and
standing, with the aim of reducing patient admission, improving health outcomes,
increasing income, identifying healthcare trends promptly, and communicating
competently with the target market. However, to be capable to complete such
determination, innovation methods are obligatory to be pertinent, accurate, detailed
and timely. It is indispensable that the patient innovation team must be able to
regulate what section of the organisation wants change and the process that will be
initiated for implementing such innovation activities.
It was understood that the patient innovation must focus on reducing
readmission of COPD patients to the hospital, which was accredited to the fact that
they were not aware of the community health service that was available and did not
utilise it. Owing to the fact that there was a major gap in the knowledge and

12NURSING
awareness among COPD patients about the community services, the benefits they
offer, and the positive health outcomes that can be achieved on using them, the
project focused on patient innovation through the dissemination of leaflets that would
contain descriptive information about COPD, its symptoms, risk factors, and
management strategies. Application of Lewin change management model was also
considered appropriate for this change management since it would encompass three
stages of unfreezing, change and refreezing. Thus, it was realised that the process
of change that will be implemented will encompass development of a perception that
a change is required, followed by a shift towards the new, anticipated level of
performance and in conclusion, solidifying that innovativeservice as the standard.

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Appendix
Timeline of project
Event Sep Oct Nov Dec Jan Feb Mar
Project
planning
Unfreeze
Change
Refreeze
Leaflet
development
Leaflet
disseminatio
n
Clinical audit
Survey
response
Graph 1- Gantt chart for patient innovation project

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Patient feedback
1. Did this leaflet elucidate COPD in a manner that was easy to
comprehend?
Yes No
2. Did this leaflet use medicinal words that you did not recognise? Yes No
3. Was this leaflet lucid and simple? Yes No
4. Did this leaflet help you understand the risk factors for COPD? Yes No
5. Did this leaflet encourage you to seek help from community
service?
Yes No
6. Did this leaflet answer all your queries to your contentment? Yes No
7. Did you check thisleaflet for COPD or other health condition? Yes No
If No, Form Is Complete
a. Did this leaflet provide youdirections about steps you need to
follow toprevent or manage thisdisease?
Yes No
If No, Form Is Complete
b. Was any contact number or helpline provided? Yes No
c. Will you use the community service in future? Yes No