Dissertation: Home Drug Infusion Therapy Program in Malaysian Hospital

This dissertation focuses on introducing a Home Drug Infusion Therapy (HDIT) program within a Malaysian hospital, specifically the Acacia care home, to address emergency department overcrowding and improve patient care. The study employs a change management approach, utilizing various research methodologies and a literature review to explore the effectiveness of HDIT. The dissertation delves into organizational development processes, including the HSE change model and PESTLE analysis, to facilitate successful implementation. Evaluation methods are detailed, including aims, methods, and dissemination plans. The project aims to reduce hospital admissions, improve patient flow, and decrease infection rates. The dissertation also addresses the implications for stakeholders and future developments, offering recommendations for healthcare organizations seeking to implement similar programs. The study highlights the benefits of HDIT, including improved patient outcomes and reduced healthcare costs. The document provides a comprehensive overview of the subject matter.

DISSERTATION
Introducing a Home Drug
Infusion Therapy program in
my Hospital

ABSTRACT
In the Acacia care home, hospital is facing a significant issue of emergency department
overcrowding. The major issue related to the boarded admitted patient and there is continuous
crisis throughout the week. Cited venture have realized the reduced patient safety level with the
hospital. The present report provides timely, evidence based management of all emergency cases
in the cited venture. In the following dissertation, the change management program has been
systematically addressed with respect of the health and care organization. In order to launch this
change related to the home drug infusion therapy, researcher have used several methods of the
researcher methodology through which it can obtain an appropriate solution. In addition to this
literature review provides the detail knowledge and understanding about the topic so researcher
have bifurcated this section in various themes. The major aim of this dissertation to implement
the change in the health and social care organization so as customer can get huge benefit and
satisfaction. In addition to this, present report based on the implementing lean health care
principles and improve patient flow.

Table of Contents
ABSTRACT.....................................................................................................................................2
1 INTRODUCTION........................................................................................................................1
1.1 Introduction...........................................................................................................................1
1.2 Organizational context..........................................................................................................3
1.3 Rationale of the study............................................................................................................3
1.4 Description of the changes....................................................................................................4
1.5 project Issue..........................................................................................................................4
1.6 Focus and purpose of the project..........................................................................................5
1.7 project Aim............................................................................................................................5
1.9 The expected organization impact.........................................................................................5
1.10 Summary and conclusion....................................................................................................6
2 LITERATURE REVIEW..............................................................................................................7
2.1 Introduction...........................................................................................................................7
2.2 Search Strategy......................................................................................................................7
Database......................................................................................................................................7
Search Engines............................................................................................................................8
Key search Terms........................................................................................................................8
Boolean Operators.......................................................................................................................9
Inclusion and exclusion criteria..................................................................................................9
2.3 Review of the themes..........................................................................................................10
Theme 1 HIDT and its effectiveness........................................................................................11
Theme 2 Inpatient bed utilization and reducing hospital admissions......................................16
Theme 3 Elective surgery cancellation.....................................................................................17
Theme 4 Emergency department boarding...............................................................................18
Theme 5 Reduce hospital infection rate...................................................................................19
2.4 Implication of the project....................................................................................................21
2.5 Summary and conclusion....................................................................................................21
3 ORGANIZATIONAL DEVELOPMENT PROCESS................................................................22
3.1 Introduction.........................................................................................................................22
3.2 Critical review of approaches to organisational development............................................22
3.3 Change models and rationale for Organizational development model...............................25
3.4 HSE change model..............................................................................................................28
PESTLE ANALYSIS:....................................................................................................................30
3.4.1 Initiation...........................................................................................................................33
3.4.2 Planning............................................................................................................................34
3.4.3 Implementation................................................................................................................35
3.4.4 Mainstreaming..................................................................................................................36
3.5 Summary and Conclusion...................................................................................................36
4 EVALUATION...........................................................................................................................37
4.1 Introduction.........................................................................................................................37
4.2 Significance of health care evaluations...............................................................................38
4.3 Evaluation...........................................................................................................................39
4.3.1 Aims.................................................................................................................................39
4.3.2 Methods and measure.......................................................................................................40

4.3.3 Results..............................................................................................................................42
4.3.4 Dissemination plan...........................................................................................................42
4.4 Summary and conclusion....................................................................................................43
5 CONCLUSION AND DISCUSSION.........................................................................................43
5.1 Introduction.........................................................................................................................43
Project Implication....................................................................................................................44
Stakeholders..............................................................................................................................44
Practices....................................................................................................................................44
Theory.......................................................................................................................................44
Strength of the project...............................................................................................................44
5.2 Summary.............................................................................................................................45
5.4 Limitations..........................................................................................................................45
5.5 Conclusion and future development...................................................................................45
Recommendation...........................................................................................................................46
REFERENCES..............................................................................................................................47
Appendix.......................................................................................................................................53

1 INTRODUCTION
1.1 Introduction
In the present era, the need of the health and care organisation is continuously increased
due to the illness and health issues. In order to deliver an impressive service to patient, it is great
responsibility of the health care provider to focus on such measure by which service user can
receive health services and care. In the health and care organisation, health care experts and
doctor plays a very crucial role who gives their best contribution to provide effective treatment
and care to patients so as they can able to improve their health issues.
In the health and care organisation, it is very important for the health care experts and
doctors to understand the issue of the patients related to their health and treat with them in such
manner so as they can improve health illness. As per the project it has been founded that there
are various serious illness and disease occurs in the present time among the people due to the
improper life style, unbalance diet and engaged schedule. By these all reasons, many of the big
health disease founded among the people Ellenbecker and Tsai, (2015). In the medical sector,
there are various effective treatment and acre services developed by which health disease can
easily improve among the people. It has been also founded that in the health and care
organisation various kinds of impressive treatment available by which major kind of health issue
can improve in the fastest manner. In the present time, home drug infusion therapy is mostly
founded in the health and care organisation. In the Today's time, home infusion therapy industry
is the product of technological and medical advancement achieved primary during the past two
decades. Home drug infusion therapy is an example of an effective treatment which includes new
method of drug supplies in the human body, innovation in technology, advance equipment, novel
ways of organising and delivering health care services. In the present era, the service users who
gets the home drug infusion therapy they mostly prefer hospital impatient treatment. In order to
organise the home drug infusion treatment services and supplies vary important on the route of
administration, types of vascular access device, types of therapy and rate of administration. In
addition to this, in order to organise this mentioned therapy program in the health and care
organisation there is huge requirement of high qualified and talented health care experts and
service provider. Sometime, in order to deliver the HDIT service in the hospital, management
organise the training and development program so as they can able to learn the new skill, talent,
ability and knowledge about deliver an impressive services and treatment to them. The cost of
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the home drug therapy program cost depends on the perspective of those paying them. HDIT is
not too much expensive treatment but it needed special expertise on the part of nurse. It needed
substantial amount of pharmaceuticals and clinical pharmacy services. It required an impressive
quality of equipment and technology so as all process of this therapy can conduct in an effective
manner. In addition to this, patient associated cost in the home drug infusion therapy divided into
two categories that are medical cost and non-medical cost.
In the present dissertation, the major objective of the investigator is to introduce a home
drug infusion therapy in the hospital. For this objective, researcher has made several themes
which provides clear understanding and knowledge about the home drug infusion therapy. In this
dissertation, various researcher methodology has also been discussed in order to obtain an
appropriate outcome of the investigation. By having an application of change in the treatment
process with an assistance of home drug infusion theory the issues can be resolved effectively. It
means the consideration of change management is essential because it allows to ensure that long
term goals and objectives can be accomplished properly. Moreover, the issues in regard to
clinical pharmacy services can also be resolved properly by having an application of change
techniques.
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1.2 Organizational context
In the present era, there are continuously increasing the requirements of health and care
service. Due to changing life style, complicated schedule and unbalancing diet every individual
have founded some kind of health disease. By this reason, there are various kinds of health and
care organisation has been developed in the country. An effective health and care organisation
have main aim is to deliver an excellent and high quality of care services to patient and
overcome their health issues. In the Malaysia, there are various effective health and care home
has been developed and in this series Acacia care centre is a famous nursing home which is
located on the London. There are 62 single rooms which all have en suite facilities with 18
bedroom. It is one of the famous care home in the London which delivers various kinds of health
treatment and care services according to the patient requirement Bowen, Privitera and Bowie,
(2011). There are 18 bedrooms on the top floor that are specially designed to cater for resident
who may suffer from the various health disease such as dementia, cancer, physical disability, old
age disease, learning disability etc. The major objective of this hospital is to deliver a high
quality of care services to patient and improve their health issues. Cited venture have high
qualified and skilled staff member and health experts who have complete knowledge and
understanding about to deliver the care service. The main effective feature of this organisation is
that it focuses on the palliative care, respite care, physiotherapy, separate dementia care unit etc.
In addition to this management also organise training and development program for the service's
provider who have lack of knowledge about the care services and who are fresher within the
organisation. This is well designed and structured health and care organisation in the Malaysia
which comes under famous hospital. It is privately owned and registered for a maximum of 62
service users. There are effective arrangement for the operation and treatment of service users.
Moreover, It has various functional department which organise and operate the different
functions and activities of the organisation. Cited venture focuses on the actual issue and disease
of the patient and deliver the care services accordingly. In the present time, within the Hospital
Yan in Malaysia management is going to introduce the Home drug infusion therapy for overcome
the high disease among the patient. Home infusion therapy involves beneficiaries receiving
medication including chemotherapy drugs in their own home by other than oral means.
1.3 Rationale of the study
In this present dissertation, there are several reason by which scholar has chosen this
topic as a project topic. The one of the major reason for choose this topic is that investigator have
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huge interest and curiosity about this topic as they wanted to know that how introduce the home
drug infusion therapy in the hospital. In addition, this, investigator also wanted to know about
this therapy and its benefit for the patient in the hospital. Another reason for selecting this topic
as a project title is that scholar have sufficient data and information about this mentioned subject.
Furthermore, scholar wanted to know that how this home drug infusion therapy conduct within
the hospital and how it is work for improving the health issue and disease among the patient. In
addition to this, it can be said that by having an effective consideration of change activities the
issues need to be resolved so that proper measure can be taken into account. Change is essential
so that issue in health care practice can be overcome effectively. However, there are number of
research studies are being framed in health care practice but very little research are being
presented in context to home drug infusion therapy. It means by having an effective reference of
present study the limitations of previous studies can be resolved.
1.4 Description of the changes
In the following report, team plans to introduce the changes related to implementing the
home drug infusion therapy in the Acacia care home. In this organisation, team will select and
implement evidence based best practices solving the problem within the one year by use of HSE
model. The major reason for implementing the changes is to overcome the crowd in the hospital
and overcome the rate of infection.
1.5 project Issue
In the present dissertation, researcher has been selected the topic of introducing the home
drug infusion therapy in the Hospital Yan in Malaysia. The purpose of the home infusion therapy
program is to provide an effective treatment and care services to the patient so as they can
improve their health issue and disease Tien, Sivinski and Lew, (2017). An eligible service users
receives this services in a qualified setting for improve or sustain in the client health. The
agency's home infusion therapy program includes parenteral nutrition which is also known as
total parenteral nutrition and home infusion supplies and equipment. This topic selected as a
dissertation topic because in the present era, there are various kinds of the big health issues
occurs among the human being due to the improper balancing of diet, ineffective life schedule
etc. In the today's time, many of the people occurs with the heavy disease which cannot easily
overcome by the normal health care and treatment. In order to deliver special services and care to
patient, hospital decided to introduce the home drug infusion therapy. In order to overcome the
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health issues and disease in the present time which does not easily overcome and improve by the
oral medication, this home drug infusion therapy has been applied in the health and care
organization.
1.6 Focus and purpose of the project
In the present dissertation, investigator consider upon the introducing the home drug
infusion therapy in the hospital. For this objective, investigator have design a systematic
literature review along with various themes of the home drug infusion therapy. In the present era,
there are continuously increase the health disease and issue among the people and they want
effective and special care within the health and care organization. In order to deliver special and
fastest treatment of patient, health experts and care provider focus on this home drug infusion
therapy program Ellenbecker and Tsai, (2015). With help of this therapy, patient can instantly
improve their health disease. In this dissertation, home drug infusion therapy and its outcome and
effectiveness has been systematically addressed.
1.7 project Aim
“To introducing home drug infusion therapy in the Hospital:A case study on Hospital Yan in
Malaysia”
1.8 SMART project Objective
 To provide Home drug infusion therapy to at least 50% of patients who are fulfilling the
criteria of new service by end October 2017
 To overcome the elective surgery cancellation rate due to bed shortage by 30% by end
October 2017
 To reduce the financial terms and expense of patient by 30% by end October 2017
 To decrease number of emergency department boarded patient by 30% in the end of
October 2017
 To reduce infection rate in the hospital by 40% in the end of December 2017
1.9 The expected organization impact
While Acacia care home implement the change related to home drug infusion therapy
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then it will directly affect its existing and future situation. In this report includes a description of
how things currently are with respect to the issue like behavioral, structural, personal and cultural
categories. Following are systematic expected organizational impact-
The current situation The expected outcomes
 Current staff are exhausted and feel
insecure as a result of working in a high
patient flow environment. In addition to
this, patient also dissatisfied with
existing delivered services
 Existing staff are always searching for
weaknesses in order to blame the
others.
 Operation and treatment process is too
big due to which patients are
dissatisfied
 In the future, satisfaction of the staff
member and patient will increase
because overall structure of the business
will improve.
 Every staff member have responsibility
to provide high quality treatment and
services to patients and deliver solution
for bad situation
1.10 Summary and conclusion
From this entire discussion in the introduction, the major aim and objective of the project
has been identified. From this introduction it has been concluded that the major objective of the
Hospital Yan in Malaysia is to provide home drug infusion therapy to the patient who are not
able to recover their health issue by oral impatient (Lowes and Hulatt 2013). Hospital Yan in
Malaysia is going to organise the program of home drug infusion therapy under which its health
care experts and doctor will responsible to provide this infusion therapy at home. By this aim,
cited venture wanted to reduce infection rate in the hospital by 40% in the end of December
2017. In addition to this, another objective of the investigator is to decrease number of
emergency department boarded patient by 30% in the end of the October 2017.Thus, from these
analyses it has been founded that there are major three kinds of the home drug infusion providers
who delivers the care and treatment to the patients who are serving from the high disease health
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issues. Hence, from this above discussion about the home drug infusion therapy it has been
founded that in the health and care organisation, this mentioned therapy is a great full treatment
of the patient by which those patient can get an impressive treatment and care services who are
not able to go to the hospital and they have serious health issue which do not improve by the oral
medication within the hospital. In order to deliver this treatment, health care experts use an
impressive technology and equipment through which such kind of therapy can arrange at the
home.
2 LITERATURE REVIEW
2.1 Introduction
In the dissertation, literature review is one of the essential chapter which provide the
detail knowledge and understanding about the project topic. In the literature review there are
various kinds of themes designed by the scholar so as clear understanding about the dissertation
topic can obtain in the dissertation. In the present dissertation, scholar have main intension to
introduce the home drug infusion therapy in the Hospital Yan in Malaysia so as every patient
who are not able to take the oral impatient can get an excellent services and care from the doctor
and health care experts. In order to attain this objective, scholar has bifurcated the entire
literature review in the several themes such as Meaning and concept of the Home drug infusion
therapy, Inpatient bed utilization and reducing hospital admissions, Elective surgery cancellation
etc.
2.2 Search Strategy
Systematic process has followed for searching the literature for the present dissertation
about the topic of introducing the home drug infusion therapy in the Hospital Yan in Malaysia. In
this topic included identification, retrieval and management of independent studies on the project
topic. In this literature search process included the selection of keywords, using electronic data
base, deciding inclusion and exclusion criteria.
Database
In order to search the literature researcher has used the electronic database. The major
reason behind this using electronic data base is that it is very fastest medium to collect the
literature in the minimum time period. In addition to this, electronic database also assist to the
scholar in collect and obtain the information about the large numbers of journals, articles and
acts. Thus, it can be said that scholar can largely beneficial by obtaining relevant studies for the
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present project on the topic about to introduce the home drug infusion therapy program in the
health and social care organisation.
Scholar has been used the following database
Databases Description
Psych-INFO It is one of the largest resource in the world at
where various kinds of the reviewed literature on
the various kinds of therapy and its impact on
the patients. This web have more than 4 millions
bibliographic records which consider on
behaviour and social sciences and psychology.
MEDLINE This is another bibliographic option of the
database which includes various kinds of article
and journals on the topic of nursing, health care,
medicines and dentistry etc.
CINAHL It is index of journal which includes allied
health, health care, nursing services, treatment of
patients etc.
Search Engines
In order to search literature of the investigation, scholar has sued search engines such as
EBSCO host which assist to investigator in obtaining a relevant content about the topic. It is an
electronic journal host and contains journals from a number of publishers. This also aid to
investigator in search an appropriate article from the varieties of the collection of journals.
Key search Terms
In the process of investigation, scholar has used various kinds of search terms. With help of these
search terms, scholar can obtain relevant information about the topic from internet. It is the main
variable that assist in defining a particular search. Following are some key search terms that will
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