Planned Change in a Department or Unit

Planned Change in a Department or Unit


Change is inevitable, and organizational change is at the core of an organization’s perpetual existence. Change occurs at different units of the organization, increasing frequency, and magnitude in the health institutions (Marquis  & Huston, 2015). Acquired Pressure Ulcers is a national concern due to patient morbidity, treatment cost, and reimbursement issues. Stages III and IV pressure ulcers (PUs) that occur during hospitalization are among the conditions considered preventable. This study will look at Hospital Acquired Pressure Ulcers as a patient care problem and the changes to be effected to alleviate the problem.

Statement of the problem

The patient care problem under consideration is Hospital Acquired Pressure Ulcers. It is common for hospitals to evaluate Pressure Ulcers through surveillance method. However, the surveillance is not done frequently. The exercise is carried out at an interval, for example quarterly. Unfortunately, this does not provide enough data that can make follow-ups and understand the patterns of HAPU and curb the problem. Initiating a change that focusses on eliminating the problem comprise theoretical applications, leadership competency and sound recommendations (McAlearney,et al.2014).

Description of change and process

However, skin care protocol that includes an automatic referral to wound care nurse for patients at risk can be recommended so as to achieve its goals of being zero mandatory pressure ulcers for the year 2016. The referral process will include submission of referral in Electronic /Medical Records through the order pathway. On receiving the referral, the WOCN will have to consult with the bedside nurse on skin impairment issues and provide treatment and recommendations (McAlearney,et al.2014). Further, the bedside nurse will have to accompany WOCN to where the patient is during assessment and wound care consult.

The input of Joint Commission in change process

The input of Joint Commission is critical in facilitating change in the hospital. It is worth to note that adhering to the guidelines of Joint Commission that include patient safety and quality will help in realizing sustainable change. Partnering with Joint Commission would assist in assessing the performance standard of the nurses, competency level of the healthcare providers and gauge the patient safety and threshold quality compliance. Besides, Joint Commission would assist in the process of creating a solution towards the achievement of high performance through rigorous evaluation of various stakeholders (Marquis & Huston, 2015). Besides, Joint Commission accreditation would certify the change made by the hospital in its efforts to eliminate Hospital Acquired Pressure Ulcers

Having this protocol in place, proper monitoring of patients will be done. Moreover, with electronic medical records in place, current and updated information on a patient can be traced and hence proper decisions can be made. Notably, adhering to this protocol will facilitate tracking of patients and ensure the problem is alleviated in the community of the hospital achieving the goals of the hospital; To eliminate hospital-acquired pressure ulcers and to prevent progression of community-acquired pressure ulcers.

Change model

There are many changed models which can be adopted to facilitate the change of the norm in the hospital so as to achieve its desired goals. The most common model is the one by Kurt Lewin. This model is the most popular when it comes to change implementation. Though it was first presented in 1947, the model is still popular.

The theory or model of Kurt has three major steps or phases. These stages are; unfreezing, moving, and freezing. We are going to look at all these stages and how they can be employed in our case. Beginning with freezing, the first stage, is one of the most important phases of change implementation. It is the preparation stage for all stakeholders. It is where all parties concerned get to understand what the change is and get ready to move away from the current situation. The nurses, management and other stakeholders will be informed of what is to happen, acquaint themselves with what they will expect and also getting convinced that this is what they want. Motivation is key here once they realize that change is coming (Mitchell,2013). The same motivation will propel the process of change to the final stage. It is after an evaluation whereby the pros of the project will have outweighed the cons. Setting up deadlines for change will also help in ensuring that maximum efforts put into the project and as such, cooperation is realized.

The second phase, according to Kurt, is the moving or transition stage. He called it transition because he was aware that change is not an event but rather a process. The stage happens when we make the desired changes (Shirey, 2013). People get unfrozen as they move to a new style or practice of doing things. However, this stage is not a walk in the path. Many problems arise and for the project to realize its success then these problems must find solutions promptly. People are unsure at this stage, and they will need guidelines and motivations to get back their strength and work towards the success of the project. Moreover, they are still learning about changes and at times, they have to be given time to understand what is happening. Support at this stage is important. It can be provided in the form of training, coaching and also expecting mistakes as part of the process. It is also important to use role models and further allow people to make mistakes.

The last phase is the freezing or refreezing stage. This is where stability is established once changes are in place. Changes have been accepted and become part of the people.

The model will be used to effect change in the organization and further assist the organization in achieving its goals of eradicating hospital-acquired pressure ulcers.

Steps to facilitate change

For the change to be effective there was training on electronic record management practices. Furthermore all the necessary tools for the digitizing process and migration to digital platform were acquired. The systems include but not limited to computers and scanners. Patients’ records had to be digitized while the new admitted patients had their records captured in the system. The nurses and other healthcare service providers were assessed after training to gauge their level of knowledge for a smooth transition during the change (Laureate Education, Inc.2012). Reviewing the checklist on proper records organization and the time taken for records to be retrieved. Furthermore, updating of patients records to monitor the change progress.


The main stakeholders will be the participant in the process of change. It includes but not limited to nurses and medical records officers. Besides, some members of the community need to be part of the implementation to ease dispersion of the information (McAlearney,et al.2014). Besides, people providing palliative care to the elderly and home care to the sick would equally be involved.


Effective mitigation measure against Hospital Acquired Pressure Ulcers is a collaborative effort by the administration, all health care professionals, and the community. In that respect, in devising ways of eradicating hospital acquired pressure ulcers call for radical changes from the training of personnel, counseling patients and buying electronic record taking systems (Marquis & Huston,2015). The change the organization uses will ensure that the situation is curbed and declared a zero hospital-acquired pressure ulcers zone.


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