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Dec 6, 2023
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INTRODUCTION This project was developed timely, over a period of five weeks, looking at reducing catheter related infection rate at St. Mary’s Medical Center. The project began by developing a strategic plan by first giving a summary of the issue; then conducting a SWOT analysis for the proposed change; then preparing a balanced scorecard, budgeting and timeline tools; proposing a core team of change champions; creating an evaluation plan, and finally an executive summary. These are elements that are critical to the successful implementation of any project. In light of the issue of this project, which is to reduce the rate of catheter associated urinary tract infection, all the components will be implemented and the success rate will be ascertained at the end of the projected timeline period. There are too many incidences of catheter related infection at the organization, and it needs to be reduced to a zero percent rate overtime, because the hospital is already and will in the future be given a bad rating if the figures remain stagnant. The reason that this is alarming is because all the instances of the infection occurs within the hospital and not after discharge. The new catheters that are proposed have gone through a trial period and the results have been encouraging. It is the intention that the proposal in this project will be fully accepted and implemented by management, so that St. Mary’s Medical Center will live up to its mission of ‘providing a full spectrum of quality, cost-efficient health care’ (Tenet healthcare, n.d.). Summary of the issue ‘A catheter is a tube in the bladder that removes urine from the body’ (Miller, Ogilvie & Zieve, 2014). When the tube is in the body for a long period of time, it is known as an indwelling catheter, which will increase the likelihood of developing a urinary tract infection (UTI) in the
bladder or kidneys. Catheter infection occurs because the urethral catheters inoculate organisms into the bladder and promote colonization by providing a surface for bacterial adhesion and causing mucosal irritation (Medscape, n.d.). Catheter infection is a common problem in especially the elderly. It relates for almost 40% nosocomial infections and 10% and 27% of catheterized patients become bacteriuric within 5 days. Reports have shown that there is a ten percent incidence of catheter related infection amongst the elderly and this increases to thirty percent amongst those who are in nursing homes. There is a thirty three percent mortality rate in this disease which calls for measures to deal with this disease. Approximately 80% of nosocomial urinary tract infections are as a result of urethral catheterization. Bacteria is introduced into the bladder while a catheter is been inserted or during the manipulation of the catheter or drainage system. The most common cause of this infection is the enteric pathogens such as Escherichia coli. Various bacteria or fungi are the causes of catheter related infection. The symptoms of a catheter related UTI includes: cloudy urine, blood in the urine, a strong urine scent, the urge to urinate quite frequently to name a few. To test for the infection a urinalysis or urine culture test will be done. A CT examination or an ultrasound of the urinary system may also be done. The most common type of treatment for UTI is through the use of antibiotics. This unmet need is evident because of statistical evidence. Reviewing data from the balance scorecard the organization reported a 17.5% catheter associated infection during the period of January to September 2014 compared to 0% during October 2014 to April 2015 when the new catheter was in trial. As the mission of the organization is to ‘provide a full spectrum of quality, cost-efficient health care’ with a vision to ‘distinguish itself as a leader in redefining
health care delivery’, the organization is doing its best to provide safe and effective healthcare by trying to reduce the rate of catheter associated infection (Tenet healthcare, n.d.) Urinary tract infections holds the same position as pneumonia as the second most common kind of healthcare associated infection and is responsible for more than 15% of all infections that have been reported by acute care hospitals. Annually, Urinary tract infections account for approximately 40 percent of all hospital-acquired infections. Eighty percent of these instances are attributable to urethral catheters. A patient with a catheter, has a three to seven percent change of developing UTI (Institute for health improvement, 2015). Attempts have been made in the past to address this issue. There has been an intervention to restrict usage of catheter in surgical patients. Secondly, there has been attempts to introduce different catheters or catheter materials or finding alternative to using the indwelling urinary catheters .The stakeholders that should be included in the strategic planning process in regards to the catheter related infections includes the managers, vendors and patients. In the organization that the project is been done, the managers did an assessment and found out that when they use the original catheter it increases the risk of catheter related infection, but when they used a different type of catheter, it reduced the level of infection to 0. Conducting a SWOT analysis for the use of this new type of catheter will be very useful to determine the attitudes of both the internal and external stakeholders to this change. SWOT analysis A SWOT analysis is the process of exploring the internal and external environments of an organization and extracting convenient strategies based on its strengths, weaknesses, opportunities and threats (Ghazinoory, Abdi, & Azadegan-Mehr, 2011). Conducting a SWOT
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analysis for the use of this new type of catheter will be very useful to determine the attitudes of both the internal and external stakeholders to this change. Two strengths – two strengths of using this procedure are that: It will lessen the incidence of infections in the organization. Based on the evidence already seen, switching to this new catheter has shown to reduce infections. Another strength is that it prepares the organization to adapt and embrace change. Two weaknesses – two weaknesses of this procedure are that: There is an issue with the budget. The money that has been allocated to make this change from the old catheters to the new catheters is been allocated elsewhere so this may result in the objective of really lessening the instances of catheter infections not been achieved. Another weakness is that even if another budget is prepared, this could lead the organization into financial difficulties, because the money that will have to be spent to acquire these new catheters may have to be financed from other departments and thereby putting other projects at risk. Two opportunities – two opportunities of this venture are: This will place the organization in a position where it can give to more needy organizations. Presently, there is are a lot of the old catheters in storage, and instead of throwing them away, the organization now has the opportunity to give to a more needy facility. Another opportunity is that the purchase will help to build new relationship with the vendors and this could lead the hospital into financial gains in the future as they seek to acquire more resources, which could be acquired at a cheaper rate. Two threats – two threats of this venture are: The organization will be placed under scrutiny by stakeholders who do not agree that this venture should be pursued. If the
organization’s plans fail, then this will lead to a breakdown in the communication of the manager-staff, organization – stakeholder. It could also lead to future mistrust. Another threat is that because of the disunity amongst the staff to change to this new system, the work performance may be compromised as staff members may feel that they voiced their opinion but their opinions were not taken into consideration so they no longer feel a part of the organization therefore they do not need to perform up to standard. Though threats and weaknesses are always viewed in a negative light, in this instance, they can prove as opportunities. In terms of the threats, the organization now has the opportunity of educating the staff about the benefits of switching to this new catheter. It has the opportunity of showing how the ratings of the organization can improve as the incidences of catheter infection is lessened. As the staff work together, and the stakeholders watch to see what happens, the trust will be strengthened. In terms of the weakness, this will give the organization the opportunity prepare budgets that will facilitate unforeseen circumstances. Balanced Scorecard A balance scorecard, according to Balanced scorecard institute is ‘a strategic planning and management system that is used extensively in business and industry, government, and nonprofit organizations worldwide to align business activities to the vision and strategy of the organization, improve internal and external communications, and monitor organization performance against strategic goals’. The cost of acquiring the new catheters is justified based on the outcome, because there will be a significant reduction in the amount of infection that will be seen in the organization, which will amount to a significant reduction in the amount of money that the hospital spends annually to treat this infection. The balance scorecard in the diagram
below depicts a representative of the overall objective of the project, while keeping in line with the vision and strategy of St. Mary's Medical Center. Balanced Scorecard FINANCIAL
OBJECTIVE: To decrease the amount of money spent on antibiotics to treat infection
MEASURE: Achieving an infection rate of 5% or lower
TARGET: Every re-admitted patients with catheters
ACTION: Acquiring new catheters
LEARNING AND GROWTH
OBJECTIVE: To provide staff with proper level of training to provide care
MEASURE: Positive attitude of staff in embracing change TARGET: clinical staff
ACTION: In-service education CUSTOMER
OJECTIVE: To provide safety and quality care
MEASURE: Survery with 90% satisfaction rate
TARGET: Internal and external stakeholers
ACTION: Implementating marketing plan
INTERNAL BUSINESS PROCESSES
OBJECTIVE: To provide patients with the best quality care MEASURE: Improved ratings from stakeholders TARGET: All stakeholders ACTIONS: Train and motivate staff, provide patients with a conducive healthcare environment To be the first choice in healthcare
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Budgeting and Timeline Tools The timeline for the completion and implementation of the proposed project change are illustrated using a Gantt chart, which is ‘one of the most popular and useful ways of showing activities (tasks or events) displayed against time’ (gantt, n.d). The other portion which deals with budgeting, uses the capital budget tool to look at the overall cost of implementing the project. During the budget preparation, the challenge that was encountered was with the use of the capital budget due to unfamiliarity with this tool. One of the anticipated challenges is that the budget may not be accepted by management. Financial resources, according to Business dictionary, are ’the money available to a business for spending in the form of cash, liquid securities and credit lines’. The financial resources that will be needed for the proposed change is cash. The challenges that will be encountered is that the budget may not be approved. Capital budgeting analysis Column1 Budgeted Actual Variance year 1 $600,000.00 545455 $54,545.45 Investment $500,000.00 Rate 0.1 payback years 5 NPV $454,545.45
Gantt chart Reference Business dictionary. (.n.d). Financial resources. Retrieved from http://www.businessdictionary.com/definition/financial-resources.html Gantt. (n.d). What is a gantt chart? Retrieved from www.gantt.com, Change to a new catheter by December 2015 Task name Duration(weeks) May June July Aug Sept Oct Nov Dec Finalize budget 1 Management approval 2 -3 Source vendors 4-6 Meet with vendors 7-8 Implement trial 9-20 Analyze and get feed back 21-22 Train staff 23-24 Final testing of the catheter 25-29 complete change 30-34 Project Start
Finalize budget
Management approval
Source vendors
Meet with vendors
Implement trial
Analyze and get feedback
Train staff
Final testing of the catheter
complete change
-25
-20
-15
-10
-5
0
5
10
15
20
25
30
0.9
0.92
0.94
0.96
0.98
1
1.02
1.04
1.06
3 May
3 Jun
3 Jul
3 Aug
3 Sep
3 Oct
3 Nov
Proposed Core Team of Change Champions When implementing a project, it is important to have persons on the team who will add valuable insights to the projected change. The type of project to be engaged in will determine the type of shareholders that will be utilized, whether internal or external stakeholders. The stakeholders for this change includes the: vendor, patients, and staff. Each of these stakeholder’s involvement is very important. The vendor’s role will be to provide education on the product to the staff and patients to get them to buy into the product. The patient’s role will be to cooperate with the staff in switching to this new set of catheters and the staff’s role will be to embrace the change and encourage the patients to embrace the change as well. Some of the strategies that can be used to generate a core team to ensure that stakeholders buy-in to the change, is to have persons on the team who are interested in the change and who have a different skill set in the team. If persons are placed on the team who have no interest in the change, this will dampen the effort of the team, as there will be a lot of confusion and counteractions when solutions are proposed. Having persons who are all interested in the change, however is a good way to start because from the very onset it will be known that these persons are all in agreement with the proposed change. Having a different skill set will help to sell the product, for example, having someone on the team who is good at budgeting, who will show the financial benefits to be gained from this investment; someone who is good at negotiating, who will negotiate with the vendors to get the best price for the products; someone who is good at training, who will properly educate the stakeholders on the benefits to be had from this investment. Jones et.al outlines some additional strategies that can be implemented which include: starting at the executive level, (change is inherently unsettling for people at all levels of an organization, when it is on the horizon, all eyes will turn to the CEO and the
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leadership team for strength, support, and direction.); involve people from every level in the organization. As transformation programs progress from defining strategy and setting targets to design and implementation, they affect different levels of the organization. Change efforts must include plans for identifying leaders throughout the company and pushing responsibility for design and implementation down, so that change “cascades” through the organization; communicate the message to the organization, without assuming that everyone will readily accept the changes that will be meted out in the organization. Evaluation The introduction to week eleven assignment states that ‘creating an evaluation plan is a critical part of developing a strategic plan. The evaluation plan used the balance scorecard as its evaluation tool. The plan will be developed by checking in initially within a one month period to see whether any of the objectives have been met, then have an ongoing evaluation within a three month and a six month period. Refreezing will be encouraged by using the Kurt Lewin change theory. According to Lewin, this is the final stage of a change. Refreezing is necessary to stabilize the new state after a change has been implemented. Refreezing allows the changes to be refrozen as the norm of the organization, and is very important to help people to stick with the new changes, preventing them from going back to the old way of doing things. The process of refreezing in the case of this project is to first help the staff to forget their attachment to the old catheters and get them to embrace the new catheters. Positive reinforcement will be used to help them to refreeze into the new catheters. The refreezing process is expected to culminate within six months. The step that will be involved in cementing this change are: showing all who are involved in the change process that the change is real; giving them rewards for embracing this change; cementing the change into the formal systems and structures ( this will be done by
disposing of the old catheters that are in stock and replacing them with the new catheters); getting them to look into the future to see how the organization can have zero percent or at maximum one percent infection rate; getting them into action where they no longer revert to or think of reverting to the old catheters, but utilize the new catheters on their patients; use formal rituals to confirm change and finally, building this change into the social fabric, where this will now become the new norm of the organization. Executive summary Company St. Mary’s Medical Center (Reducing Catheter Associated Urinary Tract Infections) Introduction Visualize this: you are admitted to the hospital and on your third or fourth day you realize that something is terribly wrong. A catheter associated urinary tract infection has taken over. How would you feel? Would you want to continue using that same brand of catheter or would you want a change? This project is looking at reducing catheter associated urinary tract infections. The objective is to change to a new brand of catheter that, has had a successful six month trial period in reducing the incidence of catheter related infection. This brand has been tried and proven. Guaranteed to reduce catheter related infection rates, to 0%. Objective The objective is to make recommendations to management to change to this new set of catheters. Risks and opportunities The opportunity exists to place the organization in a position where it can give to more needy organizations. Presently, there is are a lot of the old catheters in storage, and instead of
throwing them away, the organization now has the opportunity to give to a more needy facility. Another opportunity is that the purchase will help to build new relationship with the vendors and this could lead the hospital into financial gains in the future as they seek to acquire more resources, which could be acquired at a cheaper rate. The risks
of this venture are: The organization will be placed under scrutiny by stakeholders who do not agree that this venture should be pursued. Another is that the work performance may be compromised as staff members may feel that they voiced their opinion but their opinions were not taken into consideration so they no longer feel a part of the organization.
Solution The Solution: To switch from the bard catheter that is normally used to the duette catheter. Management Team When implementing a project, it is important to have persons on the team who will add valuable insights to the projected change. The type of project to be engaged in will determine the type of shareholders that will be utilized, whether internal or external stakeholders. The stakeholders for this change includes the: vendor, patients, and staff. Each of these stakeholder’s involvement is very important. The vendor’s role will be to provide education on the product to the staff and patients to get them to buy into the product. The patient’s role will be to cooperate with the staff in switching to this new set of catheters and the staff’s role will be to embrace the change and encourage the patients to embrace the change as well. Resources The resources that will be needed for successful implementation of this product will be financial resources – to purchase the new set of catheters, human resources – will be needed to train the staff on the proper use of the new catheters.
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References Balanced scorecard institute. (n.d). Balanced Scorecard Basics. Retrieved from http://balancedscorecard.org/Resources/About-the-Balanced-Scorecard Business Dictionary. (n.d.). Financial Resources. Retrieved from www.businessdictionary.com Gantt. (n.d). what is a Gantt chart? Retrieved from www.gantt.com Ghazinoory, S., Abdi, M., & Azadegan-Mehr, M. (2011). SWOT methodology: A state-of-the-
art review for the past, a framework for the future. Journal of Business Economics & Management, 12(1), 24–48. Retrieved from the Walden Library databases Institute for health improvement. (2015). Catheter-Associated Urinary Tract Infection. Retrieved from http://www.ihi.org Jones, J., Aguirre, D. & Calderone, M. (2004) .10 Principles of Change Management. Retrieved from http://www.strategy-business.com Medscape. (n.d.). Catheter-related urinary tract infection. Retrieved from www.emedicine.medscape.com Miller, S., Ogilvie, I. & Zieve, D. (2014). Catheter-related UTI. Retrieved from http://www.nlm.nih.gov/medlineplus Tenet healthcare, (n.d.). Our commitment to quality. Retrieved from https://www.tenethealth.com/about/our-story