Introduction
Quality is a top priority of all organizations operating in the modern world, and healthcare facilities are no exception. The administration of Avicenna’s Center, a local medical center, acknowledges the need to improve the quality of services provided in several departments, including their cardiovascular surgery department. The medical staff employed in this department utilizes various instruments to improve quality, which includes making post-discharge calls to all patients.
Harrison, Auerbach, Quinn, Kynoch, and Mourad (2014) claim that this practice reduces the rate of readmission and improves patient outcomes. Therefore, it was decided to develop and implement an intervention aimed at establishing a policy regulating follow-up calls and healthcare employees’ compliance with the standard. This paper includes the description of the project design, its implementation and the evaluation of its effectiveness, as well as theoretical foundation guiding the process.
Theoretical Background
The implementation of any intervention is a complex process that requires the use of a sound theoretical foundation. Nilsen (2015) analyzes the existing theoretical frameworks and divides them into such categories as process models, determinant frameworks or implementation theories, and evaluation paradigms. At the same time, the researcher stresses that the use of a single framework could limit the effectiveness of some aspects as the focus will be on certain areas (for example, implementation). According to Nilsen (2015), other important areas tend to be neglected and ignored. Nilsen (2015) claims that it is necessary to utilize several models to ensure that the entire implementation process will be managed effectively.
Therefore, the implementation of this intervention will be carried out in terms of the social cognitive theory. It will also involve the elements of the FSN Knowledge Utilization Model developed by Duhamel, Dupuis, Turcotte, Martinez, and Goudreau (2015) and Borrelli’s framework. The social cognitive theory will be employed as the program entails close interactions between different groups. This paradigm is based on the premises that social contexts are central to people’s learning, so the implementation (especially training stage) will entail the collaboration of the stakeholders.
Borrelli’s framework will guide the implementation process as it provides an effective model that implies such stages as training, treatment delivery, treatment receipt and treatment enactment (Quested, Ntoumanis, Thøgersen-Ntoumani, Hagger, & Hancox, 2016). The phase of treatment receipt is important as it aims at enhancing stakeholders’ motivation to complete certain tasks and make them their common practice. Finally, the FSN Knowledge Utilization Model includes several components, but this project will utilize such elements as ritualization, peer coaching, and empowerment (Duhamel et al., 2015). These components will help nurses to acquire knowledge and skills, as well as be motivated and committed to the goals of the program.
Design and Implementation
The proposed intervention will include the following stages: training, implementation, evaluation, and ritualization (ensuring sustainability). All the nursing professionals of the department will participate in this project as the training will be provided during their working hours. As mentioned above, some community nurses will take part and will collaborate with the medical staff and patients. This collaboration will enhance the effectiveness of the program that involves the use of post-discharge phone calls (Thompson, Fahs, & Kell, 2016). The educational stage will involve three training sessions during the first week and one meeting each week during a month.
The first three meetings will include lectures, workshops, and discussions. Importantly, the nurses who make post-discharge phone calls will share their experience with the focus on possible challenges, effective strategies, as well as the positive outcomes for patients and healthcare practitioners. These people should be encouraged to explain why they choose to make follow-up calls although it is not required yet. The administration can assign one of the nursing leaders to run the training sessions or can invite a professional trainer who specializes in this area and has the necessary experience. During these meetings, the nursing practitioners will be informed about the communication channels they will use (with patients and community nurses) as well as other technical and administrative aspects.
The following meeting will mainly include discussions and workshops. Based on the Borreli’s framework, the intervention will ensure the exchange of ideas and close attention to the stakeholders’ attitudes. Each time nurses’ feedback will be elicited in different forms including short reports, questionnaires, and discussions. The FSN Knowledge Utilization Model also describes ways to facilitate peer coaching and professionals’ empowerment, and demonstrates their benefits, so peer coaching will be encouraged. It is noteworthy that some nursing professionals have quite extensive experience, which makes them ideal coaches.
They can be asked to be coaches and mentors of new nurses or less experienced healthcare practitioners. This empowerment and collaboration can positively affect the staff’s motivation and increase their commitment to the project goals.
Meek, Williams, and Unterschuetz (2018) note that almost half of the medical staff express their dissatisfaction when they have to make post-discharge phone calls, which makes hospitals outsource this service. The researchers argue that professional staff can reduce the workload of nurses, which will be beneficial for their performance. However, there is no sound evidence that this method is cost-effective, so it can be more appropriate to motivate and encourage the staff to provide this service. This can be done during the stage of training and implementation that will involve close collaboration of nursing professionals.
The implementation stage will start two weeks after the commencement of the program. Both nurses from the medical center and community health nurses will call the patients two or three days after their discharge. The nurse whose shift was on the day of the patient’s discharge will call the patient. Miller and Schaper (2015) claim that one of the most serious challenges of the implementation of the intervention involving follow-up calls is reaching patients.
In many cases, nurses may have to call several times, which can disrupt their work during the day. In some cases, patients will not be reached, and this may negatively affect the evaluation process. In order to avoid these potential hazards, the medical center’s staff will inform the patient about the day of the planned call and ask them about their preferred time. It is important to make sure that nurses will explain the need to contact the patient and mention the positive outcomes associated with post-discharge calls.
The medical staff of the healthcare facility in question will also inform community nurses about the patient who is discharged so that the latter could call them within the period mentioned above. The communication between the center’s department and the community health entity will be conducted through the information system. Community nurses will receive information about patient health history and other relevant details. Lau et al. (2015) state that the availability of resources, advances in technology and infrastructure have a considerable influence on the process of the implementation of any intervention in the clinical setting. Therefore, it is essential to ensure that the participants have access to the medical center’s information system and the associated devices.
The participants will have a specific form to mark the phone calls they made. The form will be available via the information system utilized at the medical center. The nursing practitioners will report about their follow-up calls to patients and communication with community nurses, and the latter will complete the same forms. The use of this reporting method can be regarded as a checklist for the staff. During the phone calls to patients, nursing professionals will ask a set of questions developed for this intervention. Clearly, the questions will depend on the patient’s health history and other relevant information. Furthermore, the nurses participating in the program will discuss with the patients some details associated with self-care and lifestyle appropriate to their health condition.
Expected Outcomes and Ensuring Sustainability
The potential outcomes of the intervention include a lower rate of readmissions, overall patient satisfaction, as well as nurses’ commitment to the use of post-discharge phone calls as their regular practice. Medical staff’s potential compliance with the new standard is one of the primary outcomes of this program. It is expected that healthcare practitioners will feel empowered and motivated to ensure the high-quality of the services they provide each day. They will be prepared to accept the change and sustain it. The establishment of standards, guidelines, and policies is another anticipated result. These policies will be developed on the basis of the evaluation of the intervention.
The evaluation of the project will also involve the analysis of its cost-effectiveness as the nurses will be paid for the hours spent on training and regular meetings and the trainer will need a certain payment. The readmission rates will be calculated at the beginning of the proposed intervention and three months after its start. As far as patient satisfaction is concerned, the data will be collected by nurses during their post-discharge phone calls. The patients will be asked about their overall health condition and their attitude toward the received phone call. This feedback will be included in the forms nurses will complete.
The perspectives of nurses should be analyzed in order to ensure the ritualization of the new practice (Duhamel et al., 2015). Nursing professionals will complete brief questionnaires that will reveal the level of their satisfaction with the intervention and their readiness to make it a part of their daily routine. The attitudes will be quite visible during the meetings so the corresponding information should be documented and analyzed as well. The participants’ feedback can be instrumental in improving the project.
The creation of the guidelines and policies should be accompanied by the development of the corresponding culture (Duhamel et al., 2015). Nursing professionals should acknowledge the benefits of close communication with patients as well as community health professionals. The adherence to new standards will be possible when the medical center’s staff will see direct results of the project. For example, it is necessary to stress that lower readmission rates are linked to patients’ satisfaction that often translates into positive outcomes for the healthcare facility.
Some common motivation methods should not be overlooked, and nurses should be rewarded for their compliance with the new policies and their overall performance. It is possible to introduce ratings or best employee awards. Bonuses and perks (such as flexible hours, more days off, training, and promotion) can be utilized for high-achievers. Finally, it is essential to make sure that new employees will embrace the culture and adhere to the standards.
Nursing leaders will perform the central role in this process. Regular meetings should involve the discussion of the benefits of post-discharge phone calls. Nursing leaders will be coaches and mentors as they will guide and empower other nursing practitioners. Regular discussions and face-to-face interactions will ensure the development of proper relationships. These professionals can take part in the process of standards development as well.
Conclusion
On balance, it is possible to note that the intervention in question aims at improving quality. The project implies the establishment of a new standard concerning post-discharge phone calls. Nurses of the cardiovascular surgery department will collaborate with community nursing practitioners to improve patients’ health outcomes and their satisfaction. During the process of implementation, it is necessary to pay specific attention to such areas as technology and resources availability, training, participants’ attitudes towards the program. The evaluation of the project will address its cost-effectiveness, readmission rates, patient outcomes, patient satisfaction, nurses’ perspectives on the matter.
The sustainability of the standards developed on the basis of the evaluation can be ensured with the help of coaching and empowerment as well as the most common and effective motivational methods. It is expected that the proposed program will improve the quality of the services provided at the medical center in question.
References
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