Question

You are the Director of Acute Respiratory Care in a small community hospital in Suburban Barrie, Ontario. You have been asked to be the leader of a project to design a new protocol for ICU admission. The former criteria of admission to ICU for any respiratory failure was:

                Oxygen saturation below 93%

                Tachypnea above 30 (RR>30)

Gasping for air and possible confusion/delirium of the patient/Encephalitis

Blood pressure below 90/60

Fail to improve Oxygen saturation upon application of CPAP

Presence of ARDs (acute Respiratory Distress) on imaging

(The above criteria are only few pre-requisitions and are all in combination together. The information only given for your own reference and you are not obligated to talk about the details like above in your essay)

The present criteria are now less sensitive which means that patient for instance need to have oxygen saturation below 89% for admission to ICU and so on. Therefor, due to lack of the number of ICU rooms we need to admit the harsh and sever patient status who are severely unstable, and we transform the regular infected patients into In-ward department and not ICU. Thus, our outcome is to be more specific for admitting patients into ICU- the patients who really are in danger of respiratory failure.

In order to plan for this change, you must design a change process plan which will ensure you will be successful in planning and implementing this change in procedure. Write a scholarly paper to address the following questions:

1. What type of change is being asked for in this situation?
2. Define who the target group is in this situation.
3. Explain how you would determine the hospital’s readiness and capacity for this particular change.
4. As the leader, how would you motivate the staff to embrace this change?
5. Discuss the factors which will affect the organization’s capacity for change.

Answer 1

A change process plan for ICU:

Intensive care unit is a special department / unit of a Hospital in which critically ill patients , in danger of dying , are admitted and closely monitored. This unit is also called as Critical care unit or intensive therapy unit. Intensive Care unit of a hospital is the vital department of the particular facility, where the advanced medical facilities, equipments and competent health professionals work together for saving the life of a critically ill patient. Presently our hospital is facing a challenge of increased number of critically ill patient population group, and the number is more when comparing with the present bed capacity of our ICU. So there comes a need of a revised admission criteria for ICU admission.

After the analysing the present situation and the facilities available currently in ICU, a new criteria for ICU admission is given below:

* All respiratory arrest patients

* All cardiac arrest patients

* pulse ratw is below 40 or above 140 beats per minute.

* Oxygen saturation below 90 %

* Respiratory rate at or above 40 or at or below 8 breaths per minute.  

* systolic Blood pressure below 90 mm of Hg

* Hypercapnia with respiratory acidosis

* prolonged or repeated seizures

* Glass gow coma scale score at or below 2.

Hospital readiness and capacity for the change can be assessed by the tools like flowchart, process mapping etc. Assessing the readiness of the Healthcare facility can help to address the potential failures. Assess the attitude and opinion of the management and employees regarding the propsed change. Assess the organisation's communication pattern to communicate the change to the all staff members. Hospital readiness for change can be assessed by monitoring quality of the organizational context to support the practice change.

As a leader ( I ) can suggest some of the strategies to motivate the staff to embrace the change. The proposed activities are:

* conducting the staff meetings and state the changes

* listening to the feed back of the staffs and  acknowledge the feed back

* Clarify their doubts on ' whys'

*provide training for the staff  

* Define the clear roles for each staff responsible for different task.

The factors that affect the organisation's capacity for change are the organisation's size , structure, physician's and nurse's attitude towards the change, team work and leadership within the organisation. Seeking the opinion from the management and the main Healthcare professionals who works in the organisation is the preliminary step before implementing the change.