D156 Leadership and Management E-Portfolio Template
Student Name
Western Governors University
D156 Business Case Analysis for Healthcare Improvement
Prof. Name
Date
D156 Leadership and Management E-Portfolio Template
Instructions for Course Deliverables
To meet the course requirements, students are required to complete the CPE Record following the guidelines outlined in the Assessment Task Overview. This e-portfolio must contain all necessary deliverables, including written reflections. Students can enter reflections directly into this template for each phase. Alternatively, they can insert pre-prepared Word or PDF documents by following these steps:
- Position the cursor where the content should be placed.
- Select Insert, then click the arrow next to Object.
- Choose Text from File.
- Navigate to and double-click the intended file.
- Repeat this process for any additional files.
CPE Table: Estimated Time and Completion Dates
| Deliverable | Estimated Time to Complete | Date of Completion |
|---|---|---|
| CPE Table | 10 minutes | 8/31/2024 |
| Individual Stakeholder/Team Member Table | 10 minutes | 8/31/2024 |
| Needs Assessment | 1 hour | 8/31/2024 |
| SWOT Analysis | 1 hour | 8/31/2024 |
| Impact Analysis | 1 hour | 8/31/2024 |
| GoReact Screenshots/Posts | 1 hour | 9/1/2024 |
| Video Reflection | 30 minutes | 9/1/2024 |
Stakeholder Table
| Role |
|---|
| Director of Patient Clinical Outcomes |
| Director of Informatic Services |
| Director of Medical-Surgical Department |
| Manager of Post-Surgical Units |
| Manager of Medical Units |
Needs Assessment and SWOT Analysis
What are the key issues identified in the needs assessment?
An increasing number of patient falls, with and without injury, have been reported during shift changes on medical-surgical units. These incidents predominantly occur during handoffs, especially when reports take place away from the bedside, such as at the nursing station. Several contributing factors were identified:
- People: Nurses and Assistant Clinical Nurse Assistants (ACNAs) tend to conduct reports at the nursing station rather than at the bedside, limiting patient observation.
- Environment: High patient acuity and cluttered rooms filled with medical equipment obstruct staff awareness.
- Process: Staffing shortages and competing demands on staff reduce the focus on patient safety.
- Interventions: Current policies and procedures require reassessment and improvement to enhance fall prevention strategies.
What interventions are planned to address these issues?
The proposed strategies include:
- Shifting to bedside reporting to improve staff visibility and patient safety during shift changes.
- Increasing staff education emphasizing the importance and benefits of bedside reporting.
- Assigning unit secretaries to manage non-clinical tasks, thereby allowing clinical staff to concentrate more on patient care.
SWOT Analysis Summary
| Category | Details |
|---|---|
| Strengths | 1. Strong backing from directors and managers for bedside reporting implementation. |
| 2. Existing policies supporting fall prevention measures. | |
| Weaknesses | 1. Limited staff knowledge regarding the impact of bedside reporting on reducing falls. |
| 2. Resistance among staff due to concerns about increased workload and time constraints. | |
| Opportunities | 1. Support from nursing departments for bedside reporting to reduce falls. |
| 2. Establishment of fall prevention workgroups to track progress and share best practices. | |
| Threats | 1. Non-compliance and resistance to new procedures from staff. |
| 2. Management concerns about potential overtime and challenges in enforcing new processes. |
Impact Analysis
What benefits can be expected from implementing the improvement project?
Benefits are categorized as organizational and nursing-related, each with an assigned impact rating on a scale from 1 (low) to 3 (high):
| Category | Benefit | Impact Rating |
|---|---|---|
| Organization | 1. Fewer falls during shift changes, both with and without injury. | 2 |
| 2. Reduced costs associated with prolonged hospital stays and additional treatments resulting from falls. | 3 | |
| Nursing | 1. Improved efficiency and safety on hospital floors, leading to better patient outcomes. | 2 |
| 2. Enhanced nurse ability to prioritize patient needs, contributing to higher patient satisfaction. | 3 |
Total Benefits Score: 10
What risks might the project pose?
Risks are also grouped into organizational and nursing categories with impact ratings:
| Category | Risk | Impact Rating |
|---|---|---|
| Organization | 1. Staff resistance due to perceived extra workload and change fatigue. | 3 |
| 2. Bedside reporting could prolong shift change time, possibly causing overtime. | 2 | |
| Nursing | 1. Discomfort in sharing sensitive information at the bedside with patients or family members present. | 1 |
| 2. Insufficient education on bedside reporting benefits may weaken staff buy-in and effectiveness. | 2 |
Total Risks Score: 8
What is the overall impact ratio, and what does it indicate?
The impact ratio is calculated by dividing the total benefits by the total risks:
[
\text{Impact Ratio} = \frac{10}{8} = 1.25
]
An impact ratio above 1 indicates that the benefits of the project exceed its risks. This suggests that implementing bedside reporting is a favorable strategy for reducing patient falls and enhancing safety.
Video Reflection Summary
Discussions with stakeholders and the clinical preceptor underscored the urgent need to address falls occurring during shift changes. Approximately 3% of falls on medical-surgical units happen during this time, primarily due to reporting being conducted away from the bedside.
The current method limits staff’s ability to monitor patients closely, as nurses are occupied with completing reports, responding to call lights, and alarms. Transitioning to bedside reporting facilitates direct visual assessment of patients, enabling staff to prioritize care and prevent hazards more effectively.
The primary goal is to reduce falls by adopting bedside reporting practices. The needs assessment, including a fishbone diagram categorizing contributing factors into people, environment, process, and interventions, supports this approach.
SWOT analysis identified management support and existing policies as strengths. However, resistance to change and lack of education are significant weaknesses. Opportunities include nursing department support and fall prevention workgroups, while threats involve compliance challenges and confidentiality concerns during bedside discussions.
The impact analysis shows a positive benefit-to-risk ratio, with expected outcomes such as fewer falls, shorter hospital stays, cost savings, and improved patient satisfaction. Although risks like staff resistance and potential overtime exist, these are considered manageable.
Overall, the project promises to enhance patient safety through improved care practices during shift transitions.
References
Institute for Healthcare Improvement. (2020). Patient Safety and Fall Prevention. https://www.ihi.org/resources/Pages/Tools/PreventingPatientFalls.aspx
Joint Commission. (2019). National Patient Safety Goals. https://www.jointcommission.org/standards/national-patient-safety-goals/
D156 Leadership and Management E-Portfolio Template
Tucker, S. J., & Spear, S. J. (2018). Improving nursing shift handoff through bedside reporting: A patient-centered approach. Journal of Nursing Care Quality, 33(1), 27–33. https://doi.org/10.1097/NCQ.0000000000000275
Wong, C. A., Laschinger, H. K., & Cummings, G. G. (2019). The impact of bedside handover on patient safety: A systematic review. Nursing Outlook, 67(2), 136–145. https://doi.org/10.1016/j.outlook.2018.11.0031