Problem Identification for a Planned Change Practicum Project

Selecting a problem to address through a planned change project will require careful consideration of many variables. Here are a few suggestions to help you identify a problem that is relevant, feasible, and appropriate for a planned change practicum project:

• In collaboration with your faculty and/or mentor, brainstorm problems, concerns, or opportunities for improvement which you could address by leading a planned change project.
• Consider the overall scope of the project, realizing that it should fit into the timeframe of the practicum, be feasible, and be something for which you have the power to facilitate change.
• Remember that in order to secure support, most organizations will want validation that a project is worthwhile and necessary. Toward that end, be sure to identify the potential value added to the organization through the project:
  • Improved health outcomes for patients
  • Improved compliance with regulatory guidelines
  • Improved fiscal outcomes (the financial bottom line)
  • Improved health care delivery methods or practices (to enhance quality, safety, or best practices)
• Review current scholarly literature and professional publications regarding the problem to make sure you have a clear understanding of the facts, relevant health policy compliance, and evidence-based practice.
• Obtain feedback and insights from key leaders and experts within the organization, and within the field, as you identify a problem to address.

Make the Connection

Here are a few examples that may serve as a springboard for additional ideas. As always, remember that the scope of your project and available timeframe must be considered as you identify a problem or opportunity for improvement:

• Reduce 30-day readmission rates as mandated by the Hospital Readmissions Reduction Program (through the ACA)
• Improve compliance with National Patient Safety Goals (or other standards of care)
• Improve HCHAPS scores
• Reduce rates of infection
• Increase compliance with core measure indicators (or other standards of care)
• Reduce the patient safety risks
• Implement nurse peer-review program in your agency (just one example of performance improvement)
• Coordinate transition to patient bedside reporting (just one example to enhance communication)
• Initiate patient navigation of CHF patients to improve health outcomes and decrease readmissions

Think About It

As you think about next steps and identifying a problem of interest or need, ask yourself:

• Is there a problem or need that I can address?
• Is there an opportunity for quality improvement that I could lead?
• Are there specific best practice standards of care that need to be instituted?
• Are there specific regulatory guidelines for which compliance must be assured?
• Are there expenses that could be diminished or contained?
• Is there a health outcome that needs to be improved?
• Is there a healthcare delivery process that needs to be enhanced?

Often these items are prime targets for planned change initiatives that will benefit the patient and the organization.  Contact your mentor to discuss ideas you have, and they may have additional ideas to share.  Collaborating with your course instructor, mentor, and the organization to determine the focus of your project creates a win-win situation for you, the organization, and all involved stakeholders.

How will you make a difference?  How will you lead change in your corner of the world?

Assessment of the Problem

In order to investigate the organizational context and external factors impacting your selected problem, you will need to intentionally examine the following:

• SWOT analysis of the organization (strengths, weaknesses, opportunities, and threats relevant to your planned change project)
• Stakeholder involvement and support (identification of who is impacted by the problem, who will be impacted by the planned change, and strategies to engage these stakeholders to garner their input and support)
• Financial implications of the problem and proposed planned change (present financial impact of the problem or need, cost of the change initiative, anticipated cost savings realized through the planned change, etc.)
• External factors which drive or impact the problem (i.e., legislative mandates, health policy compliance, national quality directives, evidence-based standards of practice, accreditation requirements, external benchmarking, reimbursement guidelines, etc.) Note: Support from current professional publications and scholarly literature will be required to validate the external influencing factors.

As you consider each influencing factor, it is helpful to also consider the necessary assessment strategies for each element. Additionally, please note that the process of assessing internal and external influencing factors is iterative, rather than a ‘one-time’ task. As new evidence unfolds, or as stakeholder agendas change it is important to stay abreast of the elements, and relationships, which impact your project. There may be financial implications, regulatory, compliance, reimbursement, or accreditation factors relevant to your project that emerge over time. It will be important to maintain an ongoing assessment of these factors throughout your journey.

Strategies for Data Collection

Take a look at the data collection methods described below. How might you use these strategies to assess internal and external factors impacting the problem?

Influencing Factor

Strategies for Data Collection

SWOT Analysis

• Internal assessment of the organization to determine the strengths, weaknesses, opportunities, and threats relevant to the problem and the planned change project
• Review of organizational documentation regarding the problem
• Key informant interviews with organizational leaders, team players, and other experts when necessary to define the SWOT

Stakeholder Involvement

• Identification of all stakeholders who are affected by this problem or will be impacted by your planned change project
• Consider stakeholders both internal and external to the organization (i.e., organizational departments, health care professionals from other disciplines, community members, patients, families, administration, etc.)
• Develop strategies to engage stakeholders in order to solicit their feedback and perspective regarding the problem, and to garner their support of the planned change

Financial Implications

• Information regarding this element will likely require discussion with the appropriate leader or health care administrator. Information to discover includes:
  • What is the present financial impact of the problem?
  • What are the anticipated costs involved with the planned change project?
  • What are the anticipated cost savings realized through the planned change?

External Factors

• This element will likely require review of the literature, current best practices, related policies, etc. relevant to the problem or problem:
  • Legislative mandates
  • Health policy compliance
  • National quality or patient safety directives
  • Evidence-based standards of practice
  • Accreditation requirements
  • External benchmarking (such as HCAHPS, core measures, accountable care organizational practices, CMS guidelines, value-based purchasing, etc.)
  • Reimbursement guidelines
• Be sure to cite and reference sources as you validate these external factors within the literature
• Make sure that your literature support is current within five years, and that it is from credible scholarly sources
• Key informant interviews may also provide insight to additional external factors within the community

Practicum Application and Activities

Earlier in your MSN coursework, you may have identified a problem and initiated a SWOT analysis, as well as investigation of influencing factors that shape this problem. Take time to revisit any previous work and take the necessary ‘next steps’ to complete an actual or hypothetical SWOT analysis, and an actual investigation of the external variables that shape the problem. Review the Johns Hopkins Appendix G and the SWOT Analysis and Assessment of Influencing Factors Worksheet located in the MSN Toolbox area of the course. Proceed with the following activities. Document your practicum-related activities on the Practicum Log:

• Prepare a plan with specific talking points to meet with your faculty (and practicum mentor if available) regarding the implementation and evaluation of your planned change project.
• Meet by phone with faculty (and practicum mentor if available) to discuss assessment of the problem and influencing factors.
• Revisit current, scholarly publications that support the identified problem. Document your findings using a literature review tool or the Johns Hopkins Appendix G document, located in the MSN Toolbox for this activity.
• Complete the SWOT Analysis and Assessment of Influencing Factors Worksheet located in the MSN Toolbox.
• Validate your work on Phase 1 with your faculty (and practicum mentor if available) as needed.
• Revise your work as necessary.
• Submit the following with your time log, once Phase 1 is completed:
  • Submit your literature review tool that supports the identified problem or the John Hopkins Appendix G
  • SWOT Analysis and Assessment of Influencing Factors Worksheet

In this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

1. Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
2. Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.
3. Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct.
4. Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
5. Discuss what additional aspects mangers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue.
6. Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.

Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.1:       Exemplify professionalism in diverse health care settings.

1.3:       Exercise professional nursing leadership and management roles in the promotion of patient safety and quality care.

3.4:       Demonstrate professional standards of practice.