Applying a model or framework for change ensures that a process is in place to guide the efforts for change. 500-750 words, discuss a model or framework to use to implement an evidence-based practice proposal project.
Include the following:
1. Identify the selected model or framework for change and discuss its relevance to the project.
2. Discuss each of the stages in the change model/framework.
3. Describe how to apply each stage of the model or theoretical framework in the proposed implementation.
4. Create a concept map for the conceptual model or framework selected to illustrate how it will be applied. Add this as an appendix.
minimum of four peer-reviewed recent sources.
Evidence-Based Practice Project: PICOT Paper
Daysha Y. Polk
Grand Canyon University
June 1st, 2021
Evidence-Based Practice Project: PICOT Paper
Generally, a high level of patient satisfaction for the clients in the emergency department (ED) is vital, especially at this time when the healthcare system is shifting towards patient-centered care. Prakash (2010) notes that patient satisfaction levels significantly impact on medical malpractice claims, patient retention, and clinical outcomes. That is, it affects quality healthcare’s timely, efficient, and patient-centered delivery, making it both a proxy but a very effective key indicator for measuring the hospitals and doctors’ success. Consequently, supporting the improvements of patient satisfaction levels can positively affect several healthcare organizations’ components, such as preventive possible malpractice lawsuits, securing a positive local reputation, and enhancing patient retention rates. Thus, there is an increased need to develop strategies to improve ED patient’s satisfaction with the provided care services. Increasingly, the use of real-time location systems (RTLS) by hospitals to track patients, instead of relying on the traditional, manually-entered status updates, is increasingly being viewed as a better strategy to decrease the number or rate of Left Without Being Treated (LWBT) patients, and thus, improve ED patient’s satisfaction levels and hospital’s revenue collection (Boulos & Berry, 2012). Thus, the paper will explore whether the utilization of RTLS in the hospital’s ED, compared to manually-entered status updates to tract patients, help decrease the rate of LWBT and to raise revenue collection within 6 months, for ED patients with decreasing satisfaction levels with the provided healthcare services.
A wide array of factors is responsible for the decreased rate of satisfaction levels amongst ED patients. The current delays, long waits, leaving without being treated, decreased revenue collection from the ED unit, and reduced patient satisfaction scores have negatively portrayed the hospital’s reputation to the public. As a result, the daily patient visits have continued to decrease as people attribute the facility to poor emergency care services delivery. All these complications result from the use of combined data resources and manual entry status updates when tracking patient records. This manual tracking cannot meet the demand for many patients and leads to overcrowding due to and reduced patient flow in the ED. Therefore, there is a need to install an automatic patient tracking system to increase the flow.
Patient satisfaction level, especially for hospital’s emergency department (ED) is increasingly becoming a key health quality indicator. Patient satisfaction regards the degree to which patients are happy with their healthcare (Heath, 2016). Patient satisfaction levels is a care quality measure and gives healthcare providers information on the various aspects of health and medicine, such as their care’s effectiveness and their empathy levels. According to Xesfingi & Vozikis (2016), patient satisfaction is a healthcare quality’s measure given that it provides insight into the provider’s success at realizing the patient’s care expectations, and is also a key patients’ perspective behavioral intention’s determinant. While satisfaction has always been an important factor when delivering any form of a service, it has recently gained prominence or primacy within the healthcare space, especially at this time when the healthcare industry is fast shifting towards patient-centered models. According to Vocera’s 2016 ‘Rise of the Chief Experience Officer’ report, about 64% of the interviewed healthcare professionals stated that their healthcare organizations prioritize patient satisfaction in a similar extent to which they value clinical workflow and patient safety improvements. Increasingly, patients are demanding a larger claim in their healthcare, with the expectation that their healthcare providers will attain a certain service level.
Healthcare quality is increasingly becoming a universal issue, making the healthcare industry to undergo rapid transformations. According to Asamrew, Endris and Tadesse (2020), the rapid transformations are primarily driven by the need to realize its patient population’s ever-increasing needs and demands, instead of the traditional professional practice standards-based needs. In their study of a patient’s satisfaction score with a specialize hospital in Ethiopia, the researchers determined that patient-healthcare provider interaction and general facility amenity-related factors explained about 96.4% of the variability in the net overall satisfaction score. The hospital’s inpatient pharmacy services, the availability of laboratory, radiology and pain management services, and good quality services provided by the hospital physicians positively influenced patient satisfaction scores. Additionally, availability of accommodation rooms, toilet cleanliness, and dietary services had significant association with the patient satisfaction levels. In yet another study, Son and Yom (2017) classifies the factors impacting on ED patient’s satisfaction levels into three interrelated forces, including predisposing characteristics, enabling resources and need. First, the predisposing characteristics include demographic factors (age, sex, marital status and past illness), social structure (education and employment), and belief (subjective health, perceived social class and attitude towards health service – quality and status). Secondly, then enabling resources include family (income and type of health insurance) and community (type of hospital, mode of arrival, time taken, delayed or missed treatment and frequency of visiting the ED). Finally, the need factors include reason for visit and service received. Joe Greskoviak, president and chief operating officer at Press Ganey, categorizes the factors into communication, provider empathy, and care coordination (Heath, 2016). All these points are interrelated and affect each other.
Delayed or missed treatments have become a notorious phenomenon in most hospitals. In a recent research by Asheim et al., (2019), it was discovered that the prolonged ED stay was associated with a higher probability of being discharged from the ED without admission to the hospital and that there was no significant difference in hospitalization length for the admitted patients. Thus, the researchers concluded that prolonged ED stay was not associated with increased risk of death. However, many studies have determined that delayed or missed treatments are strongly associated with decreased patient satisfaction levels and reduced revenue for hospitals. Furthermore, ED overcrowding also reduced emergency care quality by prolonged patient total length of stay, increased rate of patients left without being seen, ambulance diversion, decreased patient satisfaction, decreased revenue collection, and etcetera (Wang et al., 2017). According to Wand (2019), the lengthy documentation and assessment processes, timeliness of consultations and delays in decisions about patient disposition in ED can lead to reduced ED patient satisfaction levels and frustrations by ED staff and hospital executives. As noted above, the complications are primarily caused by the hospital’s reliance on combined data resources and manual entry status updates when tracking patients and their records – all of which cannot meet the healthcare service demand for the many patients, leading to reduced patient flow in the ED, overcrowding, and delayed and missed treatments.
Technology can significantly help hospitals solve the mentioned complications. Primarily, by installing a RTLS, an automatic patient tracking system in the ED, hospitals can significantly increase the patient flow in their EDs (Drazen & Rhoads, 2011). According to Garie Fallo, the Western Reserve Hospital’s CNO, a technology suite can help improve care efficiency in EDs and boost patient satisfaction scores by 90% through streamlining the clinical workflow (Heath, 2016). With an automatic patient tracking system, patients would not need to stop at any stage for manual tracking, stipulating that there would be neither delays, prolonged wait times on stretchers, nor family waiting. Rather, the process would appear more satisfied, with a very seamless move to the ED room. Thus, right from their arrival, the patients would have a higher satisfaction with the provided services. The side-effect of the high satisfaction scores, according to a review of various peer-reviewed publications on the importance of patient satisfaction carried out by Prakash (2010), includes improved patient loyalty and retention, reduced vulnerability to price wars or bargains, consistent improvement in revenue and profitability, increased staff morale with reduced staff turnover, reduced risk or malpractice suits and accreditation issues, and increase personal and professional satisfaction. Consequently, by installing the proposed RTLS, hospitals can improve the ED patient’s satisfaction levels. Specifically, RTLS, compared to the manually-entered status updates to tract patients, help decrease the rate of LWBT and to raise revenue collection within 6 months, for ED patients with decreasing satisfaction levels with the provided healthcare services.
References Asamrew, N., Endris, A. A., & Tadesse, M. (2020). Level of Patient Satisfaction with Inpatient Services and Its Determinants: A Study of a Specialized Hospital in Ethiopia. (J. Haughton, Ed.) Journal of Environmental and Public Health, 2020(Article ID 2473469), 1-12. Asheim, A., Nilsen, S. M., Carlsen, F., Næss-Pleym, L. E., Uleberg, O., Dale, J., et al. (2019, December). The Effect Of Emergency Department Delays On 30-Day Mortality in Central Norway. European Journal of Emergency Medicine, 26(6), 446-452. Boehm, L., & Petty, K. (2016). The Rise of the Healthcare Chief Experience Officer. Vocera’s Experience Innovation Network. Boulos, M. N., & Berry, G. (2012, June 28). Real-Time Locating Systems (RTLS) In Healthcare: A Condensed Primer. International Journal of Health Geographics, 11(25). Drazen, E., & Rhoads, J. (2011, April). Using Tracking Tools to Improve Patient Flow in Hospitals. Retrieved May 30, 2021, from California Health Care Foundation (Online): https://www.chcf.org/wp-content/uploads/2017/12/PDF-UsingPatientTrackingToolsInHospitals.pdf Heath, S. (2016, May 24). Patient Satisfaction and HCAHPS: What It Means for Providers. (Xtelligent Healthcare Media, LLC) Retrieved May 30, 2021, from Patient Engagement HIT (Online): https://patientengagementhit.com/features/patient-satisfaction-and-hcahps-what-it-means-for-providers Prakash, B. (2010). Patient Satisfaction. Journal of Cutaneous and Aesthetic Surgery, 3(3), 151–155. Son, H., & Yom, Y.-H. (2017). Factors Influencing Satisfaction With Emergency Department Medical Service: Patients’And Their Companions’Perspectives. Japan Journal of Nursing Science, 14, 27–37. Wand, T., Crawford, C., Bell, N., Murphy, M., White, K., & Wood, E. (2019, July). Documenting The Pre-Implementation Phase For A Multi-Site Translational Research Project To Test A New Model Emergency Department-Based Mental Health Nursing Care. International Emergency Nursing, 45, 10-16. Wang, H., Kline, J. A., Jackson, B. A., Robinson, R. D., Sullivan, M., Holmes, M., et al. (2017, October). The Role Of Patient Perception Of Crowding In The Determination Of Real-Time Patient Satisfaction At Emergency Department. International Journal for Quality in Health Care, 29(5), 722–727. Xesfingi, S., & Vozikis, A. (2016, March 15). Patient Satisfaction With The Healthcare System: Assessing The Impact Of Socio-Economic And Healthcare Provision Factors. BMC Health Services Research, 16(94).
|Course Code||Class Code||Assignment Title||Total Points|
|NUR-590||NUR-590-O500||Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change||100.0|
|Criteria||Percentage||1: Unsatisfactory (0.00%)||2: Less Than Satisfactory (80.00%)||3: Satisfactory (88.00%)||4: Good (92.00%)||5: Excellent (100.00%)||Comments||Points Earned|
|Selected Model or Framework for Change||12.0%||The selected model or framework and its relevance to the project are not discussed.||The selected model or framework and its relevance to the project are incomplete.||The selected model or framework and its relevance to the project are summarized. More information or support is needed.||The selected model or framework and its relevance to the project are discussed. Some detail is needed for clarity or support.||The selected model or framework and its relevance to the project are thoroughly discussed. Rationale or support is provided.|
|Stages for Model or Framework||13.0%||The stages in the change model or framework are not discussed.||The stages in the change model or framework are only partially discussed.||The stages in the change model or framework are outlined. There are some inaccuracies. More information is needed.||The stages in the change model or framework are discussed. Some detail is needed for clarity or accuracy.||The stages in the change model or framework are thoroughly discussed.|
|Application of Model or Framework to Proposed Implementation||15.0%||Application of each stage of the model or theoretical framework to the proposed implementation is omitted.||Application of each stage of the model or theoretical framework to the proposed implementation is incomplete.||General application of each stage of the model or theoretical framework to the proposed implementation is outlined. More information is needed.||Application of each stage of the model or theoretical framework to the proposed implementation is described. Some detail is needed for clarity or support.||Application of each stage of the model or theoretical framework to the proposed implementation is thoroughly described.|
|Concept Map for Model or Framework||15.0%||A concept map for the selected conceptual model or framework is omitted.||The concept map for the selected conceptual model or framework is incomplete or inaccurate. The concept map is attached, but not in the Appendix.||A general concept map for the selected conceptual model or framework is attached in the Appendix. There are inaccuracies.||A concept map for the selected conceptual model or framework is attached in the Appendix. Some detail is needed for clarity or accuracy.||A detailed and accurate concept map for the selected conceptual model or framework is attached in the Appendix.|
|Application of Theoretical Framework in Decision Making (C.1.2)||10.0%||The ability to apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level is not demonstrated.||The ability to apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level is not consistently demonstrated. There are significant gaps and inaccuracies.||The ability to apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level is generally demonstrated. There are some gaps or inaccuracies.||The ability to apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level is adequately demonstrated.||The author has clearly demonstrated the ability to effectively apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level.|
|Required Sources||5.0%||Sources are not included.||Number of required sources is only partially met.||Number of required sources is met, but sources are outdated or inappropriate.||Number of required sources is met. Sources are current, but not all sources are appropriate for the assignment criteria and nursing content.||Number of required resources is met. Sources are current, and appropriate for the assignment criteria and nursing content.|
|Organization and Effectiveness||20.0%|
|Thesis Development and Purpose||7.0%||Paper lacks any discernible overall purpose or organizing claim.||Thesis is insufficiently developed or vague. Purpose is not clear.||Thesis is apparent and appropriate to purpose.||Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.||Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.|
|Argument Logic and Construction||8.0%||Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.||Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.||Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.||Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.||Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.|
|Mechanics of Writing (includes spelling, punctuation, grammar, language use)||5.0%||Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.||Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.||Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.||Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.||Writer is clearly in command of standard, written, academic English.|
|Paper Format (Use of appropriate style for the major and assignment)||5.0%||Template is not used appropriately or documentation format is rarely followed correctly.||Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.||Template is used, and formatting is correct, although some minor errors may be present.||Template is fully used; There are virtually no errors in formatting style.||All format elements are correct.|
|Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)||5.0%||Sources are not documented.||Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.||Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.||Sources are documented, as appropriate to assignment and style, and format is mostly correct.||Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.|