Assignment: Organizational Readiness Assessment and Literature Review
Section A: Organizational Readiness Assessment
Culture is an important element that determines the manner in which change is implemented in an organization. It determines the manner in which people make decisions that contribute to organizational success. Organizational culture should be facilitative in nature. Further, it should allow the use of new approaches to implementing organizational strategies. The phenomenon should also be flexible to ensure that new interventions are used to enhance the realization of the set organizational goals. Besides, the employees should take responsibility of the decisions they make in undertaking their assigned tasks. They should also have the freedom to try innovative ways in which the goals of their organization can be achieved. Therefore, this essay examines the readiness of my organization to embrace the proposed change. It also refines the developed PICOT statement and summarizes research articles relevant to it.
Organizational culture and readiness assessment for this project was done using a tool developed by Cameron and Quinn (2011). According to the tool, assessment of organizational culture and readiness is done with a consideration of six main dimensions of organizational culture. The dimensions include dominant characteristics, organizational leadership, and management of the employees, organizational glue, strategic emphases, and criteria of success. Each of these dimensions has four questions that are scored based on the prevalent conditions. For instance, an alternative is scored 55 if it has very similar characteristics with the organization, 20 if somewhat similar, five if similar, and zero if dissimilar. An average is then computed to determine the organizational readiness and culture. The analysis tool by Cameron and Quinn (2011) was selected because of its focus on multiple aspects of organizational culture and readiness. It also allows for the determination of the improvement initiatives that can be adopted to enhance organizational readiness for change.
The outcomes of the readiness and culture assessment revealed that my organization is ready to embrace the proposed change. The organization has an overall score of 90% in its readiness and cultural assessment. The organization had the highest scores in areas that included criteria for success, strategic emphases, management of employees, and organizational characteristics. There were moderate scores in dominant characteristics in the organization. The organization scored poorly in organizational glue. It had a number of strengths that demonstrated its readiness to embrace change. They included people sharing information freely, being ready to take risks, leadership exemplifying excellence in facilitating development, and utilization of teamwork to get organizational tasks done. A few potential barriers to change were identified. They included the lack of formal rules related to implementing change, resource inadequacy to create new changes, and lack of efficient processes that improve resource use. However, these obstacles will be addressed by ensuring that the proposed intervention addresses the critical needs of the organization, optimizing opportunities brought by the intervention, and aligning the intervention with the expectations of the organizational stakeholders.
In sum, organizational readiness assessment should be undertaken prior to implementing evidence-based interventions in the clinical settings. The assessment provides insights into the organizational strengths as well as areas of weaknesses that will enhance the implementation process. It also guides in the adoption of measures that will manage anticipated forces that hinder the implementation process. Therefore, the right tool should be selected to obtain most accurate information on the readiness of an organization to embrace evidence-based practice.
The utilization of evidence-based practice in nursing practice has gained significant popularity in the modern world. Health
organizations and training institutions have recognized that evidence-based practice has significant benefits to patients, healthcare providers, and institutions of healthcare. The development of evidence-based practice interventions relies on the utilization of best-available evidence on the provision of care. Therefore, this section of the project explores the problem statement and reviews the literature relevant to my PICOT statement. The PICOT statement for the evidence-based intervention is as follows:
In African American patients with diabetes mellitus type 2, does the use of health information technologies result in improved glycemic control within eight months when compared to its non-usage?
Diabetes is one of the health problems facing a significant proportion of the American population. According to American Diabetes Association, about 26 million people in America live with diabetes. The number of people with pre-diabetes is estimated to be 79 million. These statistics implies that one in every three adults in America will have diabetes by the year 2050. The cost implication of diabetes in America is enormous. It is estimated the cost of diagnosed diabetes in the state has risen as seen from the fact that it was $346 billion in the year 2012 (American Diabetes Association, n.d.).
Diabetes largely affects African Americans when compared to people from other ethnicities. The difference could be attributed to factor such as socioeconomic status that increases disparities in access to the needed healthcare services. The disease burden among African Americans is also high when compared to other ethnicities. The high rate of disease burden among them is attributed to factors such as their lack of or poor access to as well as adherence to medications (Canedo et al., 2018).
The management of diabetes is mainly achieved with the use of pharmacological and non-pharmacological interventions. Patients with diabetes type 2 are prescribed oral hypoglycemic drugs that help them in controlling the level of blood glucose. There is also the use of lifestyle and behavioral modifications. Patients with the disease are required to maintain active physical exercise and take special diets to ensure that the level of blood glucose is regulated (Reusch & Manson, 2017). Effective management of diabetes type 2 depends largely on the level of patient adherence to these treatment methods. Accordingly, patients should ensure that the medications are taken during the right time, dosage, and frequency. They also have to adhere to the lifestyle and behavioral medications that will ensure effective management of the disease.
However, evidence has consistently revealed that adherence to diabetic medications is lower in African Americans when compared to individuals from other ethnicities (Elsous, Radwan, Al-Sharif, & Abu Mustafa, 2017). The lack of or poor level of adherence to medications and lifestyle modifications increases the disease burden among this population. According to Elsous, Radwan, Al-Sharif, and Abu Mustafa (2017), the lack of or poor adherence to treatment for type 2 diabetes arise due to factors such as patient-related, therapy, social, disease, healthcare system, and disease-related factors. It is therefore important that healthcare providers explore the available interventions that can be utilized to increase the level of adherence to treatment by this population.
Health information technologies promise to increase the level of adherence to treatment by African American patients with type 2 diabetes. A research conducted by Conway and Kelechi (2017), revealed that the use of health information technologies such as mHealth and eHealth can increase the level of awareness among the patients with diabetes type 2. They can be used to provide information related to the importance of adherence, scheduling clinical visits, and danger signs that patients should report if experienced. The use of health information technologies is also associated with enhanced satisfaction with the treatment by the patients. This could improve the rate of adherence to treatment among them (Bailey et al., 2019). A study that was performed by Yoshida et al. (2018) revealed that the use of health information technology led to improved adherence to treatment by patients with type 2 diabetes as evidenced by the reduction in the level of HbA1c. It therefore proves evident that the use of health information technology can improve the level of adherence to treatment by African Americans with type 2 diabetes.
Research Used to Support PICOT
A research conducted by Yoshida et al. (2018) was used to support the PICOT statement for this project. The research is a meta-analysis that was conducted with the aim of determining the effect of health information technologies on glycemic control in patients with type 2 diabetes. The researchers used 34 studies that were analyzed for the effect of the intervention. The results revealed that the use of health information technologies led to a clinical and statistical reduction in the level of HbA1c. However, it has the limitation of not using study participants to validate the effect of the intervention. Despite this weakness, the researchers proved that the use of health information technology could improve adherence to treatment in patients with type 2 diabetes.
The other research is that conducted by Bailey et al. (2019). The research was a pilot study that investigated the use of electronic health records based strategy to enhance adherence to medication in patients with diabetes. The researchers used 100 patients who were administered with the intervention. The intervention included the use of electronic health record that provided them with support alerts on medication risks, medication summaries, outreach for concerns of the patients, and monitors for medication use by the patients. The outcomes of the research revealed that the intervention resulted in a high rate of satisfaction among the patients on the use of the intervention to increase medication adherence among them. The study had a limitation in the sense that it used a small number of participants. This makes it hard to generalize to a wider population. Despite this, it shed light on the manner in which health information technology can improve adherence to treatment in patients with diabetes type 2.
The last research that supports my PICOT is the one by Conway and Kelechi (2017). The study was an integrative review that investigated the use of digital health to improve medication adherence in patients with hypertension or adult diabetes. Articles for the review were obtained from databases that included Scopus, EBSCOhost, and PubMed. The results from 13 studies that were included in the review revealed that there is somewhat benefit in the use of digital health to improve adherence to treatment in patients with diabetes and hypertension. This study is associated with a weakness that includes its lack of using human subjects. However, it points towards a possibility of improved adherence to treatment with the use of digital health.
In summary, the review of the available literature has shown that the use of health information technologies can improve adherence to treatment among African American patients with diabetes mellitus type 2. It can be seen from the research that there is scarcity in evidence on the use of health information technologies in the management of diabetes. Few studies have also investigated the impact of the intervention in African American patients. Therefore, the proposed intervention will address this gap in knowledge by investigating the effect of the intervention among African American patients with diabetes mellitus type 2.
Evidence-Based Practice Proposal – Section A: Organizational Culture and Readiness Assessment and Section B: Proposal/Problem Statement and Literature Review
In order to formulate your evidence-based practice (EBP), you need to assess your organization. In this assignment, you will be responsible for setting the stage for EBP. This assignment is conducted in two parts: an organizational cultural and readiness assessment and the proposal/problem statement and literature review, which you completed in NUR-550.
Section A: Organizational Culture and Readiness Assessment
It is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization\’s readiness.
Develop an analysis of 250 words from the results of the survey, addressing your organization\’s readiness level, possible project barriers and facilitators, and how to integrate clinical inquiry, providing strategies that strengthen the organization\’s weaker areas.
Make sure to include the rationale for the survey category scores that were significantly high and low, incorporating details or examples. Explain how to integrate clinical inquiry into the organization.
Submit a summary of your results. The actual survey results do not need to be included.
Section B: Proposal/Problem Statement and Literature Review
In NUR-550, you developed a PICOT statement and literature review for a population quality initiative. In 500-750 words, include the following:
Refine your PICOT into a proposal or problem statement.
Provide a summary of the research you conducted to support your PICOT, including subjects, methods, key findings, and limitations.
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.
WACO— The Baylor Center for Family and Community Ministries has teamed up with the Baptist General Convention of Texas Christian Life Commission to launch the Texas Hunger Initiative, an initiative aimed at reducing hunger in Texas through bolstering church food ministries.
As with any project implementation its best to envision any potential issues before they arise. Therefore, I anticipate a few potential issues with the proposed implementation of my project. The first foreseen issue identified for the proposed implementation of my evidence-based project are financial concerns and will continue to be an ongoing concern. I was able to identify a couple of strategies to help with the financial concerns including executive leadership engagement in the process. Being fully transparent with the executive leadership team regarding the implementation plan including cost and methods of saving will aid in gaining their support. Another financial strategy would be to develop a team of subject matter experts/educators on the Physician Orders for Life-Sustaining Treatment (POLST) program utilizing the system Respecting Choices Model within the system. With the development of the program within the system there will be a reduction in further cost to outside resources.
The second foreseen issue is a lack of clinician buy in to the program and change management. In order to address this area education, engagement, and communication are necessary strategies. The education will include up-to-date best practices, refresher courses, audit, and review. The engagement strategies include ensuring confidence in their work, standardized workflow, ensuring collaboration and stakeholder involvement. The communication strategies include ongoing updates on education and engagement opportunities, events, current POLST literature, and development of newsletter.
The third foreseen issue is lack of quality of the POLST process and order sets. Quality of the work is a multifactorial problem; in that it relies heavily on the first two foreseen issues. “The quality of POLST documentation is only as good as the conversations that precede it” (Abbott, 2019, p. 297). Therefore, if there is a lack of financial support or clinician buy in, ultimately leading to a reduction in POLST quality.
Research on POLST implementation is actively being reviewed and updated therefore in order to ensure that my proposed evidence-based practice proposal is based on current evidence it’s necessary to regularly search for the most up-to-date literature.
Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department. Annals of Emergency Medicine, 73(3), 294–301. https://doi.org/10.1016/j.annemergmed.2018.10.021
The only issue I see with the proposed implementation of my project is allowing both nurses and patients the time to get used to the implemented process. Most organizational change initiatives fail because we apply strategies that are not tailored for the structure of the concerned organization. I work at the VA in Lancaster and our structure is a healthy one. Changing a healthy structure requires trust, clarity, and integrity. Employees are accountable for what they do. If they need skills, they can get trained or ask support to their managers. Anyone in the organization, not only managers, is likely to ask questions like: “When will you be ready?” or “Have you tested the quality of your realization?” Everyone is accountable to their colleagues. Here are the guidelines to follow to identify the most appropriate change approach. It decomposes the movement from the current state to the future state in five steps (Cavarec, 2014):
- Formulate change
- Plan change
- Implement change
- Manage transition
- Sustain change
Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles (Silver et al., 2016).
Investments in new clinical practices do not stop with their developers; enormous effort and resources are directed to introducing new clinical knowledge to healthcare organizations. These investments include mobilizing human resources through the establishment of knowledge brokers, evidence-based practice committees or teams and identifying opinion leaders and champions who will support the practice excellence (Virani et al., 2009).
Cavarec, Y. (2014). Increase your organization readiness to change. Paper presented at PMI® Global Congress 2014—North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.
Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., Bell, C. M., Chan, C. T., & Chertow, G. M. (2016). How to Sustain Change and Support Continuous Quality Improvement. Clinical journal of the American Society of Nephrology : CJASN, 11(5), 916–924. https://doi.org/10.2215/CJN.11501015
Virani, T., Lemieux-Charles, L., Davis, D. A. & Berta, W. (2009). Sustaining Change: Once Evidence-Based Practices Are Transferred, What Then? Healthcare Quarterly, 12(1), pp 89- 96
“Hunger in Texas can be reduced with some structure and innovation, and I believe we’ll be well on our way to that within six years,” said Jeremy Everett, who will lead the project.
The endeavor coincides with hunger relief efforts associated with the Texas Baptist Offering for World Hunger, which now grants $475,000 to 95 Texas hunger relief organizations. The project will increase the capability of current ministries in the state that deal with hunger. The project will begin by identifying regional leaders in the state and forming networks to satisfy the diverse needs of each region.
“I like how this project starts with a strengths assessment and then allows us to build on those strengths using a model that takes cultural and environmental sensitivity into account,” Everett remarked.
“Having the Baylor School of Social Work as a partner to enhance and nurture the network of Texas Hunger Offering ministries is like a new harvest,” said Suzii Paynter, the BGCT Christian Life Commission’s director. “Great individuals are caring for God’s ‘least of these,’ and this initiative will provide them with the resources, support, and blessing they need to accomplish even more, especially as we focus on Texas Hope 2010.”
Everett has lived with his wife, Amy, and their two children, Lucas, 4, and Sam, 2, in San Antonio’s West Side, a notoriously low-income neighborhood, for the past five years.
Everett, who worked with Baptist Child & Family Services, was instrumental in the establishment of Guadalupe Street Coffee, a café with computers and wireless Internet connectivity for adolescents who did not have access to computers. Everett worked as a community developer in West Side, bringing together city council members, business owners, and students and officials from the local high school.
Everett will be able to put his community development skills to action on a larger scale through the Texas Hunger Initiative. The effort will first focus on El Paso, the Rio Grande Valley, and the counties of Bexar and McLennan, with the goal of developing and implementing ways to combat hunger via policy, education, community organization, and development.
Everett explained, “We’ve chosen to focus on these locations initially since there are established programs and ties.” “We can establish effective collaborations by building on the trust that currently exists.”