LA+2

1. Conduct an analysis of your project to identify some of the internal and external factors that may influence the direction of your planning. We discussed this together in class and you applied it appropriately – internal is what is directly going to be affected within your particular scenario or program. External are all the influences on your program from outside the program or influences your program will have on the external environment. External Environment: a) Opportunities: Possibility of cost effective care thus reducing unit budget use Staffing recruitment and retention Possibility of decreased workload Opportunities for interdisciplinary collaboration

b)Threats: Staffing recruitment and retention - good that you identified this can be both threat and opportunity Nursing burnout related to high acuity unit Possible challenge to scope of practice related to LPN assignments Communication breakdown between nursing staff - is this external or internal? Possible increased strain on budget related to extended stay of patients caused by listed threats Resistance/reluctance to implement change

Internal Environment:

a) Strengths: Expertise of staff Collaboration of nursing staff Client satisfaction Staff satisfaction Financial status- increased cash-flow Stakeholder involvement (employee suggestion program)

b) Weaknesses: Expertise of staff Client satisfaction Staff satisfaction Budget concerns- increased need for orientation, in-services, support services Horizontal violence related to perceived nursing hierarchy and resistance to change

2. Create a mission statement and vision statement for your project team.

Our mission statement is to improve the health and wellbeing of the patients on our cardiac unit and provide quality health care through multidisciplinary collaboration with an emphasis on safe, competent and ethical care. Your target audience for your MS is the leadership team and stakeholders - think about listing your key idea that sets you apart from the competition and how you will measure success as this is very good as an opening statement but should go on to describe how you will do this differently and more specifically.

Our vision statement is to provide cost-effective, streamlined care that results in patient and staff satisfaction in a supportive, collaborative environment. A good first effort. In your change project, some tips are that your vision should reflect your values and the behaviours your consumers can expect to see in working with your organization. Recall that your vision statement focuses on future outcomes. Your audience is your consumers - what will they derive as a benefit from working with your organization and what DIRECTION (future) is the organization moving towards (i.e. where does it see itself in the future when it's goals have been realized)? These points could be listed as a part of your MS since cost-effectiveness and staff satisfaction may be more of a concern for leadership and stakeholders such as staff. For clients, you may want to focus on quality of care, increased staff-to-client ratios, and values such as building collaborative relationships with clients as partners in care or something along those lines that reflects a value of caring for the individual and providing more personalized and attentive services.

3. Develop one goal and related objectives for your scenario. Goal: Addition of LPN staff onto the cardiac unit with minimal disruption in quality of patient care. Good, specific, measurable. Objectives:

a) One addition staff member per orientating staff member, per shift working on the unit during the change period to facilitate new staff learning and orientation.

b) Mandatory, paid education sessions related to horizontal violence, scope of practice, unit behavioral expectations. - great that you have anticipated some barriers and are addressing them from the start

c) Ongoing evaluative feedback opportunities related to change process in the form of personal communications, staff meetings, anonymous options (ex: comment drop box) and focus groups. - involvement of key stakeholders is key - good thinking

4. Identify key strategies you would focus on to enhance the success of your project.

Involvement of all key stakeholders during entire change process Encouragement of positive attitudes and approach to change Addressing conflict and negative attitudes openly and transparently Application of ongoing PDSA

5. Identify one small change associated with your project that you could conduct a change test on and outline a PDSA cycle.

One change that is associated with our project that could be tested is the delegation of assignments within the new proposed staff mix.

PDSA Cycle:

Plan: Objective: Proposed assignment delegation of 2 LPN’s with full assignments, 5 RN’s with full assignments and 1 RN in charge/float nurse.

Prediction of what will happen and why: We predict initial resistance to LPN full assignments and multiple duties of charge/float RN because of tradition unit culture and assignment delegation.

Do: Carry out the plan, document observations and feedback from stakeholders, record appropriate data.

Study: Analyze data, compare results to predictions and summarize what was learned.

Act: Results will determine action, if results are positive then implemented changes will remain. If negative results occur, PDSA cycle will be restarted with new objective. Nice example of one small, specific change that can be tested and evaluated. You clearly understand how to apply the tools and theory and will find it much more easy to do when the time comes to work on your change project! I hope my comments will help you with your project.