Challenges and obstacles that occur during a practice change intervention are inevitable and, if properly addressed, can enhance the initial strategy and lead to even more sustainable improvement. In the East Orange General Hospital Clinic, the issue of the impoverished beneficiaries’ tendency to skip their follow-up visits with the doctor emerged, and the project to solve it was developed and presented by the preceptor and me. The intervention included influencing the client’s decision-making through education where the population’s specific characteristics are considered and making attending hospitals more affordable (Ofei-Dodoo et al., 2019). The implementation revealed the strategy’s weak points and challenges, such as communication difficulties, patient education, and reaching out to the local policy-makers. This paper aims to discuss the speed bumps and pitfalls of implementing the practice change project to increase the follow-up visits attendance among impoverished patients.
A significant part of the East Orange General Hospital Clinic’s clients represent the impoverished population, and their tendency to skip follow-up visits became a serious concern for providers. Indeed, non-attending additional appointments decrease healthcare quality and result in worsening patient outcomes (Ofei-Dodoo et al., 2019). The practice change project included influence through communication, education, and policy change; obstacles and speed bumps occurred in all three directions. For instance, the decision to contact and notify patients through additional tools such as WhatsApp and email revealed issues, such as using personal data aside from medical software and the lack of administrators. We were forced to stop the notification practice for two weeks, during which we developed a consent to sign about the further utilization of information to contact clients. The team also used a work breakdown structure to educate more administrators about the intervention and involve them in the project.
Patient education also faced pitfalls related to the clients’ perception of healthcare and the inefficiency of the universal protocols we developed. Each individual had a unique background and diverse reasons to skip follow-up visits; thus, the scenarios we assumed as appropriate did not work in most cases. Establishing proper communication at visits included building trust, making influential arguments, and addressing personal aspects to convince patients about the need to attend the hospital when necessary (Kim et al., 2020). Consequently, we decided to change the strategy and used the SMART objectives based on which practitioners could select the proper patient education tactic rather than using an inefficient universal protocol (Heinen et al., 2019). The adjustment in this section of intervention supported practice change enabling each client to get the personalized recommendations and motivation to attend follow-up visits.
The problem of the impoverished beneficiaries skipping their follow-up visits also occurred because of the Texas local policies regarding transportation and insurance costs; thus, addressing the issue included reaching the administration. The initial practice change project had to offer changes in the regulation of transportation prices or develop discounts for rides to the hospital (Hajizadeh et al., 2021). We faced a speed bump because the policy-makers had the COVID-19 pandemic consequences as the main priority of their work, and our initiative was not met with the expected enthusiasm. We maintain contact with the local government, and to address the obstacles, we included the project’s development and presentation to the intervention strategy.
The speed bumps and pitfalls that occurred during the implementation of the practice change enabled me to become a responsible nursing leader and build trustworthy relationships. Furthermore, the need for addressing the obstacles showed how important it is to share feedback and openly communicate with the team. Patient education, notification, and general awareness of beneficiaries’ circumstances improved during the work on the practice change project, and the contact with policy-makers revealed weak points of collaboration with the government.
References
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review.BMC Nursing, 20(1), 1-9. Web.
Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378-2392. Web.
Kim, M., Lee, J., & Doo, E. Y. (2020). Factors influencing healthcare provider-patient communication of patients with chronic diseases. Journal of Korean Academy of Nursing Administration, 26(2), 73-83. Web.
Ofei-Dodoo, S., Kellerman, R., Hartpence, C., Mills, K., & Manlove, E. (2019). Why patients miss scheduled outpatient appointments at urban academic residency clinics: A qualitative evaluation. Kansas Journal of Medicine, 12(3), 57. Web.