2. Describe the organizational and/or delivery system environment in which your intervention will take place.
VA inpatient system. Model: multi-divisional forms; Size: on each unit that this intervention will take place, there are around 15-20 nurses with one charge nurse, 3-5 nursing aides during a shift. There is 1 attending hospitalist on at a time. Hierarchy: centralization; however, the complexity is in that the nursing staff and hospitalist staff are sub-units of a higher level sub-group and there is not necessarily communication between nursing and physician sub-units.
3. Based on Shortell’s 4 domains of organizational change, identify organizational barriers that could potentially impede successful implementation of your proposed intervention.
Clinical Quality Performance
If we experience an increase in ICU transfers Patient Satisfaction If we experience an increase in patient/family member dissatisfaction; if staff members do not buy in and, in turn, create patient dissatisfaction.
Organizational Learning: Resistance to change for habitual reasons, fear for job and/or patient safety, lack of buy-in
Financial Performance
Some staff may see this as potentially leading to losing their job given less work is required of them
4. Using the same 4 domain model, describe how your intervention plan can take advantage of organizational strengths OR propose practical methods for addressing these barriers within your program.
Clinical Quality Performance:
Track ICU transfers after implementation
Patient Satisfaction:
Can track patient satisfaction scores before and after the intervention
Organizational Learning Knowledge:
transfer process and open communication across roles can be facilitated by having communication improve between hospitalists and nursing staff and within the two groups.
Financial Performance Productivity: should improve since resources will be better allocated to the sicker patients