Introduction The proposed organizational change is designed for Cincinnati Children’s Hospital Medical Center (CCHMC) in Cincinnati, Ohio. CCHMC’s vision statement states that it “will be a leader in improving child health (Cincinnati Children’s, 2013). ” Therefore, to provide and advance excellence of care, it is necessary to improve constantly. The Centers for Medicaid and Medicare Services (CMS) passed regulations commencing on October 1, 2008 that denies reimbursement for selected conditions occurring during the hospital stay and are not present on admission (Stone, Glied, McNair, Matthes, Cohen, Landers, & Larson, 2010).
Catheter-associated blood stream infections are listed as one of three hospital acquired conditions covered by the new CMS policy. Health-care associated infections, which are common, expensive, and are often preventable causes of inpatient morbidity and mortality (Stone et al, 2010). After careful review of literature, Nursing Practice Council (NPC) would like to change from daily soap and water baths to 2% chlorhexidine gluconate baths in critical care areas. Organizational Change Plan Intravascular catheters are indispensable in critical care areas. They provide essential, stable, and large bore access to critically ill patients.
Unfortunately, their use puts patients at risk for local and systemic infectious complications, including but not limited to local site infection, catheter-related bloodstream infections (CA-BSI), septic thrombophlebitis, endocarditis, and other metastatic infections (lung abscess, brain abscess, osteomyelitis, and endophthalmitis) (eResource: An Education Program Infection Control & Patient Safety, 2011). The cost of care for a patient with a CA-BSI is estimated to be between $34,508 and $56,000 (Rello & Sabanes, 2009); while annually the cost for all patients’ ranges from $296 million to $2.
3 billion (Consunji, Dimick, Hendrix, & Lipsett, 2010). After review of evidence-based research, CCHMC instituted a central line bundle three years ago. The key components of the bundle include: good hand hygiene, maximal barrier precautions upon insertion (use of sterile technique), chlorhexidine skin antisepsis, optimal catheter site selection (avoidance of femoral veins if at all possible), and daily review of the line necessity with prompt removal of unnecessary lines (Classen & Marchall, 2009).
The total number of CA-BSI’s saw an initial drop by 40% with the roll out of the bundle but in the past year that number has seen a slow but steady increase. CCHMC is now proposing a change in how critical care patients are bathed. Studies show that daily bathing with CHG decreases the incidence of CA-BSI’s among children in the ICU (Milestone et al. , 2013). Through the hospital’s Nursing Professional Practice Council (NPPC), it is recommended that staff no longer use soap and water, but instead use CHG wipes.
Their use could decrease CA-BSI’s by 50% (Cheng & Karki, 2012). An individual’s awareness and knowledge of what needs to change and why, are vital steps in the change process. Evidence shows that healthcare professionals are often unaware of, and lack familiarity with, the latest evidence-based guidance (National Institute for Health and Clinical Excellence, 2007). Lack of motivation and practical barriers (lack of resources) on the individual level can be hard to overcome. Ineffective communication with employees is a barrier the organization could face (Rampur, 2010).
Prior to applying the change, NPPC should state and provide in writing the specific goals this new proposed change in practice will achieve. The NPPC should also provide a succinct statement of vision and rationale for the projected change implementation, as well as a plan of action (Rampur, 2010). No matter how well planned the change program is, there will be conflicts. To avoid potential resistance it is necessary to identify potential factors that will influence proposed change. The common aspects are: communication processes, employee participation in the change development, and the quality of the information available (evidence-based research & continuing education).
Furthermore, motivation can be considered one of the main factors that can contribute to either a positive or negative outcome. If an employee lacks motivation toward the change, this behavior could negatively influence implementation of the change (Spector, 2010). In order to overcome potential factors affecting organizational readiness for the proposed change, it is essential to have in place a well-organized project management protocol.
Planning, implementation, testing, education, and feedback are essential items that would guarantee a successful result (Powers, Peed, Burns, & Ziemba-Davis, 2012). Managers are considered the most critical success factor when they engaged as an effective supporter. Management must maintain open communication with the workforce concerning any information about the benefits of the change; otherwise, they will keep resisting the change (Rampur, 2010).
The end users are the most limiting factors when change is concerned because implementation of the new ways of achieving old tasks becomes a challenge; therefore, bringing in the aspect of fear to the proposed change. For example, people fear change as they do not feel prepared enough for the new procedure even when it might lead to more favorable outcomes. Kurt Lewin, theorist of the 20th century, based his change theory model on a three-step process: unfreeze, change, and refreeze (Spector, 2010).
Lewin’s unfreeze step identifies disturbances to behavioral patterns within the organization. According to Morrison (2010), the disruption initiated during the unfreeze stage resulted from getting people to change their day-to-day activities, unlearn their bad habits, and open to new ways of reaching their objectives. Once the unfreeze takes place, it is then that through education and a well developed plan the organization is then able to move through the process of change. Ultimately, a new state of balance with environment is achieved and the organization refreezes (Morrison, 2010).
Successful change can be accomplished with the support of effective internal and external resources. To ensure that the desired change is accepted and maintained into the future, certain internal and external resources must take place. First it is crucial that organization provides the resources and rationale for the change. The staff need the education that this change is important and can ultimately affect patient mortality. The organization needs to impress upon the staff that revue is affected and that they are on the front line to stop the monetary waste.
External resources such as vendor’s consultants provide knowledge and skill necessary for the change. The consultants can make site visits and demonstrate the products, provide their company’s research, and proof of organizational savings to the staff. Training workshops are also another important resource to ensure positive change. Outcome data that may be collected are rates of bloodstream infections among patients in the critical care area. In addition, adverse events to CHG bathing should be collected to evaluate any negative impact of the practice change.
Documentation of the daily bath using CHG in the electronic medical record will allow for communication among nursing staff that the daily bath was given and could be used as a process measure. Conclusion Any change process is normally not an easy task. CCHMC would like to continue to see a decrease in CA-BSI’s and proposed that using CHG for baths instead of soap and water would allow that number to decrease. Furthermore, the hospital would see a decrease in lost revue.
Based on the findings and analysis of all the factors influencing any organizational change, it is obvious that project management and it’s components, internal and external resources, in addition to a well assembled plan can bring a successful change for any organization. Organizational change is complicated and very often people resist, but with the necessary tools, planning, and appropriate support system, the needed change can be accomplished.
References Cincinnati Children’s Hospital Medical Center, (2013). Vision and Mission. Retrieved from http://www.cincinnatichildrens. org/about/mission/ Cheng, A. C. & Karki, S. (August 2012). Impact of non-raised skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systemic review. Journal of Hospital Infection, 82(2012), 71-84 Classen, D. & Marschall, J. (2008). Strategies to prevent central-line associated bloodstream infections in acute care hospitals. Infection Control Hospital Epidemiol, 29(2), 15-19 Consunji, S. , Dimick, J. , Hendrix, C. , & Lipsett, P. (2010).
Increased resource use associated with catheter-associated bloodstream infections in the surgical intensive care unit. Arch Surg, 136(2), 229-234 eResource: An Education Program on Infection Control and Patient Safety. (2011). Retrieved from http://www. e-resource-safety. org/article_1/descrip. php Milstone, A. M. , Elward, A. , Song, X. , Davis, M. , Orschelin, D. , Obeng, D. , Reich, N. G. , Coffin, S. E. , & Perl, T. M. (2013). Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicenter, cluster- randomised, crossover trail. The Lancet, 381, 1099-1106 Morrison, M.(2010). Kurt Lewin three step model and theory change.
Retrieved from http://repidbi. com/management/kurt-lewin-three-step-change-theory National Institute for Health and Clinical Excellence. (2007). Retrieved from http://www. nice. org. uk/media/af1/73/howtoguidechangepractice. pdf Powers, J. , Peed, J. , Burns, L, & Ziemba-Davis, M. (2012). Chlorhexidine bathing and microcial contamination in patients’ bath basins. American Journal of Critical Care, 21(5), 338-342 Rampur, S. (2010). Barriers to change. Retrieved from http://www. buzzle. com/articles/barriers-to-change.
html Rello, J. and Sabanes, E. (2009). Evaluation of outcome of intravenous catheter-related Infections in critically ill patients. American Journal of Respiratory Critical Care, 162(3 Pt 1), 1027-1030 Spector, B. (2010). Implementing organizational change: Theory in practice (2nd ed). Upper Saddle River, NJ: Pearson Prentice Hall Stone, P. , Glied, S. , McNair, P. , Matthes, N. , Cohen, B. , Landers, T. , and Larson, E. (May, 2010). CMS changes in reimbursement for HAIs: Setting a research agenda. Medcare, 48(5), 433-439. doi: 10. 1097/MLR. 0b013e3181d5fb3f.