HSC 6011: Change Proposal for Reducing Elderly Malnutrition

This report presents a comprehensive change proposal focused on reducing malnutrition incidences among elderly patients at London Bridge Hospital. The proposal identifies malnutrition as a significant issue, highlighting its impact on health outcomes and the need for improved nutrition delivery. It outlines the problem, justifies the proposed change, and details the expected outcomes, aiming to enhance the welfare of elderly patients. The report employs Kotter's 8-step change model, including establishing urgency, forming a guiding coalition, creating and communicating a vision, empowering others, planning for short-term wins, consolidating improvements, and institutionalizing new approaches. It also incorporates a quality improvement model and discusses leadership strategies. The report provides a background on the aging population in the UK and the vulnerability of the elderly to malnutrition, emphasizing the importance of addressing this public health problem. The implementation plan includes creating a team, using the Kotter’s model, and addressing the need for improved healthcare services tailored to the elderly. The goal is to improve the nutritional status, quality of life, and mortality rates of elderly patients. The report concludes by emphasizing the need for swift and effective responses to the nutritional needs of the elderly, and the importance of providing food and health assessments for those lacking family support. This report is contributed by a student to be published on the website Desklib.

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Table of Contents
1.0 introduction....................................................................................................................................3
1.1 broad overview of the change proposal....................................................................................3
1.2 change justification and what I seek to achieve.......................................................................4
1.3 The expected nature of change.................................................................................................5
2.0 Background....................................................................................................................................5
3.0 Implementation for the change.....................................................................................................6
3.1 Change model (Kotter)..................................................................................................................7
3.1. 1 Establish a sense of urgency..............................................................................................7
3.1.2 Form a powerful guiding coalition....................................................................................7
3.1.3 Create vision........................................................................................................................7
3.1.4 Communicate the vision.....................................................................................................8
3.1.5 Empower others to act on the vision..................................................................................8
3.1.6 Plan for and create short time wins.................................................................................10
3.1.7 Consolidate improvements and produce more change..................................................10
3.1.8 Institutionalize new approaches.......................................................................................10
3.2 Quality improvement model...............................................................................................10
3.3 Leadership................................................................................................................................11
4.0 Conclusions..................................................................................................................................12
6.0 References....................................................................................................................................14

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1.0 introduction
1.1 broad overview of the change proposal
According to the records from London Bridge Hospital in the United Kingdom, 35 percent of
patients admitted to the elderly ward are malnourished, and others are at high risk of
becoming malnourished. It is depicted that 93 percent of the people at risk might be living in
the community (Slee, Birch & Stokoe, 2015).Malnutrition are both causes and consequences
of sickness, it has significant influence on health outcomes and are essential to all healthcare
pathways. Surprisingly, these challenges affecting the elderly are still being poorly
recognized in the UK and healthcare setting regardless of many reports of inadequate
nutrition (Maynard & Williams, 2018).It is important for National Health Service to address
the challenges and improve the delivery and commissioning of excellent nutrition in London
Bridge Hospital.
The best thing that can be done is to come up with change proposal, the change proposal will
help in reducing malnutrition incidents in London Bridge Hospital elderly ward. National
health services (NHS) should mobilize change in the hospital unit. NHS is a public-funded
national body which aims it providing healthcare services in the UK (Iganski & Mason,
2018).Malnutrition is a condition that is caused by eating food which some nutrients are
either too low or too high that the diet leads to health complications. It may involve proteins,
calories, vitamins, carbohydrates, and minerals (Rondel, Langius, de van, Kruizenga, 2018).
The elderly are always the backbone of our society, so there is a great need to protect them
against malnutrition. Some of these scenarios always just occur due to negligence by the said
family members who need to take great care of their relatives. Taking good care of the
elderly is something that should be very imperative to all the people in a society. Being old is
something which nature bestows to us, so that makes it inevitable; you cannot avoid falling in

REDUCING MALNUTRITION INCIDENCES IN ELDERLY PATIENTS 4
that phase of human life. This proposal tends to bring a new face that needs to be placed into
consideration so as to reduce cases of malnutrition among the elderly in the health unit to
increase their mortality rate. Malnutrition among the elderly is always associated with many
things that the project will iron out to ensure proper living standard among the elder patients
admitted to the hospital. Consequently, a good or a healthy living among all the people in a
family setup is always a symbol of good economic status in the community or within the
entire national scope. Candidly, it is a macabre that is characterized due to many things:
reduced food intake is one of the major problems, increase prices of food making foodstuff to
be very difficult for them to purchase, sensory impairment, and lack of a properly balanced
diet (Haste et al.2018).
1.2 change justification and what I seek to achieve
Honestly, across the entire globe, the elderly people are acknowledged to be one of the
vulnerable people in a community or the society at large. Indeed, what amazes is that still
there is a little input done to them to meet some of their intended needs, or even recognizing
some of the contributions and the unique capacities that they have or possess in the society.
Admitting, some of the interventions do ignore the special needs of the aged people in the
London Bridge Hospital elderly unit. The intervention does clearly, separate against and on
instance look down upon their capability to support themselves individually. It goes without
mentioning that most of the agencies have come out clearly to protect and safeguard the lives
of elders who suffer from malnutrition. Though less interest, manpower or knowledge have
been put towards protecting the elderly group in the hospital who are always the victims of
circumstance. Emergency programs which will act as an intervention towards the cases of
malnutrition among the elderly should be initiated to tackle this menace that deprives as the
elderly people who most of them are always our grandmothers, grandparents or even our
parents. Health services may not be tailored towards supporting the elderly in the society due

REDUCING MALNUTRITION INCIDENCES IN ELDERLY PATIENTS 5
to insufficient information about the needs of the elderly and the problems that they
encounter (Wolters, et al. 2018).
1.3 The expected nature of change
This proposal has an aim of hopefully, improving the welfare of the elderly people in London
Bridge Hospital. It goes without mentioning. The project will be working towards
enlightening all the humanitarian agencies and most of the government institutions to always
respond swiftly and effectively to most of the nutritional requirements of the elderly people.
Responding to the emergency dietary issues of the elderly is also one of the primary things
that the proposal needs to seek or give solutions. Thus, providing adequate food to the older
people who are malnourished will also be a necessity. It will also help the malnourished
people who lack support from their families and relatives to get quick access to foodstuff, and
proper health assessment among themselves.
2.0 Background
The population in the UK in the year 2016 was at its highest ever, at 65.5 million and
estimated to reach 75 million by 2035. The improvement in healthcare facilities and lifestyles
would make the population get older.
The aging population in the United Kingdom is affected by factors including fertility,
mortality, lifestyles and health provisions. The age proportion of people of 16 to 64 years has
been relatively steady over the last 30 years, but recently it has started to decline and is
estimated to decrease further in the future if an appropriate measure is not put in place.
Aging occurs to human beings with a progressive and irreversible slowdown of body
functions involving social, mental, physical and psychological effects that makes the body of
a person to be considered vulnerable. Malnutrition and chronic diseases are common more so

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during famine or disasters. The elderly people are the most vulnerable group in which the
effects of multiple deficiencies and under nutrition manifest themselves (Ohashi et al. 2015).
3.0 Implementation for the change
Malnutrition is a very significant but ignored public health problem. 10% of the population in
the United Kingdom is affected by the problem. This has cost the country about £7.0 billion
per year and half of the costs is spend on the patience of above 65 years.
National Health Services (NHS) in the UK is a body that provides for the healthcare needs for
all the UK citizen. The organization deals with over one million patients after every 36 hours.
It takes care of everything including routine screening, antennal screening, transplant
treatment, treating long-term conditions and also end-of-life care.
Malnutrition among the elderly too complicated to be addressed by the government or
National Health Service alone, The government should show example in tracking
malnutrition through the creation of the body of government that would deal with nutrition
problems and preferably within the sector of local Government and communities (Heo,
Tozour, Delahaye, Zhao,Cui, Barzilai & Einstein, 2016).
The Kotter’s change model will help London Bridge Hospital to improve the capability to
change and escalate chances of success. The hospital first should create a team of people that
will help reduce the causes of malnutrition among the elderly.
People do not always take change as a positive experience. By following its Kotter’s 8 step
change model, the organization will reduce malnutrition incidences in elderly patients and
become proficient in change implementation. The first three steps of the model are creating
the appropriate climate for change, change in in the health sector is the forth and the 6th step.
The last two steps are to improve implementation and consolidation.

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3.1 Change model (Kotter)
3.1. 1 Establish a sense of urgency
Creating urgency is the capability to identify pressing challenges as opportunities. Addressing
malnutrition problem in the elderly can give a chance for adopting a positive change. This
first step motivates doctors and practitioners to embrace change by emphasizing the need for
solving these pressing problems (Wentworth, Behson & Kelley, 2018).
This step is crucial according to Kotter. By making people aware of the necessity for and
urgency for change in reducing malnutrition of the elderly, support will be made. This needs
an honest, a convincing and open dialogue. This will convince the employees of the
organization of the importance of implementing change. This would also be accomplished by
discussing with them and deliberating possible solutions (Petrou, Demerouti & Schaufeli,
2018).
3.1.2 Form a powerful guiding coalition
Forming a guiding coalition involves leaders to pursued people to implement new practices.
The coalition group may include a nurse director, resource nurses, nurse educator, and a
clinical supervisor amongst others who would be ready to be committed to assisting in
guiding in this process. These nurse leaders would need to be educated to apply the Kotter’s
model by the director. The leaders will review the literature behind the malnutrition of the
aging population from London Bridge Hospital, and leaders will need to utilize their
understanding of the model (D’Andreamatteo, Ianni, Rangone, Paolone, Sargiacomo, 2019).
3.1.3 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 was to
reduce malnutrition among the elderly. Indeed the project is characterized by some upshots

REDUCING MALNUTRITION INCIDENCES IN ELDERLY PATIENTS 8
that need to be given consideration. Preferably this upshot comprises: preventing the adverse
effects that may attack the elderly, improving service provision satisfaction, and lastly
receiving proper and intermediate health care. Honestly, the enshrined vision of this initiative
was borrowed from some of the current literature that depicts several issues, inclined towards
supporting the potential value significance of beside handoffs. It goes without mentioning
that the well-known A 3-step procedure which gave a flashback hinted out about the vision
had to be established, and generally it comprised some key integral issues like; elaborating on
duties and responsibilities of most of the incoming and outgoing nurses, and lastly creating
one of the most formalized communication channel which will serve the handoffs
alternatively (Smith & Rauhut, 2019).
3.1.4 Communicate the vision
Thus, it goes without an utter ado that once a vision is created by the implementer or the
initiator of the issue. That message should be shared promptly amidst the members who are
going to execute has been planned. Admiringly, some of the write-ups illustrating the
imperative significance of the well-known besides handoffs and enactment of change of the
said sporadic change according to what is enshrined in the Kotter’s model could be available
for dissemination amidst the staff members. It is the phase that is well associated with
frequent staff meetings, and educations programs are always used to articulate an issue
concerning the known vision of the three-phase procedure (Gross et al. 2019).
3.1.5 Empower others to act on the vision
Even though the enshrined perceptions are always efficiently communicated, adoption
specifically requires we should buy in fro from other people. Accomplishing this step,
expects the team members to be acquainted with vision and to be bestowed the autonomy to
act. As the subordinate staff needs to be empowered to get used to the vision by making or
creating some of the tools which will establish the foundation of a system that is home-

REDUCING MALNUTRITION INCIDENCES IN ELDERLY PATIENTS 9
grown. A known example of these sporadic changes comprises the standardization of
communication via nursing Kardex,that need to be electronically kept up to date due to each
shift. Tough, the staff was initially introduced to (situation, background, assessment, and
recommendation) but instead, it never gave credence to communication issues that exist
within the unit. Consequently, staff members had to organize or developed an excellent
system which outlined the description of a certain situation, plan, and intervention. Not, only
did the new system addressed the local environmental challenges but also it brought a sense
of possession to those people who used it appropriately. The documentation of this same
process is also mediated by what is known as the situation, intervention, and plan
communication procedure illustrated in the Supplemental Digital content. DMS had also to
be adapted with the purpose of identifying, developing countermeasures, implementing, and
evaluating the said change (Shanks, 2016).
One of the most known key examples during the predetermined time is where nursing hurdles
are always convened. Some problems were also identified when patients were found to be
sleeping when handoffs took place. The countermeasure that had to be put in place is that it
was perceived to be safer to wake patients while they are asleep, introduce the incoming
nurse, and also implement bedside handoff. At the implementation of the handoffs had to take
precisely one week and then be evaluated by the said authority in place. It had to be a
necessity to convene nursing huddles weekly with the purpose of assessing the effectiveness
of the countermeasure until perfection is achieved. As on the hand, it was upon effective
leadership to provide assistance to some of the staff members. Who may become hesitant to
the said change which had to be implemented at all cost? The stated procedures are always
strictly done repeatedly with an objective or an aim of resolving the existing problem
(Hosking & Anderson, 2018).

REDUCING MALNUTRITION INCIDENCES IN ELDERLY PATIENTS 10
3.1.6 Plan for and create short time wins
It is believed that changes are always considered very easy to envision and implement
though they are also termed to be more challenging to sustain. At this step is upon the team
members to establish clear and visible wins (Jones, Firth, Hannibal & Ogunseyin, 2019). At
local levels, an example of two quick wins is always identified. Team members were also
able to fast track some missing medications in an electronic medication administration data at
the commencement of the shift. One of the other known quick win realizations was the ability
of to make their shift to be more efficient and leave on time. Making the highlights on these
wins reinforced the momentum of this project (Bousquet et al.2019).
3.1.7 Consolidate improvements and produce more change
For the Organizations to implement change should be able to support change and encourage
innovations and at the same time maintaining visions. The changes should be reinforced and
maintain and keep the main goals of the organization in focus. Strengthening the practical
procedure of maintaining good health and emphasizing the need to reduce malnutrition
among the elderly (Kumah, Ankomah, & Antwi, 2016).
3.1.8 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 and nurses need to be oriented (Rabinovici et
al.2019).
3.2 Quality improvement model
In the health sector, quality improvement is the structure that is utilized systematically to
improve how healthcare services are delivered. The model has features that can be measured,
examined, developed and controlled. The model involves continuous efforts that can be used
to attain predictable and stable process results. To achieve sustainability, it needs the

REDUCING MALNUTRITION INCIDENCES IN ELDERLY PATIENTS 11
commitment London Bridge Hospital with support from National Health Service, more so top
management (Schell, 2019).
The organization will need to identify the goals or the aims. Goals are what the organization
needs to achieve; it will then be broken down into sub-processes or discrete elements. After
that, it is important to define what each element constitutes through confirmation and
nomination via chart audits or performance audit (Araújo-Soares, Hankonen, Presseau,
Rodrigues & Sniehotta, 2019).
The last step in the process is tested and implement changes. The spread of the good ideas
that will help address the problem will be an important contribution to individual patients and
the health sector at large (Repaczki, Hrnicek, Heissenbuttel, 2019).
3.3 Leadership
Change leadership is the ability to enthuse and influence others through, vision drive and
personal advocacy, and resource access to form a strong platform for change. Sustainable and
successful improvement of an organization depends on the effective leaders who understand
how to build and disseminate the organizational goals, manage conflict and intimidate
resistance (Kerzner, 2019).
Leadership can either have a positive or negative effect on change depending on the
effectiveness of the change method that is applied within the dynamic of the organization.
To ensure effective leadership, they will help in implementing change. The following are the
techniques that the management of London Bridge Hospital should implement change
(Iskandar, 2019).
Planning - The leaders of London Bridge Hospital should understand that change enhances
both the organization ability to perform the duties at an efficient and an effective manner. It is

REDUCING MALNUTRITION INCIDENCES IN ELDERLY PATIENTS 12
evident that sometimes employees are resistance to change and their leaders should plan for
resistance to change (Bush, Bell & Middlewood, 2019).
Educating – leaders should ensure that both the patients and the employees understand the
reason and the need for change to fully address malnutrition concerns and avoid further
problems, training and educating people on the change and ensure that they are comfortable
and perform their duties very well (Smith & Rauhut, 2019).
Communication- leaders should create a communication process which recognizes change
and prevent employees from becoming very fearful due to fear of the unknown.
Communicating with employees will help in ensuring that all staff and employees understand
the visions of the future (Holman, Brown, Carter, Harrison & Rounsevell, 2019).
Participation – leaders can make employees to be very active in the change process by
involving them in the change decision process. This will allow employees to participate in
solving potential challenges (Araújo-Soares, Hankonen, Presseau, Rodrigues & Sniehotta,
2019).
Support – leaders should come up with new skills and train employees on change
implementation. The leaders of the organization must review the structure of the organization
to ensure that it supports the change (Wanigarathna, Jones, Bell, Kapogiannis, 2019).
4.0 Conclusions
Old people are very vulnerable to malnutrition. Moreover, efforts to reduce the challenge by
providing proper nutrition faces various practical challenges. The first challenge is that the
requirements for nourishment is not well defined because the rate of basal metabolic and lean
body mass reduces with age (Amarya, Singh & Sabharwal, 2015). Some causes of
malnutrition that has been highlighted in this report can be addressed by implementing the
changes in London Bridge Hospital.

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Application of Kotter’s model would be handy for the success of this project. This is because
it is advantageous, easy to follow and well-structured that provides a helpful framework for
the implementation of measures to reduce malnutrition (Jones, Firth, Hannibal, Ogunseyin,
2019). The mode can be used to instrument change by selecting an appropriate group of
people that will encourage others to change until the practice becomes a custom (Gross, et al.
2019).The National Health Service Will need to apply the Kotter’s models before it is too
late.

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