Change Management and Leadership: Improving Patient Nourishment Report

This report presents a quality improvement initiative focused on enhancing patient nourishment within a healthcare setting. It addresses the significant issue of malnutrition in hospitals, highlighting its negative impact on patient outcomes and mortality rates. The report proposes the implementation of a MUST (Malnutrition Universal Screening Tool) score tool, color-coded patient identification, and improved support during mealtimes. Kotter's 8-step change management model is selected as the framework for implementing these changes, with detailed steps including establishing a sense of urgency, forming a guiding coalition, creating a vision, communicating the vision, empowering others, planning for short-term wins, consolidating improvements, and anchoring the changes. The report emphasizes the importance of stakeholder involvement, staff education, and continuous monitoring to ensure the successful adoption and sustainability of the proposed changes. The ultimate goal is to improve the quality of patient care, empower patients, and reduce the incidence of malnutrition-related complications.

Running head: CHANGE MANAGEMENT
Name of the student:
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INTRODUCTION
Quality improvement is about making healthcare safe, effective, patient-centred,
timely, efficient and equitable (Health Foudation). According to the Health Foundation,
there is a complelling case for applying organisational quality improvement approaches
to healthcare. We think that all staff have a role to play in ensuring the healthcare
services continue to improve. The documented literature highlighted that in a clinical
setting, the high rate of morbidity observed due to inadequate nourishment received by
the patients. Tucker et al. (2012) suggested that 20 to 50 percent of hospitalized adults
are malnourished in United Kingdome. The significant number of health professional
failed to provide additional attention to the patients who are malnourished and require
additional nourishment (‘Qiu et al. 2015). Hence in the clinical setting, it is required to
improve quality of care to the patients by implementing MUST score tool for identifying
need along with screening and creating a colour code for the patients who need extra
attention, that is, feeding, encouraging during mealtimes and throughout the day. It will
provide nurses an opportunity to enhance their practice of providing quality care to the
malnourished patients and become aware of their practice (Cotogni et al. 2017).
Moreover, the improving quality of care empowers patients, boost their self-esteem,
increase the possibility of faster healing and improve patient satisfaction (Berezowska,
Passchi and Bleiker 2019). Hence, this quality improvement initiative is required in the
clinical setting for reducing the global burden of disease and a high morbidity rate. In
order to implement the changes, Kotter's change model can be the best suitable model
of change. The model recognizes the need for incorporating opinion of staffs and other
stakeholders. Hence it is the best suitable model for implementing changes.
Background
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Nourishment is fundamental and is as crucial as medications and different sorts of
treatment. It is every individual nurse’s duty to keep up with patient wellbeing by
creating powerful, proof- based practice and initiative at all dimensions. Good nutrition,
hydration and pleasant eating times can significantly improve more older individuals'
wellbeing and prosperity. It is inadmissible that in certain wards in different hospitals
there is an inability to offer help at eating times for the individuals who need it and an
absence of good-quality, alluring and nutritious sustenance – this establishes an
absence of regard for patients' dignity (Department of Health and Nutrition Summit
Stakeholder Group, 2007).
Nutrition is a basic piece of patient consideration that is regularly dismissed or ignored.
Age concern (2006) contended that it is a 'national outrage' that six out of ten more
older individuals are in danger of becoming malnourished, or their circumstance
breaking down, in medical clinic. Patients who are malnourished remain in hospital
longer, are more times bound to develop complications during medical procedures, and
have a higher death rate than the individuals who are well nourished (Age Concern,
2006). A noteworthy extent of patients admitted to hospital are in danger of ailing
health. Keeping up the nourishing condition of patients who are in hospital is a crucial
part to be considered. In any case, the Audit Commission (2001) referred to studies
exhibiting that up to 40% of grown-up patients are either admitted to hospital with
hunger, or become malnourished during their stay.
Malnutrition can be characterized as a condition of sustenance where a lack,
abundance or awkwardness of vitality, protein or different supplements, including
minerals and nutrients, causes quantifiable unfavourable impacts on an individual's
body work and clinical result (Royal College of Physicians, 2002).
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About 5% of the UK population are believed to be underweight, and it is evaluated that
roughly two million individuals are malnourished at any one time. Lack of healthy
sustenance can, and does, influence everybody (Gregory et al, 1990) yet the most
vulnerable incorporate those with long-term conditions, older individuals, those who
have been just discharged from hospital, and the individuals who are poor or socially
segregated. Ailing health is both a reason and result of infection – it inclines individuals
to, and postpones healing from, disease.
Age concern (2006) contended that it is a 'national outrage' that six out of ten more
established individuals are in danger of becoming malnourished, or their circumstance
breaking down, in medical clinic. Patients who are malnourished remain in hospital
longer, are more times bound to develop complications during medical procedure, and
have a higher death rate than the individuals who are well nourished (Age Concern,
2006).
The Council of Europe's (2003) Resolution ResAP(2003)3 on Food and Nutritional Care
in Hospitals distributed 10 key qualities of good dietary consideration in clinics. Two of
these identify with the MUST scoring tool that all patients are screened on admission to
recognize ailing health or those in danger of it. All patients are re-screened week after
week and that all patients have a consideration plan, which recognizes their wholesome
consideration needs and how they are to be met. In addition to this tool, I would create
colour-coded paper to make it easy to recognise a patient who needs extra attention
that is, feeding, encouraging during mealtimes and throughout the day.
In this case, two best change management can be chosen for implementing
change such as Lewin's change management and Kotter’ change management. Kurt
Lewin's change model based on three models of change such as unfreeze, change and
freeze which provide a high-level approach to change in the organization. It gives a
manager and framework for implementing a change effort which always very sensitive
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and accepted by employees associated with the organization (Cameron and Green
2015). The stakeholders are required to provide their contribution to implement
necessary changes. On the other hand, Kotter's 8 step change model comprises eight
overlapping steps which were developed from the experience gathered by the
organizations in order to implement successful changes. (Grol et al. 2013) In
providing managers to identify the needs and quality issues that are affecting the
growth of the organization. While both of the models are frequently used by the IT
facilitates quality improvement, drives individuals towards transitions and ensures that
project meets the criteria of the desired outcome with detailed eight steps, unlike three
steps of Lewin's change management (Cameron and Green 2015). Hence, in order to
implement the quality improvement initiatives, Kotter's change management model is
the best suitable model which can act as a framework of change.
IMPLEMENTATION OF THE CHANGE
Change Model
Malnutrition is a very significant public health problem and according to Community
Care 2019, studies show that 10% of the population in the United Kingdom is affected
by the problem. Creating colour-coded sticker to be placed above the patients’ bed to
help recognise if the patient needs extra support during mealtimes. A patient who
needs extra support or assistance during mealtimes may be possible that they may
need some kind of encouragement especially with fluid intake in between meals and
these stickers would also remind staff to stop and offer, assist or encourage fluids or
snacks. Kotter’s 8-step change model developed by John Kotter is a model that is still
being used to help embed change in an organisation effectively. Following the change
model will help in improving the capability to change and escalate chances of success.
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Establish a sense of urgency
` Creating urgency is the capability to identify pressing challenges as
opportunities. Poor nutrition can lead to much worse outcomes so it is important to
tackle this in hospitals. Poor nourishment of the patients leads to poor prognosis of the
disease, resulting in a high mortality rate. Hence in order to implement the change, it is
crucial to establish a sense of urgency within the professionals working in hospitals.
The sense of urgency can be created by showing the staffs the changes that are
required and poor outcomes because of the lack of changes in patients (Small et al.
2016). In this case, the health professionals are required to provide with resources for
gaining proper literacy which highlights the negative consequences of lack of
nourishment and possible guide to address the research question (Pollack and Pollack
2015) . The nurses are required to encourage to embrace the changes that are
required to implement.
Form a powerful guiding coalition
Forming a guiding coalition involves leaders to pursued people to implement new
practices. The coalition group may include members of the MDT, for example, a ward
manager, dietician, nurse educator, and a clinical supervisor amongst others who would
be ready to be committed to assisting in guiding in this process. The nurse educators,
clinical supervisors will receive education regarding the eights steps of the changes and
relevant literature to implement possible changes from ward manager and higher
authorities. After gathering the literacy, they will collectively create a team charged with
creating a vision so that the health professionals can achieve the desired goal (Wheeler
and Holmes 2017).
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Create vision
This third step is to create a vision that will help the organization to develop
strategic initiatives and steer the change to achieve the set objectives. The vision of
this project is to improve the quality of care by implementing the through screening of
patients and creating color-coded paper to identify patients who require additional
attention during mealtimes and throughout the day (Pollack and Pollack 2015). The
ultimate outcome of this vision is to empower patients, boost their self-esteem,
increased the possibility of faster healing and improve patient satisfaction. The guiding
vision was created with the assistance of relevant literature.
Communicate the vision
Once a vision is created by the implementer or the initiator of the issue, the
message should be shared promptly among the members of the team. This could be
done through different ways including sharing on Trust intranet, creating leaflets and
staff meetings. It is the phase that is well associated with frequent staff meetings, and
education programs are always used to articulate an issue concerning the known vision
of the three-phase procedure (Gross et al. 2019). Communication is important for every
team member to be able to voice out their opinions. Adding feedback on how the vision
is improving is of importance in order to get the highest level.
Empower others to act on the vision:
While creation of vision effectively communicated, the adaptation of the changes
require time. In this case, for understanding the vision, team members are required to
understand the vision and should be given the autonomy to act on the vision. They can
be empowered by developing an advanced tool to track those color-coded papers and
nurses are required to act on this new change through effective communication (Gross
et al. 2019). They are required to involve in the activities which involve the color-coded
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paper attached to the patients The nurses are required to provide additional support
from the higher authority in order to empower them
Plan for and create short time win
At this step it is important for the team members to establish clear and visible
wins (Jones, Firth, Hannibal & Ogunseyin, 2019). In these steps, the staffs are required
to identify the discrepancy in their practice reading the proper nourishment of the
patients who required the support most. Another example of quick wins is the
realizations that nurses are able to provide accurate nourishment to the patients more
efficiently which improves the health status of the patients (Wheeler and Holmes 2017).
To acknowledge these feelings of nurses, it is required to provide emotional and
financial incentives so that they feel motivated, empowered and able to improve their
practice of providing proper nourishment to the patients.
Consolidate improvements and produce more change
For the ward to implement change it should be able to support change and
encourage innovations and at the same time maintaining visions. The changes should
be reinforced, maintained and keep the main goal of the ward in focus to strengthen the
practical procedure of maintaining good health. Reinforcing the practical steps for
continuous screening of patients who are admitted to the hospitals or before
admissions and maintaining the proper use of color-coded paper in recognizing the
patients who require additional attention during meal time and throughout the day
(Wheeler and Holmes 2017). The guiding coaches and supportive staffs are required
to recruit in the clinical setting so that nurses can facilitate their practice by involving
themselves in the training and identifying the discrepancy of training (Wheeler and
Holmes 2017). The health professionals must foster critical thinking, interpersonal skills,
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and reflective skills for improving their practice of providing safe and responsive care to
the patients.
Institutionalize new approaches
A substantial change needs a cultural movement to make the vision of the
organization to be the norm. To do this people need to be educated (Rabinovici et
al.2019). Feedback from the service users is detrimental be it positive or negative. The
nurses are required to provide the feedback regarding the new changes of the
organizations and issues they are experiencing due to new changes
Quality improvement model `”
Quality improvement is a systematic and formal approach to the analysis of the
practice performance and efforts for improvement. The quality improvement is crucial
for health care which leads to the measurable improvements in quality of care and
health status of the target patients groups (Hignet et al. 2015). While growing bodies of
evidence focused on different approaches of quality improvement, there two different
quality improvement approaches highlighted by most of the researchers such as the IHI
Model for improvement, Lean methodology.
IHI Model for improvement is a conceptually simple model for improvement in
the health care sectors. IHI models have different steps such as setting aims,
SETTING GOAlS, brainstorming and PDSA cycle establishing measures, selecting
changes, testing changes, implementing changes and spreading changes (Gold et al.
2016). Like the IHI model of improvement, lean methodology is also used for
improving the quality with the help of four steps such as evaluation, changes
implementation, control, and standardizations. The similarities between these two
models are both the models doesn’t replace, change model, rather both the models
facilitate the changes in the organizations. However, since IHI facilitate the patient’s
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experience of care by optimizing the performers of the health care professionals, it is
the best suitable model of quality improvements (Gold et al. 2016).
As the PDSA model is the part of the IHI model of improvement, in order to
bring the changes this quality improvement approach would be the best model.
Considering the model, the first step is to set an aim such as to identify patients
who require additional with the help of MUST tool and color-coded paper and provide
nourishment to the patients. The second step is to set a goal such as “ to improve the
health status of the patients by 50 to 80-% with help of MUST tool and color coding
papers within the next 6 months. The third step is to make aware of the changes that
required and apply theory such as the chronic care model to provide the care. The
team is required to generate lists and consider are linked to the outcome in questions
and bringing changes to these factors. The next phase is to use the PDSA Model for
quality improvements.
PDSA cycle model stands for plan, do, and study and act cycles which is a very
small cycle of changes which is used to optimize the performance of health
professionals. In the first step (plan), the team will plan for a change in the process
such as health professionals will screen every patient during admission, especially
older adults and provide the color-coded paper according to the health status. In the
second step, the change in the process would be performed within short interval such
as two to three weeks, In third steps, study, the team is required to evaluate random 10
patients who were present and conduct the audit in order to assess the health
conditions. In the fourth step (ACT), the team is required to implement the changes
according to the result of the audit.
Leadership:
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Leadership is highly desired competencies in organizations in order to bring
desired changes. As discussed by Brewer et al. (2015)leadership is the most crucial
attribute of a manager which assists employees to maximize their efficiency through
encouragements and motivations so that they can achieve the desired goal. There are
different leadership approaches observed in the health care sectors such as Visionary,
Servant, Autocratic, Laissez-fair, Democratic, Pacesetter, Transformational.
Transformational leadership is the most suitable leadership approach in implementing
this quality improvement. Brewer et al. (2015), stated that in this approach, the leaders
encourage, inspires and motivate employees in order to create changes that will
improve the quality of care and patient satisfaction. The impact of this leadership
approach is that it will improve the performance of the health professionals, improve
the identification process of the patients with an additional need, and reduce the high
morbidity rate associated with poor nutrition and vulnerable immune system. The
changes can be evaluated by using certain measures such as improved status of the
patients, reduced rate of sudden death in health care, engagement of patients in
meals and faster recovery of patients. It will improve the faster recovery of patients and
high patient satisfaction.
The changes can be evaluated by conducting a survey of the patients and
interview of the nurses so that it would be easier to gain the idea of successful
implementation of the changes. The proposed changes can be communicated with the
CEO of the organizations and local government as well as policymakers through
arranging face to face meeting and telephonic meetings.
CONCLUSION:
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Thus it can be concluded that quality improvements are crucial for providing
quality care to the patients. In this current context, the significant number of health
professional failed to provide additional attention to the patients who are malnourished
and require additional nourishment. The changes are required to implement for
improving quality of care for the patients who require additional attention. The
challenges in implementing this change are that a significant number of health
professionals failed to cope up to with this change. The benefit would be it is effective
to improve the quality of care of patients. The transformational leadership approach
would be the best suitable approach which will provide proper nourishment to the
patients with additional needs.
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