NUR 590 Topic 2 Discussion Question 2
Do you foresee any issues with the proposed implementation of your project? Identify a strategy to help create or sustain a higher level of readiness to change with your organization and discuss how current research or literature will be used to ensure that change is based on current evidence.
As with any project implementation, it is best to anticipate any potential issues ahead of time. As a result, I anticipate a few potential issues with my project’s proposed implementation. The first anticipated issue identified for the proposed implementation of my evidence-based project is and will continue to be financial concerns. I was able to identify a couple of strategies to assist with the financial concerns, including the involvement of executive leadership in the process. Being completely transparent with the executive leadership team about the implementation plan, including costs and cost-cutting measures, will help you gain their support. Another financial strategy would be to form a team of subject matter experts/educators on the Physician Orders for Life-Sustaining Treatment (POLST) program, based on the system’s Respecting Choices Model. The development of the program within the system will result in a reduction in additional costs to outside resources.
The second anticipated issue is a lack of clinician buy-in and change management.
Education, engagement, and communication are essential strategies for addressing this issue.
Education will include current best practices, refresher courses, auditing, and reviewing.
Among the engagement strategies are ensuring confidence in their work, standardizing workflow, ensuring collaboration, and involving stakeholders. Ongoing updates on education and engagement opportunities, events, current POLST literature, and newsletter development are among the communication strategies.
The third anticipated problem is a lack of quality in the POLST process and order sets.
The quality of the work is a multifactorial issue that is heavily reliant on the first two foreseen issues.
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“The quality of POLST documentation is only as good as the preceding conversations” (Abbott, 2019, p. 297). As a result, if there is a lack of financial support or clinician buy-in, POLST quality will suffer.
Research on POLST implementation is actively being reviewed and updated therefore in order to ensure that my proposed evidence-based practice proposal is based on current evidence it’s necessary to regularly search for the most up-to-date literature.
Also Read: NUR 590 Topic 1 Discussion Question Two
Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department. Annals of Emergency Medicine, 73(3), 294–301. https://doi.org/10.1016/j.annemergmed.2018.10.021
The only issue I see with the proposed implementation of my project is allowing both nurses and patients the time to get used to the implemented process. Most organizational change initiatives fail because we apply strategies that are not tailored for the structure of the concerned organization. I work at the VA in Lancaster and our structure is a healthy one. Changing a healthy structure requires trust, clarity, and integrity. Employees are accountable for what they do. If they need skills, they can get trained or ask support to their managers. Anyone in the organization, not only managers, is likely to ask questions like: “When will you be ready?” or “Have you tested the quality of your realization?” Everyone is accountable to their colleagues. Here are the guidelines to follow to identify the most appropriate change approach. It decomposes the movement from the current state to the future state in five steps (Cavarec, 2014):
- Formulate change
- Plan change
- Implement change
- Manage transition
- Sustain change
Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles (Silver et al., 2016).
Investments in new clinical practices do not stop with their developers; enormous effort and resources are directed to introducing
new clinical knowledge to healthcare organizations. These investments include mobilizing human resources through the establishment of knowledge brokers, evidence-based practice committees or teams and identifying opinion leaders and champions who will support the practice excellence (Virani et al., 2009).
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Cavarec, Y. (2014). Increase your organization readiness to change. Paper presented at PMI® Global Congress 2014—North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.
Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., Bell, C. M., Chan, C. T., & Chertow, G. M. (2016). How to Sustain Change and Support Continuous Quality Improvement. Clinical journal of the American Society of Nephrology : CJASN, 11(5), 916–924. https://doi.org/10.2215/CJN.11501015
Virani, T., Lemieux-Charles, L., Davis, D. A. & Berta, W. (2009). Sustaining Change: Once Evidence-Based Practices Are Transferred, What Then? Healthcare Quarterly, 12(1), pp 89- 96
I anticipate issues with my project’s proposed implementation, including financial difficulties. My project is about the significance of continuous CPR during defibrillation. For many decades, the priority of CPR was identified as airway, breathing, and circulation. The American Heart Association recently announced that circulation would take over as the top priority during cardiopulmonary resuscitation (American Heart Association., n.d.). This means that early and continuous high-quality compressions are seen to improve circulation and perfusion during CPR, which aids in improving patient outcomes. According to Clark et al., 2019, interruptions in chest compressions lasting more than 10 seconds are associated with poor outcomes: “previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause during chest compressions with lower odds of survival” (Clark et al.,2019). Getting not only nurses but also physicians on board with the new evidence-based practice is a major impediment to implementation. It is extremely difficult to change people’s practices, especially if they have been practicing for a long time. To encourage staff buy-in to this new practice, a significant amount of education and support from leadership and clinical education will be required. Furthermore, the research I gathered revealed that in simulation studies, ECG devices and the LUCUS device were found to be the most beneficial for performing continuous compressions during defibrillation. These devices are extremely expensive and may be out of reach for small rural community hospitals. In this case, small community hospitals will be unable to provide patients with the most up-to-date evidence-based practice care due to a lack of funding. This is not only a barrier to implementation, but it is also a barrier to providing the best possible care to the patient.
To assess the organization’s readiness, capacity, and strength to change and implement this project, I would use The Organizational Readiness to Change Assessment (ORCA) tool. For a project of this size, I believe this tool would be capable of assessing all areas of change in order to determine whether the organization is a good fit for the project and vice versa.
American Heart Association . (n.d.). CPR Facts and Stats. cpr.heart.org. https://cpr.heart.org/en/resources/cpr-facts-and-stats.
Clark, L. R., McDannold, R., Mullins, M., & Bobrow, B. (2019). Pause Duration During Manual CPR is Associated With Survival and Favorable Neurological Outcome in All-Rhythm OHCA. Circulation, 140(Suppl_2), A458-A458.
The first issue with any proposed project implementation is that people avoid change due to fear of failing to adapt to the new system, losing their comfort zone and lack of confidence in their choice, or possibly a previous bad experience when workflow changes. Another issue that could cause the project to fail is a lack of communication. I should be more vigilant in dealing with this issue through effective communication, timely communication, and transparent communication methods to ensure that all stakeholders are involved in the process ( (Project.2021). Another issue is the availability of a workforce. It is critical for project success to assess the available workforce to determine whether additional staff and skill sets are required to complete the project. As a leader, ensure that all project stakeholders are on the same page and have a clear vision by inviting them to actively shape and provide feedback on the project plan.
An evidence-based approach involves an ongoing, critical review of research literature to determine what information is credible, and what policies and practices would be most effective given the best available evidence. It also involves rigorous quality assurance and evaluation to ensure that evidence-based practices are replicated with fidelity and that new practices are evaluated to determine their effectiveness( nicic.gov).
Projects: (2021). 9 Project management Challenges and How to Overcome them. https://kissflow.com/project/project-management-challenges.
National Institute of Corrections. (n.d). Evidence-based Practices (EBP). https://nicic.gov/projects/evidence-based-practice-ebp.
From an institutional standpoint, I do not foresee any issues with implementing my EBP Project because the nurses are already engaged in patient education and have the resources to implement the project. However, patient compliance and adherence may prove to be problematic. According to Pan et al (2019), noncompliance with treatment regimens is primarily responsible for uncontrolled blood pressure among patients diagnosed with hypertension.
Before implementing change, organizations need to assess readiness for change. Therefore, it is imperative that organizations analyze systems, processes, and more importantly people when conducting change readiness. As cited in Borges & Camila (2020), 70% of organizational change fail due to lack. of employee adoption of the changes. Change readiness assessments can aid in facilitating change by collecting quantitative and qualitative data measurements about where readiness gaps may exist.
Once the change readiness assessment has been conducted, data summarized and reviewed, and issues addressed, change can be initiated. John Kotter’s 8 Step Change Model would be most appropriate because it involves establishing, maintaining, and sustaining change. Kotter’s model states that organizational change is vital to be successful (Kuo & Chen, 2019). The eight steps of change in Kotter’s model are: create urgency, organize a guiding team, develop a clear and concise vision and strategy, communicate the vision, utilize empowerment to remove obstacles or barriers, create short-term victories, build on the change, and cement changes in culture (Kuo & Chen, 2019).
Borges, R., & Camila, A. Q. (2020). Understanding the individual’s reactions to the organizational change: A multidimensional approach. Journal of Organizational Change Management, 33(5), 667-681. doi: http://dx.doi.org.lopes.idm.oclc.org/10.1108/JOCM-09-2019-0279
Kuo, Y. L. & Chen, I. J. (2019). Facilitating a change model in age-friendly hospital certification: Strategies and effects. PLOS One, 14 (4). https://doi.org/10.1371/journal.pone.0213496
Pan, J., Wu, L., Wang, H., Lei, T., Hu, B., Xue, X., & Li, Q. (2019). Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine, 98(27), e16116. https://doi.org/10.1097/MD.0000000000016116
As with any change there is stress on an organization or staff in the process of the change, even good change causes stress to staff as their process is changed moving them out of their comfort zone (Ost et al., 2020). In every population from nursing to the janitor, change has moments of unacceptance, In my project of teaching a new practice change from EBL to QBL I foresee change stress and pushback, due to lack of trust in this new process. Utilizing assessment tools such as a SWOT analysis to address readiness is the first step to understand where the population of a EBP project is ready to accept(Renalt, 2021). Once barriers are identified one can start to formulate a plan to address those barriers and to navigate around them by removing barriers, acceptance of a change is made easier.
Transformation or change is a large problem area in an organization, Implementing or using a change management tool such as ADKAR also will help in the success of a project. ADKAR is an acronym with the following meanings, A= starting with awareness, presenting the issue, why it is a problem or why they should be a change. D= creating desire or want to become engaged in the process, creating a desire of the how this will improve practice and outcomes. K= giving knowledge or improving knowledge in the process, through providing the research for staff to understand. A= abilities, or assessment of abilities of the nurse involved, do they have the tools, understanding, equipment needed. Finally, R= reinforcement or circling back to address issues that arose in the process after development and re-enforcement of usage of a practice(Pawl & Anderson, 2017).
As the leader of a project understanding there may be pushback, self-awareness is another area needed for assessment and creating a support system around oneself when “hiccoughs” happen, a process has a lot of push back. Assessing or understanding your emotions and the intellectual intelligence of those you are leading, or teaching will help you to stay focused and look for solutions.
Ost, K., Blalock, C., Fagan, M., Sweeney, K. M., & Miller-Hoover, S. R. (2020). Aligning organizational culture and infrastructure to support evidence-based practice. Critical Care Nurse, 40(3), 59–63. https://doi.org/10.4037/ccn2020963
Pawl, J. D., PhD, RN, OCN, CNE, & Anderson, L. S., PhD, RN. (2017). The use of change theory to facilitate the consolidation of two diverse Bachelors of science in Nursing programs. Nursing Outlook, (65), 233–239. Retrieved May 4, 2021, from
Renalt, V. (Ed.). (2021). SWOT analysis: Strengths, Weakness, Opportunities and Threats. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/swot-analysis/main