Healthcare organizations constantly experience new challenges, which compel them to respond positively through planned change. The respond constitutes planned change as it enables healthcare organizations to overcome their challenges and provide effective, safe, and quality services to the patients. Planned change does not occur accidentally as Marquis and Huston (2012) assert that it is “a deliberate application of knowledge and skills by a leader to bring about a change” (p. 163). Hence, for a planned change to happen in a healthcare organization, managers have to undertake deliberate actions such as adopting, planning, and implementing certain changes. In this view, this essay identifies the problem in the nursing department, which involves the inability of nurses to complete OASIS data set assessment accurately within the Medicare set guidelines for payment, legal, and professional standards, and offers the appropriate solution using a change theory.
The problem in the nursing department is the inability of nurses to complete OASIS data set assessment accurately as per the guidelines of Medicare, and thus, affect payment, legal, and professional standards of nursing. OASIS is a form of data that enable home health agencies to assess outcomes of patients and relay them to the Centers for Medicare and Medicaid (CMS) for purposes of reimbursement, legal proceedings, or assessment of quality of care. Essentially, OASIS is an important instrument that nurses use in collecting data from patients and reporting their outcomes to the CMS. The inability of nurses to collect and report OASIS data accurately violates the requirements of CMS, which necessitate all home health agencies to receive certification for their compliance with the guidelines for collecting and transmitting data of patient outcomes. Failure of a home health agency to comply with the requirements of CMS means that it would not receive certification for the Medicare Conditions of Participation (CoP). Moreover, the quality of healthcare services would be poor due to inaccurate collection, assessment, and reporting of patient outcomes. According to Grant, Colello, Riehle, and Dende (2010), for healthcare organizations to achieve magnet status, they must comply with the prevailing standards of practice. Thus, the inability of nurses to collect and report patient outcomes accurately using OASIS is a huge problem that shows the extent of noncompliance with CMS guidelines.
Training of nurses is a specific and realistic change that the department can adopt as a way of enabling nurses to collect, assess, and report accurate data to CMS. Since technology is dynamic, healthcare providers should always update their knowledge and skills so that they can keep abreast with technological advancements aimed at improving healthcare services (Bevan, 2010). In this case, if nurses undergo appropriate training on how to collect, assess, and report patient outcomes to CMS, they would be in a position to improve their professionalism in the provision of quality care. Additionally, the training would enable the nursing department and the healthcare center to comply with the requirement of CMS, and thus, make it receives certification for the CoP. Bevan (2010) argues that the acquisition of new knowledge and skills is important because it builds the capacity for change. Hence, the provision of appropriate training to nurses in the department for specific duration would improve quality of nursing care and enhance compliance with CMS guidelines.
Alignment of Change to Mission and Vision
Since the mission of the healthcare center is to improve human life by providing quality and cost-effective healthcare services, the training of nurses would aim to achieve this mission. Training of nurses to acquire knowledge and skills of collecting, assessing, and reporting patient outcomes to CMS would enhance accuracy of data and professionalism among nurses, which improve quality of nursing care. Furthermore, the training would enhance cost-effectiveness of healthcare services because CMS would be in a position to assess patient outcomes and reimburse medical costs without incurring unnecessary experiences. Hence, by focusing the training on quality and cost-effectiveness of healthcare services would align it to the mission of the healthcare.
The training of nurses would also align it with the vision of making the healthcare center to be the best place to provide care, practice medicine, work, and serve the community. The knowledge and skills of using OASIS would enable nurses to provide quality and cost-effective healthcare services, which could transform the healthcare center. As the problem entails inaccuracy of data, the training would align knowledge and skills with the values such as honesty, integrity, and fairness. The relevant professional standards that are applicable in the training of nurses are quality care, competency, and collaboration. Quality of care and competency of nurses are two professional standards that training of nurses seeks to achieve. Collaboration is another professional standard, which would enable the department to comply with guidelines of CMS in the improvement of patient outcomes.
Implementing Change Using Model
The appropriate model for implementing proposed change of training nurses is change management theory or model of Kurt Lewin. The change management model elucidates that change is a process that comprise of three phases, namely, “unfreeze, movement, and freezing” (Marquis & Huston, 2012, p. 163). The unfreezing phase involves initiating change and dismantling resistant forces that are present in a given system. The phase of movement entails implementation of the change as per the procedures and plans set out at the initial phase. The freezing involves stabilization of activities implemented so that they remain incorporated in the system and prevent the relapse of the previous culture. Therefore, implementation of the training program would follow the change management model of Kurt Lewin.
To facilitate change effort using the change management model, the implementation would take place through three steps. The first step entails presentation of the impact of inaccurate entry of data into OASI and the urgency of complying with CMS guidelines. The presentation aims to make nurses realize the negative impact of the erroneous data that they present to CMS and how they influence patient outcomes. Battilana, Gilmartin, Sengul, Pache, and Alexander (2010) note that effective change cannot occur unless respective parties are aware of the need for change. The presentation stage is in line with the first phase of the change management model, which aims to sensitize nurses about the need and urgency of training. The second step involves the development of protocols and procedures that nurses should undertake and always refer when collecting, assessing, and reporting data. The existence of protocols and procedures would enable nurses to adhere to the guidelines of CMS, and hence, promote compliance with the requirements for CoP. Schifalacqua, Costello, and Denman (2009) assert that planned change requires specific procedures for people to easily adopt and apply them. The second step is in tandem with the second phase of the change management model.
In the third step, which aligns with the third phase of the model, the implementation of the training program would ensure that the instituted changes stabilize. To stabilize instituted changes, the training program would have to formulate standards and set up follow-up activities aimed at ensuring nurses to apply gained knowledge and skills. Continued monitoring and evaluation of nurses would make them adhere to the CMS guidelines for OASIS.
The nature of stakeholders in the implementation of the training program determines the effectiveness of change. Battilana et al. (2010) argue competencies of leaders determine the successfulness of the planned changes. In this view, the inclusion of leaders with appropriate leadership skills is imperative. Important stakeholders, who can initiate and manage the change of training nurses on how to collect, assess, and report OASIS data are manager of the healthcare center, CMS expert, nurse leader, head of the nursing department, and nurses. The manager is an important stakeholder because he/she has the capacity to liaise with CMS and support the program of training nurses. The CMS expert would bring essential expertise during training so that nurses could obtain the right information about the application of OASIS in reporting patient outcomes. Head of nursing department and nurse leader initiate the program and train nurses, who are recipient stakeholders.
Change management in an important aspect in implementing changes in organizations. Since nurses are unable to provide accurate data of patient outcomes through OASIS, training of nurses is a specific and realistic solution. Effective implementation of the training program requires the application of change management model of Kurt Lewin. The three phases of the change management model are in line with the three steps of implementing the training program. As collaboration is essential, manager of the healthcare center, CMS expert, nurse leader, head of the nursing department, and nurses aid in the implementation of the program.
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