Design for Change in Healthcare: Rosswurm and Larrabee’s Model

Nowadays, there is a high rate of patients’ readmission to health facilities soon after being discharged which is rather expensive. Avoiding unnecessary hospital readmissions is imperative for patients, payers, families, as well as health care providers. The proposal entails the use of Rosswurm and Larrabee’s Model for change. The proposal entails evaluating the need for change in practice; identification of the problem, as well as connecting it to potential interventions; reviewing the literature; and formulating a case for practice improvement (Birk, 2012).

Step 1: this phase will entail assessing the need for the change in the practices of securing home monitoring devices for heart failure patients at the time of discharge in order to reduce the incidence of hospital re-admissions. My concern in changing the procedures of securing home monitoring devices for heart patients at the time of discharge rather than after discharge was motivated by my 1-year internship in a hospital. When I was working there for my internship, I was highly dissatisfied with the high re-admission rate that was present in the hospital and particularly among the Medicare group patients who were suffering from chronic heart failures.

Over 30% of those patients who were discharged with a diagnosis of heart failure were readmitted at least once in three months with readmission rates fluctuating between 25-54% in 3-6 months. Therefore, that is the reason why I feel responsible for providing accurate information to appropriate stakeholders pertaining to the high re-admission rate associated with elderly patients suffering from chronic heart failures.

There is a possibility that multidisciplinary management approach and home-based intervention can reduce the high readmission rate, as well as the high hospital stays in heart failure patients. I started my process by reviewing available literature pertaining to the issue, as well as consultations from relevant experts in this fields, producers, guidelines and concerning policy. I unearthed enough support that home care monitoring for elderly people who are suffering from heart failure can help reduce hospital readmissions and particularly when they are secured at the time of discharge, rather than after discharge considerably.

The literature review will be followed by embarking on my process for pursuing the change process. This will entail meeting with various stakeholders and discussing about the visibility of the change process. Some of the stakeholders I plan to invite to the meeting will include; hospital administrators, physicians, clinical leaders, pharmacy team, as well as staff nurses. At the meeting, I will avail a summary of my literature findings and a copy of the current policy used for regulating the administration of heart monitoring devices.

In case my proposal is overwhelmingly accepted and that it is established that the current procedure follows the securing of the heart monitoring devices after the discharge rather than at discharge, the group will develop a committee to review the current policy and procedures and come up with better ones in accordance with the evidence presented by the literature review (Hines, Yu & Randall, 2010).

The second stage will involve connecting the problem with interventions and outcomes. Home care management can play an essential role in providing effective, as well as cost efficient healthcare for heart failure patients. It is noted that adoption of modern improved technology to monitor patients along with the support of a health care provider greatly improves heart failure management, as well as cuts down the costs of health care.

The failure to secure heart monitoring devices for heart failure patients at the time of discharge is the one that is causing the current high incidences of hospital readmissions. The literature review conducted revealed that appropriate applications of home care monitoring devices of heart failure patients is a very effective strategy for reducing re-hospitalizations. The review of the literature showed that the chief main of the devices are to bring improved outcomes, decrease hospitalizations, as well as reduce readmissions.

These devices enable the patients to become co-managers of their illness. By implementing the devices, the health care providers are required to embark on developing strategies for effective management, as well as encouragement of good health practices. The study validates a multidisciplinary method that encompasses inpatient education, outpatient home care and compliance monitoring is essential to patients in all health care settings.

The study reinforced the importance of tele-management. In order to find out the relevancy of the information gathered from the literature, I engaged physicians specialized in cardiac treatments in conversation. From this conversation, I learned that the factors highlighted from the literature review resonated with the physicians’ arguments (Desai, 2012).

The third step entails synthesizing best evidence. The information received in step 2 enabled me to review the literature further in order for the researcher to synthesize the data presented and formulate a framework that will assess the strengths, weaknesses as well as the gap that exists in the literature. This research is then supplemented with clinical judgment and any relevant data to either adopt the change practice or reject it.

The next literature review will be more focused and concentrated on reviewing the literature on the benefits associated with securing monitoring devices of heart failure patients at the time of discharge. The second research reinforced about patients safety and satisfaction. The outcome of the study indicated the need for securing heart monitoring devices for patients diagnosed with heart failure problems as a means of improving their quality of life, as well as avoiding unnecessary readmission (Louis, Turner, Gretton, Baksh & Cleland, 2003).

Step 4 entailed designing a change practice. It involves synthesizing best evidence. In additional, relevant stakeholders should advocate for the changes and identify resources required in implementing the change process. Then the group will be disassembled and the project handled over to a specified group to develop new procedures that will reflect recommendations pointed by the group. Then the procedures written down will be reviewed by relevant stakeholders from the group to see whether it is written in accordance with the group recommendations (Silow-Carroll, Edwards & Lashbrook, 2011).

Stage 5 entails Implementing and evaluating the proposed procedures. A pilot study for the practice change will be implemented and assessed after a predetermined time frame, more adjustments and revisions will be made which is a subject to acceptance or rejection in the practice change.

If the outcomes from the pilot study support a change in practice, the new policy and procedures will be adopted in the hospitals with roll-out dates, as well as staff education. It is noted that continue education as well as staff-in service education will be administered and tailored in improving the success in the implementations of the new evidence-based practice (Stone & Hoffman, 2010).

The sixth step will involve integrating and maintaining the change process. The implementation of the proposed change process will be followed by integrating and maintaining the changes. The team that will oversee the change implementation should monitor the realization of the implemented change and incorporate appropriate amendments in order to maintain the change process.

Reference List

Birk S. (2012). Reducing hospital readmissions. Healthcare Executive. 27(2),17-24.

Desai, A. (2012). Home Monitoring Heart Failure Care Does Not Improve Patient. Journal of Circulation. 2(125), 820-827.

Hines, P., Yu, K., & Randall, M. (2010). Preventing heart failure readmissions: is your organization prepared? Journal of Nursing Economics. 28(2), 74-86

Louis, A., Turner, T., Gretton, M., Baksh, A., & Cleland, J. (2003). A systematic review of telemonitoring for the management of heart failure. The European Journal of Heart Failure ,5, 583–590

Silow-Carroll, S., Edwards, J., & Lashbrook, A. (2011). Reducing Hospital Readmissions: Lessons from Top-Performing Hospitals. Synthesis Report. Web.

Stone, J., & Hoffman, G., (2010). MedicareHospital Readmissions: Issues, Policy Options and PPACA. Congressional Research Service.