Innovations in health care service are essential to ensure that health care institutions are effectively managed. A successful innovative management strategy will require a prescription of a change system that would enable health care institutions recognize the harm due to exposure to health risks such as shortage of Central Sterilizing Supply Department could cause (Stanhope, 2006). The purpose of the change in the Central Sterilization Supply Department is to avoid the potential harm that could result as due to inadequacies (Heath, 1998; American Nurses Association, 1999). The CSSD is an important means of preventing hospital cross infection (Emslie, 2008).
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Thus, all institutions of health care must adopt CSSD quality assurance policies and procedures to mitigate probable adverse injuries posed by shortage of CSSD risks. This paper focuses on designing a health institutional change strategy that will ensure effective operation of the CSSD to eliminate risks associated with shortages. In sum, this paper will: identify the problem and rationale for the need of change; explain the aim of change; enumerate support evidence for change; summarize the main events and time table; provide a description of the desired change; business plan; strategy; summary of the main events; consequentially map for events; risks; control mechanism; transitional arrangements; resources; cost and budget; summery of costs; evaluation; dissemination of plan; limitations; and conclusion.
Identification of the problem and rationale for the need for innovation
The Central Sterilizing Supply Department (CSSD) is a special health institutional department where the cleaning, packing and sterilizing of all equipments for use in the wards and theatres take place. In modern health institutional practice, the CSSD has become indispensable because it is a very effective and economical means of providing sterile equipment for the aseptic technique. The CSSD may also be used for the disinfection after use of large pieces of equipment such as incubators, oxygen tents and ventilators. The CSSD is therefore an important means of combating hospital cross infection. Other CSSD advantages include: saving of nursing time; can standardize packs; the sterilization process is effectively controlled and safe (Zeichner, 2005).
The identification of the problem and the rationale for the need of change of the CSSD is essential in change management strategies. In the identification process, the change management committee will need to gather all information related to current and past incidences that could have happened as a result of shortage of Central Sterilizing Supply Department within the hospital (Youngberg, 1998). The committee will have to identify potential risk or exposure areas by using tools which could include: one, examining the existing incident reports as a primary tool. Medical reports on incidence occurrences are important in locating specific and potential areas of risk exposure.
All the information related to the incidences is recorded for accurate identification of areas of potential risk exposure due to shortage of CSSDs; two, the change committee will attend workshops such as morbidity and mortality, and quality management meetings to collect information on the actual medical errors that occur as a result of CSSD shortages (Rousel, 2003). Workshops and conferences may also be used to assist in gathering information (JCR Staff 2004); third, the change management committee will have to direct the medical records department to provide medical reports received from law firms (Wilson, 1999).
The Aim of the Change
The main aim of changing the CSSD in health care institutions is to establish proper policies and procedures that would ensure that CSSD has enough equipment and adequate qualified staff that complies with the laid down policies and procedures that would ensure safety at all levels (Linderman, 1999; Wunderlich, 1996). The purpose is to transform these procedures and ensure availability of adequate staff that is qualified to guarantee safety procedures within a health care setting. Lewin (1951) states that change can be adopted by either increasing the force of change in the intended direction or by reducing the existing opposing forces (Clarke, 2002: Acello, 2002).
Therefore, this paper will use Kurt Lewin’s change model to increase the force of change to avoid potential risk exposure as a result of shortage of CSSD. The change will adequately address the problem of staff compliance to the intended policies and procedures to eliminate unsafe work practices, poor attitudes and beliefs relating to protection procedures, and lack of knowledge and skill (Cherry, 2005: Gershon, et al., 1995).
Support Evidence for the Change
The concept of Central Sterilizing Supply Department was first introduced in the nineteenth century by Florence Nightingale, a concept that led to the evolution of health care institutions. She formed the department in 1854 on request of the British government and assisted reduce the death rate from 38% to acceptable 2% of wounded soldiers during the Crimean War (Wolper, 2004). Another milestone in the transformation of CSSD was the discovery of bacteria as the cause of disease. Sanitation was the principle focus of preventive medicine and elimination of infections in health care institutions before the discovery (Conte, 2001: Center for Diseases Control and Prevention. 1998).
In 1865, Semmelweis assembled and analyzed the clinical data in the obstetrical wards of the Krakenhaus hospital in Vienna to prove the contagious nature of postpartum infections. He then affected a management change routine where everybody entering the clinic to wash their hands with soap and water and soak them in a chlorinated limes solution. The results were amazing, in three months, the obstetrical death rates declined from 18% to 11/2% (Wolper, 2004).
Louis Pasteur proved in1822-1895 that bacteria were reproduced by reproduction and were not spontaneous, as previously believed. Lister continued Pasteur’s work where he made a discovery that broken bones over which the skin was intact, usually healed without any complications; when they are exposed, however, fractures developed the same type of infections that grew in amputations and other operations. Lister proposed that this finding provided additional evidence that some element circulating in the body was responsible for the infections (Center for Diseases Control and Prevention, 1998: Rello, 2007). By 1870, health care institutions in Germany were paying attention to Lister’s theories and sprayed carbolic solution in theatre room, drenching both surgeons and patients. As a result, it was now possible to perform surgery without fear of infection (Wolper, 2004: Jagger, 1998).
The discovery of steam sterilization and anesthesia modernized surgery practice and made it possible to be performed on regular basis. The introduction of steam sterilization was the beginning of surgical asepsis different from the earlier less effective antisepsis measures (Gruendemann, 2002). The three discoveries, that is, bacteria as the cause of diseases, anesthesia, and steam sterilization led to the development of the modern hospital. By 1895, Wilhelm Konrad discovered the x-ray thereby completing the foundation of the modern hospital (Gains, 1999).
In the UK, the first purpose-built CSSD was at Musgrave Park in Belfast. The processes of sterilization continued to change in a positive direction. However, there were occasional setbacks, for instance, in 1972; there was an outbreak of infection caused by contaminated commercially made intravenous preparations due to a failure of the bottles in an autoclave to reach an appropriate temperature (Wolper, 2004 :). The British standards committees and the department of Health of England and Wales prepared improved standards for the design, engineering, and testing of sterilizers and to advice on their use and management.
The central processing of surgical instruments was standardized by use of wrapped trays containing sets of instruments for each operation. Later, Scott Sheila a nursing officer in the department of health convinced her colleagues to introduce the system in the operating theatres. This system was gradually modified and introduced in all CSSDs, and it is still in use today.
Description of Change
After comprehensive diagnosis of the need for change in the CSSD procedures, the change assessment strategy will be done. The established change committee will to address the risks or medical errors whenever they occur as a result of shortages in the Central Sterilizing Department. The change measures undertaken must be proactive such as; establishing new efficient guidelines for reporting adverse incidences to guide health care staff about the procedure they should undertake to ameliorate adverse events of shortage of CSSD such as injuries and death (Wachter, 2008).
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The change management strategy will entail the assessment of CSSD past experiences and current exposures. Involvement in change process is motivational, for instance, it helps raise; health care staff morale to comply with CSSD procedures, community image, cash flows, and other health care stakeholders. The effectiveness of the change process of CSSD working procedures would be determined by the number of reported incidents on harm or injuries.
The change committee will employ key change strategies for collecting information whenever an adverse event occurs as a result of shortages in Central Sterilization Supply Department (Daly, 2004). After comprehensive identification and assessment of the problem and the need for change, the change committee will then establish effective control measures to be followed. These control measures will respond to potential areas of risk posed by shortage of Central Sterilizing Supply Department, and consequently reduce the liabilities involved related to these risks.
Young (2002) states that all risks that pose harm or death to patients and medical staff should be effectively addressed within the health care institution. Once these potential risks are identified and assessed, the change management committee would take appropriate control measures aimed at eliminating the risks. The change expected would also involve adoption of action plans that will ensure that CSSDs resources and time are applied effectively in areas reflecting potential high risk. When carrying out assessment of high potential risks involved, the change committee consider the adequacy and safety of all its surgical equipments, by ensuring that it considers clear points when processing instruments used in theatre.
The CSSD change program would be aimed at assisting the change committee in evaluating the CSSD work practices and medical safety devices such as; timely supply of sterile materials, disinfection procedures, adequacy of surgical equipments, procedure for sterilizing critical items, and instruments cleaning procedures based on the existing data. The change strategy then proceeds to “engineer out the problem of the CSSD shortage as close to the source of the problem as possible (JCR, 2004).
The change strategy is aimed at transforming the CSSD work practices, for instance, by; one, CSSDs are equipped with necessary equipments (McCormick, 2002); two, the change committee would establish procedures that guarantee all surgical theatres staff that is professionally trained and educated to ensure observation of high aseptic standards (Gruendemann, 2002). It also ensures that the surgical staff is not affected by the distractions, thus, ensuring smooth flow of surgical procedures; three, ensuring that CSSD has adequate supply of instruments necessary for an operation to guarantee health, safety and precaution of both patients and medical staff; fourth, policies that guarantee availability of sterilizing facilities at all times for use instruments.
The CSSD program is a premier change strategy designed to reducing potential high risks events related shortage of Central Sterilization Supply Department. The mission of the change initiative is to put in place procedures that will guarantee; timely delivery of sterile supplies, quality conformity, and efficient procedures in health care surgical departments, a central area in CSSD. All health care institutions would need proper and efficient procedures to run CSSD activities such as cleaning, disinfecting, sterilization of high risk items, and supply of sterile materials. The CSSD change program would fulfill as these requirements. The CSSD change program would also enhance the CSSD building blocks which include: having well trained and educated medical staff to handle work procedures in the CSSD; enhancing information systems through planning and tracing; efficient standardizations of processes, equipment and instruments, and the infrastructure of the CSSD.
The business plan justifies the implementation of policies and procedures that are well coordinated and multi-disciplinary to respond to the challenges posed by shortage of Central Sterilization Supply Department. The CSSD shortages can cause unprecedented devastating effects to both patients and medical staff that should not be contemplated. Therefore, this business plan designs clear policies and procedures aimed at solving the problem of CSSD shortages and contains; details all the people involved in the CSSD the specific roles they play, establish clear communication processes, provide clear action plans to be undertaken including risk assessment, medical staff and education strategies, equipment purchase and supply strategy, and control strategies of CSSD activities. Structured communication is essential in the health care setting to facilitate appropriate responses (Rousel, 2003: Brennan, 2006).
The CSSD change blue print is intended to provide improved institutional service delivery of the CSSD. The change implementation strategy concurrently proceeds and involves medical staff from key medical departments from top down and from bottom up. The head of departments will be co-opted at the steering committee to oversee the implementation process. From bottom up, the change blue print principles and goals will be implemented at the service level through a series of individual involvement in established procedures that involve partnership with other departments. Each implementation procedure at this level will be led by an operational change team.
A series of health care ad hoc management committees to offer support will also be formed to focus on change issues that formed change teams may encounter during the change development and implementation process.
The steering committee led by the heads of the surgical department, nursing, dental, and obstetrics. The responsibility of the committee will be to supervise and guide change implementation efforts. It will also select and sequence collaborative change initiatives, select operational change team leaders and management support teams. They will be in the forefront in campaigning for these changes by modeling the principles of departmental collaboration. The steering committee will also address the following; mobilization of interests and consensus building to make the changes to be acceptable, establishment of staff development blueprint that addresses work teams at all levels, such as, support for team building, training, promotion of innovation, strategy identification to support sustainability of practice, and others.
Summary of the main events and the timetable
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Consequentially map for the events
The purpose of this section is to provide advice and guidance on the establishment of the best CSSD practices. In consideration of the necessary actions, there are a number of steps that need to be considered for an effective CSSD that will minimize risks associated with shortages. Most significant, is to secure CSSD equipment buying and supply chains by considering: working out efficient supply chain procedures that is cost efficient and agility to respond to flexible requirements; CSSD equipment and supply chain that is robust and reliable, able to supply products in schedule consistently; and consolidation of supplies wherever possible to reduce traffic and possible contamination.
There are possible risks that may pose some set backs in the implementation process of the desired change. The main threat that will affect implementation of this change will come from the costs involved in the procurement of the CSSD equipment. The costs of establishing these instruments are extremely high and may be affordable to most health care institutions yet they are absolutely necessary. To control the hiccups resulting from the difficulties felt by health care professionals in understanding the mechanisms of implementing the new strategy, experts will always be placed on standby to address their concerns. Furthermore, efficient training mechanisms put in place will save time and costs in terms of providing the health care workers the necessary skills as conveniently as possible.
Health care experts would be adversely consulted to mitigate the difficulties that health care workers may face in understanding implementation strategies of the new program. Efficient training and education strategies would also be established as control mechanism to offer health care workers with the necessary skills.
The implementation of this change would be performed for a period of two years. The transitional arrangements will be overseen by the established committees led by the steering committee, operational change team, and ad hoc management support committees.
Consultancy services from health care professional s would be sourced for current information on modern management and prevention strategies of shortage of CSSD risks. Furthermore, all CSSD supplies will and manufacturers would also be consulted closely as major resource entities to ensure that the program succeeds
Cost and Budget
Much of the cost of executing this program would be expended on consultancy and training of health care workers. The projected budget cost would cost at least USD 150,000 to cover all the projected costs. This amount will be adequate to actualize all aspects of this program. The program shall be funded by the hospital and the ministry of health. The expected results after implementation of the strategy will be to prevent and if possible eliminate shortages of CSSD and save medical costs.
The true test of the effectiveness of the change outcome will be determined by the level of compliance and the measure of the resultant adverse incident levels reported. This evaluation method will assist in determining the ability and capacity of the health care professionals in dealing with the new strategy. In addition, efficiency as a result of the program will be determined by the number of incident reports of injuries relating to CSSD shortages. The successes of the program implementation will determined by the reduced number of injury incidences related to shortage of CSSD. The health care professionals will also be required to provide frequent feedback that will assist in gauging the success of the program. The feedback from these professionals will assist in ensuring that health care professionals comply with the new strategy.
Evaluation of the program will performed after 2 years of pilot testing. The evaluation strategy will be based on designing a program in terms of providing health care employees with protection against adverse risks associated with shortages in CSSD. The expected evaluation outcome should demonstrate; appropriate implementation and enforcement of the implemented CSSD new strategy aimed at reducing reported incidents of risks associated with CSSD shortages.
It should also demonstrate a reduction in costs attributed to combating adverse effects arising from risks associated with shortages of CSSD. Finally, the evaluation strategy will also aim at measuring the competence of health care personnel in implementing the new changes in the CSSD department before the adoption of the new strategy. This will be achieved through trail tests to ensure that health care personnel are able to simulate what they have been trained to know (Cherry, 2005).
Dissemination of Plan
The change implementation dissemination plan would involve the use of effective implementation strategies. A systematic process to support the adoption of the new CSSD policies and procedures would be used to communicate the practice change. The interventions that would be adopted to improve change acceptance include involvements in interactive education and training, engagement of opinion leaders and peer group leader, and use of action plans. The education strategy would be the most essential strategy to develop an understanding of how and why the CSSD change model is necessary. However, education alone may not be sufficient, it will be supplemented by clear practice guidelines and policies.
The change strategy will be limited to managing to only changing transforming the policies and procedures The health care professionals will be required comply and practice the new strategy. This project can not control the actions of health care professionals.
As a sensitive area in any health care setting, health care providers must strive to the CSSD has adequate and necessary facilities and efficient working procedures to ensure operations. Managements must be conversant with change management processes necessary for institutional transformation in order to reduce or eliminate health risks. Effective utilization of risk management strategies is vital in transforming health care working procedures. There are no universal approaches that are applicable in all health care institutional setting. Each entity can use an approach that is relevant to its circumstance in terms of reducing or eliminating risks.
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