AH Organization: A Case Study

Leadership and change theories are fundamental to success of the alarm management project. TJC (2013) have required a commitment from the highest level of leaders as the first requirement in phase I of the NPSG 06.01.01. The basis for the alarm management project for the AH Organization rests on the theory of leadership and the commitment to the values of the organization by the senior leadership team and consequently for those who follow. The values include stewardship, trust, integrity, collaboration inclusion, courage, innovation and excellence. The IOM states that leaders of acute healthcare organizations are challenged to deliver high quality care that is timely, cost effective, safe, and accurate, while achieving customer satisfaction
(Graper, 2015). The IOM further elaborates that the challenges in care delivery as a result of the healthcare reforms that have imposed pressure on organizations to provide care to more patients, while accomplishing the care with fewer defects at a lower cost. These challenging conditions have left the healthcare workforce skeptical as it has become more difficult to provide ideal care with fewer resources. Therefore, the leadership component in transforming safe care is paramount to the success of this project (Graper, 2015).
Leadership requires trust and a culture of transparency, and guidance using the tenets of transformational leadership to facilitate change as pointed out in the publications of Malloch, and Wong & Giallonardo (Graper, 2015).
Staffs are expected to follow the guidance of leaders’ hold individuals accountable. However this is best achieved through trustful leader-frontline relationships where the value of the project is thought to hold worth by all involved. According to the executive summary from the IOM and Rogers work on trust, changes to organizational restructuring initiatives and the impact of healthcare economics, has diminished the frontline staff members’ trust in hospital leadership. Despite the mistrust, ultimately healthcare organizations must overcome this hurdle and promote and develop trust to achieve efficient, safe, and effective outcomes through cost effective measures. Since nurses have significant exposure to patient alarm systems, their impact on quality outcomes is a key element for the success of this alarm project and mitigating adverse alarm events. Positive front line staff behavior is significantly influenced by their trust in the organization’s leadership (Graper, 2015). Therefore, it seems reasonable for healthcare leaders to address leadership as an influence on the alarm management
project.
An analysis of AH Organization’s culture of safety survey, created by the Agency for Healthcare Research and Quality, exposed opportunities for improvement to leaders.
The areas noted to enhance were communication, trust, team work and hand-off, and problem solving (Graper, 2015). Common to leadership concepts is support for enhancing and promoting trust in healthcare relationships as a root cause for promoting behaviors that promote safe, quality outcomes (Graper, 2015). The outcomes include patient satisfaction, nurse satisfaction and quality measures, such as those related to infection, fall rates and adverse events. With knowledge of these concepts, one goal of positive leadership style is to promote an environment of trust between leadership and the frontline care providers, most frequently nurses, which is expected to result in positive, committed behaviors towards clients and the safety measures as set by the NPSG. Work published by leadership scholars including Laschinger, Finegan, & Shamian, Rodgers, and Wong & Giallonardo, show positive behaviors will promote safe quality outcomes, including improved patient satisfaction and behaviors that may help reduce harmful events (Graper, 2015). The benefits of positive leadership are one of the reasons the commitment was directed in the NPSG
six.
As a result of the many descriptions of what makes an effective employee and leader, in leadership literature, an attempt to adopt a leadership style and approach for this author has been a lifelong career focus. In adopting a leadership model, terms such as engaged, empowered, transformed and authentic are used to depict a nurse that will effectively carry out organizational goals in a way that will translate to positive patient outcomes has been a prominent theme in this author’s attention. According To Laschinger, Rodgers, and others, organizational behavior that leads to positive outcomes can be traced back to trust in the organization’s leaders (Graper, 2015). Additionally, regulatory agencies such as the Pennsylvania Department of Health, The Joint Commission, Center for Medicare & Medicaid Services, and third party payers impose standards on healthcare organizations to produce safe, high quality results (Graper, 2015). The combined effect of AH Organization internal facilities surveys, the commitment to organizational excellence, and the pursuit of Magnet resignation and re-designation, as well as influences from governing healthcare bodies, and economic pressures, culminate to the commitment to have a strong leadership presence to transform care and carry out the alarm management project.
A successful alarm management program will not only depend on trustful leadership transformation, but additionally by leaders employing the change theory. Staff behavior changes are directly related the theories of change and a strong foundation for this project. Alarm responses, leadership support will be required. Roussel (2014) outlines the three stages of Lewin’s change theory, unfreezing, moving, and refreezing.
The education and evidence will help to unfreeze the behavior. The leadership team will need to monitor the change and reinforce the positive behaviors. Starting the change process of reducing nuisance alarms prior to the end due date will expedite the compliance. Further reinforcement by empowering frontline staff leaders, will help administrative leaders to hold staff accountable in real time when the impact is most significant.
The concept of desensitization creates a lack of response to the frequent alarm sounds. This is a result of human nature that occurs with most people when exposure to a stimulus is repetitive; in the project analysis, this is called alarm fatigue (AACN, 2013). The key to mitigating alarm fatigue is to decrease the frequency of false alarms. Many of the false alarms are tied to care habits or lack of measures that can reduce the false alarms. Often the staff members are not aware of these long standing patterns of behavior which can make it difficult to change. Change that is difficult can take significant effort and time to take hold (Roussel, 2014).
In this project, the change was stimulated by two forces, the NPSG and the sentinel event. Leadership is required to comply with the regulatory mandate, which have a tight timeline. But more critical is the impetus brought on by a negative outcome. Emotionally, no one wants to see a patient harmed. Additionally, there is leadership motivation to avoid regulatory sanctions and possible litigation. The nature and frequency of adverse events can stress an organization and the consequences have a ripple effect, which in turn has an impact on morale. The urgency with which staffs respond to alarms is a culture and perception issue that will require strong leadership presence to change behaviors (Mondor & Finely, 2003; Gorges, Markewitz, & Westenskow, 2009).