Gardening Therapy for Mental Health

Introduction

The NHS services are struggling to ensure high standard of care are maintained in the wake of financial and operational drawbacks it is experiencing. In order to achieve quality care the leadership of the NHS both at local and national levels must focus on service improvement and clinical excellence. The NHS needs to redesign its services in a way to ensure there is safety, savings on cost, effectiveness, streamlining of services and improved experience of care. Service improvement will also help remove the negative connotations people have on nursing (Craig, 2018). NICE offers guidelines which are supposed to ensure excellent standardised care is achieved across all NHS facilities. It also decides which innovations should be adopted by the NHS but this does not deter clinicians from being innovative in healthcare provision (Charlton and Rid 2019). Service innovation in this context is taken to mean new set of behaviours and ways of doing things that are different from previous practice and are aimed at improvement in health outcomes, efficiency in administration, cost effectiveness and improved user satisfaction. Which are implemented by planned and coordinated actions (Nolte, Health systems for prosperity and solidarity 2018).

The topic of this dissertation is to explore gardening and growing food as a therapeutic intervention for people with mental health disorders who are patients at Recovery Team East in London. This Patient Service Innovation (PSI) project aims to provide gardening sessions in addition to treatment as usual (TAU). Current research suggest that gardening therapy is linked to increased release of happy hormones serotonin and dopamine and reduced release of stress hormones, (Alaimo et al. 2016) which is helpful in treating patients with anxiety and depression and other mental health disorders and is seen to reduce demand on health care services and improve outcomes of care, therefore, it is a subject worth exploring (King’s Fund, 2016). This essay will also critically explore relevant approaches and strategies that can be applied in the management and delivery of care and their effectiveness in line with national health and social care policies. It will also explore and critically evaluate current health care challenges and policy drivers to manage these challenges as well as the importance of the key principles of Clinical Governance and its role in quality improvement and clinical excellence.

Moreover, it will provide a rationale and aims of this project by reviewing current research, statistics, costs, NICE guidelines and other reports. The PSI will be explored through the principles of SMART and practice models such as process mapping. It will also discuss the change models, possible barriers to dealing with change and methods of developing a positive work culture that embraces the innovation. This essay will also provide a GANTT chart with plan, implementation and evaluation of proposed gardening sessions as well as reflect on the role of the nurse in this project and how it can be delivered. Without involving appropriate training to the nursing workforce and other healthcare professionals, it may not be possible to implement service improvements (Craig, 2018).

Theory

The NHS is often considered as the society’s most precious resource which has undergone a lot of radical reforms since its establishment in 1948 (Sempik, 2010)In the post- war British government, the Minister of Health Aneurin Bevan started a bold and pioneering plan to provide free health care to everyone at the point of need. Before the creation of NHS people who needed to see a doctor had to pay for it and many could not afford it due to low wages.

The NHS faces challenges such as shortage of staff. This is not only because of lack of funds to hire staff. The NHS has nearly 100,000 posts which are funded but do not have enough personnel to fill these posts and the problem is estimated to get worse with a figure of 250000 by 2030 (Kings Fund, 2018). The problem of understaffing puts a lot of pressure on the available working force, forcing them to work long hours leading to fatigue. It also limits the amount of time a clinician can spend with a patient (Wise, 2018). Many of the staff working in NHS feel that they do not have a safe environment which enables them to carry their work. This is due to inadequacy of resources and a blame culture which fosters fear of making mistakes. This puts a lot of pressure on the doctors eventually leading into them making avoidable mistakes (Wise, 2018). The members of staff from minority groups also feel discriminated on racial grounds in areas such as career development, availability of training and from patients.

The NHS constitution says their staff members have rights to a safe working environment, which is free from any form of discrimination. They should also have freedom to act on behalf of their patients and should have opportunities for the development and progress of their careers (NHS Constitution, 2015). The NHS five year forward view recognizes the problems faced by its service providers and plans on ensuring there are enough, properly skilled personnel in the workforce to solve the problem of understaffing and ensure their staff can spend enough time attending to their patients. In the plan NHS sets out to ensure its staff members have rewarding jobs, have access to opportunities for the development of their skills, access to modern equipment, and work in a positive culture which supports them to deal with the complex and frequently stressful nature of healthcare delivery (NHS long term plan, 2019).

The NHS faces a challenge of increased demand for services due to an ageing and growing population. There has been a change in the demographics where there is an increase in the aging population (Royal College of physicians, 2017). This is due to advancements in medical care which have meant people now live longer. The baby boom after World War 2 also had a contribution (Centre for ageing better, 2018). Though a positive development it has created a lot of strain on healthcare system. These aging populations tend to need much of care and support than cure. It is generally expensive to take care of older populations as compared to younger populations. A 65 year old person will need double the care that is needed by a 30 year old. This also implies that there is an increase in the number of people living with long term chronic conditions such dementia, cognitive aging, osteoporosis, diabetes mellitus and multiple chronic conditions (Jaul and Barron, 2017).

The NHS has set out programmes such as healthy aging guides which help in avoiding ill health as people age. This approach focused on maintaining the independence of the ageing population. There are also personalised care planning tools to enable old people receive tailored care as their level of frailty increases. The NHS needs to have a greater coordination of healthcare across social care and between the different levels of healthcare. This is because this population requires different services from different players in health services as well in social care services simultaneously. Adequate long term care facilities need to be built since the aging population requires much more long term care as compared to acute care. This will also reduce the strain in hospitals (Jaul and Barron, 2017).

Even though there has been an increase in the allocation of funds to the NHS little of this allocation has been to infrastructure and therefore the hospitals infrastructure are out of date with problems such roof leakages and out dated equipment. The NHS social care progress are offered on a means tested basis thus its only available to the poorest persons in the aging population but even worse is the fact that it is still rationed heavily (Timmins, 2005). A step that has been taken to ensure that NHS is able to survive involves moving the care of patients into general practice clinics and community settings instead of hospitals. Increase in the funds allocated by the government to the NHS by reducing allocations of funds on the social care and increasing the allocation of funds to mental health (Kings Fund, 2018).

Clinical governance is a set of processes and clinical guidelines, through which NHS organizations are accountable for the continuous improvement of quality of their services (Gerada and Cullen, Quality in primary care, 2004). It is based on proven clinical policies which are deduced nationally. It results in the creation of an environment that enables clinical excellence to flourish. The main aim of clinical excellence is to improvement patient care and staff excellence. Therefore the failure of clinical governance does not necessarily imply a bad service or failure (Travaglia, 2011).

The principles of clinical governance include involvement of the consumer, where the consumer refers to the patient, their families and their carers. They can be involved in designing and planning the care the patient receives to ensure the care meets the individual needs and preferences of the patient. Under this principle patients are provided with health literacy which enables them to make informed decisions with regard to their care. They are also encouraged to give feedback (Pharmaceutical society of Australia, 2018).

The second principle is governance, leadership and culture, under this principle there is a commitment to quality and safety in the provision of healthcare where a culture that does not accept behaviours that put the patient at risk are cherished. It includes clearly defined roles and responsibilities, adequate staffing and the provision of equipment necessary for safe care. It also entails the provision of strong clinical leadership. leadership which delegates its authority and ensures that patient safety issues are effectively communicated, clinical expertise is available when needed, management of clinical risks and prevention of incidences and maintenance of appropriate clinical expertise (Pharmaceutical society of Australia, 2018).

The third principle is clinical performance and effectiveness. This principle sets standards, guidelines to professionals and policies which ensure quality and safety is achieved. It combines the use of high quality research findings, experience gained from clinical work and values of patients to provide safe and quality services. The principle advocate for transparency in availing information about safety incidences, feedback from consumers, measures put in place to ensure quality and anonymous clinical data to stakeholders. It also sets to ensure that clinicians have the relevant expertise through training. Another important part of this principle is clinical measurements and monitoring which can be achieved by caring out audits (Pharmaceutical society of Australia, 2018).

Background

Gardening therapy in healthcare is not a new concept. It can be traced back to 1990s where physical and mental wellbeing were associated with the natural landscape. This included both the view alone and also working in it. The healing aspect of natural landscapes was believed to be based on the individual’s view of the landscape, its cultural concept and importance to the individual. These beliefs largely influenced the healing properties conferred to the individual from the landscape. In other cases the healing properties of the landscape were believed to be as a result of the serenity and aesthetic qualities of the landscape (Sempik, 2010).

The view of the role of therapeutic landscapes in mental healing was challenged in the 1940s and 1950s with the creation of the NHS in 1948, where the government policies then barred the minister of health from allowing farming in the NHS unless it was absolutely needful for the wellbeing of the patients. This move was bitterly contested but succeeded to a given extent because many NHS farms were closed. However people who believed gardening was important to health and wellbeing shifted to other methods of realising the same. The efforts of these people were further encouraged by social movements linked to nature one such profound one being horticultural therapy and the coming together of other disciplines such as nursing. This field attracted a lot of research work leading to its development (Sempik, 2010).

Gardening therapy provides for peoples being needs and social interventions (Clatworthy et al., 2013). The social interventions are opportunities for person to person interactions which promote a sense of belonging and social inclusivity.

Weeding as an element of gardening was identified to be beneficial in providing affirmation both at an individual level and at a community level. When one has completed their target area they would feel a sense of personal accomplishment. At a community level the persons originally stigmatised due to their ill health are once again viewed as active, capable and productive members of their communities. They also receive affirmation from those who enjoy the fruits of their labours (Diamant and Waterhouse, 2010). Social inclusivity is particularly important to those experiencing mental illnesses. These persons frequently face social exclusion due to lack of equal access to opportunities such as paid employment, education, housing and leisure (Diamant and Waterhouse, 2010). The garden setting fosters interactions among clinicians, patients and health practitioners.

Gardening therapy provides contact with nature, occupational activities, and physical exercise which have positive outcomes for people with mental health conditions (Clatworthy et al., 2013). As an occupational activity it helps the persons involved to develop specific knowledge and skills which enables them to do meaningful activities. Gardening offers a place where physical activity can take place. It can be used to meet the daily and weekly physical activity recommendations of the patients leading to higher physical functioning. Increased physical activity reduces the risks of being overweight or obese (Alaimo et al., 2016). Physical exercise has been regarded to be helpful in the treatment of those with mental health problems (Clatworthy et al., 2013). Contact with nature provides a sense of tranquillity and connection at a simpler level which may give persons experiencing psychotic stress opportunities to confront their difficulties (Clatworthy et al., 2013).

In the treatment of mental illness gardens represent something beyond just a place to get treatment. It represents an environment full of activities and new ideas with shared resources. This gives the individual an opportunity for a direct engagement with the soil, an opportunity to engage with others, learn from them and have a common goal. It fosters feelings of safety, acceptance and value for those involved and gives them an opportunity to achieve their goals of recovery in an environment they are used to rather than a deficit oriented one. Gardening also improves mental health by reducing stress hormone levels and feelings of tranquillity (Alaimo et al., 2017).

Gardening helps persons to make a choice for healthy eating (Alaimo et al., 2017). One such way is that gardens avail a supply of fresh foods which would not be available if the gardens were not there. Persons who garden and their households eat fruits and vegetables on a more frequent basis and in much more quantities compared to non-gardeners. Gardening helps people to eat more healthfully by influencing the individuals, especially young people to try new fruits and vegetables. The constant exposure to these foods also removes prejudices and dislikes. The behaviour change can be understood from the theory of self-determination where the manner in which an individual behaves is influenced by intrinsic motivation as well as extrinsic motivation which is well internalised. The principle of autonomy which is key in this theory makes individuals feel responsible for their actions, feel capable of achieving desired outcomes and realise the impacts of their actions on others. These can be achieved within the garden system (Alaimo et al., 2017).

Most of the studies which have been conducted on the benefits of gardening therapy have involved persons who volunteered to participate in the interventions. This could imply such persons had particular interests in gardening or were aware of some perceived benefits of gardening. Generalizations of the benefits of gardening to persons with mental health difficulties should thus be done with care and peoples choices on whether to participate or not respected (Clatworthy et al., 2013).Gardening also experiences key limitations such as availability of land (Alaimo et al.,. 2017). (Clatworthy et al., 2013) notes that other the papers reviewed indicated that the patients were receiving other treatments in addition to gardening, these treatments were not specified.

Rationale aim and objectives of the PSI

In this paper gardening therapy is implemented as a patient service innovation for mental health treatment in addition to treatment as usual in the recovery team East of London. This follows the numerous benefits of gardening therapy to patients with mental illnesses. It provides for the “being” and social needs which are opportunity for people to interact with others. It also provides contacts with nature, occupational activities and physical exercise which have positive outcomes for people with mental health conditions. Gardening therapy also influences the dietary habits of patients, helping them to make choices for healthier eating. Gardening therapy is linked to increased release of happy hormones serotonin and dopamine and reduced release of stress hormones. This aids in treating patients with anxiety and depression and other mental health disorders. To achieve this, the following specific objectives are to be met.

I. To critically explore relevant approaches and strategies that can be applied in the management of the change and the role that different team players and leaders will play.

II. To improve the patients physical wellbeing. The gardening sessions are to provide patients with an opportunity to exercise which ensures they are physically fit. The patients are also expected to be able to make choices for healthier eating following exposure to fruits and vegetables.

III. To improve social inclusion. A majority of mentally ill patients are socially excluded because they do not have careers or are seen as not able to engage in useful work. By participating in the gardening therapy they will be able to interact with each other and the staff in the gardens and most importantly this will act as their source of useful labour, giving them a sense of importance and belonging.

IV. To improve emotional and mental health. In the process of gardening the patients will meet the hard issues of life such as death, for instance in the dyeing of insects and plants at a level which is more manageable and hence this will help them in dealing with such.

Change management strategy

Change has always been deemed a necessity for innovation, where change can be seen as a driver for innovation or innovation a driver for change (Moreira et al., 2016). There are many change management models and theories. These include the Lewin’s model, Kotter’s change management theory, Lippit’s change management model, Kübler-Ross Five Stage Model, social cognitive theory and ADKAR model. The Lewin’s model of change management involves three stages, unfreeze, change or movement and refreeze. In this model behaviour is captured as a balance in forces acting in opposite directions (“Kurt Lewin’s change model,” n.d.). These forces are driving forces which encourage change and restraining forces which oppose change. The unfreezing step is where the status quo is disturbed by increasing driving forces and reducing the restraining forces towards the desired change (“npdsamplechapter.pdf,” n.d.). This step if followed by change itself. At this step the actual change is achieved. The last step which is refreeze ensures that the change is a permanent one and the new way of doing things becomes the norm (Frabbiele, n.d.).

This theory recognizes the important roles that leadership and communication play in the change process. It offers a good framework for institutional change (Hussain et al., 2018). It incorporates changes in thoughts, behaviour and feelings and is thus more productive. The refreezing stage ensures that the change is made permanent. Although this stage is normally criticised on the basis that change is a progressive thing and therefore there should be no refreezing. It is paramount to note that without this step things will just bounce back and no change will have been accomplished in the end of it. The Lipitt’s theory is an extension of the Lewin’s theory and is a seven step theory with a major focus on the role that the change agent plays in order for change to be realised. It also places emphasis on the preparedness of those receiving the change to undergo it (Pryor et al., 2008). Under this model effecting change is largely dependent on the change agent’s ability to mobilise other players(“npdsamplechapter.pdf,” n.d.). The kotter’s change model is an eight stage model whose major focus is the response that people have to change. It ensures that people accept to change and prepare to change rather than focusing on the change itself. A set back with this theory is that the eight steps must be followed to ensure success and this can be time consuming. The social cognitive theory relates that individuals would want to change or maintain a certain way of doing things based on what they perceive to be the consequences of their behaviour. The perceived consequences can be both long term and short term. The individual must then believe that they are able to perform the desired behaviour change.

Gardening therapy as a patient service innovation for patients suffering from mental illness in Recovery Team East in London would require the participation of the nurses, the hospital managers, the patient and their families to work together to achieve its success. The Lewin’s change model which incorporates the roles of all these stakeholders in the change process therefore offers the best change model to use to achieve the change (“Kurt Lewin’s change model,” n.d.). The three steps of the Lewin’s theory ensure that the change is incorporated and made permanent. This is also suitable for gardening therapy because it is rather a permanent change based on the vast research it is based on. This model is also useful because this kind of change is a planned change and not one that is just cropping up and must be dealt with for the organization to survive (“Overview-Change-management.pdf,” n.d.). This does not imply that further innovations or change cannot happen but simply means that these can happen on an already established framework.

In line with the unfreezing part of the model, time and resources should be taken to educate patients, their caregivers and families and the staff of the recovery team east in London on the importance of gardening to health outcomes. This will be in the form of talks and webinars, arranging visits to other institutions which are successfully using gardening therapy, having persons who have benefitted from gardening therapy share their experiences. The patients should also be encouraged to give their views on what they think are the pros and the corns of the gardening therapy. They should also give their suggestions on what they think are the best fruits, vegetables and flowers to be grown and how the garden should look like (Söderback et al., 2004). All these are to ensure that everyone understands the benefits the change will bring to them and thus eliminate resistance to the change (Frabbiele, n.d.).

The project will involve horticultural therapy carried out both indoors and outdoors. The activities to be carried out include; involving the persons in growing new plant from seeds and cuttings, transplanting seedlings into pots, arranging flowers, observing the garden and plants, identification of plants, flowers and fruits familiar to the participants through touch and smell and having garden clubs where the patients can discuss about their experiences and learn new things about the fruits and vegetables, for instance their Latin names. The activities will be arranged so that the patient has tasks which they can do as individuals and those that are done in groups. Personal progress reports will be written for both individual and group tasks. The goals for individuals will involve such things as improved memory of the taste or smell of the fruits for persons with dementia or achieving a sense of purpose for those with suicidal tendencies. Group goals could include increased amount of social interactions for those with withdrawal symptoms (Jarrott et al., 2002).

The plants that will be grown in the garden include a variety of flowers including roses, calla lilies, white carnations, daisies and lilies to create an aesthetic and aromatic environment and chosen on the basis of the meaning. Selected indoor plants will be grown in in nursery beds ready for potting. Vegetables such kales, cauliflowers, fruits such as tomatoes and capsicum from pepper plants and fruit trees such as mango trees and citrus trees and shade trees. The design of garden should include looping paths and be enclosed for safety of the patients. T

In order to ensure the gardening therapy meets the physical, intellectual and emotional needs of all the patients involved (Scott, 2017). The therapy activities must be based on a current assessment of the optimum level of functioning of the patient, their preferences and their individual goals. To achieve this, the therapist is to 1. Conduct assessments on abilities and limitations of all patients 2. Based on the assessment develop a personalised care plan for the individual. 3. In liaison with the patient develop a set of behavioural goals which can be attained, observed and measured. 4. Document the progress of the individual 5. Where need arises to review and make amendments to the care plan.

The horticultural therapy is to be carried out together with treatment as usual. The care plan will involve; a horticultural therapist who will assist in the design of the therapeutic garden and assist patients to attain therapeutic and vocational goals and be present to help the patients during gardening sessions, administrators who will motivate the change and assist in the day to day managerial duties of the facility, a registered nurses who will administer medication, asses and plan nursing care requirements for the patients, write and update the health records of the patients, listen, talk to and encourage the patients to take part in the gardening therapy and monitor the progress of the patients, a therapist who will define therapeutic processes, encourage the patients to share their emotions and examine other issues which affect the patients such as substance abuse, LGBTQ issues, suicide, stress and relationships, social workers to assist with the diagnosis and treatment of mental health and behavioural issues, psychologists to treat behavioural dysfunctions and psychological problems and promote healthy behaviour, psychiatrists to assess the physical and mental conditions of the patients, provide a diagnosis and prescribe medications for the management of the patient.

Role of the leadership in implementing change

In order for change to achieve the support and sponsorship of the project must be there. This support should come from the top executives, departmental managers and staff groups of the facility where the garden is. Political factors must also be considered for the process to occur smoothly.

Leadership refers to “a process by which an individual influences a group of other individuals in order to achieve common goals”. Leaders play five key roles in the change management process. They motivate change and create vision in line with the unfreezing step of the Lewin’s model (Hussain et al., 2018). They develop political support and manage the transition and this represents the moving step of the Lewin’s theory. Lastly they and sustain the theme of the change in accordance with the refreezing step of the Lewin’s model of change management The leadership must thus ensure that the restraining forces are kept low while the driving forces for the change are increased. The leadership must therefore create the right influence with those whom they are working with to achieve the change. They must work closely with them motivating them to achieve the objectives of the change while at the same time helping them to overcome hindrances towards the change (Seo et al., 2012).

Transformational leadership rather than transactional leadership is needed for the change process to be successful. Many attempts to bring abound change end up being terrible failures. To avoid this, the leaders must share the relevant information needed by the employees to make decisions to participate in the change process. The goals, expectations and purpose of the change must be clear to everyone involved in the process. The role of each individual in the change process must be clear. Good leadership should provide autonomy as much as is possible in the change process (Kavanagh and Ashkanasy, 2006). The leaders must be willing to listen to people’s suggestions, their grievance and their disappointments on the change process. This feedback must then be acted upon to ensure the success of the change. To motivate individuals toward the desired change have small achievable milestones or short term goals which will help the patients and stakeholders have a sense of accomplishment that they are achieving the desired outcome. People love receiving validation for their accomplishments and celebrating their positive steps towards the change is a great motivation (Hussain et al., 2018).

Evaluation

The safety of the patient as they undergo through the healthcare system is of utmost concern. One way of ensuring this safety is achieved is to ensure that quality is maintained throughout healthcare and this is achieved by maintaining a comprehensive quality assurance programme which can be achieved by conducting clinical quality audit (Esposito, 2014).

Clinical quality audit is a structured process of collecting independent information on the efficiency, effectiveness and reliability of the safety of the healthcare system and drawing up plans for collective action. An audit to the system aims at assessing how health and safety of patients is being managed by comparing it with the relevant standards. This will help in identifying the weakness and strength of the system in place (Busari, 2012).

Structuring the audit plan, should be guided by an objective at hand. Auditing focuses on the past adherence to establish requirements, and will improve future performance by identifying aspects of systems and procedures that require improvements. While conducting the clinical audit, the following are the principles that guide it; preparation of the audit, setting criteria and standard of the audit, data collection, data analysis and implementation of changes and improvements, and checking and maintenance of the audit recommendations (Esposito, 2014).

In preparing for an audit, the following are considered; choosing of an audit topic, defining a clear purpose and providing clear audit information to the management. The topic should be of specific importance and easy to make collection when called for. The choice of criteria and standards is the second steps taken in the design of a clinical audit and it requires the participation of all stakeholders. Audit criteria are explicit statements of objective in the exercise. Audit standards are standard of care to be achieved for a specific criterion, usually expressed as a percentage. Both criteria and standards dependable sources should include; international guidelines, scientific literature, expert consensus, data from other health care centres and individual case studies (Busari, 2012).

Data collection can either be done prospectively, resulting in the acquisition of fast data of optimal quality or retrospectively which means a slower acquisition of high quality data. Variables to be tested and type of analysis to be done should be recorded before commencing the data collection. The data collected can either be quantitative or qualitative (Johnson etal., 2000). Patient privacy must be ensured in the use of the acquired data. Another critical step is data analysis and interpretation. The analysed data results are then compared to the standards. In this stage professionals are involved to a large extent to ensure that the analysed results get the right interpretation and necessary action taken (Roberts et al., 2002). At some point the test results may give out a negative report, whereby the analysed data is not in-line with the set standards. Audit team should lay down strategies and recommendations to implement in the event where there are significant differences between the analysed results and set standards (Esposito, 2014).

Checking and maintenance of the changes made in the healthcare system is the final and most critical stage in the clinical auditing. In this part verification and monitoring of implemented strategies take its root. It’s important to check the effects of the changes made in the healthcare system and the cost of maintaining the new guidelines (Esposito, 2014).

Reflection

The need to constantly improve healthcare delivery cannot be underestimated. This means that that the pursuit for better patient outcomes, patient satisfaction, safety and improved quality of life is paramount. To achieve this constant pursuit of innovative ways of delivering care are necessary. Innovation comes with change which if not properly managed results in the failure of the innovation. To manage change effectively, the following key aspects are necessary; effective leadership and clinical governance, selection of a suitable change management model, user involvement and continuous quality assurance. It is however important to note that innovation in healthcare is not a walk in the park.

Leadership during change management process plays the important role of advocating for the change. Leaders help other stakeholders to understand the need for change and the benefits of change. This means that through effective communication and feedback they help unfreeze the status quo and increase driving forces for the change to take place. For change to be successfully implemented the leaders must assess the readiness for change, develop strategies for success and as well plan for the change (Seo et al., 2012). Leaders outsource for the resources that are needful for the change to happen such as getting top managers and executives to sponsor the change. They must also be keen to ensure the change is implemented. After the desired change has taken place they ensure it is cemented through methods such as acknowledgements and rewards (Hussain et al., 2018).

There are many models of change management choosing a suitable model that will yield the desired outcome is therefore important. The choice is dictated by the type of change. Change can be reactive which means it is instituted as a response to an event, it can also be a planned change which mainly aims at making improvement. In either case a suitable model is a necessity. Another thing that dictates the model used is the scope of the change that is, the change can be an institutional change or occupational (Pryor et al., 2008).

The users of NHS facility are patients and their families and caregivers as well as professionals who take care of the patients. In order for successful implementation of change these persons must be involved. This can be done by provision of time and adequate resources to enable them to make their contributions to the change process. It is also necessary to provide feedback on the implementation of the suggestions and responses on concerns and complaints of the users. This would ensure that most of the user preferences are met as the change is rolled out. Short term goals to be met by the users are paramount in addition to the long term goals. This helps to create a general feeling that progress is being achieved and therefore acts as a motivating factor once accomplished.

Quality assurance is necessary to evaluate whether the desired and planned change has actually happened. Without this incorrect assumptions may be made on the success of the change process. Quality assurance also helps in the analysis of the change process and can help identify corrective measures that should be taken once deficiencies are identified (Esposito, 2014).

Time management

Time is money is a phrase which is widely used and it denotes the importance of proper management of tie as projects are undertaken. On the other hand time lost can never be retrieved. The innovation must be implemented in a reasonable amount of time as indicated in the GRANNT chart (Wolters and Hussain, 2017).

Conclusion

For the NHS to remain a place where people can choose to get their healthcare needs provided. It must focus on high standards of safe, patient centred care. Since the world is ever changing and so are healthcare needs, this can only be achieved by a constant innovation of ways to improve quality of care and good clinical governance. Innovations disturb the status quo and bring in change. This change must be properly managed for the success of the innovation.

This essay outlines gardening therapy as a patient service innovation and explores how this innovation is made a reality by choosing the Lewin’s model of change management to act as a guide to implementing the change. It identifies leadership as a key requirement for the change process. It also outlines how gardening therapy can be carried out and the staff involved in the innovation to be successfully implemented.

Recommendation

There should be focus on equity which is not always considered in existing research despite the evidence that not everyone has the same access to green places. (King’s Fund)

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