Improving Quality, Change Management and Leadership Assignment A guide to success
Disclaimer
This session is to guide you only. All information is from the Academic Regulations available at :
https://www.lsbu.ac.uk/__data/assets/pdf_file/0008/84347/acade mic-regulations.pdf
Please make sure that you refer to this if you are in any doubt.
What do you have to produce?
You need to submit a 3000 word Report relating to a change idea.
This needs to be submitted by 23.55 on 24th May 2021
Extra Time??
If you are eligible for extra time then you need to let me know that you are taking the extra time. This will extend the opening of the portal for 2 weeks ; hence the submission will be on 7th June 2021 at 23.55.
Extra time is indicated on Moodle site as ‘Eligible for sensitive marking’ to the marker. If it is not indicated then we will need proof before any marks can be released.
Extenuation
Extenuation guidance is available at :
https://my.lsbu.ac.uk/my/portal/My-Course/Exams- Assessments/Extenuating-circumstances
If extenuation is upheld, you will have a further 1st attempt in 2nd Submission period ( usually July).
If you do submit and your extenuation is upheld you can re- submit in July to have the opportunity again. You do not have to do this if you are happy with your mark. If you do wish to submit again please let the Module leader know.
What about extensions?
There are NO extensions for HSC students. If you do not submit on time, your work will not be marked.
2.46 For students on a professionally accredited course, for example in the School of Health and Social Care, where the professional body does not permit late submission, these regulations will not apply. The course specification will clearly advise if this is the case.
Assessment and Examination Procedures 2019/20
Front Sheet
submit with a front sheet.
Your work is anonymously marked however please label your submission with your Student Number.
For example: 350001.doc
Turnitin
Turnitin will check similarities in your work against other submissions from a wide area. We do not expect similarities of over 20% ideally.
Markers will check if the similarity is high and can see the breakdown ( as can you).
If you have a higher score, it is usually due to a large amount of direct quotation or ‘lifting’ passages from books or documents. At best this is poor academic practice and at worst you will be referred for Academic misconduct. You should be able to submit via turnitin until submission
Where do I start ?
Title of the module gives you a clue!
Improving Quality, Change Management & Leadership
These three elements are crucial. Additionally you need to include co-production and collaboration with other professionals.
Formative Assessment will give you guidance as to whether the change idea can be suitably linked to the learning outcomes of the module.
You MUST use headings in the report
These are suggested basic headings, but you may use more :
Introduction Background
Implementing the change – this is main body. You can use sub headings in this section if you wish.
Conclusion
Remember
You should not use the first person in the report
Imagine you are sending this report to someone who oversees the Trust area – it may help!
Share template example
Papers:
During this session I will share excerpts from past papers. Please note that any attempt to copy these will be picked up by staff and in Turnitin and will result in an AMI
Introduction
A broad overview of the change report , what you are seeking to achieve
• Justification for change which you have identified from practice
• Briefly identify the change model you will be using
Recommend no more than 50-100 words for the introduction
A clear example:
This report will introduce a proposal for the installation of near-infrared devices (NIRD) on all paediatric
wards, to assist in peripheral venepuncture and cannulation (V&C). The Nursing and Midwifery Council
(NMC) (2018) endorses change to quality improvement (QI), as all registered must deliver care alongside
the best available evidence. There is a continual need to implement QI changes into practice (Mitchell,
2013).
A weak example:
Page 5 is when the change idea is introduced!
The purpose of this paper is to describe how palliative care unit can successfully adopt and
implement a change-of-shifts reporting at the bedside by using Kotter’s change model so that palliative
care patients can be provided with care that will enable them to die a good death.
Background (300-500 words) Discuss why the change is needed and what evidence there is in literature to support the change.
t may be that this change has been implemented elsewhere and there is a perceived need that this will improve quality.
Introduce the concept of quality improvement as this is important throughout.
You may wish to discuss service user involvement or co- production at this stage if it is a change that would benefit from this in this section.
Make sure all your work is supported with policy or literature. Maintain Trust confidentially
A
Sun et al. (2013) publish NIRDs( Near infra-red devices) benefits during V&C as their study resulted in time reduction in
finding the first available vessel. Their study group also had a 56.7% first-attempt success rate, compared to the control
groups 33.3%. The literature also identifies the advantages of NIR imaging for patients with; small or non-visible veins,
difficult access or darker skin. As melanin within the epidermis absorbs minimal visible light, even less so with darker skin
(Cuper et al., 2011). However, as NIR light is absorbed by the blood, skin colour is rarely an issue. Allowing for greater
distinction between blood vessels and surrounding tissue, illustrating the impact this change can have on QI.
Batalden and David (2007a) define QI as the combined efforts of; healthcare professionals, patients and families, in
making changes resulting in improved; patient outcomes, system performance and professional development. The Health
Foundation (2013) illustrates six dimensions of healthcare quality; safe, effective, efficient, equitable, person-centred and
timely. Leaders must actively consider these dimensions when developing QI. Previous evidence indicates the importance
of QI as it ensures high standard person-centred care and without it our healthcare system would not continue to
constantly develop (North East London Foundation Trust, 2017).
A weak example:
However, this problem may be solved by utilizing the bedside handoff (sometimes referred as change-of-shifts
reporting at bedside) communication approach where the outgoing health care providers, especially the nurses (nurses
who are finishing their shift) and incoming health care providers give and receive the report containing all the necessary
information about the patient at the bedside. This approach is important because it provides a better way to end and
commence another shift with effective communication and at the same time engaging the patients in their health care
plans. This implies that nurses utilize evidence-based or best practices whilst improving the patients’ security and
satisfaction. This approach also ensures that the nurses spend much time with patients so that they can have a better
understanding of the patients and provide them with essential education that can help them cope with the difficult
situations they are experiencing.
Implementing the change ( Main body)
You can use sub-headings in this section if it helps and here are some suggested headings for you but as long as the work flows and has the elements for the assignment then the headings are not important.
• Change management model/Framework that you will use • Potential barriers to change • Impact on others ( Interprofessional collaboration/co- production • Application of Quality improvement tools/ recognition of importance of QI • Role of leadership in change • Evaluation of the change – how will you know it has been successful?
Change Management Frameworks/ Models
You need to identify and discuss the one change management framework that you are going to apply to your change idea.
We have looked at some of these:
Lewin, Kotter, NHS change model
You need to demonstrate that you understand at least two of them, compare and contrast ( from evidence in your reading) and explain why you have chosen one of them
A clear example:
Lewin (1947) is defined as a force field analysis with three stages; unfreezing, moving and refreezing,
resulting in the evaluation of driving and resisting forces to change (cited in Jones and Bennett, 2012).
Hussain et al. (2018) describe Lewin’s model as changing the current quasi-stationary equilibrium state
by; increasing driving forces, decreasing status quo maintaining forces or a combination of both. Tracey
(2020) publishes Lewin’s beneficial simplistic and collaborative approach, as well as its strong address to
change resistance. Yet, Cameron and Green (2020) observe managers using the model as a planning tool
as opposed to an organisational development model. Resulting in unfreezing becoming a planning phase
and not implementing any interventions to change attitudes. Lewin’s simplicity and focus on resisting
forces appear beneficial in the eyes of Tracey (2020). But its simplistic nature assumes organisational
structures operate in stable conditions, Burnes (2004) re-emphasises by expressing Lewin’s framework
does not consider the dynamic nature of change in current practice.
A weak example:
From the analysis of the literature review, three diagnostic models can be identified. These include
Kotter’s change model, Lewin’s Change Management Model, and McKinsey 7S Model. Out of these
change models, Kotter’s change model should be selected as an appropriate change model for adopting
and implementing bedside handoff approach. This change model is suitable due to its adaptability to the
organization and its capability to incorporate various staff reactions to change. Though Kotter’s change
model is rarely applied in nursing, the model should be selected because it is clear and easier to use
compared to other change diagnostic models. Moreover, the model utilizes effective imagery that is
comprehended easily by health care providers in palliative care. The conceptual framework in Kotter’s
change model provides a perfect structure that will enable the bedside handoff approach to address the
safety of palliative care recipients during the bedside handoffs (Noble, 2011).
Link your change to the chosen change model
For example, if you chose Lewin, there are 3 stages and you need to talk about these:
Unfreezing : How would you convince people to change? What are the barriers to change and how would you try and over come this and get people on board?
Change – what is the change and how would you implement this. Remember not to do something too large, the change is small and may be in stages ( so you may follow the model at different points of the intervention).
Re-freezing – How are you going to ensure this takes place? Think about the role of audit and evaluation?
Clear Example :
Unfreezing
Lewin’s (1951) three-step change model states that for change to occur firstly you must ‘unfreeze’ the ‘status quo’.
Staff will be invited to a team briefing to discuss whether change is required. Transformation practice development
empowers staff to reflect on the need for change and to help explore ideas and solutions (Dewing, 2010).
Evidence will be used to identify the problem that needs to be solved, the risks and consequences of dehydration. Using
SWOT analysis, the team will be engaged in finding solutions to benefit patients. Where staff can collectively identify
factors (people, resources and systems) that may hinder change, these factors can potentially be ‘’unfreezed”. A ‘working
party’ and ‘hydration champion’ will be identified and a clear project plan and objectives will be agreed (Hollis, 2011; NHS
Improving Quality, 2014).
Clear Example (cont):
The purpose of ‘refreezing’ is to sustain change that has been implemented. The changes need to be embedded into the
way of working and everyday ward life. Therefore, change can take longer than planned and results may not be seen
immediately (NHS Improving Quality, 2014).
All aspects of the change project will be designed and implemented in close collaboration with the MDT and patients.
Throughout the project, both patients and staff will be asked for feedback. Any achievements and positive outcomes thus
far, will be celebrated and negative comments will be addressed, and the change process will be reviewed.
Barr and Dowding (2016) argue that change is not always this simple and, in the UK, long term planning can be
problematic due to political and economic influences. Lewin’s change model is optimistic in suggesting that once change is
implemented, equilibrium will be restored. Therefore, in order to develop and support staff and patients throughout the
change the Plan Do Study Act (PDSA) tool will be used to monitor and manage it over time (Ellis, 2019).
Weak Example: ( Kotter model)
Stage 7: Building on the Change. For change to be successfully implemented, care providing
organizations need to constantly support changes and have continuous innovation while keeping the
vision of the project intact. reference? The guiding coalition needs to be constantly trained, coached,
and supported. Who says so? Why? The organization should foster reflections and emphasize on the
necessity of sustaining critical thinking. This may trigger new procedures to be developed.
Potential barriers to change
What might be barriers or concerns raised by others in the change process?
Are these justified? How would you work to overcome these issues? Why is this important in a change situation?
What are the problems of implementing a change when you do not have people in agreement? Will it work?
Remember you need to support this with literature and good references / use of literature
A clear example:
Furthermore, NICE (2018) publishes distributors of NIRD provide the initial training, inferring only
minimal additional training by the trust is necessary, signifying no substantial extra costs. However, Lima-
Oliveira (2017) declares the wide use of this technology is lacking due to the initial cost of commercially
available devices. With low-cost NIRD still within the improvement phase (Pan et al., 2019). Although the
cost of supplying a NIRD on every paediatric ward would be large, the initial installation within a few
trusts should create awareness to instigate the need for the device in other trusts. Yet it must be stated
that these training sessions will not be a fix all solution to the barriers. However, from initial installation
they should help NIRD to progress easier through the implementation process.
Impact on others (Interprofessional collaboration/co-production)
How might your change impact on others? What other professionals would you need to collaborate with and how would you do this?
Re-consider if you need more input from service users at this stage as well as other professionals.
What is the potential impact on other areas if this change goes ahead?
A clear example:
NIRD installation involves many professionals; nurses, doctors, healthcare assistants, nursing associates,
student nurses and housekeepers. All clinical professionals are impacted as there is a need to adapt the
current V&C process. To ensure this, off the ward training sessions should be multidisciplinary, allowing
for the mix of various professionals. Stephens et al. (2016) discuss its benefits as colleagues can share
improvement ideas and engage in interprofessional discussions and problem solving, away from the daily
professional hierarchy. However, even with these training sessions, it is still the responsibility of all
professionals to provide support to those whilst in practice, increasing interprofessional working (IW).
Crawford (2012) defines IW as the joining together of different disciplines, inferring a collaborative
relationship. Resulting in clearer communication, with information and guidance being shared, allowing
for the protection and betterment of health for all service users (World Health Organisation, 2017
Application of Quality improvement tools
What else would help to keep the momentum going ?
What change tools could be helpful to you? Consider those such as PDSA, 5 whys and the fishbone ( remember the paper aeroplanes? )
A clear example:
Although this cycle is widely recommended as an effective QI tool Knudsen et al. (2019) declares direct
claims that the cycle leads to improvements must be interpreted with caution. As the cycle has
methodological limitations with; its inability to be applied to big and complex issues, oversimplified
methodology and underestimation of the appropriate resources and support necessary to proceed with
a PDSA-based project (Dixon-Woods et al., 2014; Reed and Card, 2016). Despite its limitations, Reed and
Card (2016) state the PDSAs powerful approach, with projects that can adhere to its stages actually
improving the culture of healthcare
Role of leadership in change
Justify and explain the best leadership style for your change idea? How do differing styles potentially affect the success of the change? You need to discuss the most appropriate style and also consider how you may need to change the style at different stages.
Remember you need to support this with literature and good references / use of literature
A clear example:
Nielsen et al. (2019) describes laissez-fair leadership as not solely about non-leadership but rather the
avoidance of leadership when needed. Associating it with increased levels of anxiety amongst
subordinates, with Legood et al. (2018) also implying its relation to increased job frustration, leading to
deviant behaviour. Furthermore, it does not correspond with the CM’s ‘leadership by all’ component.
Illustrated as a theory of shared leadership, with acts of leadership originating from anyone, no matter
their placement within the healthcare hierarchy. Laissez-faire infers a complete absence of “leadership
by all”, meaning progression onto any of the next stages would be impossible.
Evaluation
iscuss how the change will be evaluated.
How will you know if the changes are improving quality?
This could include audit processes.
A clear example:
The NHS change model states that measuring the outcome of any change idea is crucial to ensure the
increase in QI. As by evaluating outcomes it becomes clear as to whether the change idea is better for all
those involved. The most common healthcare evaluations are clinical audits, with Johnson and Sollecito
(2018) defining them as the collection and summary of clinical performance data over a specified period
recalled back to professionals to monitor, evaluate and modify behaviour. Healthcare Quality
Improvement Partnership (2012) dictates the benefits of audits as; promoting expected practice,
providing education opportunities and improving service delivery and patient outcomes.
A weak example
It is evident from the existing literature that open communication between healthcare providers and
doctors is an essential aspect of death and dying a “good death.” However, several studies reveal that
communication in end of life care is still below optimal. Among the various aspects of communication in
palliative care, interprofessional communication and communication to pass information were found to
be the aspects that were not effectively implemented in a palliative care setting. However, these two
aspects can be improved by adopting and implementing bedside handoff communication approach
where the outgoing health care providers, especially the nurses, and incoming health care providers give
and receive the report containing all the necessary information about the patient at the bedside.
Conclusion
Conclude and summarise the importance of your change idea and what you hope this will achieve towards improving quality of care.
This does not need to be longer than 200 words and should not introduce any new ideas that have not been mentioned in the main body.
Common errors
Poor structure, grammar, spelling and punctuation
No headings or limited headings
No clarity as to what the change idea is
Too much detail on background and not enough about how the change will be implemented
Think – What would you want to know if you were receiving a proposal for change?
General
Write in 3rd person, not the first person
Take care with your grammar and spelling. Proof read ( or get someone else to).
Include a range of appropriate literature from textbooks, journal articles and policies. A mix of these will demonstrate that you have engaged with evidence. It is not the number of references but how you use them to develop critical analysis.
DO NOT overuse internet or webpage sources. The Moodle reading list will help you.
Release of results
The provisional results will be released via Moodle on 15 working days after the submission ( remember there may be Bank Holidays)
It will be any time during that day and no specific time, although every effort will be made to do so as soon as possible
The assignments will be moderated and marks then agreed before final ratification on your profiles
Extra Help
https://www.lsbu.ac.uk/student-life/student-services/learning- resources
Library – can help with searching etc. 3rd Floor helpdesk
500 words You can submit 500 words for review up to 3 weeks before submission. I will allocate you to a team member to make comment and feedback. Please do not send them all to me ! You can only submit one draft to one person Please try and avoid introductions and conclusions as this does not allow for any depth of discussion to indicate you are writing at level 6
