Assignment: Leading People, Processes, and Organizations in Interprofessional Practice NURS-FPX4010

NURS-FPX4010 Leading People, Processes, and Organizations in Interprofessional Practice

Assignment Leading People, Processes, and Organizations in Interprofessional Practice NURS-FPX4010

For this assessment, you will create a 2-4 page report on an interview you have conducted with a health care professional. You will identify an issue from the interview that could be improved with an interdisciplinary approach, and review best practices and evidence to address the issue.

For this assessment #2, you will report on the information that you collected in your interview, analyzing the interview data and identifying a past or current issue that would benefit from an interdisciplinary approach.

This could be an issue that has not been addressed by an interdisciplinary approach or one that could benefit from improvements related to the interdisciplinary approach currently being used. Additionally, you will start laying the foundation for your Interdisciplinary Plan Proposal (Assessment 3) by researching potential change theories, leadership strategies, and collaboration approaches that could be relevant to issue you have identified.

When submitting your plan, use the Interview and Issue Identification Template [DOCX], which will help you to stay organized and concise. As you complete the template, make sure you use APA format for in-text citations for the evidence and best practices that are informing your plan, as well as for the reference list at the end.

Additionally, be sure to address the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assignment: Leading People, Processes, and Organizations in Interprofessional Practice NURS-FPX4010

Summarize an interview focused on past or current issues at a health care organization.
Identify an issue from an interview for which an evidence-based interdisciplinary approach would be appropriate.

Describe potential change theories and a leadership strategies that could inform an interdisciplinary solution to an organizational issue.

Describe collaboration approaches from the literature that could facilitate establishing or improving an interdisciplinary team to address an organizational issue.

Communicate with writing that is clear, logically organized, and professional, with correct grammar and spelling, and using current APA style.

SCENERIO

Vila health: collaboration for change

The only constant in the world of health care is change. When changes happen at health care facilities, the process can go roughly or smoothly, depending on how well the collaboration among staff is with the process.

Last year at Clarion Court Skilled Nursing Facility, which is in Shakopee, MN, and part of the Vila Health

network, the implementation of Healthix, a new electronic health record (EHR) system, was very bumpy for all involved, leading to serious risks to patient safety.

Vila Health’s central QA office has asked you to travel to Clarion Court and talk to several staffers on both the management and patient care sides to get some perspectives on what went wrong (or right!) and what lessons can be learned for the future.

First, talk to management.

Stephen Silva

Administrator, Clarion Court

I understand why you’re here, and I don’t want to be uncooperative. But I want you to keep something in mind as you talk to everyone here: this situation happened because of problems upstream in the Vila Health network. If we were allowed more autonomy at the facility level, this wouldn’t have gone so roughly.

What do I mean? Well, the pressure from Vila Health Corporate to keep costs low and run a steady profit is intense. And I mean, I understand that this is a business. Of course! But we need to balance short-term thinking with long-term perspective. Anyway.

Just day to day, it was getting clear that our old record system was being held together with duct tape and bailing wire, and we needed to upgrade. But rather than let us run our own search for the right system for our situation, we get a mandate from Corporate that if we were going to upgrade, we would need to buy Healthix, because Vila Health has an ongoing relationship with them and we’d get a deal.

And: I mean, I like a deal! I need to keep costs down, so that’s great. But it’s not great to wind up with the wrong tool just because we got a deal. Healthix’s designed for hospitals and we’re a skilled nursing facility. And those are related things, but they’re not exactly the same thing.

If you need to screw something together, you don’t go and buy a hammer just because they’re cheaper. But nobody at corporate would listen to me when I tried to make that point.

After running roughshod on us there, corporate stomped down on us again by insisting we use an “implementation coach” that they had an existing relationship with. So we get some guy flying in from Baltimore who doesn’t know us, our staff, our needs, or anything other than how to make Healthix work in the big hospitals he usually works at.

I think that was 90% of our trouble right there, this guy from the outside coming in and just refusing to listen to everybody here when we told him over and over that this or that detail just wasn’t quite right for us. People talk about staff buy-in as an important thing, and ours pretty much evaporated after the second day of that clown stomping around in here ignoring everyone’s suggestions.

I’m sure you’ll hear more about this, but that’s the main thing. Excuse me, I’ve got to go on to a meeting. But remember: sometimes things go smoother if you let the people on the ground make their own decisions.

Elise Wang

Director of Operations

I guess I’m glad someone’s asking about the EHR implementation. God, that was a nightmare. I think that ended up chewing up an entire year of my life, with different phases of rampup, and then implementation, and then, I don’t know, fallout. There were long stretches where I’d just wake up in the morning and have to force myself to get out of bed because I didn’t want to go in and deal with the day’s mess.

I know Stephen’s upset with a bunch of the process stuff, how we ended up using Healthix instead of a system more suited for our facility, and so on. And he’s got a big point! But to be honest, I think the trouble was a lot more localized. We were always going to pick *some* system, and every system has its quirks.

I think the whole thing was a massive, massive failure of change management. A place like this only works when there’s teamwork and collaboration. And that stuff doesn’t just happen, you have to make it work. And I was trying to lay the groundwork- I know the staff here, I know who responds to what, and I was trying to get things rolling with the kind of slow, collaborative process that we value here.

But we had this abrupt, crash timeline with the corporate implementation coach coming, I think his name was Josh, and he just keeps bulldozing ahead and ignoring what people said to him, and that’s just a recipe for disaster.

He irritated our IT guys when they had some concerns, and then they stopped cooperating. You know, absolute do-the-bare-minimum-required-and-nothing-further type thing, just short of a strike. And if I could kind of understand that on the human level, WOW was that unhelpful and disruptive.

And pretty childish. It took Stephen calling them into his office and chewing them out for them to participate even grudgingly.

But I don’t know. I could have told him that if our IT people felt shut out of a thing they’d eventually be responsible for, they’d react badly. I *did* tell him that. But he didn’t listen.

We had kind of the same sort of situation with the nurses, too. But less childish in their case. They felt like the training process was leaving them unprepared and left behind, and they had to start making choices about using Healthix the right way or just taking care of patients.

And they chose patients, of course, but that wasn’t good in the long run. I’m sure you’ll hear more about that from them when you start talking to them.

Chad Cook

IT Manager

Hey, there. I’m happy to talk to anybody and everybody about that stinking EHR. I came so close to quitting so many times with that thing.

I gotta tell you, running IT in this place isn’t a picnic in the best of times. I like my coworkers and respect the other managers, but since this is a skilled nursing facility everyone acts like IT is an afterthought. And I kind of get that- for a long time, it was! But c’mon, we’re a couple of decades into the 21st century now, and technology is core to everything! It’s like trying to have a car without brakes or something.

So we’re underfunded and understaffed and overstretched to begin with. That means it takes most of our capacity to keep things running, not leaving us a ton of bandwidth for planning and for special projects. Which sucks, and is no way to run a railroad, but when I try to tell Stephen that he just sighs and says the budget is what it is. So you shrug and move on and wait for the whole thing to blow up.

My gut tightened up when Stephen decreed that we were doing a new EHR, then. I could see the need, for sure. But I could also see that we didn’t have the staff to really do it right, and probably weren’t going to take the time to even try.

It was just rush rush rush, boom, here’s this new system that’s getting rammed down our throats by corporate, sprinting the whole way. And then this joker from corporate swoops in to tell us what to do and how to do it, never taking a moment to listen to me or my guys if we had something to say.

By the sixth round of that, yeah, we got pretty irritated, and yeah, I might have taken my guys aside and told them it’d be fine by me if they did what was specifically asked of them and not a thing more. I mean, Corporate Josh is going to ignore our knowledge from making this place work? Fine, we’ll keep that knowledge to ourselves.

But you know what? Corporate Josh got to fly back to Baltimore and I had to sit here with my team and help the medical staff fight their way through the worst user interface I’ve ever seen.

Had to be calm and patient when they got mad at the clunkiness and took it out on us because we were the only ones handy, even though we didn’t have any say in picking the stupid thing.

Or then be the guy having Stephen yell at me that patient care is sliding because the care staff are having so much trouble with Healthix that they’re falling behind and crucial stuff isn’t getting entered and people’s medication schedules got blown.

That was fun! I still get to be the guy who has to sweat through patch installations every two weeks and then go around apologizing for the bugs that pop up every. Single. Time.

I guess we’ve gotten through the worst of it, and nobody died because of it, but wow was that bad. And it would have been a whole lot easier if I could have at least felt like I was defending my own decision instead of something forced on me.

Shonda McCrae

RN

Ohhhhhhh, Healthix. I hate Healthix.

I got into this line of work because I wanted to help people, not because I wanted to fight with computers. I can barely work my phone! I mean, I don’t think I’m a dumb person by any means, but we’ve all got our strengths and being good with computers isn’t one of mine.

But OK, I know it’s a tool of the trade these days. I understand that. I liked the paper chart system, but I knew that we were way, way behind the times with it, and I was excited when Administrator Silva said we were getting with the times.

But it just hit us like a tidal wave! No time to talk about what we needed, no time to figure out what was best for us! Just this burst of workers showing up to install computers in all the rooms—and boy did that cause a mess, playing some kind of shell game with our patients from room to room—and then a couple hours of really half-assed training and then here we go, on our own.

That “coach” they brought in, Josh Whatshisname, I tried to tell him that it takes me a while to learn how to do things on computers. He just kept pushing me away and telling me that the IT folks here would always be able to help me. As if. Those guys sit around and watch YouTube videos all day and won’t get off their butts unless Administrator Silva is on the phone personally telling them to go help out.

I remember the first week we were using Healthix, I kept having all kinds of trouble just logging in to the system to enter vital signs. You know, something that just takes a second with a paper chart.

And should just take a second with a computerized system! But you try to log in and just get this error message saying “invalid security domain” or something like that. You re-enter your stuff, over and over, just getting more and more panicked and falling behind on your rounds!

Then you get one of the IT guys to leave their YouTube to come and help you and they just shrug and have you try again for the tenth time, and then they tell you that it’s a known problem that Healthix has “trouble with authentication” sometimes. A known problem! Well that’s sure helpful!

I ended up just writing vitals down on paper again and then trying to catch up and reenter it all later in the shift when there was quiet time and I could try logging in again.

But that didn’t work so well, because sometimes there’s not a quiet time, and sometimes you lose the sheets of paper, and it’s just a mess. And that’s not counting the times you couldn’t see some important note about a patient that’d been left in Healthix because you couldn’t log in! We’re lucky we got through that.

Lisa Cotrone

LPN

I am so tired of talking about Healthix. I go home and complain about it to my husband every night. He’s sick of hearing about it. I’m sick of talking about it. But I hate it so much I can’t stop.

I’m a real practical person. If there’s something I need to get done, I want to get it done by the straightest route possible. I don’t want to have to monkey around with logins and go to this screen and then that screen and go through this pull-down list and try to remember what all the new abbreivations mean that are just a little bit different from the old abbreviations.

I’m not dumb. I can see why people want to use a system like Healthix. But holy cats did we do a bad job of setting it up here. After you log in, you have to click through three pages to get to the page we nurses need the most often to enter vitals and check for status notes. Why can’t we just make it so that that page is the first thing that comes up? I don’t know if that’s possible or not, because every time I suggest it, the IT guys just get huffy.

I just don’t like being told that all of this is the way it is, this or the highway. Take the time to explain it to me and I’ll be a lot more on board. Especially if you sit and listen to what I have to say. You might not even agree, just make me feel like I’m part of the process, not some little kid just being told what’s what.

Also: you better not tell her I said this, but I got really sick of Shonda’s cutesy oh-I-can’t-help-myself routine as we were trying to make it work. Sure, we were all frustrated, and sure that system was a stubborn mess. But suck it up and figure it out! Don’t just get all woe-is-me. I got so tired of getting yanked off of my own rounds so that I could come to her rescue. Especially when she knew that I wouldn’t be able to help her! It was tough not to feel like she just needed an audience for her little show.

I guess it’s better now, but there are still a lot of little pockets of hurt feelings here and there. Of course, there always are.

Nora Church

RN

Wow do I hate Healthix, and I especially hate the way we brought it in here. I was really excited when it was announced that we were installing it. It sounded great, and the list of stuff it was supposed to help us with sounded so awesome.

But then once it got installed, the reality didn’t match the sales job at all! We got told this story about how our lives were going to be so easy, just entering information and having easy access to whatever we needed to see.

But then we just get thrown to the wolves, barely any training. A lot of our patients have been in the system for a while, and their info is all garbled and messed up in there. And that’s if you can get to it! Once it lets you log in—which might take a while, depending on what kind of mood the system’s in—you open the system and see 20 tabs you have to pick through, and maybe three of them are actually useful to you.

And then as you’re poking through, every now and then the whole thing freezes up and just gives you a spinning circle for half a minute. When you’re in with a patient, you always want to be paying attention to them! But since we’ve installed Healthix, you’re always distracted by fighting with the computer.

Am I mad that management and IT here just left us hanging to figure it out on our own? You bet I am, but I’m not surprised. I’m used to that. Here’s the thing that really burns my butt: some of the nurses on staff who won’t help anyone else out.

I hate to name names, but take Lisa Cotrone. She got her head above water faster than anyone else with this thing. It was still clunky for her, but she could get by. But you ask her for help and she gets all snippy at you really fast. “I figured it out, why can’t you?” is her whole approach to the world. That’s not helpful, and it doesn’t really leave me full of warm feelings for the long term.

I bet you heard this a lot, but I’m one more person who spent a couple of weeks carrying a little notebook with me on rounds, writing stuff down to enter later. I know a couple of patients missed meds because of that. It was a disgrace, and we’re lucky it wasn’t a full-on disaster to get us in the newspapers.

Transcript example

Good afternoon everyone and welcome to my Collaboration and Leadership Reflection Video for NURS4010: Leading People, Processes, and Organizations in Interprofessional Practice. My name is Michelle Taylor.

During this video I plan to:

• Reflect on an interdisciplinary collaboration experience noting ways in which it was successful and unsuccessful in achieving desired outcomes.
• Identify how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature.
• Identify best-practice leadership strategies from the literature, which would improve an interdisciplinary team’s ability to achieve its goals
• Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work more effectively together.
• I’ll make mention of authors from the literature.

First let me provide some background

The experience I will share tells the story of the interdisciplinary collaboration that occurred during my hospital’s monthly electronic medical record down time planning. I’ll refer to the electronic medical record as an EMR.

As a health care informatics analyst, my job is to serve as a liaison between the clinical and information technology (IT) teams. The IT team has asked me to help identify an appropriate time for the EMR to be taken off line in order to perform mandatory software and hardware updates.

The EMR is used to enter orders, allocate medications, document patient care activities, generate lab and other diagnostic results, perform allergy and drug-drug interaction checking, monitor for fall, infection, and sepsis risks. While the EMR is “down” or off-line none of these functions are available and clinicians need to rely upon paper-based down-time procedures.

Needless to say, clinicians are dependent upon the EMR for all their patient care activities, and any gap in its availability causes anxiety, frustration, and has the potential to impact patient safety. Because of this, clinicians want the EMR to always be available, and operating at peak performance. The IT team, on the other hand, are required to conduct periodic software and hardware updates in order to maintain system reliability and performance.

The IT team advised my manager that an EMR down time was needed to apply required security patches and upgrade the server operating system. The team anticipated that the entire EMR, including labs and the diagnostic imaging system known as the PACs system, would need to be taken down to apply the patches and perform the upgrades.

If these tasks were not performed there was a great risk that the security of the EMR would be jeopardized, and the database corrupted, ultimately resulting in the inability to utilize the EMR or access any patient information. The IT team would need approximately four hours to complete the updates.

My manager tasked me to work with the clinicians and IT team to determine a date and time for the down time, create the down time plan, identify resources to provide support pre, during, and post down time, provide down-time related education, and conduct post-down time interviews to identify opportunities for improvement.

After thanking my manager for the opportunity, and taking a deep breath I started to work. Given the fact that all departments would be impacted by the down time for at least four hours, I realized that I would need to engage all of members of the interdisciplinary teams(physicians, nurses, laboratory staff, radiology technicians, patient access teams, IT staff, emergency room staff, etc.) to determine a date and time for the EMR down time.

The objective was to identify a four-hour block of time where the least amount of patient care activities would be impacted by the lack of access to the EMR. What a great opportunity to see interprofessional collaboration in action!

The published evidence would support my idea. Quoting from a 2015 publication the Center for Applied Research:

• Effective interprofessional collaboration promotes the active participation of each discipline in patient care, where all disciplines are working together and fully engaging patients and those who support them, and leadership on the team adapts based on patient needs.
• Effective interprofessional collaboration enhances patient- and family-centered goals and values, provides mechanisms for continuous communication among caregivers, and optimizes participation in clinical decision-making within and across disciplines. It fosters respect for the disciplinary contributions of all professionals.

I’ll now go step by step through the Plan-Do-Study-Act process. I’ll refer to that as the PDSA.

Let’s start with Plan

PDSA as advocated by Donnelly and Kirk —- (writing in 2015) — as a foundation, I met with the nursing, physician, lab, radiology, health information management, emergency department, and IT stakeholders to plan the down time.

During these meetings the IT team leaders explained the need and reason for the down time, underscoring the long-term benefits, despite the short-term “pain.” Other stakeholders shared critical patient care activities that occurred in their areas during a 24-hour period. Clarke (writing in 2013) would call such activities as collaborative learning, a demonstrated method for achieving shared successes.

The stakeholders explored the pros/cons of a variety of days/times for the EMR down time. As expected, no one day/time was optimal, but realizing the long-term importance of the event, the stakeholders agreed that the EMR down time would occur on Tuesday from 1:00 a.m. to 5:00 a.m.

This selection was made for the following reasons: allow end of day billing transactions to be completed; permit the phlebotomy team to begin their morning rounds on time; had a historically low volume of emergency department visits; a radiologist was available to be on site to read imaging studies; and nursing unit staffing was acceptable.

Now I’ll look at the ‘Do’ phase of the PDSA

On Tuesday at 1:00 a.m. the IT team implemented the plan and “took the EMR down.” During this time, the clinical teams resorted to their down-time procedures to request, document, and monitor patient care activities. From 1:00 a.m. to 4:45 a.m. the IT team rebooted 64 servers, applied 14 security patches to the software, installed the new version of the operating system, and tested the updates to make sure there were no negative impact on the EMR. The clinical teams could access the EMR at 4:55 a.m.

Now let’s explore the Study phase

At Tuesday 8:00 a.m. the organization’s stakeholders met to review (“or study”) the down time events. This activity is supported by 2018 guidance from the Institute for Healthcare Improvement support the value of PDSA cycle as a scientific method. We demonstrated this best practice when the stakeholders identified what worked well during the down time, listed opportunities for improvement, and summarized and reflected upon lessons learned.

Last, but not least, let’s explore the Act phase

The stakeholders identified the following as lessons learned:

• Tuesdays from 1:00 a.m. to 5:00 a.m. was an optimal time to take the EMR offline
• Downtime procedures need to be reviewed with all nursing staff as several units did not know how to obtain down time forms
• Additional phlebotomy staff are needed to help with first round lab draws in order to minimize delays in lab result processing
• The PACs administrator needs to be on site to assist radiologists with down time processes
• The clinical informatics staff needs to round every hour to support staff pre, during, and post down time
• Providing an explanation of the importance of the down time was critical to the success of the event
• There was no delay in critical test result notification or medication errors during the down time
• Future down time events will be communicated at least two weeks in advance; all stakeholders will meet two days before the