CBT Innovation in Acute Inpatient Care

Introduction

This proposed patient service innovation project (PPSIP) aims to introduce the use of self-management skills of cognitive behavioral therapy (CBT) in an inpatient acute setting for the service users with a diagnosis of anxiety disorder. Patient service Innovation (PSI) ensures that efficiency is enhanced when delivering healthcare services to a patient(s). PSI is essential regardless of the field that an individual belongs to, particularly within the current National Healthcare Service (NHS). This is to ensure that service users received a high quality of care. Additionally, access to healthcare dissertation help can further improve the development of such projects by providing valuable insights and research support. PSI is a fundamental aspect of healthcare advancement.

The PPSIP is divided into two major parts. The first part will outline the backgrounds of innovation. This includes the NHS and recent key developments and policies, the justification, aims, and objectives of the innovation as well as evidence base that stimulated the PPSIP. The second part will provide details of how the PPSIP will be implemented; this includes change Management Strategy, Leadership Theory, Time Management, Evaluation, The Role of the Nurse in Service Improvement and Innovation and Conclusion. The above format will ensure that all relevant areas regarding the PPSIP have been covered. This PPSIP involves all the service users with a diagnosis of anxiety, educating the nurses in an inpatient acute ward and the purpose is to introduce to the nurses the use of self-management skills of Cognitive Behavioural Therapy (CBT) for the service users with a diagnosis of anxiety in an inpatient mental health acute ward. This PPSIP has been chosen since studies show that there is an increase in anxiety and depression in the population (Chunn, 2016). The rationale for the innovation will further be explored within part 1 of the dissertation

PSI is paramount because it presents the importance of service improvement and clinical excellence within the health and social care environment (Chunn, 2016). The NHS is the critical driver of PSI in England. They ensure that the delivery of healthcare services progress in terms of pace and measure of change. According to () there are factors which slow down the change such lack of resources. Therefore, it is reasonable to state that there are some barriers to overcome in attempting innovation. This PPSIP aim to ensure service improvement in mental health settings.

Theory

This section will provide a history of the NHS along with key advancements. The NHS was created in 1948 with the view that all individual should be able to access healthcare regardless of their socioeconomic status (NHS 2018). According to Maynard and Bloor (2008), 1946 NHS act focussed on prevention and treatment of illness however as a result of lack of funding, cuts on resources and management in the area of prevention led to NHS underdevelopment (Maynard and Bloor 2008).

It can be seen that the same challenges that were evident are still prevalent today. Current challenges in NHS include lack of funding, resulting in NHS not being able to provide all services required therefore resulting in prioritization, shortage of staff, e.g. Doctors and nurses and high sickness level result in services struggling to meet their demand. The aging population for example in UK people are living longer than ever this result in higher morbidity putting a strain on national service. Again, high level of stress due to reduced rest, sleep, technology and social media resulting in anxiety and putting a strain in mental health services ()

The increase in the evolution of medical science and technology is also a key driver for a change in the NHS because NHS has to ensure that key policies and legislation created are in line with changes in technology. (the medic portal 2018)

According to Alex et al. (), National Institute of Health and Care Excellence (NICE) recommended the use of CBT for anxiety disorder in 2004 prior to that NHS was spending 3% of mental health budget in talking therapy, as a result of this a small fraction of SUWAD were able to access CBT. In 2006 the government introduced a stepped care model focusing on Improving Access to Psychological Therapy (IAPT).

This stepped care programme was introduced with the aim of increasing access of CBT for SUWAD although there is a significant improvement in access of CBT however the issue of the waiting list of SUWAD to access CBT remain a concern. When looking at the foundation of the NHS, it can be identified that the service has been set upon principles and values that have aimed to drive the NHS towards excellence. The principles have been set for patients and the public; as well as staff members. The NHS constitution is inclusive of the views and opinions of the public and staff. It is renewed every10 years, taking into consideration that a patient needs change and there are factors involved that can have an influence on values and principles.

The principles that apply to my PSI include; The NHS aspires to the highest standards of excellence and professionalism. CBT has been selected, and it will be ensured that CBT would be offered to staff members within the inpatient acute setting in addition. This will ensure that staffs are accountable for the support they offer and the care that they provide to patients. The NHS is accountable to the public, communities, and patients that it serves (Kings Fund, 2018). It is important that staff continually develop their skills, ensuring that the support and services that they offer to patients are of a high standard.

The value that links to my PSI; is a commitment to quality of care. As stated above, the quality of care needs to meet the standards and needs of patients.

The NHS, five-year view, has outlined targets for the 2018/2019 (England NHS, 109). The main target that links to my PSI is that there will be an increase in psychological Talking therapies, it has been stated that by the end of 2018/2019 there will be 200,000 more people getting care this care will include Cognitive behavioral therapy. This will have a positive effect on patients; they will have a better chance of receiving the care that will steer them towards positive recovery; consequently, equipping them with the skills to prevent a relapse or episode.

Another target that has been put in place is Care closer to home. There will be an investment in crisis resolution; this should “mean a one-third reduction in adults sent out-of-area for inpatient psychiatric treatment.”

Improvement and clinical excellence are paramount when identifying and highlighting the future of the NHS (King Fund, 2016). Improving staff knowledge and offering staff training leads to excellence and quality improvement. Ways in which we can ensure that this takes place is by incorporating inclusiveness and equal opportunities all staff members.

Background

According to Hofmann and Boettcher (2014), Anxiety disorders are the most prevalent psychiatric disorders with a lifetime prevalence rate of 28.8%, and it is the sixth leading cause of morbidity. Anxiety has been classified as a mood disorder; it is often closely connected with the depressive disorder. The conditions mentioned are linked with cognitive impairment and fluctuations in normal brain activity (Kizilbash et al.,2012).

In the United Kingdom, the Department for Health in conjunction with the Local Boroughs have placed substantial priority on the mental health issues of adults while seeking interventions that would effectively mitigate the prevalence (NHS England, 2017)

Anxiety is so common that one in nine people experienced the disorder globally (Baxter et al. 2013). Gustad et al. (2013) indicated that anxiety is often a symptom of other mental health disorder such as paranoid schizophrenia, schizoaffective and bipolar disorder (Serafini et al. 2017). Craske and Stein (2016) indicated that people could experience anxiety every day of their life.

However, an individual is diagnosed with anxiety disorder if the level of fear, stress and anxious expressed by the individual is highly out of proportion to the threat in question and continued to be the same for at least six months (Craske and Stein 2016) The disorder comes at great personal and economic cost which in turn may reduce the quality of life for an individual (). Anxiety can lead to a low quality of life due to the fact that there is a risk that it may affect areas of an individual’s life which causes them to live a less than ideal life. A literature review by Hofmann et al. suggested that women are the most affected gender (65%) and it is usually aged between 15 and 34 (Hofmann et al. 2014).

It is vital to understand that it is normal and a part of daily living to experience anxiety or temporary worry (National Institution of Mental Health, 2017), although it becomes a disorder when it is persistent and gets in the way of normal human functioning (McManus, 2016).

Health professionals determine what the diagnosis is and also determine what appropriate treatment can be used by using the DSM-5. (DSM-5, American Psychiatric Association, 2000). Disorders such as anxiety and depression are classified under the Diagnostic and Statistical Manual of Mental Disorders; fifth Edition (Sharma et al., 2011). This corroborates the position of the National Health Services (2017) who described anxiety as entailing the feelings of fear and excessive worry. In the same vein, depression, otherwise known as depressive disorder, includes persistent depressive disorder, and seasonal affective disorder (MIND, 2017). Anxiety is a contributed factor in decreasing work productivity, diminished functioning in social activities and economic instability and as a result of the magnitude of the effect of anxiety treatment options has been proposed (Olatunji et al. 2013). The most treatment options are pharmacotherapy and psychotherapy. However, a treatment that has been shown to work for both depression and anxiety is Cognitive Behavioural Therapy (CBT). It is encouraging that anxiety and support for such mood disorders is getting the attention it deserves in the British public sphere and also in the media. It is not only in the United Kingdom that the subject matter is enjoying public debates; the WHO Report (2015). This highlights the fact that there is a high demand for treatments such as CBT. When there is a high demand for treatments and services, it can put a strain on the NHS and professionals because not all patients’ needs may be met. In addition to this patients may not receive enough sessions due to the fact that there may be a waiting list etc. Cognitive Behavioural Therapy (CBT) has become a popular approach to therapy since it can be applied to a variety of issues. CBT is based on the evidence that psychological distress and mental disorders are maintained by cognitive factors (Asnaani et al. 2012). Therefore, by addressing the cognitive factors, one will be resolving the psychological distress and mental disorders. Ehde et al. (2014) stated that CBT is a psychological therapy which involves talking with the goal to reduce symptoms, improving the individual functioning and thereby causing a reduction of anxiety disorder. According to Dutra et al. (2008), CBT has proven to be effective in treating anxiety and depression. Hofmann, Wu, and Boettcher (2014) carried out a meta-analysis of literature than involved 3,326 participants spanning 59 trials. The researchers found that CBT was very effective in improving the quality of life of the participants (Hofmann, Wu, and Boettcher 2014). They added that the coping mechanisms presented through CBT were found to be successful in aiding the participants in dealing with their anxiety. Face-to-face interactions when delivering CBT and group settings provided a higher efficiency as compared to internet-delivered treatments (Dutra et al. 2008).

Hofmann, Wu, and Boettcher (2014) thus concluded that CBT is valuable when treating anxiety disorders and It was found that relapse rates were comparatively lower when CBT was used as compared to other pharmacological interventions. Although CBT combined with pharmacological interventions was found to be successful with relapse rates lower when treatment was terminated as compared to treatment using drugs only. According to NICE ( )

The treatment of anxiety with CBT appears to have long term effects. For example, when a service user with a diagnosis of anxiety completed full CBT sessions, the chances of relapse is significantly lower compared with when the service user was treated with medication only. This is because CBT will address some of the coping mechanism (NICE …) The researchers thus concluded that CBT seems to be more efficacious when compared to other psychotherapies. However, there are some barriers and challenges in delivering CBT. () indicated that CBT is not effective to every individual although it has proven that the percentage of the individual that benefits from CBT is significantly higher to compared to those that are less beneficial (). According to Niles et al. (2017) CBT sessions require regular attendance, level of commitment as well as carrying out extra activities between sessions and this could take up lots of time and some service users find it difficult to take out those times possibly due to their other life engagements ((Hofmann, Wu, and Boettcher 2014). Service users with complex mental health problems/ learning disabilities will find it difficult to engage as CBT sessions often require structured sessions to be beneficial.

As the author stated earlier the statistics of individual experiencing anxiety is one in nine people and statistics formulated from 2013 state that the number of anxiety cases in the UK about 8.2 million this shows that anxiety is a huge issue of a concern that requires attention ensuring that service users experiencing anxiety receive best possible quality of care The current NHS endeavors to deliver quality healthcare for all individuals regardless of their background. An implementation of the proposed PSI will help in achieving that mandate by ensuring people get access to quality mental healthcare since there will be more than enough knowledgeable personnel. The registered nurse will play a vital role in planning, implementing and evaluating the efficacy of the PSI. However, before CBT can be offered to patients in the acute setting extensive training and practice will need to take place. Training will need to be vigorous due to the fact that staff members will be dealing with vulnerable adults. Government initiatives have increased interest in cognitive behavioral therapy to treat people with mental health issues by helping them solve problems themselves (Ford, S 2011). Interest in CBT is increasing because it is also a therapy that gives the patient power and promotes their accountability in their recovery.

Rationale/Aims and Objectives of the Proposed Patient Service Innovation Project (PPSIP)

The chosen PPSIP is introducing self-management of CBT to nurses an acute inpatient ward for patients with the diagnosis of anxiety. This innovation will address the area of concern outlined in the background section since it will give the nurses the skills needed to enhance the treatment of anxiety disorders. As shown in the background section the prevalence rates for anxiety are relatively higher than other mental health disorders as well as increase in mortality and co-morbidity rates (Hofmann, Wu, and Boettcher 2014) Therefore, there is a need to introduce self-management of CBT this will go a long way to help SUWAD to learn their coping skills the will enable them to live a normal life As CBT is the most effective treatment for anxiety disorder with long term positive effect (Niles et al. 2017). Introducing self-management of CBT to nurses who are mostly frontlines caregivers to SUWAD will bring a massive increase in functionality of SUWAD and it will also reduce the chances of relapse incidents, and in the long run, this will reduce hospital admission

The waiting list

The background showed that in CBT face-to-face treatment was the most productive mode of therapy. More knowledgeable people translate to greater effective treatment in the form of face-to-face treatment can be applied. The efficacy of the therapy will thus be increased. One of the ways through which the effectiveness of the innovation will be measured is by seeking a positive change in the knowledge and attitudes of the staff in relation to using CBT as a treatment for depression and anxiety disorders. The other long term measure is a reduction in relapse rates amongst the patients. Therefore, an increase in the knowledge of CBT treatment techniques in staff is the proposed innovation.

Change Management Strategy

There are a number of change models that can be used in the nursing profession when implementing PSI. The first change model is Lewin’s Change Theory. Lewin’s theory involves three stages: unfreezing, moving, and refreezing. Lewin’s Model is based on the force field model which augurs that change is spearheaded or repelled by different forces. The forces that initiate the switch are known as driving forces, and they move in the direction of change while. Restraining forces are those that go against change. In Lewin’s Model the first step, unfreezing involves finding means through which individuals can let go of patterned behavior and finding means through which resistance can be overcome and group conformity outgrown. Unfreezing is very important since it will determine the success of the second and third steps. Thus, if unfreezing is not successful, the rest of the steps will not be successful, and change will not occur (Kritsonis, 2005). During unfreezing there is a lot of flux which makes it easier to identify the driving and restraining forces (Shirley, 2013). Thus based on unfreezing an individual can ascertain whether they should strive to increase the strength of the driving forces or decrease the influence of the restraining effects or combine the two. The second step is moving, and it revolves around changing thoughts, feelings, and actions. It involves urging those involved in the change process that maintenance of the status quo is not beneficial in the long-term. It also includes working with others to find the knowledge that will aid in the change and identifying the leaders that will be at the forefront of the change. Shirley (2013) notes that the second stage is usually the most difficult since it involves convincing people that change is needed. The third stage is refreezing, and it ensures that the changes made become habits. Success in this stage will prove that the changes made have grown ingrained into the culture and it will create a new equilibrium.

The other change model is Lippit, Watson & Westley’s change, model. They take Lewin’s model and divide it into seven steps. The steps are diagnosing the problem, assessing motivation and capacity for change, assessing change agent’s motivation and resources, selecting progressive change objectives, choosing appropriate change agent roles, maintaining change, and terminating helping relationships. This model focuses more on the people affected by the change rather than the change itself, and it involves more communicating, rapport building, and finding means to establish the mechanisms for feedback (Lehman, 2008). The next change model is Havelock’s change model. The model is a modification of Lewin’s change model, and it is made up of six steps. The six steps are building a relationship, diagnosing the problem, acquiring the resources needed for change, selecting a part for the solution, establishing and accepting change, and maintenance and separation. Havelock believed that it would be better if the model for change includes the building of knowledge and integrating theories into the process in a systematic manner. The other model is Roger’s Innovation diffusion theory, and it focuses on the individual rather than the process itself. The model also recognizes the importance of having agent drivers, making the most of group strengths and managing the factors that that would impede the change process. The model is divided into five stages, and they are knowledge, persuasion, decision, implementation, and confirmation. Roger’s theory shows the rate at which an individual picks up ideas and the pace at which they are willing to adapt to change (Rogers, 1995). The above four theories are the ones that are most utilized in the nursing profession. Lewin’s theory is most known, but it is considered to be simplistic since it considers change to be static rather than dynamic and filled with many unknown variables. The other three theories are a bit better since they acknowledge the dynamism of change by increasing the number of steps needed for the change to be affected. However, all approaches can be applied depending on the degree of change.

The theory chosen for rolling out the PSI is Roger’s Innovation Diffusion Theory. Roger’s argument focuses on the individual rather than the whole group and acknowledges the power of change agents in affecting change. The method also shows the willingness of individuals to make changes, and that is important since the PSI involves knowledge acquisition and dissemination. The primary component of the project is knowledge acquisition, and it will take place in small hospitals and work its way upwards. Small hospitals/clinics have been chosen because they have smaller staffs and thus it will be easier to manage and evaluate the effects of the change or lack thereof. Additionally, it makes sense to start small and scale upwards since it will be easier to refine the process going upwards rather than downwards. Significant scale changes in big hospitals involve many unforeseeable variables which may, in turn, lead to substantial barriers. The project will focus on the individual staff and strive to ensure that they understand the reason why change is needed and the effects that will arise as a result. Individuals knowledgeable in using CBT in various paradigms will be required to disseminate the knowledge to the staff. Hospital administration will also be involved in the process since they will have to arrange times which their team can be taught about CBT and given the opportunity to test what they have learned. Various doctors, psychiatrists, and psychologists will also be needed especially in the last part of the process, confirmation, to ensure that the staff has been adequately briefed and they have a good grasp of the knowledge taught.

For the innovation to be successful, organizational culture will have to be considered. While all hospitals under NHS have a mandate to provide quality healthcare for all individuals, they have different cultures guided by the individuals who work there. Therefore, Roger’s Innovation Diffusion Theory will serve as the overarching model for change but minute modifications shall be made to ensure that it conforms and adapts to different organizational cultures. The other resources needed will be time and teaching rooms. It takes time to acquire knowledge, and teaching rooms will be required for knowledge acquisition. As with all changes, there are bound to be barriers. The chief obstacle will be resistance to the change. People will seek to maintain the status quo and resist the change being advanced. The strategy to combat resistance is finding key people who will be the drivers of change. The key people must be people with good rapport and good standing with the staff. When the staff sees that a person they trust is going along with the change, they are more likely to accept the change. The other barrier will be organizational culture, and key leaders of the hospital will be needed to head changes in corporate culture. The additional hurdle that will be faced is finances. The combat this, the NHS can be lobbied to set aside some funds from its medical progress kitty and direct them towards the PSI since in a sense it is medical progress. If the NHS can be convinced to be part of the PSI, then all other barriers can be easily overcome since they have the resources and systems in place that will fast track the change process.

Leadership Theory: Successfully Implementing a Change

For the change to be successfully implemented leadership will play a significant role in relation to team working/building, developing a positive work culture that facilitates and embraces change/innovation/service improvement and coming up with methods of motivation in regards to change management. For the transition to be successful in the long run, a strong team needs to be built around the change process. The team(s) will be led by the people identified as the key change agents. The critical change agents will be leaders who have a good rapport with the people and carry some influence over them. People will be more receptive to change when they are led by an individual that they trust has their best interests in mind. Therefore, teams will be built around key change agents. With cohesive groups led by strong leaders set in place, it will be easier to develop a positive work culture that will facilitate and embrace change and innovation. Everything rises and falls with leadership; thus a positive culture will travel from the leaders downwards. It is essential that a core set of values be set that will guide the organization and trickle down to the individual employee.

Developing a positive work culture is essential. Research by the audit firm Deloitte found that (2012) 94% of executives and 88% of employees believe that a concrete organizational culture is paramount for the success of a business. Agarwal (2018) notes that there are ways through which a positive work culture can be developed. First, clear values should be set for the organization. A clear set of values and ethos will act as a roadmap for employees on the way that they should conduct themselves in the organization. Staff should be included in developing the core values so that they feel a part of the organization. Second, leaders should foster collaboration and communication. Open communication is important more so during the change. Regular audits should be carried out to evaluate how people are interacting with each other. Open communication will serve as a means through which people can continue learning, and any inherent biases towards change can also be dealt with. Third, an inclusive environment will be created. People will thrive where they feel that they are being listened to and where they have access to equal opportunities. Additionally, it is vital that people are motivated in regards to change management. The methods expounded in relation to building a positive work culture can also apply when building up employee motivation. Open communication will be crucial since it will help change agents understand any aversions that employees have in relation to the change. When people are heard, they will be more motivated to adapt to the change as opposed to a scenario where they are forced to change regardless of their misgivings. Second, Roger’s Innovation Diffusion Theory focuses on the individual; thus people can be motivated in regards to change management by aligning change management goals with their personal goals. Third, clear goals and rewards should be set in relation to the change management process. Staff will be more motivated if they see the purposes of the change management and if they are rewarded in one way or another. Therefore, a favorable organizational structure and a motivated workforce will be fundamental driving forces in the change management process.

Time Management

The change process would not be fruitful without proper time management. In relation to planning, it is estimated that three to four months will suffice to identify a small hospital in which the PSI will be rolled out. The small hospital will act as a guinea pig to the process, and it will determine the success of the PSI when it is rolled out in other hospitals. Implementation will take four to six months depending on the availability of the staff and resources. The availability of staff will be the principal barrier to the implementation stage thus working with hospital administration to set aside time will be key. Depending on the size of the staff implementation time will increase by two months since more staff translates to more teaching time. Conversely, with a small team, it may take less than two months to teach them. Evaluation will take four to six months. Assessment will require personnel qualified in CBT to observe how staff are utilizing their new found knowledge. Evaluation will take place in controlled environments before staff is allowed to use their expertise on patients without the presence of qualified personnel. It is important to have a time management plan since it helps one know whether they are behind schedule or on schedule. A time management plan will also outline critical milestones of the innovation, from beginning to end.

Evaluation

While planning and implementing are essential stages in the change management process, evaluation is also very important since it ascertains whether the desired changes have taken effect. Evaluation is vital for quality assurance and clinical excellence. Assessment creates a structured approach through which performance can be measured (Uy, Lizarondo, & Atlas, 2016). Evaluation can be done at the end of the process or during the process. The best form of valuation occurs during the process since it shows whether the institution is living up to its core values and ethos. In change management, evaluation is paramount since it assesses whether the desired change is taking effect or not. An appraisal is vital for quality assurance since it measures current progress against the set quality standards. If the standards fall below the set quality, changes need to be made to ensure current standards meet the set quality standards. In relation to clinical excellence, an evaluation will determine whether patients are getting quality healthcare, how staff deal with patients, declining or rising cost, level of patient satisfaction and whether rates if adherence to guidelines have improved. A positive assessment is a sign of good clinical excellence while a negative one is a sign that changes need to be made. Therefore, evaluation is vital for quality assurance and clinical excellence.

The evaluation method chosen for the PSI is pre and post clinical audits couples with satisfaction surveys from the patients. Pre and post clinical audits were selected since they are continuous and form the basis of unremitting quality improvement. According to Esposito and Canton (2014), an examination “consists in measuring a clinical outcome or a process against well-defined standards, established using the principles of evidence-based medicine.” The comparison of everyday practice with well-defined standards will serve as a basis of improvement every day. In relation to the PSI, a pre-audit will set a baseline, and a post audit will assess whether the benchmark has been exceeded. It the post-audit shows that the baseline has been exceeded then the implemented changes have taken hold. Conversely, if the post-audit shows the benchmark has remained the same or below the baseline, then the effected changes have not taken hold. The outcome will be sustained through continuous employee learning. The purpose of the PSI is not a one-off acquisition of knowledge rather continuous learning that may take a lifetime. The purpose of the evaluation will be to ensure that within a year, the staff has acquired enough experience to be able to handle cases. Satisfaction surveys will be used on patients, and they will assess whether they were given quality healthcare. It is expected polls at the beginning of implementation may not reflect well, but a definite improvement is expected at the post-audit survey. Therefore, pre and post clinical audits and satisfaction surveys will be employed during the evaluation process.

The Role of the Nurse in Service Improvement and Innovation

The role of the nurse in service improvement and innovation is vital. Nurses will take part in improving services and innovating since they seek to grow the nursing practice, to progress health outcomes and to develop patient experiences. Hughes (2006) notes that “nurses provide up to 80% of primary care to patients.” As such, nurses are critically positioned to spearhead any service improvements and innovation. Since nurses interact more with patients than any other healthcare giver, they should be included in formulating policies that will grow the quality of care for patients. Nurses see and understand what patients experience when they receive poor healthcare, and as such, they are best situated to offer critical insights when formulating policies. Regarding the PSI, teaching nurses, CBT will help alleviate the strain that doctors have in relation to anxiety increased cases. The nurse can offer CBT treatment once the doctor has diagnosed the patient and depending on the severity of the case doctor involvement may not be necessary. Additionally, nurses are more than doctors in any given hospital; thus they have the numbers to make lasting change in relation to improving service and innovating. While doctors may be a bit detached from day to day humdrum of the hospital, nurses are usually involved in every facet. Therefore, nurses should be considered as crucial change agents when big or small changes are being implemented in the hospital and healthcare service in general. Nurses will lead the change since they understand what is needed for the transition to occur. In terms of implementation, nurses deal with patients more and numerically they are more than doctors thus if there is a comprehensive healthcare change needed, nurses should be considered as implementers unless it is something that does not concern them such as changes in hospital architecture. In relation to evaluation being involved in the first two parts of the process positions the registered nurse as the best individual to carry out an assessment. There is the danger of being biased since they have been involved in the process from the beginning to the end. However, the registered nurse is still the best individual to evaluate the efficacy of the changes that have been advanced. The assessment should be in relation to set measurable milestones. Also, in regard to subjective things such as patient satisfaction the nurse is best placed to gauge that since they interact with the patient from the beginning of the healthcare process to when the patient is discharged. It is imperative for the nurse to be involved in all the operations since it aids in providing excellent patient care in a dynamic, ever-changing health care environment. Every member involved in the healthcare process should be included when formulating, implementing and evaluating change because everyone plays a key and critical role in the process. The involvement of the registered nurse will lead to service improvement and innovation.

Conclusion

Patient Service Innovation (PSI) is essential. PSI ensures that efficiency is enhanced when delivering healthcare services to a patient(s). The PSI advanced in this paper is “improving the knowledge of staff/skills on self-management of CBT for the service users with a diagnosis of anxiety within an acute inpatient setting. Anxiety is on the rise, and that means that more knowledgeable individuals will be needed to deal with the issue. Rather than hiring new personnel, the proposed PSI is that current staff be taught how to advance treatment for anxiety using the CBT treatment model. CBT is based on the premise that psychological distress and mental disorders are all maintained by cognitive factors. There is evidence-based research that shows CBT is not only efficacious in treating anxiety but also in treating other disorders such as depression, drug abuse, and mood disorders. The change management strategy that will be applied is Roger’s Innovation Diffusion Theory which focuses on the individual. Ideally, implementation and evaluation of the PSI should take less than a year with the year divided into the planning, implementation and evaluation phases. The evaluation strategies chosen are pre and post audits and satisfaction surveys. The registered nurse will play an essential role in planning, implementing, and evaluating the proposed PSI. If the PSI is appropriately applied, it will improve service delivery and patient outcomes for those diagnosed with anxiety disorders.

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