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Scenario


A recent state-wide quality improvement project has shown that a fully electronic medication system improves the safety of medication administration. In order to share this knowledge, the state organisation has shared the results on a quality improvement website. 

The two hundred bed hospital where you work has recently had some medication critical incidents. These critical incidents occur in the context of a general increase of minor medication errors over the last three years. The hospital’s most senior Nurse/ Midwifery Leader has reviewed the information on the state’s quality improvement website. The Nurse/ Midwifery Leader calls the Nurse/ Midwifery Unit Managers for a meeting and advises of the general increase in medication errors and that there is an expectation that all wards will have adopted the fully electronic medication system within six months. The electronic medication system is freely available from the government and can be installed directly onto the ward computers

Discuss how an effective Nurse/ Midwifery Unit Manager would lead this change to address this patient safety issue.

This essay will need to :

1.provide reasons to adopt the fully electronic medication system use Lewin’s model to outline a plan of change that includes milestones and timeframes.

2.choose and apply a leadership style to the plan of change. Critically evaluate the choice and compare with at least one other leadership style.

3.describe two aspects of potential resistance and discuss how the resistance might be addressed. 

Reasons to Adopt Electronic Medication System

Change management can be described as the proper systematic approach of dealing with the transformation as well as transition of the organizational goals, technologies and procedures. Electronic medication system had been proposed to be one of the effective ways of reducing medical errors and make systems easier for professionals (Hunt et al., 2018). Therefore, this essay would be highlighting the benefits of such system and the change management model that can be followed to successfully establish it. Moreover, it will also describe the way by which proper leadership style can be implemented and the ways bywhichdifferentresistances can be overcome.

Paper based medication systems are seen to force the staff in spending valuable time. This mainly occurs when searching through the records when professionals want to determine what medications are due in a given period of a medication round.In this arena, this system helps in building the productivity as well as the efficiency of the staffs along with reduction of errors. It also helps in reducing the pressures on the resources of the healthcare system. Registered and enrolled nurses are responsible for the management of hundreds of medications for the residents (Vermulen et al., 2014). Therefore, this system would help in the decreasing the pressures of these activities of the professionals. Besides, improving the workflows, the systems are also seen to alert the staffs for the potential safety issues or any forms of missed steps in relation to the administration of medication thereby enhancing the overall governance as well as decision-making. It also helps in streamlining communications (Hurkens et al., 2017).

The first step of change in the Lewin model is called the unfreezing stage. Here employees get the idea that certain aspects of the preexisting system are going to be changed. They are therefore seen to deal with the strong emotions like that of denial, doubt, impatience as well as uncertainty. Therefore, the first step that the manager should take is to fully disclose to the employees the state of the affairs and explain to the employees the reasons why the change to electronic medication system needs to be done. The next stage is called the change where the change would be implemented within a very short period. Researchers are of the opinion the leaders needs to act vigorously and implement the change within the short time so that employees understand its  importance and longer the procedure takes, employees have the chance of relapsing into old habits (Manchester et al., 2014). The steps would be creation of the implementation system, configuration of the software, identification of the hardware needs, transferring of the data. The others steps would be optimizing the pre-launch workflows and considering the layout of the room. This would include deciding on the launch approach, development of the procedures about the time when the system would be down and then initiate a training program. The last stage would be the refreezing stage so that the employees get set with the new system and do not get back into the old tradition system (Al-Hadad&Kotnour, 2015).

Applying Lewin’s Model for Change Management

The leaders need to follow the transformational leadership style in order to establish the change and manage the change effectively among the healthcare staffs and professionals (Démeh & Rosengren, 2015). The first principle would be inspirational motivation where the leaders need to motivate the employees in ways by which they can overcome their fears and become confident in working beyond their potential to make the present change a success and meeting the organizational goals (Avolio et al., 2016).

The second step is called intellectual stimulation where the leaders need to encourage the employees to be creative as well as innovative (Engelen et al., 2015). During the time of change management, the leaders can ask the nurses to provide feedback and new ideas about how they can make the new electronic medication system more successful. This would make the employees believe that theorganization respects their ideas and the entire system is forcefully pressurized on them.

The next step is called the idealized influence where the leaders need to practice what they preach (De hoogh et al., 2015). The leaders in the healthcare centre should show the nurses about how they themselves are practicing and handling the electronic medication systems effectively and this would help them to gain trust and respect of the followers making them confident.

The next step, which is also important for the leaders to follow, is the individualized consideration. Leaders need to act as mentors to the followers and empower them individually. They need to understand the concerns of each employee and provide them support in handling different challenges in the electronic medication system (Avolio et al., 2016).

In such situation, the autocratic leadership would never be able to handle the situation, which will either result in increased resistance, poor job satisfaction among the employees, stress and fatigue among the employees and higher turnover. The productivity will be affected and ultimately, the change management initiatives will fail. Such leaders are mainly seen to provide no or very little input to their followers. This situation might turn out to be very negative as this might create distrust and negative feeling towards the organizations (De hoogh et al., 2015).Leaders here are seen to dictate and do not trust the employees with important decisions. In such situations where employees are fearful, anxious or disappointed with the change, such strict leadership only add to the strenuous situation and affect the relationship of the employees with organization and leaders,. Hence, such leadership trait can be accepted here.

One of the most important resistances might come from the senior nursing professionals who had been utilizing the tradition methods of the system because of their continuous practice and habit that they have developed over the period. It is seen that senior employees tend to suggest that they are more comfortable with the old system and they do not require new systems to adopt as that might affect their productivity. The nurses might feel uncomfortable about the new electronic medication system and might not find the reason to change. In such instances, it is very important for them to provide the statistical data about how paper based systems are resulting in errors and patient deaths. Once they understand the rationale, they should be suggested the ways by which they can adopt to the system. They would be assigned to training programs where they would be given more information about the benefits of the program. This rationale would help them to understand and accordingly help them to change their habits

Choosing a Leadership Style for the Transition

Another form of resistance might be from the junior working staffs where the main cause of the resistance would be the fear of the unknown as well as their complete lack of knowledge about the system. The new nurses are entirely new to the system and they take time for setting them up in any domain of the healthcare. They already remain nervous and stressed. Adding the burden of new system in such time would make them anxious and fearful (Obholzer, 2018). Therefore, this might create resistance where they would not like any new systems to be adopted during such strenuous times for them.  In such area to develop confidence and to gain their trust, the leaders need to arrange meetings where they need to consider the concerns of new nurses. Accordingly, they need to gain feedback from the nurses to make them feel that their concerns and wishes are cared for. Effective negotiation is very important and they can be involved in the planning of the change by asking for their suggestions and incorporating their ideas. They would feel empowered and would give chances of reconsidering their decisions and accept the change.

From the above discussion, it becomes clear that electronic medication system helps in reduction of medication errors and improves patient safety and care quality. In order to establish such change in healthcare, leaders need to be well planned and follow the Lewin model for change effectively. They need to follow the transformation la leadership, as other leadership as if autocratic would result in failure. Different resistances might arise but with effective planning and leadership, such challenges can be overcome.

References:

Al-Haddad, S., &Kotnour, T. (2015). Integrating the organizational change literature: a model for successful change. Journal of Organizational Change Management, 28(2), 234-262.

Avolio, B. J., Keng-Highberger, F. T., Schaubroeck, J., Trevino, L. K., & Kozlowski, S. W. (2016). How Follower Attributes Affect Ratings of Ethical and Transformational Leadership. In Academy of Management Proceedings (Vol. 2016, No. 1, p. 16854). Briarcliff Manor, NY 10510: Academy of Management.

De Hoogh, A. H., Greer, L. L., & Den Hartog, D. N. (2015). Diabolical dictators or capable commanders? An investigation of the differential effects of autocratic leadership on team performance. The Leadership Quarterly, 26(5), 687-701.

Démeh, W., & Rosengren, K. (2015). The visualisation of clinical leadership in the content of nursing education—a qualitative study of nursing students' experiences. Nurse education today, 35(7), 888-893.

Engelen, A., Gupta, V., Strenger, L., &Brettel, M. (2015). Entrepreneurial orientation, firm performance, and the moderating role of transformational leadership behaviors. Journal of Management, 41(4), 1069-1097.

Hunt, K. V., Harding, A. M., Taylor, S. E., & Curtain, C. (2018). Evaluation of medication dose omissions amongst inpatients in a hospital using an electronic Medication Management System. Journal of evaluation in clinical practice.

Hurkens, K. P., Mestres-Gonzalvo, C., De Wit, H. A., Janknegt, R., Verhey, F., Schols, J. M., ...& Van Der Kuy, P. H. M. (2017). Assessing the strengths and weaknesses of a computer assisted medication review in hospitalized patient. International Journal of Hospital Pharmacy, 2.

Manchester, J., Gray-Miceli, D. L., Metcalf, J. A., Paolini, C. A., Napier, A. H., Coogle, C. L., & Owens, M. G. (2014). Facilitating Lewin's change model with collaborative evaluation in promoting evidence based practices of health professionals. Evaluation and program planning, 47, 82-90.

Obholzer, A. (2018). The leader, the unconscious, and the management of the organisation. In The Systems Psychodynamics of Organizations (pp. 197-216). Routledge.

Vermeulen, K. M., van Doormaal, J. E., Zaal, R. J., Mol, P. G., Lenderink, A. W., Haaijer-Ruskamp, F. M., ... & van den Bemt, P. M. (2014). Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. International journal of medical informatics, 83(8), 572-580.

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