Introduction and Objectives
Efforts toward sustainability must be envisaged to ensure that the implemented healthcare changes are maintained and continued. The current paper aims to reveal a sustainability plan for an evidence-based program for quality improvement. The program offers moderate or equivalent intensive 90 minutes per week of physical activity intervention for adult patients with hypertension to influence systolic and diastolic blood pressures. The sustainability plan considers the measures observed during the program and the process of collecting them. A special team is responsible for implementing the current program. The paper describes the communication and training plan theoretical framework for change management and explains how the program will affect workload.
Measurement
Efforts toward sustainability must be envisaged to ensure that the implemented healthcare changes are maintained and continued. The current presentation aims to reveal a sustainability plan for an evidence-based program for quality improvement. The program offers moderate or equivalent intensive 90 minutes per week of physical activity intervention for adult patients with hypertension to influence systolic and diastolic blood pressures. The sustainability plan considers the measures observed during the program and the process of collecting them. A special team is responsible for implementing the current program. The presentation describes the communication and training plan theoretical framework for change management and explains how the program will affect workload.
Measurement Threshold for Investigation
The deterioration of patients’ condition is the for the program’s termination and the start of the investigation of the causes. The slide contains a table with blood pressure indicators at which it is recommended to start treatment at different ages, and the second table presents the target results of treatment (Williams, 2018). The threshold measures for the start of the study are an increase in pressure indicators compared to the initial patient indicators.
Survey results that demonstrated dissatisfaction with the program also begin an investigation. Similar thresholds are complaints and deterioration reported by patients. Finding out the reasons will help eliminate the program’s shortcomings and adapt it to improve results.
Clinical significance vs. statistical significance
In some cases, the statistical and clinical significance of the study results does not coincide. At the same time, statistically significant results do not necessarily imply clinical relevance. Clinical significance better indicates the presence of the impact on patient outcomes or medical practice. Nowadays, researchers tend to consider this indicator to assess the change’s potential benefit (Sharma, 2021). Therefore, if the results are clinically relevant, they provide grounds to continue program implementation.
Ownership
The quality improvement change project will be implemented in the outpatient clinic in New York City and includes adult patients with hypertension. The medical staff needs to encourage and train patients to maintain the necessary physical activity under the intervention. The care team in the clinic where the program’s implementation is planned is responsible for the process. The group includes nurses, nurse practitioners, quality improvement specialists, and education specialists. Each participant has their area of responsibility and tasks essential for implementing the project.
Nurses and quality improvement specialists play key roles among team members in the program. Nurses ensure that the program is implemented, its management, and supporting participants. The quality improvement department, in turn, will be focused on monitoring data and ensuring the safety of changes, standardization, and quality. Thus, the ownership of the process predominantly belongs to nurses and quality specialists, but several other participants are also involved in the team.
Ensuring Ownership
While considering ownership, an important aspect is confidence that participants are involved and remain faithful to their responsibilities. In this case, it is critical to ensure their interest and discuss all the necessary nuances of the program implementation. Research demonstrates that a prior understanding of the benefit of the program, its goals, and personnel’s roles helps employees remain involved in the project (Nilsen et al., 2019). The evidence obtained by other studies on the advantages of exercise for patients with hypertension will demonstrate to stakeholders the potential benefit of the program. Assigning roles and supporting people in performing tasks will also help ensure that members remain on the board.
The critical evidence of staff commitment to implementing the program will be their participation from start to finish and the fulfillment of their duties. The positive results obtained will convince the team of the benefits even more and affect the program’s sustainability. By ensuring the advantages of the intervention, participants will be even more involved in preserving it and will contribute to the spread of its use.
Communication Plan
Communication is a critical aspect of project implementation and future sustainability. At various stages of the program, communication with different audiences with several goals is required (Shall et al., 2008). The project’s initiator should find participants ready to become part of the responsible team and submit an action plan to the clinic administration. One meeting will be held before the project for these purposes. After assigning a responsible team, communication will predominantly occur among its representatives.
At the initial stage of the program, transparent communication with a discussion of program goals, areas of responsibility, and other aspects are essential. During the program, it is necessary to resolve emerging issues, share feedback, and discuss the results. In such circumstances, communication channels include regular meetings and message exchanges via e-mail. Although the leader initiates communication at the program’s beginning, it is crucial that all team representatives can start the discussion. Communication will also occur between the team and patients during the program.
In the final stages, communication is necessary for structuring and analyzing the data and subsequent results assessment. The process includes exchanging received material, discussion, and summing up and is initiated by team leaders. If clinically significant outcomes are obtained, the project’s sustainability depends on communication. Team members should focus on spreading the program to other stakeholders. Communication channels can include training, publishing, distribution of educational materials, and holding meetings.
Training Plan
Training is stipulated at all stages of the project, and its success is also influential for sustainability, as education contributes to better results. In preparation for the program, training includes working with the responsible team. Strengthening their leadership, management, and soft skills will help them communicate with project participants. It is crucial to support patients and, at the same time, promote their commitment to exercise. Training should also include a consultation on the project and the specifics of its implementation and preparation for collecting data within the program’s framework.
Training should be directed to the patients-participants during the program. Education should include exercises and doing them correctly for accurate results. Important issues that also require attention when teaching patients are the measurement of indicators, their collection, and the identification of cases in which the help of a medical specialist is needed. The latter matter is crucial to ensure participants’ safety and identify the harmful effects of exercise. Training can take place with the support of nurses and the use of prepared training materials. If the program introduces positive changes, it becomes necessary to continue training. In particular, employees will have to teach patients with hypertension to exercise as part of treatment. Other units may ask for training in the program implementation. Training requires the involvement of an educational specialist, conducting workshops, and the development of educational materials. It is possible to involve additional consultants not included in the team.
Change Management Theory
The ACE Star Model of Knowledge Transformation© for change is helpful for an efficient and transparent process of integrating knowledge into practice. It demonstrates how knowledge applied in evidence-based practice is transformed in the process. The model defines knowledge transformation as “the conversion of research findings from primary research results, through a series of stages and forms, to impact on health outcomes by way of evidence-based care” (“ACE Star Model,” 2018, p. 2). The benefits of using the model for the current research are stage clarity necessary to enable the study’s results to translate into practice and influence health outcomes.
The model contributes to integrating nurses’ scientific research into the context of the EBP and helps organize and apply knowledge. The model contributes to integrating nurses’ scientific research into the context of the EBP and helps organize and apply knowledge. Stages of knowledge transformation include:
- Researching the topic of interest.
- Summarization of the state of the science in the researched issue.
- Turning this summary into recommendations, with the addition of clinical expertise, theoretical principles, and patients’ needs.
- Conducting actions directed at integration of the received recommendations into practice.
- Evaluating the results of the actions taken on the targeted outcomes.
Ensuring Change Standardization
The team responsible for the implementation of the program can face several obstacles. In particular, weak leadership or misunderstanding between employees can cause an impasse or significantly slow the project down. Moreover, staff often resist change in an effort to adhere to regular practices. Overcoming such barriers is an integral part of the work and requires additional communication, team preparation, and confidence in the idea and the possibility of its sustainability.
The sustainability of the proposed program depends significantly on how it can be standardized. For easy standardization, the project’s views and processes must be spreadable. Sociologist Everett Rogers created a model containing characteristics contributing to the spread of the idea (Mohammadi et al., 2018). Their application is relevant within the considered program:
- Relative advantage explains why the new intervention is better than existing practices. Speaking of the program, exercise can be a valuable addition to existing hypertension treatment.
- Compatibility covers how the new idea fits existing values, beliefs, and needs. Doing exercise is good for improving health, and the program does not involve excessive load and therefore meets the needs of patients.
- Simplicity describes how easy it is to understand new ideas. The program involves training to improve pressure indicators and is quite simple.
- Trialability meets the requirement that it be possible to check using a small sample. The reviewed project and its actions suggest the possibility of such a check.
- Observability describes how noticeable the results are after the idea implementation. The program will reduce patients’ blood pressure rates, demonstrating its observability.
Workload
The program’s implementation will require significant effort and time from the responsible team. A review of the work schedule and additional workload will be necessary to train and monitor patients, prepare the essential documents, collect data, and conduct other planned actions. Therefore, the project will demand an increase in workload in the short term.
Effective management is required to reduce the workload in the initial stages of program implementation. The leader should distribute tasks among employees and set deadlines. One way to support employees in cases where the workload has increased is by providing additional compensation.
The following assumptions about changes in workload are based on successful program results. If the intervention is effective, nurses must train patients to perform it correctly. To simplify training, it is necessary to develop educational materials with understandable exercises for patients with different educational backgrounds.
Improving the patient’s condition should reduce the number of visits and the likelihood of complications in the long term. Such circumstances help reduce the workload of medical personnel – the focus shifts to supporting commitment to the program, its sustainability, and its dissemination.
It is critical to remember that due to the lack of time that medical staff usually face, it is difficult for them to change their routine, which can interfere with the program’s implementation. For this reason, communication about changes in workload is essential. This aspect will be discussed in detail at the team meeting at the preparatory stage.
Review of the Sustainability Plan
Thus, the evidence-based project aims to improve the condition of patients with hypertension through physical exercise, and the proposed plan outlines efforts for its sustainability. Within its framework, measurements of patients’ blood pressure, their satisfaction with the program, and the frequency of hospital visits will be necessary. Such indicators will be evidence of the impact of the actions taken. Ownership is entrusted to a team of specialists of various directions, but the primary responsibility is with nurses and quality improvement specialists.
Essential aspects of the program are communication and training, for which separate plans have been outlined. Communication will mainly occur in a team and with patients, and after receiving results, the program can be distributed to other units. Training is required at all stages – for the team, patients, and other stakeholders. The theoretical basis of the program is The ACE Star Model of Knowledge Transformation© and Everett Rogers’s model on the characteristics of spreadable ideas. The project will require additional work from the team, but in the long term will reduce the burden on the clinic by improving the patients’ condition.
References
Mohammadi, M. M., Poursaberi, R., & Salahshoor, M. R. (2018). Evaluating the adoption of evidence-based practice using Rogers’s diffusion of innovation theory: A model testing study.Health Promotion Perspectives, 8(1), 25-32.
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Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I., & Birken, S. (2019). Implementation of change in health care in Sweden: A qualitative study of professionals’ change responses.Implementation Science, 14(1), 1-11.
Schall, M. W., Chappell, C., & Nielsen, G. A. (2008). Transforming care at the bedside how-to guide: Spreading innovations to improve care on medical and surgical units. Institute for Healthcare Improvement.
Sharma, H. (2021). Statistical significance or clinical significance? A researcher’s dilemma for appropriate interpretation of research results.Saudi Journal of Anaesthesia, 15(4), 431–434.
The ACE Star Model. (2018). Nursing Papers. Web.
Williams, B. (2018). Blood pressure thresholds for treatment and blood pressure treatment targets in hypertension. In A. J. Camm, G. Maurer, & P. W. Serruys (Eds.), ESC CardioMed (pp. 1-33). Oxford University Press.