How to write a Healthcare Information Project: Intentional Rounding to Improve a Fall Prevention Protocol

D158: Strategically Planning the Execution of a HIP

Meetings and Organizational Policies

Project Meetings: Project meetings provide an opportunity to distribute information and communicate with teams and stakeholders during project management. The purpose of the meetings is to generate group decisions that can contribute to quicker project delivery of planned goals and expected results. The first aspect that I will consider during the meetings is the organization by tasks. Using this method, my intention will be to engage each stakeholder in discussing areas pertinent to their line of duty. Decisions that will require the input of all stakeholders will also be discussed at this point. I intend to use the transformational leadership style to inspire and empower the teams to think outside the box. This method will allow the members to participate freely and discuss openly methods that can be used to ensure the success of the project.

Regular team meetings are among the most frequent activities conducted during project implementation and can occur using various platforms. Given that most of the stakeholders are busy members of the healthcare team, both live and virtual meetings will be utilized. In-person meetings will be utilized during the discussion of important aspects of the project and voting exercises. Virtual meetings through Zoom will also be utilized especially during conveying information to stakeholders on the progress of the project. These meetings will also be used to plan for actual face-to-face discussions on important matters of the project.

The evidence-based strategy I will use to reach consensus during meetings is the Delphi method of consensus building. This method is based on the results of multiple rounds of evidence sent to experts which is then used to arrive to conclusions (Arias-Casais et al., 2019). The Delphi method will be utilized in five simple steps that will include initial list of indicators, selection of expert team, first round of questionnaires, second round of questionnaires, and analysis/presentation of results. This method was used to reach consensus on health indicators to assess palliative care global development and was very effective (Arias-Casais et al., 20190. The strategy allowed the development of best indicators to assess national-level palliative care development. The Delphi consensus building method It allows members to present their opinions without worry for repercussions and creates more time for effective decision making (Arias-Casais et al., 2019). Additionally, the Delphi model seeks to aggregate opinions from a diverse set of experts leading to quality decisions.

Review of Organizational Policies

The Centers for Disease Control and Prevention (CDC) identifies three steps that can be used to identify, analyze, and prioritize healthcare policies. The first step will involve the identification of the problem (CDC, 2015). I will seek more information from individuals that have expertise on policy issues in the organization to see how they might affect the proposed change. The second step will involve the identification of the most appropriate policy solution (CDC, 2015). I will review the current policy options in the facility regarding falls prevention and assess the available option. I will rank the policies according to priority and collaborate with the quality improvement department to identify any policy aspects that might conflict with the current change strategy. Necessary adjustments will be done if any current policy is found to conflict with the proposed change. The last part of the policy review will involve developing strategies to further the adoption of the policy solution (CDC, 2015). Sharing information and conducting additional background research will aid in the successful adoption of the new fall prevention policy.

Action Plan Development and Template

Action Plan Template

Please see the attached Action Plan Template (Appendix H)

Development of the Action Plan

An action plan is a way used to make dreams concrete by describing how strategies are used to meet set objectives. To gather input related to the development of the action plan. I intend to use the work breakdown structure (WBS). WBS is a deliverable-oriented hierarchical decomposition of work that can be used to execute actions during project management (Burghate, 2018). This tool provides room for broad and narrowed tasks that can be defined as the project continues to ensure less time and resources are utilized (Burghate, 2018). During the planning meeting, I will explain to the team how the WBS works and guide in identifying high-level items for the plan. The team will then discuss each action area and identify sub-activities until each aspect of project implementation is addressed. To reach a consensus, a brainstorming method will be used with all members allowed to table their views followed by discussions. Each member with different ideas will be given a chance to explain how it will improve the action plan including projected end dates.

SDOH and Target Population

SDOH and Socioeconomic Characteristics

Social determinants of health (SDOH) are social, economic, and environmental conditions that help people maintain their health and well-being. Patients in the surgical ward can be affected by certain social determinants that can increase the risk for falls including management after. The target population for the proposed project involves patients admitted in the surgical ward in a healthcare facility from the southeast of the United States. The majority of at-risk patients involve the elderly aged 65 years and above that are predisposed due to their increasing age. Apart from this category, most surgical patients in the facility are those suffering from long-term illnesses. Based on the hospital data, most patients are those male, unemployed, and with a history of other chronic illnesses. Patients in this category have an income of less than $25000 per year making it challenging to access healthcare services.

The majority of the patients in the department reside in low-income areas and have challenges with healthcare access due to a lack of health insurance. Social factors like smoking and alcohol intake contribute to the medical conditions observed among this patient category. The majority of the patients have conditions like diabetes, heart disease, obesity, and hypertension. For those who stay in the hospital for a few days, lack of health insurance and transportation costs makes it difficult to receive the necessary type of care. For instance, about 95% of the surgical patients use TennCare as their insurance provider and are enrolled in cheap programs that do not cover most of the services received. Another crucial aspect that affects these patients is a low level of education. Most patients are without a school diploma making it difficult to execute commands and follow protocol in the unit.

Benefits of the HIP for Target Population

Falls among inpatients are the most frequently reported safety incidents that result in physical injury and even death. The proposed project will improve the health and well-being of patients in the surgical unit in many ways. Firstly, the program will be able to identify patients at risk for falls and prevent any injury before it occurs. Patients will no longer suffer from injuries sustained during falls in the unit if the change is implemented effectively. Secondly, implementing this program will prevent disabilities that leave many patients unable to perform simple tasks like moving around, toileting and feeding, especially among the elderly. Falls cause the elderly to feel helpless, become depressed, and anxious making their lives miserable during the hospital stay. Implementing this program will reduce the length of hospitalization among patients since falls add extra few days for those who sustain injuries. Consequently, this program will improve patient satisfaction with the quality of services offered in the unit alongside the reduction of costs considering the economic background of the target population.

Force Field Analysis

Force Field Analysis Template

Please see the attached Force Field Analysis Template (Appendix I)

Positive and Negative Forces

The positive forces identified include the need to reduce costs associated with falls, the long-term benefits of the change to the patients, and the availability of support from the administration. Understanding these forces will help in motivating the team members to actively participate in the implementation of the project. The availability of support from the administration will ensure that necessary resources are availed to plan for implementation. Considering the long-term benefits of the change to the patients, the team will be dedicated to amicably agreeing on timelines to implement the change. It will also promote the active participation of each member because they all strive to improve quality care delivery. Regarding the aspect of reducing healthcare costs, the team will be ready to implement the change within the shortest time possible. Understanding cost reduction will measure for patients and the organization will guide the team in minimizing arguments, working amicably, and attending meetings to facilitate quick achievement of targets.

The negative forces identified include resistance from surgical teams, knowledge gaps among staff and members, and the cost of implementing the new change. Anticipated resistance from staff will help the team to plan talks with surgical teams and have their input before implementing the new change. The knowledge gap factor will help the implementation team to obtain necessary materials and personnel to educate staff on the relevance of falls prevention using intentional hourly rounding. Some members might see this strategy as unnecessary or ineffective given the busy nature of the surgical units. Lastly, the issue of implementation costs will help the team to effectively utilize the little available resources to see the project through. It will also influence the administrators to extend their budget to the implementation of the new strategy since it brings positive financial impacts to the institution.

Strategies for Overcoming Negative Forces

The identified strategies to prevent the negative forces are plausible and relevant. The first part will involve the education of staff and other members on the importance of falls prevention. The members will be presented with evidence-based recommendations for fall prevention and how hourly rounding can be effective in achieving positive outcomes. The second strategy will involve recruiting more staff to the surgical unit to supplement the overstretched nursing workforce. Improved staffing will ensure adequate time is available to do intentional hourly rounding and take necessary actions. To address the issue of implementation cost, the project management team and the administration will analyze other current projects in the institution and see if more capital can be borrowed to facilitate the falls prevention project.

Gantt Chart Information and Template

Screenshot of Gantt Chart

Please see the attached Gantt Chart (Appendix J)

Gantt Chart Information

Gathering information about the Gantt chart was done using six key steps. The first step involved the review of the WBS and the scope of the project. Activities were identified and deadlines set to ensure each task was completed on time. The third step involved analysis of the activities and ensuring they all belonged in the right order. Step four involved the identification of necessary resources and estimation of costs associated with the project. It was necessary to estimate the timeline and duration of each identified activity to guide the future evaluation of tasks. The last step involved the creation of the Gantt chart and arranging the tasks in chronological order.

Scope Statement

Preventing falls in hospitals is critical for safety. Falls in the surgical unit and other hospital departments cause reduced independence, functional decline, and disabilities to patients. The primary goal of this project is to reduce the incidence of falls on the surgical unit of the subject healthcare institution over the next year. Secondly, the project intends to improve patient satisfaction which will have a huge impact on CMS reimbursements due to improved HCAHPS scores. Two key deliverables are observed to guide this project. The first deliverable will involve hourly rounding in the surgical unit to identify patients at risk for falls. Secondly, developing clear and defined roles of staff during shifts will promote the fall prevention program. Education and training of staff will help to define the roles of each member and the necessary interventions required when the risk for falls is identified.

The key performance indicators for this project will include Improved patient satisfaction scores and a reduced number of falls in the unit for the next year. The HCAHPS scores will indicate the effectiveness of the fall prevention program that will translate to more reimbursements from the CMS. The number of falls in the unit will be compared with baseline information from the unit records to ascertain a reduction in fall rates. The overall outcome of the project will include a reduced number of falls in the surgical unit and improved patent satisfaction with the quality of care provided during hospitalization measured by patient satisfaction scores.

Communication Management Plan

Receivers	Context	Communication Outcomes	Key Messages	Message Medium
Administration	Project initiation	Approval to move forward with the project. Promising availability of necessary support required.	Highlight the benefits of the project to the patient and the organization.	Emails Letters Face-to-face meeting.
Stakeholders	Project planning	Gather evidence to support the implementation of the project. Understanding each member’s roles.	Highlight project goals, members’ roles, and outcomes.	Team meetings Zoom meetings Emails
Surgical Unit Staff	Project implementation	Staff acceptance of the new change and sign up for education and training.	Address the relevance of fall prevention and the proposed strategy.	Team meetings Emails
Stakeholders	Project evaluation	Review of the unit fall rates and HCAHPS scores at the end of the project.	Evaluate the success of the HIP.	Virtual meeting Face-to-face meeting Emails

Action Plan Template (Appendix H) (D158):

Action Item Owner Role or Title	Five Action Items (specific, high-level)	Phase Action Item Will Be Completed (e.g., pre-, during, or post- implementation)	Target Due Date
1. NS, Registered Nurse	Gather evidence and submit the project to the administration for approval	Pre-implementation		5/15/22
2. GH, Registered Nurse	Identify stakeholders and clarify roles and responsibilities.	Pre-implementation		5/15/22
3. RF, Certified Nurse Assistant	Complete education and training for staff.	Implementation		5/15/22
4. KT, Surgical Unit Manager	Data collection, review, and feedback delivery.	Implementation		5/15/22
5. HH, Clinical Nurse Specialist	Identify Key Performance Indicators (KPIs) and benchmarks	Post-implementation		5/15/22

Appendix I

Force Field Analysis Template (D158)

FORCE FIELD ANALYSIS

A force field analysis will help you identify the driving and restraining forces for the implementation of your healthcare improvement project (HIP). In the following table, list three positive forces that may drive the implementation of your project and three negative forces that may restrain it.

3 Positive (Driving) Forces

3 Negative (Restraining) Forces

1. Long-term benefits of the change to surgical patients in the facility.

1. Resistance from staff given the current shortage of nurses in the unit.

2. The need to reduce healthcare costs, especially for preventable adverse events.

2. Knowledge gap among staff for the need of the change.

3.Availability of support from healthcare providers and the administration.

3.Costs associated with implementation of the change.

References

Arias-Casais, N., Garralda, E., López-Fidalgo, J., Rhee, J. Y., Pons, J. J., de Lima, L., & Centeno, C. (2019). Consensus building on health indicators to assess PC global development with an international group of experts. Journal of Pain and Symptom Management, 58(3), 445–453.e1.

https://doi.org/10.1016/j.jpainsymman.2019.04.024

Burghate, M. (2018). Work breakdown structure: Simplifying project management. International Journal of Commerce and Management, 3(2), 453-461. https://www.ijcams.com/wp-content/uploads/2018/11/WBS-2.pdf

Centers for Disease Control and Prevention. (2015). Office of the associate director for policy strategy: CDC’s policy analytical framework.

https://www.cdc.gov/policy/analysis/process/analysis.html