Improving Quality, Change Management And Leadership In Managing Pressure Ulcers

Introduction

Pressure ulcer is a common and major medical condition for older persons with statistics indicating that over 1 million people in the United States are living with the condition (Pancorbo-Hidalgo et al, 2006). This means that the condition is serious and as the people age, the prevalence of the condition increases. Managing the condition requires intensive and comprehensive care from all the concerned medical practitioners as well as the caregivers.

Regarding the complexity of the condition and the required care for managing the condition, the quality of healthcare is an aspect that shouldn’t be compromised. Quality in healthcare is the measure of the standard of healthcare accorded to the patients by the medical practitioners and caregivers on the road to recovery (Dainty et al 2013). Healthcare standards define best practices that should be accorded to patients while receiving medical care in hospitals and nursing homes. These recommended standards of practice are entailed to ensure that patients access quality care in the health facilities and their safety is guaranteed to aid in recovery. Patients with prolonged medical conditions such as pressure ulcers require extra attention and care which signifies increased work for health care professionals tasked with caring for them (Pancorbo-Hidalgo et al, 2006).

The purpose of this task is to explain the necessity of quality in caring for pressure ulcers patients by explaining the condition, its risk factors, and the common prevention methods. Furthermore, the essay discusses the scope of change management, the change management model and leadership for enhancing the quality of healthcare accorded to pressure ulcers patients. The essay then discusses quality improvement methods that can be applied to enhance the quality of healthcare to managing patients with pressure ulcers.

Background

A pressure ulcer is also known as decubitus ulcers, bed sores or pressure sores is a medical condition that entails the development of swellings on the human tissues and skin due to excessive pressure on the body. This medical condition threatens the well-being of patients with limited morbidity. Pressure ulcers may have a severe effect on the body depending on the location of the sores on the human body. Studies have identified that 70% of pressure ulcers occur in people older than 65 years (Whitney et al, 2006). These categories of people are characterized by reduced morbidity and expose their bodies to pressures, both internal and external that can lead to the development of pressure ulcers.

However, Pancorbo-Hidalgo et al (2006) point out that while the majority of the patients are the old-age group, statistics have also identified that younger people with a neurological impairment or severe illness are also susceptible. The subjection of people to pressure severe enough to cause the sores increased the chances of the occurrence of the condition.

Pressure ulcers can be defined as unrelieved pressure applied with great force over a short period. This pressure leads to disruption of blood supply to the capillary network, impeding blood flow and depriving tissues of oxygen and nutrients. The presence of pressure ulcers is more manifest in body parts and tissues like the sacrum, heels, ischial tuberosities, greater trochanters, and lateral malleoli (Pancorbo-Hidalgo et al, 2006). The occurrence of pressure ulcers is fostered by a number of risk factors. These can be classified under intrinsic or extrinsic. Intrinsic factors include limited morbidity, spinal cord injury, cerebrovascular accident, and progressive neurological disorders. Other factors are coma, fractures, postsurgical procedures, dementia, diabetes mellitus, and aging skin. Extrinsic factors include pressure from any hard surfaces like a bed, wheelchair and stretcher, and friction from patients’ inability to move well in bed. Excessive perspiration and wound drainage are also risk factors causing pressure ulcers. The prevalence of pressure ulcers according to statistics is slowly increasing.

However, the intervention measures aren’t as elaborate as with other chronic medical conditions. This, therefore, necessitates quality improvement measures to increase the awareness of the condition, as well as the quality of healthcare accorded to the pressure ulcers patients. Among the current interventions of pressure ulcers include nutritional and skin care assessment and diagnosis to mitigate the condition. Pressure reduction devices can also be used to mitigate the condition by providing comfort to the patient. Static pressure reduction devices include foam, water, gel, and air mattresses while dynamic devices are the alternating pressure devices. Quality improvement through change management of the current measures is paramount to increase the standard of care accorded to pressure ulcers patients.

Implementing the change

The prevalence of pressure ulcers and the related effects necessitate measures to create awareness and prevention of the problems. This is achieved through the implementation of an effective change management strategy. Successful change must be tailored and targeted to ensure the sustainability of the change program. The change should also identify and achieve operational goals. This is achieved through fostering good coordination among the stakeholders, strong leadership, and building clear communication. These are crucial elements in enhancing and achieving the desired change. However, dynamic factors should be acknowledged and embraced. In managing pressure ulcers through increasing awareness of the condition and mobilizing resources, support and actions geared towards prevention of the prevalence of pressure ulcers, different opinions of participants should be embraced and the concerns of the patients with pressure ulcers acknowledged (Dainty et al 2013). This will result in a collaborative approach to managing the condition leading to the effective management of pressure ulcers.

The change also demands capacity building by getting into the heart of issues and focusing on the change process instead of structural and strategic changes. Capacity building and getting into the heart of the issues seeks to identify the underlying problems requiring the change and developing measures to handle these problems is a sure way of effecting change (Simanovski et al 2014). Pressure ulcers develop in patients with varying needs and the causes of the problems are numerous. An effective prevention plan should be aimed at comprehensively identifying and handling these factors. Furthermore, some factors like nutrition and poor feeding might stem from other reasons such as poverty. Thus, capacity building should be aimed at addressing these factors and empowering the patients and population to access healthy feeding.

It is important to explain that values, fears, behaviors and aspirations of all stakeholders are imperative for change. Successful change, therefore, embraces these diverse backgrounds and seeks to foster collaboration and harmony between and among the stakeholders (Nadeem et al 2013). Patients with pressure ulcers, their caregivers and medical practitioners are key players in management or the conditions. Policymakers on the other hand direct resources towards fighting pressure ulcers. Striking a collaborative relationship among these groups is crucial in enhancing the success of the change campaigns.

Change management is integral and a constantly occurring phenomenon in the organizations and groups of people. Nickols (2004) explains that managing change develops two different meanings. It implies making of changes in a planned form or response to changes occurring where the organization has little or no control over. The first reason is a proactive initiative aimed at creating and championing for change in a particular state of affairs or conditions with an outcome of bringing a better solution, or an improved standard of living. The latter implies reactive measures aimed at handling a situation that has already occurred. This situation is mostly negative and calls for corrective action to control the impact of such an occurrence. Change management in pressure ulcers should be based on the first principle of a proactive approach towards mitigating the problem.

Unsuccessful change management can result in a waste of resources, and cause fears and frustrations among sections of stakeholders. Change management campaigns require meticulous planning and commitment to change as well as collaboration from other stakeholders (Nickols 2004). However, some campaigns, though relevant and purposive end up failing of being unsuccessful. This may have serious implications such as loss of trust in the participants, killing their commitment to such programs. In this regard, there are common errors in change management including; allowing too much complacency and failure to create clear and powerful guidelines. Other errors include restricted vision, lack of communication and acknowledging change victory soon.

3.1 Change model (Kotter 1996)

A change management model is a tool that provides guidelines to develop, champion and achieve change. To effectively increase awareness and attention to pressure ulcers, a change model is needed to guide the action plan for successful goal achievement. This study builds on Kotter’s change model and a discussion is herein presented.

Kotter (1996) developed an 8 step change model that offers guidelines for pursuing change. In this model, change is driven from the bottom-up rather than from top-down. Change therefore ranges from small initiatives with little change to major initiatives with huge impact. This model also builds the idea that change is open-ended and forms part of the continuous adaptation to the changing needs of society and organizations. The success of change should be less dependent on detailed plans and change initiatives but should rather be focused on understanding the complexity of the issues and identifying a range of available alternatives (Simanovski 2014). The steps of the change model are herein discussed.

3.1.1: Establish a sense of urgency

Change in most cases isn’t managed single-handedly and thus require the contribution of other parties concerned. The effectiveness of change is often determined by inception. Creating urgency of the situation and demanding immediate actions helps to provide motivation for change. This step involves identifying threats and creating scenarios for the future of the project. Identification of threats helps identify and eliminate possible risks that could jeopardize successful change. Opportunities to be exploited are also identified in this stage. These include factors that could support the pursuance of the project. The other activities involved in this step are conducting honest discussion, giving dynamic reasons and ideas to get people talking. Gaining support from the customers, outside stakeholders and industry people are the other activities for creating urgency (Whitney et al 2006).

For instance, creating urgency for pressure ulcers campaign may begin with educating the relevant stakeholders on the importance of the project by emphasizing the prevalence of the condition, the damages of the condition on the population and the benefits of carrying out the campaign. This will help consolidate the support required and create reasons why the campaign is urgently required.

3.1.2 Form a powerful guiding coalition

With the need for urgency created, there is a need to pull together the rightful partners in pursuance of the change. Convincing people that the change is necessary to help in building the right team for the tasks. In accomplishing this, leadership is crucial since it offers direction and cements the team spirit that is vital for change. Forming a powerful coalition entails team building which involves pooling together effective change leaders and building a coherent team dedicated to the change (Kotter 1996; Nadeem et al 2013). Additionally, developing emotional commitment helps in gaining resolve from the team in pursuit of change. However, it is crucial to blend people from diverse backgrounds in order to eliminate feelings of rejections and resistance to chance. Inclusivity brings a wider team together.

3.1.3 Create a vision for change

Creating a vision for change entails linking together the ideas and mental solutions into an overall vision. Clear vision enables people to understand the reason for their support of the project for a change. A vision is enforced through creating values, and a strategy for execution of the project and achievement of the desired change. A short summary and continue practicing the “vision-speech” help to engrave the vision into the routine practice. A clear vision serves to motivate the team in working together to achieve a common objective. Therefore, adopting a short statement, also termed as a slogan, in the pressure ulcers campaign will communicate the vision of the project and unite the participants for achieving a common goal (Nadeem et al. 2013).

3.1.4 Communicate the vision.

Creating the vision statement is not just enough; the vision needs to be communicated both in words and deeds. The use of the vision should be reflected in every aspect of the project. Decision making and problem-solving should be anchored in the vision (Pancorbo-Hidalgo et al. 2006). Talking about the change vision is one of the approaches in communicating the vision of the project. Concerns and anxieties of the people should also be openly and honestly. However, all the activities should be tied back to the vision.

3.1.5 Empower others to act on the vision

Obstacles come in many forms and stem from a variety of concerns and sources. These obstacles if left unattended to may result in serious implications and possibly jeopardize the change. It is imperative for structures for change to be put in place and the barriers to these structures to be continually checked and managed. Additionally, recognizing and rewarding the people for making change happen is another strategy for dealing with the obstacles stemming from their performance (Whitney et al. 2006). Furthermore, identifying people resisting change and helping them to see what is needed in terms of the objectives of the project and the role of such people in the implementation of the project.

3.1.6 Plan for and create short term wins

In the course of pursuing the project, key achievements will be made. This victory should be used as motivation for continued commitment to the change process. Achievement of short term goals is a clever way of guaranteeing support for the project and the team becomes reenergized by the victory, leading to continued efforts to pursue the long term goals of the project.

3.1.7 Consolidate improvements and build more change

While it is paramount to celebrate the short wins, the achievement shouldn’t derail the team from the primary goal. Quick wins are just the beginning for achieving the long term goals. Setting goals after wins help to build the momentum for long term achievement of the goals (Kotter 1996).

3.1.8 Institutionalize new approaches

The new approaches and the achievements made in pursuance for change should not be lost. However, the team should work at incorporating all these achievements into the operational culture and the new approaches developed should be harnessed into the project for successful objective achievement.

3.2 quality improvement model

Quality improvement refers to a system and continuous actions leading to measurable improvement in healthcare and the health status of the targeted patient group (Nadeem et al 2013). Health care is important to persons suffering from pressure ulcer and as such, despite the severity of their condition, measures should be taken to ensure quality health care is accorded to them. Quality improvement is at the core of the awareness campaign which fosters to not only to make the condition public but also consolidate necessary resources to ensure the quality of the treatment and care for people with this condition.

Quality improvement is premised on crucial methods aimed at ensuring improved healthcare to patients with chronic medical conditions (Simanovski et al 2014). Quality improvement methods can be used to implement the desired change by identifying the loopholes in current care and suggesting possible measures to enhance the standards of healthcare. A number of these methods are discussed as below

Clinical audits

This is a quality improvement method that focuses on the clinical care of patients in healthcare facilities. The method is effective in measuring the standards of the healthcare and comparing the real care administered to the patients against the standard procedures defined in the relevant policies. Clinical audits aim at examining clinical effectiveness, patient experience, and patient safety. Usually, clinical audits entail developing a pro forma with the checklist of the recommended standards of healthcare and the examiner compares it against the clinical practice in the specific healthcare facility (Weaver et al, 2015; Dainty et al 2013). An analysis of the results if then undertaken and recommendations provided on the state of the facility in providing the required healthcare as per the standards.

While clinical audits are important, the method is only focused on comparing the state of the facility with the available standards of healthcare. New and alternative quality healthcare approaches will have to be approved as part of the standards to be integrated into the recommendations of clinical audits.

Plan do study act

PDSA is quality improvement methods aimed at introducing and testing the potential quality improvements and refine them. PDSA test is first carried out on a small scale which entails experimentation of the new improvements in a health facility and the results determine the rolling out of such improvements in other facilities. In this method, the new procedure is developed in the planning phase (Plan), implemented for a specific time frame (Do), evaluated (study) and adjusted (Act). The introduction of quality healthcare to patients with pressure ulcers may be implemented using this quality improvement method. However, the method requires longer time before the new improvements can be rolled out on a large scale to numerous health facilities.

Lean/six sigma

This is a quality improvement method that focuses on the analysis of healthcare systems to eliminate waste and redirects resources to the more efficient, improved and consistent quality of care (Palmer et al 2012). This is achieved through process mapping and it involves 5 stages; Define, measure, analyze, improve and control.

3.3 Leadership

Leadership is prudent in the quality improvement and change management for extensive care of pressure patients. This can be manifested in a number of ways. First, leadership should be provided through the change management process. The change model by Kotter (1996) details 8 steps for change through which the role of leadership in change management can’t be ignored. Leadership informs decision and provides direction. Throughout the change management process, there is a need to carefully and wise decision making and leaders can effectively direct the process. Leadership ensures the integrity of the processes and the quality of healthcare. Effective leadership from the health facility management to the nurses and caregivers providing direction for adherence to quality service delivery is necessary for the recovery of the pressure ulcers patients.

Conclusion

This essay has presented a detailed discussion of the quality improvement, and change management of patients with pressure ulcers. Patients with pressure ulcers are exposed to long term medical condition and thus require extensive, quality care for recovery. However, the current situation highlights the need for change in service delivery with the adoption of quality healthcare being necessary. This essay has thus explored the essence of change, the role of leadership and the importance of quality improvement in enhancing the healthcare of pressure ulcers patients.

References

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