In response to at least two of your peers, answer the following: Do you feel your peer’s responses spoke ‘truth to power’ sufficiently in their response t

Sarah Discussion:

To build support and sustain the two-nurse vaccine administration quality improvement project, it is important to gain buy-in from all stakeholders including, clinic nurses, providers, clinic leadership, and the Chief Financial Officer (CFO). Nilsen et al. (2020) suggest employees are more likely to support changes when they understand why the change is needed, how it benefits the organization, and how it benefits patients. For this reason, the team who led the project should share project data showing improvements to patient safety, and the organization, from the change to two-nurse vaccine administration. This information could be displayed on a visual management board, discussed at huddles, and shared at staff meetings. If people feel like they are involved in the process and improvement, they are more likely to invest in project success and sustainability.

            Though the project is complete, new enthusiasm to sustain two-nurse vaccine administration in the clinic is needed. This could be done by engaging clinic nurses in sharing about project success. Nurses who were involved in the initial project implementation could partner with statisticians and leaders to develop an abstract and paper regarding their successful quality improvement project. They could also go on to present this project at a conference to generate more enthusiasm in the community and among their team about the clinic’s commitment to patient safety with two-nurse vaccine administration. Identifying project champions can also be helpful in generating enthusiasm. Champions are meant to promote project implementation at the point of care among their team (Ferren et al., 2022). Utilizing champions will assist in gaining traction with other clinic nurses, leader, providers, and the CFO to share importance of maintaining quality improvements.

            In response to the CFO, I would respectfully attempt to shift his focus solely from finances and ask him to consider patient safety too. I would share data from the project that show improved patient safety by decreasing vaccine related errors. Medication errors are the most common errors in healthcare and can cause patients to have adverse drug reactions (Brunner et al., 2024). Medication errors can be costly to organizations. Decreasing staffing may not create cost savings for the clinic, as it is more likely for patients to experience harm, which can be costly. Therefore, it could be more cost effective to keep the staffing as it is to ensure there are an adequate number of RNs to provide two-nurse verification. 

References

Brunner, L., Siebert, J. N., Ehrler, F., Manzano, S., & Marti, J. (2024). Evaluating the Economic Impact of the PedAMINES App in Reducing Medication Errors in Pediatric Emergency Care: Cost-Effectiveness Analysis.  Journal of Medical Internet Research,  26, e52077.  https://doi.org/10.2196/52077

Ferren, M. D., Von Ah, D., & Menachemi, N. (2022). EBP champion responsibilities and sustainability: A scoping review.  Nursing Management,  53(8), 22–33.  https://doi.org/10.1097/01.NUMA.0000853152.64293.46

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses.  BMC Health Services Research,  20(1).  https://doi.org/10.1186/s12913-020-4999-8

Matthew Discussion:

 According to Solllectio & Johnson (2020), “for real innovation and improved performance, people working directly with problems and systems need to be empowered to be fully involved in designing and deciding how to improve processes and quality” (p. 322). To this extent, supporting and sustaining the two-nurse vaccine administration quality improvement initiative requires a transformational approach emphasizing shared responsibility and collaboration between leadership and frontline clinical staff. Empowering the team to be continuing to participate in the QI plan requires organizational commitment activities and intrinsically motivated individuals who possess a mutual agreeableness of enhanced value change brings for the patients, systems and themselves.  According to Zelmer (2024), high-performing health systems require strong foundations such as leadership that builds organizational capacity or setting improvement priorities and goals, developing improvement skills and experience, modeling positive behaviors and recognizing progress. Zelmer (2024) goes on to mention engaging frontline personnel in improvement culture such as having regular safety conversations/ huddles allow staff to work together to prevent problems before they occur. Moreso, creating supportive organizational policies and incentives which accelerate innovation at the point of care, is another foundational pillar of high-performing health systems (Zelmer, 2024). Continuing the adoption of the two-nurse vaccine administration plan requires disseminating performance data and procedural changes to the department regularly and deriving training and educational resources which recognize how the improvement protocol positively impacts all stakeholders, especially patient outcomes.  

            Leadership must perpetually reward those who engage in/model behaviors that proactively assist the initiative to further ingrain a culture of safety to build enthusiasm for the improvement initiative. According to Sollectio & Johnson (2020), healthcare organizations need to establish systems that reward people for good work and recognize efforts that exceed expectations, energizing staff and providing standards against which to assess poor performance (Pascale et al., 1997). This might include appraising staff and the department for meeting monthly medication error benchmarks. Management must also find ways to elicit intrinsic motivation among staff possibly by involving them in existing and future planning of the vaccine improvement plan and any other initiatives they have passion for improving. In semi-structured interviews of 30 healthcare professionals, an emphasis on the importance to have opportunities to influence changes as well as finding meaning in and understanding how changes benefit themselves and patients are paramount characteristics in successful organizational changes (Per Nilsen et al. 2020). These traits permit a seamless and organic system which both mitigates resistance to change among crucial stakeholders by allowing those most knowledgeable about their work to initiate appropriate changes (Per Nilsen et al., 2020).

            Given the vaccine administration initiative’s success in mitigating medication errors, it is rationale to sustain its continuance and impact. If the CFO asks for suggestions on discontinuing the plan for the summer, performance data as well as areas of concerns such as the underlying staff knowledge gaps must inform the response. Knowing the improvement plan may not have been fully communicated to every team member, the CFO must be made aware of this. Alongside the performance improvement data, I may suggest a department meeting and a formal vaccine policy be created to fully ensure each department nurse is held individually accountable but also proficient in the new vaccine administration measures. Continual success in contingent all department staff have efficacy in the change by creating organizational policies and resources to instruct and guide staff. Where knowledge gaps exist in this scenario, there are high odds medical error incidence increases if the two-nurse protocol is discontinued for the summer.

References

Per Nilsen, Ida Seing, Carin Ericsson, Sarah A. Birken, & Kristina Schildmeijer. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses.  BMC Health Services Research, 20(1), 1–8.

Sollectio, W. A., & Johnson, J. K. (2020). McLaughlin and Kaluzny’s continuous quality improvement in healthcare (5th ed.). Jones & Bartlett Learning.

Zelmer J. Getting better at getting better: Advancing quality and safety in healthcare.  Healthcare Management Forum. 2024;37(6):429-433.

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