Bedside Shift Reporting Innovation
Bedside Shift Reporting
Healthcare is a sensitive area that requires periodic assessment for improvement. Healthcare institutions are increasingly developing the need to evaluate their care delivery and increase their care quality and patient outcomes. Governmental policies and regulations have also led to the demand for better healthcare services.
Patients also know their rights and utilize ratings and patients’ satisfaction reports to make decisions on the healthcare facilities to attend. Thus, healthcare providers are always in a constant quest to improve healthcare services and promote patient safety. Innovations developed in healthcare can change routine practices or amend policies to produce desired outcomes.
Organizations must assess innovations for issues such as compatibility with the healthcare organization, testability, and resources required versus the expected result. This essay analyzes a healthcare innovation, bedside shift reporting, and its preparation, implementation, and evaluation.
The selected innovation is bedside shift reporting, also patient shift handing over reports to promote patient safety. The innovation will transition handing over practices from handing over reports at the nurses’ desk to handing over at the patient’s bedside using current technologies, with the significant practice change being patient involvement in the reporting. The innovation will increase the accuracy of information flow and thus promote better care quality and patient safety.
Roles of an Innovative Nurse Leader
Nurse innovators are vital professionals in healthcare institutions and quality improvement. Nurses learn many aspects of care, such as leadership, care coordination, collaboration, and healthcare improvement. Lemberger (2022) notes that nurse innovators play other roles, such as leading others, research and care improvement, and data management. These professionals have knowledge, skills, and experiences that allow them to work in the relevant county, state, and federal positions.
All nurses are innovators, and the nurse innovator role is the official nurse position responsible for healthcare improvement, especially in nursing-related work. Nurse innovators focus on healthcare improvement, care quality, and patient safety. These professionals are also involved in organizational activities that generate profit for the organization.
One primary role of innovative nurse leaders/ nurse innovators is assessing healthcare data to determine problems affecting patient and care worker populations (Brady & Byrne, 2022). They then develop and implement evidence-based best practices to solve the problems unearthed. Nurse innovators also monitor current innovations and provide reports on their performance. These professionals focus on quality improvement in a healthcare institution and are thus involved in policy development (Azar, 2021).
Innovations are implemented and supported by policies, and nurse innovators participate in the policy development processes to improve care quality and patient safety. They also act as consultants for ongoing projects and any other project not related to quality improvement. Their knowledge and skills are crucial to care quality and patient safety in organizations.
The organization is a state hospital that provides a wide range of services to a catchment population of about 30,000. It’s a referral center for many private and public health centers in the county and offers outpatient and inpatient services. The hospital also has all special clinics, including oncology, diabetes, counseling, health fitness, rehabilitation, and health promotion. Most often, patients with social needs such as mental health are isolated in healthcare because fewer facilities offer these services.
The facility also oversees community outreach programs such as school education, vaccination campaigns, and community education. The hospital values the role of the community in healthcare and thus organizes community outreach programs with stakeholders for better patient outcomes. They educate families and schools on health issues such as the COVID-19 virus and obesity and ways of preventing it. They also educate mothers to vaccinate their children amidst the resistance against vaccines despite their importance. These activities lead to healthier communities.
The hospital serves individuals with all healthcare conditions requiring inpatient or outpatient treatment services. They serve all genders equally. The hospital also serves patients with special clinic needs, such as ongoing cancer treatment and renal dialysis without admission, and those with minor issues, such as headaches, diarrhea, nausea, and vomiting, and do not necessarily require hospital admission.
There are no age limits for this innovation, and the involved population varies from one-day-old babies in newborn intensive care units to pregnant mothers. Other patients include surgical patients, patients with various illnesses such as diabetes, stroke, and end-stage renal disease, to older adults in hospice care. The population also includes individuals with emergency conditions such as hypoglycemia, torrential hemorrhage, and syncope who require short-term treatment without necessarily being admitted into the wards.
The hospital serves populations from all races and ethnic groups, including African Americans, Hispanics, Asians, whites, and interracial, without discrimination. The population of interest for this innovation excludes patients requiring outpatient services. It includes patients of all ages and gender requiring hospital admission, prolonged or short-term admission such as in the emergency department.
Team Member Roles
The innovation team will entail various professionals, including researchers, nurses, quality improvement professionals, pharmacists, doctors, nutritionists, and healthcare leaders. They will perform various roles, such as assessing healthcare data, determining the required resources, and implementing the innovation. In addition, they will make vital decisions such as those involving finance allocation.
They will also participate in monitoring and evaluation of the innovation and how it affects other areas of the healthcare organization. Informal roles include handling disciplinary cases arising from professionals in the team. The members will also participate in change management at the personal level by influencing professionals in social groups to accept and implement the innovation.
Team members Shared Values
The shared team values relate to the organizational values and culture: integrity, responsibility, team-playing, and creative thinking (innovation). Creative thinking is a value required of all team members. The members encounter professional, environmental, and patient problems that they must solve using creative ideas. The members also require integrity because they handle important healthcare data and sensitive leadership details.
Integrity helps them remain reliable and valuable and ensures cohesion in the group. The success or failure of the team depends on integrity and loyalty to the team. Team-playing skills are the most important for the team members. They make decisions collaboratively and perform most of their roles as a team.
Every team member understands their role and is responsible for their assigned patients. Responsibility ensures fewer discipline issues because each professional performs their roles efficiently and without being pushed.
Discussion of Internal and External Factors
Various factors lead to the development of this innovation. The World Health Organization states that adverse events due to unsafe care is among the ten leading causes of death. In developed countries, 10% of the patients are harmed to varying degrees when receiving care, and more than 50% of the adverse events are preventable (WHO, 2019). The most common causes of these adverse events are wrong diagnosis, prescription, and consumption of medications.
The most apparent cause of these three problems is poor communication between the patient and healthcare providers and among healthcare providers. According to WHO (2019), medication errors and health-associated infections are the primary cause of harm. The agency for healthcare research and the center for disease control and prevention, and many studies recommend the implementation of BSR as the standing handing over the practice in healthcare organizations (AHRQ, n.d.).
Research revealed marked support for the practice in various studies. Studies cite BSR as a practice that increases patient safety by reducing medical errors and patient falls and engaging patients and their families in the patient’s care (McAllen et al., 2018).
The healthcare organization reported 75 medication errors and three adverse events in the recent quarter. Fifty-eight of the medication errors and two adverse events were directly related to poor communication between nurses leading to patient identification-related errors and LASA drug errors. There were 35 minor falls, with two fatal falls leading to the death of an elderly patient and a hip fracture of another elderly patient.
Errors that remain unreported are also alarmingly high due to fear of staff reporting their colleagues due to the stern disciplinary measures related to these errors. Most healthcare providers do their best to ensure these errors are unreported. These internal factors led to the development of an innovation that would improve communication and patient safety.
Alignment to Strategic Initiatives
Various governmental, organizational, and regulatory initiatives regulate patient safety. The organization has a safety policy requiring the patients’ involvement in their care through education. In addition, these policies emphasize extensive patient education to enhance autonomy and increase satisfaction.
Bedside shift reports (BSR) engage patients to enhance their knowledge regarding their health and healthcare interventions, aligning with organizational policies. The organization also targets to improve patients and reduce the prevalence of medical errors in the organization. BSR is one strategy that aims to increase patient engagement in care interventions and reduce medical errors.
The National Institute of Health Clinical and Safety Performance metrics emphasize preventing fall risks and pressure injuries and reducing medication errors. The goal is to ensure zero pressure injuries, reduce fall risks to below 0.3 per 1000 patients, and reduce pressure injuries (NIH, 2022). The national health disparities and quality report by the agency for healthcare research and quality requires healthcare institutions to reduce medication errors associated with poor communication, a preventable risk.
The AHRQ also recommends the implementation of bedside shift reports in handing over patients to reduce errors associated with poor communication practices in patient handing over (AHRQ, n.d.). The body recognizes innovation as a change in nursing practice that promotes patient safety and involvement in their care. Bedside shift reports also help correctly identify unconscious patients or comorbidities that make it difficult for them to confirm their identities (AHRQ, n.d.).
The agency recommends that organizations implement bedside shift reports developing a checklist to assist in carrying out the role. The AHRQ (n.d.) notes that bedside shift reporting also leads to tangible quality and safety metrics improvements in patient care. These strategies are developed by governmental bodies responsible for quality improvement and ensuring patient safety hence their credibility, relevance, and significance. Thus, the proposed innovation aligns with governmental, organizational, and regulatory bodies’ initiatives and recommendations on promoting quality care delivery and patient safety.
The innovation aims to develop a formidable patient shift handing-over system that will increase patient safety and promote better patient outcomes. The organization will evaluate the innovation based on the purpose statement.
The goal is to shift the handover report from the nursing desk to bedside nursing hanging over while utilizing healthcare technologies to reduce medical errors, adverse effects, and near misses associated with poor handing over practices and increase patient safety in six months. Handing over to the patients will entail a change of many items, including tools used and terms.
At the bedside, the nurses use terms such as “you” when referring to the patient to ensure the patient understands their health status from the reports. Patients can participate fully in care and can avoid medical errors that arise from negligence or lack of information by the patients.
In the past decade, sentinel events related to poor handing over practices have been reported hence the need for formidable systems. Nurses and patients should understand their care status for maximum care delivery. The innovation will be assessed after six months, and the evaluation will be based on the ability to reduce medical errors. The decision on innovation continuity will be based on the ability to meet the purpose and achieve the strategic goal.
Review of Relevant Resources
|Scholarly Peer-reviewed Sources Published in the Last five years that support the innovation
(Article With an APA Formatted reference with Doi or retraceable link)
|Summary of findings Relevant to Proposed Innovation||Evidence Strength Level (I-VII)||Evidence Hierarchy|
|Forde, M. F., Coffey, A., & Hegarty, J. (2018). The factors to be considered when evaluating bedside handover. Journal of Nursing Management, 26(7), 757-768. https://doi.org/10.1111/jonm.12598||Forde et al. (2018) utilized an integrative review to explore factors that should be considered when exploring and describing the contents and processes of nursing handing over reports. Bedside shift handover requires various considerations before implementation. Various factors should be considered. This article studied the factors that should be considered when evaluating bedside handover in nursing shifts. The article also notes that the initiation is not a simple change of rotation but a change of practice, including how it is done, parties involved, and tools used. The significant change is patient involvement in the report handing over. The major problem facing the change is access to sensitive information that can change the course of treatment or access to protected health information by other patients Interventions to mitigate these problems should be addressed before implementing the bedside handing over shift reports.
The study analyzed articles from reputable databases and developed several factors categorized into four domains: who (persons involved, patient demographics, and staffing levels), how (teamwork, process of handover, and tools required), where (location of the shift handover, patient room characteristics), when (timing), what (contents of the actual handover. The study requires the development of a comprehensive tool that studies these and outlines these factors before implementing them. The study provides vital insight om the consideration before implementing the innovation
|Level 1- the strongest evidence||A systematic review and meta-synthesis|
|Forde, M. F., Coffey, A., & Hegarty, J. (2020). Bedside handover at the change of nursing shift: A mixed‐methods study. Journal of Clinical Nursing, 29(19-20), 3731-3742. https://doi.org/10.1111/jocn.15403||Forde et al. (2018) describe the factors considered when implementing the bedside shift handing over. The who, how, and what factors are discussed in this article. This article focuses on the process, structure, and content of bedside nursing handover. The study utilized a convergent parallel mixed-methods design. It analyzed recordings of thirty handing-over sessions and quantitative and qualitative data generated using content analysis and reported following mixed-methods rules. The article shows that bedside handing-over involves the passage of a large volume of information over a short time, with communication between the nurse, the outgoing nurse, and the incoming nurse. The shift handover is based upon the clarification of understanding of the incoming nurse ad the patient. BSR increases patients’ access to their health information. It also helps the incoming nurse develop a therapeutic relationship from the beginning of the shift. The method also entails verbal and non-verbal cues that relay compassion and care to the patients, absent in other methods. The central focus is the patient’s physical and physiological problems and other special interventions. Bedside nursing handing over increases patients’ knowledge and interactions with the incoming nurse, increasing efficiency and promoting patient safety. Bedside handing over reports is educative to the patient and incoming nurse. This study thus supports bedside handing over reports and emphasizes its ability to deliver large volumes of vital information over a short time and to incorporate patients in their care.||Level 1- weak evidence||A systematic review and meta-synthesis|
|Bressan, V., Cadorin, L., Stevanin, S., & Palese, A. (2019). Patients’ experiences of bedside handover: findings from a meta‐synthesis. Scandinavian journal of caring sciences, 33(3), 556-568.||Nurses and patients are the major stakeholders of bedside shift handover reports in healthcare. Thus, it is imperative to understand the patients’ perspectives on bedside report handing over. Bressan et al. (2019) conducted a systematic review of qualitative studies to understand patient experiences regarding bedside shift reports. The review developed major themes from the study, such as ‘being involved,’ ‘being the center of care processes,’ and ‘experiencing critical issues. Patients support the innovation because it keeps them informed and helps them develop a sense of importance after being involved in care delivery. Bressan et al. (2019) also note that bedside handing-over reports help increase patient safety through flawless information flow. Patients’ involvement can also prevent medical errors because they can help point out mistakes before they occur. The study is vital to innovation and introduces the considerable importance of patients’ perspectives. The study shows that patients accept and embrace innovation, which is important to its success.||Level V- weak evidence||Meta-synthesis of qualitative studies|
|Jimmerson, J., Wright, P., Cowan, P. A., King‐Jones, T., Beverly, C. J., & Curran, G. (2021). Bedside shift report: Nurses’ opinions based on their experiences. Nursing Open, 8(3), 1393-1405. https://doi.org/10.1002/nop2.755||Nurses are the professionals involved in implementing care interventions. Jimmerson et al. (2021) note that nurses are the closest to the patient; thus, their perspectives on a care intervention are integral. Poor attitude toward an innovation may lead to its failure and reluctance to its implementation. Jimmerson et al. (2021) conducted a phenomenological qualitative study that identified and evaluated the nurses’ experiences and opinions, grading the process, content,
barriers, and facilitators of bedside shift reporting. The study involved 22 clinical nurses and 12 nursing supervisors, and the results were evaluated for relationships. The study results showed that time taken is a vital consideration. More so, there should be a modified approach to clinical handing over. Specific information should be passed in the patient’s room, and some information should be passed outside their room. Nurses hold sensitive patient information, and some information cannot be passed into the patient room of the patient. The study recommends that innovators develop a guideline that shows which information can be passed to the patients and which cannot and modify bedside shift reporting to meet organizational needs.
|Level VI- Weak evidence||A qualitative study|
|McAllen, E. R., Stephens, K., Swanson-Biearman, B., Kerr, K., & Whiteman, K. (2018). Moving shift report to the bedside: An evidence-based quality improvement project. OJIN: The Online Journal of Issues in Nursing, 23(2). https://doi.org/10.3912/OJIN.Vol23No02PPT22||It is imperative to implement evidence-based best practices for better patient outcomes. Consulting literature for evidence the innovation for effectiveness and efficiency is thus imperative. McAllen et al. (2018) conducted a study in the hospital to determine the effects of bedside reporting on patient safety and patient and nurse satisfaction. The study demonstrated a 24% decrease in fall rates. Nurse expressed satisfaction in 67% of the aspects of care. The project implemented in the hospital demonstrated an increase in patient safety and patient and nurse satisfaction. The study shows that innovation is an evidence-based practice and will promote better outcomes in addition to shifting nursing practice. The study produces evidence that coincides with results from other studies. The analysis||Level III||A cohort Study|
Synthesis of Findings from the Literature
The literature produces vital information regarding bedside shift handing-over reports (BSR). Forde et al. (2019) assessed the factors to consider when implementing BSR. The factors are divided into the themes of who, what, when, and how. The study’s results coincide with those of other studies, such as Jimmerson et al. (2021). Jimmerson et al. (2021) note that the what (content) of the BSR should be divided into information that can be passed in the patient’s room and withheld.
Some information reduces patients’ morale when disclosed in their room in the presence of all nurses. Handing over information at the bedside also risks spillover of information to other patients hence the need to screen some sensitive information that should not reach the patients.
Forde et al. (2020) show that large volumes of information are passed over a short time at the bedside. The intervention reduces the time spent giving reports. These two studies present the limitation of BSR and the need for implementing interventions to mitigate them. McAllen et al. (2018) analyzed the effects of BSR on patient safety and nurses’ and patient satisfaction.
However, the study does not include other aspects of care, such as medication errors and patient-nurse collaboration, which are attributed to BSR (Jimmerson et al., 2018). The study shows that BSR increases patient safety and satisfaction scores. However, staff members are satisfied with some aspects of the BSR, such as passing all information at the bedside, necessitating modification of BSR. Jimmerson et al. (2021) show that staff members are satisfied with BSR, but conflicting evidence shows different.
Oxelmark et al. (2020) show that patients are satisfied with bedside reporting and prefer it due to the high degree of involvement, but staff does not. Staff reported having a higher preference for handing-over reports away from the patients. The study shows that BSR is flawed and requires various modifications before its implementation.
BSR is a complex practice change that requires various considerations. Healthcare providers should create a process map showing the activities and timeframe for the report: the process and the preferred communication method, such as the ISBAR method used. The content should also be filtered, and sensitive patient information left out and handed over at the nurses’ desk.
Each healthcare facility should modify the process to meet the organizational needs. For example, institutions with open ward structures should modify the strategy to ensure information does not easily flow from one patient to another. Access to other patients’ information is breaching confidentiality and is ethically wrong. Another recommendation is that the healthcare organization should educate nurses on best practices in communicating with the patient and other nurses during the report handing over.
Data Collection and Technology Used to Support the Proposed Innovation
Process of Generating Ideas
Research and mind mapping were the methods utilized in the idea generation process. The first step in generating ideas was to study healthcare data and collect information from nurses to determine the institution’s problems. Many conditions and systemic problems arose during the process of generating data. One that stood out was sentinel events related to medical errors. These events were nurse or patient-centered and all rotated around the flow of information.
Research also showed that the frequencies and nature of these problems as unpredictable. Thus, prevention was through enhancing nurse-patient and nurse-nurse communication. The second step was mind-mapping. It was imperative to understand the causes of the problem. Mind mapping is integral in exploring facts, generating ideas, and understanding relationships between concepts (Wu et al., 2020). The causes selected included poor communication, lack of knowledge, and negligence. An issue that struck out was that nursing communication during reports handover is significant.
Other issues included the use of illegible handwriting, a lack of nurses’ knowledge, and a lack of a clear system of handing over patients that stipulates the content and process of handing over. Mind mapping helped narrow down the points while ensuring no details were left behind. The mind map showed the urge to create a systematic handing-over method that eliminates poor communication, increases patient participation, and enhances patient safety. Research into the handing over tools leads to the bedside shift handover reports being the best practice evidence-based strategy.
Big and Small Data Examples
The major difference between big and small data in healthcare is the volume and use of data generated. Small data is generated in small quantities and is specific to a department or a healthcare intervention. Unlike small data, big data is data generated, stored, and analyzed in vast amounts that limit the utilization of traditional storage methods. Machine learning algorithms and data scientists analyze big data in healthcare.
Shah et a. (2018) state that gig data thus entails systems that collect and analyze various functions that are complex or too difficult to be carried out using traditional methods (Shah et al., 2018). One of the major big data applications is electronic health records which helps collect, avail, retrieve and analyze healthcare data. The data includes all sorts of data from mortality from specific diseases, patient information, staff, and organizational information, and external dashboards. Other big data applications include real-time alerting and telemedicine (Shah et al., 2018).
Big data in healthcare utilizes information from various areas to solve problems such as diabetes and cancer. For example, big data in cancer management can focus on the number of screened patients, newly diagnosed, patients under medications, radiotherapy, surgery, or a combination, and patients with remission. Small data entails data at the point of care.
Small data may be useless unless analyzed alongside other data to make big data (Wang & Alexander, 2020). Examples of small data include the number of pediatric patients with pneumonia, diarrhea, or fever. Data from hospital registers such as antenatal clinic, postnatal, and labor and delivery registered. The information gathered may not be meaningful unless analyzed with other data to produce information such as birth rates, neonatal mortality rates, and other reproductive health information.
Big Data in the Innovation
Big data and applications will be useful for this innovation and will provide information such as the mortality rate, sentinel events, and patient falls. The innovation will highly leverage electronic health records, a big data application. The standardized nursing terminology (handing over tool) will be installed in the electronic health records.
Electronic health records will also be sued to determine the resource needs depending on the number of patients in the organization. Big data will also provide vital information, such as patient population forecasts, to help contingency and future planning if the patient population fluctuates (Shah et al., 2018). The innovation will be evaluated before and after its implementation.
Electronic health records will offer a good platform for observing patient changes, such as patient safety. They will also help assess the impact of the innovation of the organization. Innovations can produce the desired outputs but negatively affect other aspects of the organization, such as costs and staffing needs. Healthcare quality and safety dashboards are using big data in innovation.
Dashboards store data on the organization’s performance in various areas, such as quality care delivery. They will help determine and assess the performance of the innovation against the set standards at the organization level and data from other healthcare organizations (Shah et al., 2018). It will thus help evaluate if the innovation has an overall effect on the patient’s safety and satisfaction statistics
Technology has infiltrated the health field greatly, leading to various changes that have seen health transition from how we know it. Technologies can be leveraged to reduce costs and increase efficiency. Various technologies can be used in BSR, including electronic health records that store vital patient information. Electronic health records will be leveraged to help store, access, and convey health information from nurse to nurse and nurse to a patient (Ghosh et al., 2018).
Electronic health records provide a more permanent source of information that is not prone to errors such as poor and invisible handwriting and loss of physical files. Electronic health records are password protected, unlike files that third parties can access. Computers and tablets are emerging technology vital to accessing electronic health records. Some hospitals have computers in patients’ rooms, while some use tablets to store patient information.
Tablets containing patient information are the best gadgets because they can be easily transported from one patient to another, unlike cumbersome computers. In addition, only a few tablets will be required for the various rooms. Another technology useful to BSR is standardized nursing terminology (Ghosh et al., 2018).
The innovators need to design a nursing terminology or a structured tool that will be sued to guide handing over. The tool will be filled out online, and the nurses will counter-check the information to ensure all information is correct and filled. Standardized nursing terminologies help create uniformity and ensure inclusivity of all details in nursing work.
Standardized terminologies are used in areas such as concept mapping, physical assessment, health history, and mental status examinations. They are effective in collecting patient information and reducing missed opportunities or information. These technologies will enhance the implementation and success of the innovation.
Supporting Interprofessional Collaboration Amidst Disruptive Innovation
Impact of Disruption from Proposed Innovation
Innovation can disrupt the organization, individuals, and processes. The innovation will mostly affect individuals such as nurses and patients. The innovation will shift patient-nurse interactions, and the medical language used at the nurses’ desks to a language patients can understand at the bedside. Disruption can be positive or negative, and its effects on innovations cannot be underestimated.
Nurses will explain complex information to patients hence an increase in their roles. Nurses will also be forced to filter information and share it later at the nurses’ desk, depending on which information the organization allows and disallows to be passed at the bedside (Jimmerson et al., 2021).
Patients will have access to their information hence increased autonomy, feeling of importance and regard, and improved engagement in care delivery. BSR will disrupt normal processes, the main process being handing over interventions and increasing efficiency.
The disruptions caused by the innovation could also affect the innovation itself. For example, individuals opposing it could complain, leading to extraordinarily long processes and subsequent high costs. This sequela could also lead to poor performance appraisal for the individuals. Leaders of innovations are appraised depending on the performance of their projects.
Halted projects lead to poor performance appraisal results, and professionals could lose their jobs. Warren (2020) notes that managers in failing organizations often lose their jobs, and the management team is reorganized to help achieve better results. Disruption prevents change, and care quality and patient safety are affected. Patients are exposed to safety and care quality issues. The organization is extensively affected by disruptions from innovations. Innovation disruptions such as ethical issues could lead to the halting of the projects and subsequent financial and time loss.
Time is an essential resource to any healthcare organization. Disruptions lead to loss of time and managerial resources, threatening the sustainability of the healthcare institution (Warren, 2020). Institutions take time to receive from the financial blow and may be unable to maintain other healthcare organization performance. Innovations could negatively affect the performance of other aspects of care quality, such as patient satisfaction.
A poorly orchestrated innovation could lead to access to information by other patients leading to stigma and reducing patient satisfaction, contrary to the desired outcomes. They also lead to a poor reputation from stakeholders of failure, making it difficult to implement innovations in the future, especially those requiring stakeholders’ financial input.
Strategies to Mitigate Challenges of Disruption
Disruptions can derail a healthcare organization which can take it years to recover. Healthcare providers in quality improvement positions should develop strategies to absorb disruptions without these detrimental effects. Various strategies can be employed to manage the effects of disruptions. The first strategy will prevent innovations from affecting processes, individuals, and the organization.
Contingency planning is a strategy that involves the development of alternative strategies in anticipation of failure, resistance, or other factors affecting the main strategy (Burgner et al., 2020). The strategy entails practices such as reverse brainstorming that help understand and predict what can go wrong during the innovation. The executive team members then develop strategies or a template that could be used to manage any disruption/risk if it occurs. The strategy is cumbersome but very important.
Even the best prepared and orchestrated plans can fail when conditions are unfavorable. Organizations need to create contingency plans that help them absorb disruptions without incurring significant losses (Burgner et al., 2020). Another effective strategy for managing disruptions is monitoring meeting briefs and advanced reporting (O’Reilly & Binns, 2019).
These two strategies are integral in absorbing disruptions and minimizing the effects of innovations. Monthly meeting briefs will help discuss the innovation and possible problems and their solutions. Advanced reporting will also focus on the effects of the innovation on other aspects, such as ethical issues arising from the innovation.
Leveraging Disruptive Innovations
Healthcare is dynamic, and changes in practice in the middle of innovation can cause a shift, disruptive innovations to meet these changes. In addition, policies developed during the innovation could negatively affect the innovation. The proposed innovation can leverage disruptive innovations to help the project remain relevant and significant.
Innovators learn from mistakes and amend the structure and processes to incorporate interventions that bypass the disruptions the innovation causes to the organization (O’Reilly & Binns, 2019). They also help cushion the institution against losses that could be incurred. For example, policy changes preventing or limiting patients’ access to care information could be detrimental to bedside shift reporting.
The innovation is resource intensive, and the institution could suffer from loss of funds invested in technologies and tools for handing over at the bedside when disruptions arise, leading to innovation failure. Disruptive innovations will help the healthcare institution invest in alternatives to bedside handing over or implementing interventions preventing patient access to their information and promoting better outcomes (O’Reilly & Binns, 2019).
Project leaders and healthcare providers should embrace disruptive innovations and prepare flexible plans that can accommodate changes to reduce the effects of disruptions to the innovation and from the innovation
The Pre-Implementation Plan
Diffusion in Innovation
Roger’s diffusion theory is a model that outlines communication and time used by an innovation spread throughout a system. The diffusion of innovation depends on various factors, such as the availability of resources, disruptions (as discussed earlier), and change resistance (Dolezel & McLeod, 2019). Innovation diffusion, according to Rogers, goes through various stages and individuals respond differently to change.
The first group is the early innovators and will entail the innovation management team. The team comprises individuals ready and willing to implement the new idea, bedside shift handing over the report. The group will require no persuasion to implement the intervention.
The second group is the early adaptors. These are often leaders in various departments, such as quality improvement, who understand the need for change. The third group, the early majority, will entail informed nurses and patients willing to implement the new improvements. The fourth group, the late majority, will entail individuals such as patients and reluctant nurses with limited information about the innovation.
The surveys will help identify factors that would hinder the implementation of the innovation. Professionals and patients will then receive education on these factors. The last group, laggards, entails individuals who are adamant about changing and are often the last to adapt to change (Dolezel & McLeod, 2019). They could be leaders, crippling change innovation interventions.
Creating policies that favor innovation and communicating it will make the laggards implement the change interventions. The theory also outlines the importance of analyzing and communicating the relative advantage of the innovation to the people. The innovation should also be simple to understand and compatible with the system. The testability of the results through experimental, observational methods is also vital.
The proposed innovation will begin with a test pilot that will study the effects of the innovation on patients and nurses in the cancer patients’ ward. At baseline, the innovators will assess the staff and patient satisfaction with current handover tools. They will then educate patients and staff on the importance of BSR. Minimal education on the staff is required, while extensive patient education is required.
The innovation will be implemented in the ward for a month, and the results will be evaluated before the extrapolation of the innovation to other wards. Data will be compared to understand the effects of the tool on the patients. The innovation will then spread to other wards in the hospital, such as the medical, reproductive health, and surgical wards, in which it will be implemented and evaluated for six months. The results will determine its spread to the special areas in the hospital.
According to Di Simone et al. (2018), the emergency department suffers the biggest burden of medical errors, and the nature of patient care (acute stay of patients) makes it difficult to implement interventions that prevent or manage medical errors. Areas such as ICU, HDU, newborn intensive care units, and the emergency department are special areas that require a keen analysis of an evidence-based intervention before innovations are implemented in these departments.
Positive reports will then promote the implementation of the project in these special areas. The innovation implementation in these special areas will mark the innovation’s climax, followed by the incorporation of the practice as the standard practice in the organization.
Innovation Action Plan Table
|Team Member Roles||Essential Responsibilities to Implement Proposal||Timeline|
|Team leader- Nursing services manager, Mr. Allen||Leading and chairing the meetings pre-implementation of the proposed innovation
Presenting the proposal to the hospital executive management team and external stakeholders.
Availing of healthcare resources vital to the implementation of the proposal
|Mrs. Thompson, Hospital Nursing Informaticist-||Analyzing healthcare data to determine patient safety issues related to shifting handing over reports and hospital performance relative to these issues
Contacting the different stakeholders, including patients and nursing professionals, and collecting their feedback for consideration in the innovation plan implementation
|Head of the research department, Mr. Anderson||Perform a pre-implementation survey on the nurses’ and patients’ satisfaction with the handover methods.
Research the risks associated with BSR and develop a contingency plan entailing the potential risks and possible interventions to help mitigate the challenges
|The Hospital Public Health Nurse||Oversee patient education interventions to help with their understanding of the intervention
The nurse will also coordinate nurses involved in patient education and give reports to the team responsible for the innovations on the progress of the education.
|Head of Quality Improvement Department
|Analysis of healthcare dashboard data and hospital performance against organizational and national set standards
Analyze all resources required for the innovation and produce a comprehensive report
Develop the process map entailing the various activities and processes and their implementation timeline to give an overview of the expected conduct.
Financial Implications of the Innovation
The innovation will affect the hospitals’ finances in various ways. The innovation costs will entail allowances for the professionals involved in the training programs and executive management. The innovation processes fall under the professionals’ roles, but it is important to give them allowances as incentives and motivation. The hospital will also incur costs in purchasing devices such as tablets and developing and installing supporting tools such as standardized nursing terminologies for handing over reports.
Other activities that require payment include patient education on innovation and staff training. Evaluation of the innovation will require staff enumeration and costs in developing and printing evaluation materials. The research department is understaffed and relies on external staff who conduct fieldwork to analyze and produce reports.
These costs will be significant to the healthcare organization. The innovation is not resource intensive, and the organization can provide all the funds required. Most of the costs are also not recurrent and will thus place no significant risk on the project’s sustainability.
Return on investments in healthcare innovations is majorly based on the ability of an innovation to prevent losses and costs. The innovation will reduce medical errors such as medication and patient identification errors associated with poor handing-over report practices. For example, falls and medical errors cost healthcare institutions $4-$20 billion annually (Rodziewicz et al., 2022).
In addition, lawsuits related to these problems lead to close to the same amounts. A small percentage of medical errors and falls lead to lawsuits, but the few lawsuits are very expensive and lead to massive losses to healthcare institutions. The innovation will increase patient safety and satisfaction. Patient satisfaction is an indication of quality care delivery.
Patient satisfaction leads to the development of a good organizational reputation which increases patients flow in the healthcare institution. Thus, the proposed innovation will have a positive financial implication on the healthcare organization.
Interprofessional Communication Plan
Communication is vital to any professional group and is the backbone of innovation success. The first intervention will entail deciding on a communication channel, interprofessional communication. A social media platform such as WhatsApp or Facebook group can be used to relay vital information to the group. These unofficial methods will help staff delegation and social interaction during innovation implementation (Park & Park, 2019).
Social interaction is an integral method of improving interprofessional collaboration hence its significance. An official channel is used to relay official information to enhance interprofessional collaboration. Email is the channel of choice that will be used to communicate information to all professionals.
A listserv will help reduce the enormous load of creating and sending emails to all professionals in the management team. Listservs are systems that store staff data and come in handy when distributing information and updates to staff in an organization. Sending emails to each individual in the organization can be quite tedious and time-consuming hence the need for an application that is more efficient.
Other communication methods, such as fliers and posters, will also increase knowledge and promote the acceptance of the innovation. Multimedia communication ensures that information reaches more professionals in the organization (Park & Park, 2019). Professionals will also hold meeting briefs monthly in the hospital boardroom to discuss the innovation’s progress and absorb any disruptions.
The meeting briefs will enhance communication and understanding of the state of the innovation. They will help process information and convey it to other management team professionals. The nurse informaticists will be responsible for all information in the group from the top down. She will ensure all information reaches all professionals involved, and she will receive and process their feedback.
However, the team leader and the nursing services manager will communicate with the hospital executive officials and regulatory agencies. Her roles and responsibilities in the hospital make her the most suitable professional to handle communication. The communication strategies and interventions will enhance interprofessional communication and the innovation’s success, dependent on interprofessional communication.
Evaluation of the Proposed Innovation
Innovations are developed with a specific purpose. A reflection on the goals for implementation shows that the innovation will aim to increase patient safety. The evaluation of the innovation will entail the pre-implementation, ongoing, and post-implementation evaluation interventions. According to Nandal et al. (2019), the best evaluation practices are based on the proposed innovation’s purpose and goal(s).
Evaluation will use mixed methods and evaluate nurses’ and patients’ satisfaction with the intervention. Evaluation interventions will also assess changes in medical errors, sentinel/adverse events, near misses, and patient falls. Each item will be evaluated separately, and results will be evaluated against those at the baseline and first month. Information on the severity and frequency of these events will be evaluated at the baseline, and the changes after a month will be observed.
After the innovations’ diffusion, the innovation will also be evaluated after a month to determine its effect on these care factors. A survey on the staff satisfaction with the shift handover report at baseline, one month, and six months will produce valuable insights into the effectiveness of the proposed innovation plan.
In addition, the process map developed at the beginning of the innovation will help determine if the processes and activities were carried out as planned. These interventions will all help determine the effectiveness of the innovation and, most importantly, assess its ability to achieve the desired results.
The proposed innovation, bedside shift reporting, aims to produce a quality shift handing-over strategy to increase patient safety and promote better patient outcomes. The rationale is that handing over at the nurses’ desk increases the risk for errors and does not involve the patient in the care process. Errors arise during nurse-nurse communication, most of which arise during handing over shifts.
Patients are also less involved, and thus their engagement in care delivery remains suboptimal. Bedside shift reporting increases patients’ knowledge and is a recommended strategy by the AHRQ to engage patients in their care, promote patient safety, and improve care outcomes.
The process of identifying the innovation for the healthcare setting was challenging. Besides looking at healthcare data, it was imperative to collect the perspectives of healthcare professionals in the organization. They provided a lot of information on the problems affecting the organization. Consulting research and regulatory bodies addressing was also tiring.
However, the desire to improve patient outcomes was the primary driver to maintaining the energy during the innovation development. The process also took much time to prepare and develop. However, I learned a lot in the process, such as identifying reliable sources of information and analyzing them critically to avoid bias and unreliable information. I also learned the importance of interprofessional collaboration in improving outcomes.
A major challenge in this process was developing and integrating different care aspects to develop an innovation. Studying data and providing innovation that improved outcomes without causing disruptions was challenging. The major strength in the method used to develop the innovation was knowledge backup from courses in the education program. The process utilized much nursing knowledge learned in class and clinical settings.
There are various takeaways from the innovation for the future. For future initiatives, I will first gather extensive knowledge from professionals and research studies on the innovation desired before planning to implement it. I will then consult governmental policies and regulatory body recommendations and their data about the innovation to ensure it complies with regulatory and ethical requirements.
Budgeting is also integral, and I will ensure I prepare a mock budget for the compatibility of the innovation with the healthcare organization. In addition, I will ensure I test the innovation in some areas of the organization I will be working in to help with disruptive innovations and to help achieve optimal results.
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