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Sustainability Plan Worksheet An improvement team needs to consider long-term sustainability of an improvement effort. This worksheet will help you outline the elements needed for a sustainability plan for your proposed evidenced-based quality and/or safety program design by taking you through a series of questions. By answering these questions, you will be able to develop a plan to ensure the longevity of the expected improvements from your proposed quality and/or safety program stick long-term. For each category, use the questions provided to help you draft the necessary components that will be needed in a sustainability plan. Use one or two concise sentences to inform on each bullet point/question. Provide scholarly and peer-reviewed support accordingly. Areas for Consideration Detailed Plan Measurement After project completion: What will you continue to measure? What will you stop measuring? What will you do if you see a negative effect? What will you do if you see clinical significance, but not statistical significance? Ownership Who will own the new process that was implemented? How will you tell if the person is engaged and onboard with the improvement process? Communication How will you communicate about the change and who will be the messenger? When will communication take place? How will you support individuals in the new process? What type of training will you use after project completion? Who will be responsible for that training? Change Management How will you respond to resistance/barriers to change (“But this is how we have always done things.”) How would you use your evidence-based change model to ensure adoption and sustainability? How will you standardize the process so that it is easy to do the “new” right thing? Workload Is the change increasing the overall workload to the system? If so, how can you decrease the workload? If not, how will you communicate about what is changing and not changing? Adapted from “Sustainability Planning Worksheet” by the Institute for Healthcare Improvement (2019). References © 2022. Grand Canyon University. All Rights Reserved.
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12 Quality and Sustainability: Part 2 There are many ways to define quality and safety measures. However, generally, they can be thought of as methods or processes used to ensure that products or services meet specific standards and are safe for consumers. Quality measures may include third-party certification, inspection processes, and standards compliance (Newhouse, 2020). Safety measures include hazard analysis, risk assessment, and emergency preparedness planning. Quality and safety measures are essential in nursing practice today because they help ensure that patients receive the best possible care (Newhouse, 2020). Quality measures help nurses identify areas where care can be improved, and safety measures help prevent errors and accidents. By working together, quality and safety measures can help nurses provide the highest standard of care possible.  Patient satisfaction is one quality and safety issue measured at the identified health care entity. Patient satisfaction is an important quality metric because it can indicate whether or not patients are receiving the high-quality care they expect and deserve (Brooks-Carthon et al., 2019). In nursing practice, patient satisfaction is typically measured through surveys that ask patients about their experiences with the hospital and its staff. The results of these surveys can help hospital leaders identify areas where improvements need to be made. Research indicates that several factors contribute to high levels of patient satisfaction. These include having enough staff to provide quality care, providing clear information to patients and their families, and respecting patients’ rights and privacy (Brooks-Carthon et al., 2019). Nurses can play a crucial role in promoting patient satisfaction by ensuring that these factors are present in their practice. The purpose of this paper is to discuss the issue of patient satisfaction and ways of addressing it accordingly. The paper will also discuss measures that can be implemented to promote patient satisfaction, focusing on possible barriers, stakeholders involved, change management theory, and the expected outcomes. There are many different ways to improve patient satisfaction within a healthcare organization. One way is to ensure that patients feel like they are being heard and that their concerns are addressed promptly and professionally (Nguyen & Nagase, 2021). Another way to improve patient satisfaction is to provide clear and concise instructions on following care plans and taking medications correctly. Additionally, ensuring that waiting times are minimized and that patients have access to their medical records can also help improve patient satisfaction scores.  One evidence-based program design that can be implemented to improve patient satisfaction is known as the Patient-centered Medical Home model (PCMH). PCMH can promote patient satisfaction by emphasizing team-based care, which can give patients the feeling that their providers are working together to meet their individual needs. This model of care puts the patient at the center of the care team, which can help improve communication and coordination between all providers. Additionally, the PCMH model has led to better clinical outcomes, increased patient satisfaction, and lower healthcare costs (Varga et al., 2018).  Another evidence-based program design that can be implemented to improve patient satisfaction is known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS is a national, standardized survey given to a random sample of patients after being discharged from the hospital (Williams, 2022). This survey asks patients about their perceptions of their care during their hospital stay. The results of the HCAHPS are made publicly available, which provides an incentive for hospitals to improve their scores. Additionally, the HCAHPS has been shown to be associated with increased patient satisfaction (AHRQ, 2016). Other quality and safety improvement initiatives that could be implemented to improve patient satisfaction include changing how medications are dispensed and increasing staff education on proper pain management techniques (Williams, 2022). Implementing an electronic health record system can also help reduce waiting times and make it easier for patients to access their records. There are many different ways to improve patient satisfaction within a healthcare organization. One way is to ensure that patients feel like they are being heard and that their concerns are addressed promptly and professionally. Another way to improve patient satisfaction is to provide clear and concise instructions on following care plans and taking medications correctly (Williams, 2022). Additionally, ensuring that waiting times are minimized and that patients have access to their medical records can also help improve patient satisfaction scores. For example, the evidence-based design that the hospital can implement is the Patient-centered Medical Home model (PCMH). The current design that several hospitals use is the patient advocacy program. The PCMH design is better suited to improve patient satisfaction than a patient advocacy program for various reasons. For example, the PCMH design emphasizes team-based care (Varga et al., 2018). This type of care gives patients the feeling that their providers are working together to meet their individual needs. In contrast, a patient advocacy program does not focus on team-based care. Instead, this program focuses on solving patients’ problems with their care (Varga et al., 2018). While a patient advocacy program can help improve patient satisfaction, it is not as effective as the PCMH model in improving patient satisfaction scores.  Potential Obstacles to the Implementation of the PCMH The proposed quality program to address patient satisfaction is the Patient-centered Medical Home model (PCMH). The main obstacle that may hinder the implementation of this program is the cost. The PCMH model requires a team-based approach to care, which can be costly for healthcare organizations. Costs can include hiring additional staff, such as care coordinators, and providing training for existing staff (Block et al., 2020). Additionally, the PCMH model requires an electronic health record system, which can also be costly. There are several ways to overcome such obstacles. For example, provide funding through grants or other sources of funding. Another way to overcome these obstacles is to phase in the implementation of the PCMH model over time. This can help reduce the upfront costs associated with implementing this quality improvement program (Block et al., 2020).  The ethical issues related to the implementation of a Patient-centered Medical Home model (PCMH) are privacy and confidentiality. The PCMH model requires the use of an electronic health record system, which can store patient information. This information can be accessed by the care team, which may include people who are not part of the patient’s immediate circle of family and friends (VanVactor, 2018). This can be a concern for patients who value their privacy. To overcome this obstacle, it is essential to ensure that patients know how their information will be used and have the opportunity to opt out of having their information stored in the electronic health record system.  Another ethical issue related to implementing a PCMH is the potential for discrimination. The PCMH model relies on team-based care, which means that providers from different disciplines will be working together. This can lead to provider bias and discrimination against certain groups of patients (VanVactor, 2018). To overcome this obstacle, it is vital to have policies and procedures in place that prohibit discrimination. Additionally, providers should receive training on avoiding bias and discrimination when providing care.  Another potential obstacle is resistance from staff. Some staff members may resist the change to a team-based care model because they are used to working independently. To overcome these obstacles, healthcare organizations must provide adequate funding for the PCMH program and offer training to staff members on how to work in a team-based care model (VanVactor, 2018). Additionally, clear and concise communication about the benefits of the PCMH program should be provided to all stakeholders. Identification of Required Stakeholders  When implementing a Patient-centered Medical Home model (PCMH), it is crucial to involve all stakeholders. This includes patients, families, caregivers, providers, staff, and administrators. Each stakeholder group has a different role to play in implementing the PCMH program (James, 2018). Patients and families need to be involved in implementing the PCMH program so that they are aware of the changes that will take place. They should also be allowed to provide input on how the PCMH program will impact their care.  Caregivers need to be involved in implementing the PCMH program so that they are aware of the changes that will take place. They should also be trained to best provide care in a team-based care model (James, 2018). Providers need to be involved in implementing the PCMH program so that they are aware of the changes that will take place. They should also be trained to work in a team-based care model.  Staff members need to be involved in implementing the PCMH program so that they are aware of the changes that will take place. They should also be trained to work in a team-based care model (James, 2018). Administrators need to be involved in implementing the PCMH program so that they are aware of the changes that will take place. They should also be trained to manage a team-based care model.  It is important to note that the involvement of all stakeholders is essential to successfully implementing the PCMH program. Each stakeholder group has a different role to play in the process, and all groups need to be given adequate information and training on the changes that will be taking place (James, 2018). Without the involvement of all stakeholders, the chances of success for the PCMH program are significantly decreased. Change Management Theory A variety of change management theories can be used to support the implementation of the Patient-centered Medical Home model (PCMH) to address the issue of patient satisfaction. One theory that could be used is Lewin’s Change Management Theory (Burnes & Bargal, 2017). This theory focuses on three steps that need to be taken in order to implement a change successfully: unfreezing, changing, and refreezing.  In the first step, unfreezing, the goal is to prepare individuals for change by creating a sense of dissatisfaction with the status quo. This can be done by providing information about the proposed change and its benefits. In the second step, changing, the goal is to implement the actual change. This requires individuals to learn new skills and behaviors (Burnes & Bargal, 2017). Training and support should be provided to help individuals through this process. In the third step, refreezing, the goal is to ensure the change is sustainable. This can be done by reinforcing the new behaviors and skills learned in the previous step.  Lewin’s Change Management Theory is successful in various settings, including healthcare organizations. The use of Lewin’s Change Management Theory can help ensure that the PCMH program’s implementation is successful by providing a framework for how to best prepare individuals for and manage the change process (Burnes & Bargal, 2017). Moreover, the theory could be used to support the implementation of a PCMH program by helping guide the change process. This theory can also be used to help identify the steps that need to be taken in order to implement PCMH successfully.  Evidence supports the use of Lewin’s Change Management Theory in healthcare organizations. A study conducted by researchers at Johns Hopkins University found that Lewin’s Change Management Theory was successful in helping to guide a hospital through a period of change (Burnes & Bargal, 2017). The study found that using Lewin’s Change Management Theory helped make the transition smoother and more successful. Expected Outcomes There are several expected outcomes of implementing the Patient-centered Medical Home model (PCMH) to address the issue of patient satisfaction. One outcome is that patients will be more satisfied with their care. This could lead to improved health outcomes and increased use of preventive care services (Block et al., 2020). Another outcome is that providers will be more satisfied with their work. This could lead to increased retention rates and decreased burnout. Another outcome is that costs will be reduced. This could be due to fewer hospitalizations, Emergency Department visits and decreased length of stay for hospitalizations.  To ensure the sustainability of these expected outcomes, it is essential to have a plan in place for how the PCMH program will be maintained after it is implemented. This plan should include how the program will be monitored and evaluated and how new staff will be trained on the model (Block et al., 2020). It is also essential to have a dedicated team in place to manage the program. This team should ensure that the program is being implemented correctly and that all stakeholders are aware of their roles and responsibilities.        References Block, L., Petersen, C., Coletti, D., Yalakkishettar, P., & LaVine, N. (2020). Access and Continuity: A multidisciplinary education workshop to teach patient-centered medical home (PCMH) principles. Mededportal. https://doi.org/10.15766/mep_2374- 8265.10974. Brooks-Carthon, J., Kutney-Lee, A., Sloane, D., Cimiotti, J., & Aiken, L. (2019). Quality of care and patient satisfaction in hospitals with high concentrations of black patients. Journal of Nursing Scholarship, no-no. https://doi.org/10.1111/j.1547-5069.2011.01403.x. Burnes, B., & Bargal, D. (2017). Kurt Lewin: 70 Years on. Journal of Change Management, 17(2), 91-100. https://doi.org/10.1080/14697017.2017.1299371. James, A. (2018). Action learning: a process to support change implementation. British Journal of Healthcare Management, 24(9), 426-427. https://doi.org/10.12968/bjhc.2018.24.9.426. Newhouse, R. (2020). Selecting measures for safety and quality improvement initiatives. JONA: The Journal of Nursing Administration, 36(3), 109-113. https://doi.org/10.1097/00005110-200603000-00002. Nguyen, T., & Nagase, K. (2021). Patient satisfaction and loyalty to the healthcare organization. International Journal of Pharmaceutical and Healthcare Marketing, 15(4), 496-515. https://doi.org/10.1108/ijphm-02-2020-0011. VanVactor, J. (2018). Leveraging the patient‐centered medical home (PCMH) model as a health care logistics support strategy. Leadership in Health Services, 26(2), 95-106. https://doi.org/10.1108/17511871311319696. Varga, S., Lombardi, M., & Maio, V. (2018). Improving the patient-centered medical home (PCMH) evaluation process is essential to foster the PCMH movement. Population Health Management, 20(1), 1-2. https://doi.org/10.1089/pop.2016.0085. Williams, K. (2022). Sleep protocol—Use of evidence‐based practice (EBP) to improve patient outcomes and patient satisfaction while hospitalized. Worldviews on Evidence-Based Nursing. https://doi.org/10.1111/wvn.12562.

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