Running head: CRITICAL REFLECTION SCENARIO-BASED ESSAY 1

Change Implementation Process and Quality Improvement

Student’s Name

Institutional Affiliation
CRITICAL REFLECTION SCENARIO-BASED ESSAY 2

Change Implementation Process and Quality Improvement

Leadership during a change is an essential component in the nursing practice. Strong

leadership guides continuous quality improvement of health care. Leading a change process may

be challenging to a nurses’ leader as it is met by complexities and tasks that require maximum

support from the nursing staff. Provision of patient-centred care requires quality healthcare

improvement, which is marked by better communication patterns using both verbal and health

records. Introduction of electronic medication as one of the health improvement is likely to

improve patient and clinicians communication as it acts as a communication tool in healthcare

settings. Despite many benefits associated with the introduction of electronic medication,

initiating a change may not be warmly welcomed. Therefore, mental and physical capacity is

targeted first, then communication of the change information and necessary tools follows. Both

formal and informal mechanisms are then incorporated to enable the nurses to adapt to the new

normal without reverting to old ways. Transitioning from traditional medication system to

electronic medical records requires strong nursing leadership, to mitigate possible resistance to

enable the provision of quality patient-centred nursing care.

Reasons for Adopting Electronic Medication System

Electronic medication management is an essential trend in healthcare facilities. The

system offers significant benefits to the healthcare sector. According to Baysari et al. (2016), the

computerized medication system allows the clinician to access medical records at their

convenience thus reducing medical errors, contribute to better compliance, saves time and cost

thus increasing patients safety. The paper-based system has shortcomings as it is time-consuming

and full of mistakes which translate to medication errors or near misses during the provision of

health care. Another pitfall of the manual medication process is that in most cases paper record
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are illegible and inaccessible from different points at the same time, which may lead to errors in

medications. In the management of a large number of patients, paper records are cumbersome

and hard to access, which may lead to medication errors. For instance, in the case, being a nurse

leader in charge of two hundred beds hospital, communication breakdown may exist as access to

patient records in paper form is limited. Full electronic medication system will enable smooth

communication due to ease in access to medical records, thus guaranteeing patient safety.

The main reasons for supporting transitioning from traditional medication process in a

200-bed scenario is that a lot of medication errors occurs in highly populated hospitals. Baysari

et al. (2016) note adopting and implementation of the electronic medication system eliminate

these errors by increasing accuracy in the dispensation of medications to the patients.

Consequently, reduction of errors results in better treatment, quality improvement and increased

life expectancy among patients. Besides, the system will improve efficiency and efficiency

among nurses and midwiferies due to automation of services. Therefore, the introduction of

electronic medication project in a 200-bed hospital facility is also beneficial in improving patient

participation in the provision of self-care ease in the monitoring of the operation by the managers

and nurse leaders (Baysari et al., 2016). The accomplishment of the change and adaptation could

be successful by applying Lewin’s three-step model in outlining the plan of change, the

milestones and cementing the change.

Lewin’s Model to Outline a Plan of Change

Below is an outline of the change milestones and the timeline

The Change Step Activity Timeline

Freezing stage a. Conduct a meeting with the nurse management and Week one -

midwifery department week eight

b. Create the need for change by elaborating the

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current condition and providing a new methodology.

c. Collect feedback from the participants

Change Outsource the experts Week nine

implementation Upgrade all the necessary equipment to 16

Train the staff and check the suitability of the project.

Refreezing process  Continue training and involving the other staff. Week 16-21

 Support and conduct regular follow up on the staff

while assisting them to solve any challenge

encountered with the use of the new system.

 Allow the staff to continue operating independently.

All staff may not warmly welcome transformation process if the champions of change do

not introduce it accordingly. According to Hussain et al. (2018), Lewin's first step in the

introduction of change is unfreezing. Unfreezing is set to outline the need to set a foundation for

the change by eliminating unproductive practices and eliciting a positive response toward the

proposed change. For instance, in the 200-bed facility, unfreezing would commence with

meeting the nurses and members of the midwifery department to explain to the importance and

need for change. During the meeting, the change champion needs to present the statistics in

medication errors that have occurred in the health centre. The staff will then step up in presenting

an alternative method and the projected results after a successful kickoff of the new process.

Since the main aim of unfreezing is showing the staff the workability of the new methodology,

the leader will then display the benefits of the method in promoting patients safety. The expected

timeline to acquire maximum motivation from the rest of the colleagues is seven weeks. In the

eighth week, initiation of the initial stages of the change. Evidence-based introduction of an
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alternative method will foster the spirit of change thus, allowing the staff to embrace the next

step which the actual introduction of change.

Source: https://courses.lumenlearning.com/principlesmanagement/chapter/7-5-planning-and-

executing-change-effectively.

The second stage is the actual implementation of actual change. During the execution of

change, the leader needs to take into consideration the contributions of other employees as it

allows one to detect and mitigate resistance. The change champion needs to be one of the nurse

staff who has prowess in the area who will work closely with external consultancy hired to

upgrade the essential systems. In our hospital scenario, the change champion who is the nurse

manager will outsource a group of external experts to upgrade the medication procedures into an

electronic system. Installation of the system will take at least six weeks to complete. After a

successful set up of the system, the hired team is also expected to spend at least three weeks

training the nurses, midwiferies, and other clinical staff on how to use the systems. One

additional week is useful in monitoring the progress and ensuring the system is effective before

cementing or refreezing the new normal process.

The final stage in Lewin's three-stage change model is refreezing. The process of

refreezing entails making the implemented change by removing the staff from the state of
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transitioning to a permanent, productive steady-state (Hussain et al., 2018). During this period,

the facility will ensure every clinician is conversant with the new system and enjoys working

under the new system. Further training and follow up will cement the change and allow the

majority of the staff to embrace it. Building on confidence requires employees to be allowed to

work independently with the new system. Quality improvement is outcome-oriented. Therefore,

during the set five weeks of cementation of the new normal, the result will be compiled to

display the effectiveness of electronic medication program.

Leadership Style for Change Implementation

Transformational leadership entails creating a vision and guiding the team to achieve the

goal through inspiration. According to Merrill (2015), the primary focus is mainly on motivation

and morale to help the team members mould into the desired shape in the achievement of the set

goals. The transformational leadership will be most suitable in implementation of the change

process. Working in teams to meet the set goals can inspire the staff to commit to the unfreezing

and becoming motivated to change throughout all other change processes. Unlike transactional

or management leadership, where the leader motivates the team through rewards and

punishment, the transformational leadership will cement the change and motivate them to

become a part of change pioneers. In comparing with transformational leadership with other

forms of leadership, it's clear that the health care staff are more motivated to carry on the change

process as they can see the vision and the motives of the change process (Merrill, 2015). For

instance, the nursing staff and the midwiferies will be motivated to involve the patient in

personal care and efficiently conduct their medication process without fear of committing

medication errors. In a reward-punishment transactional leadership, the team may be motivated

to avoid the punishment, but, as soon as they achieve it, there will be less motivation to soar to
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higher levels (Merrill, 2015). The leaders are also expected to reevaluate the leadership method

to come up with the most effective leadership style to impact the change process positively.

Potential Resistance

Resistance is almost inevitable during the change process. According to Bovey & Hede

(2001), resistance during the change process could result from fear of unknown. The fear that the

change could lead to negative implication to the staff or inconveniences during the provision of

nursing care. That fear makes the staff discouraged since they are not conversant with the

changes being implemented. When people are afraid, they tend to distance themselves with the

situation, causing the fear, which in the case will negatively impact the change process. The staff

may also fear that computerization of the processes may end up replacing them. To mitigate the

fear of the unknown, the change team leader should explore the source of their worries other than

addressing the concern. The fear of the unknown is also addressed by enlightening the staff that

the new systems are intended to benefit everyone, other than replacement (Bovey & Hede,

2001). Another source of resistance may result from a lack of trust. The target team may lack

trust in the process and their leaders. The leaders need to build trust and interest with the team,

which will prevent resistance to change. Similarly, the team needs to be assured of training and

support until they are conversant with the new electronic medication system.

Leaders play an essential role in managing and implementation of change. Changes such

as the introduction of electronic medication system minimize medical errors and ensure patients

safety. The change can be implemented through the utilization of various models such as

Lewin’s three-step process of unfreezing, implementing the change and refreezing to cement the

change and to allow the nursing team and the midwiferies adapt to the new normal. The change

process could be further implemented by utilization of different leadership style such as

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transformational or transactional leadership. The change process could also encounter resistance

from the fear of unknown and mistrust of the process and staff. Therefore, successful change

implementation could lead provision to better patient care and outcomes.

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References

Baysari, M., Richardson, M. L., Zheng, W. Y., & Westbrook, J. (2016). Implementation of

electronic medication management systems in hospitals.

https://www.safetyandquality.gov.au/sites/default/files/migrated/Implementation-of-

electronic-medication-management-systems-in-hospitals-A-literature-scan-

%E2%80%93-December-2016.pdf

Bovey, W. H., & Hede, A. (2001). Resistance to organizational change: the role of cognitive and

affective processes. Leadership & Organization development journal.

https://www.researchgate.net/profile/Andrew_Hede/publication/235284220_Resistance_t

o_organizational_change_The_role_of_cognitive_and_affective_processes/links/54c8525

50cf238bb7d0de358.pdf

Hewitt, J., Tower, M., & Latimer, S. (2015). An education intervention to improve nursing

students' understanding of medication safety. Nurse Education in Practice, 15(1), 17-21.

https://www.sciencedirect.com/science/article/abs/pii/S1471595314001565

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin's

change model: A critical review of the role of leadership and employee involvement in

organizational change. Journal of Innovation & Knowledge, 3(3), 123-127.

https://www.sciencedirect.com/science/article/pii/S2444569X16300087

Merrill, K. C. (2015). Leadership style and patient safety: implications for nurse

managers. JONA: The Journal of Nursing Administration, 45(6), 319-324.

https://journals.lww.com/jonajournal/Abstract/2015/06000/Leadership_Style_and_Patient

_Safety__Implications.8.aspx