Barriers And Facilitators To Implementing Changes In Clinical Practices For Patient Safety

Barriers to changes in clinical practices:

You are required to conduct a literature review of the current professional literature on implementing change in clinical practice (in other words, translating research evidence to practice) In your review analyse and discuss what the literature states about
- the barriers to change in clinical practice overall
- the facilitators to change in clinical practice overall
- consider how might those barriers and/or facilitators impact on the implementation of
the changes to practice that you have recommended regarding Ysabel Green’s care.

- For your literature review, you will need to search the current nursing literature using library databases (for example CINAHL – the Cumulative Index of Nursing and Allied Health; MEDLINE; Scopus) to identify current research and expert discussion related to this topic.
- You should provide 10 or more current and authoritative references. – The majority of your references should be peer reviewed journal articles from the last 5 – 6 years.
- Your literature review must contain an introduction and conclusion.
- Your work must be referenced using APA 6 style including a reference list (see links on the LMS site for this subject located in the assignment resources section).

To assist you in your preparation of how to present your project you will need to formulate a project plan.For this section, use the following five (5) steps to develop your project plan (These steps have been adapted from WHO Library Cataloguing-in-Publication Data: Implementation research toolkit - Module 5 - Disseminating the research 
1. Give a brief outline of the topic that is the focus of your project. (Your topic will be one of the safety standards you researched in Project Part A relating to Ysabel Green’s case briefly outline how the standard was compromised In Ysabel’s care) Students Please note: when you present this case to your audience you are required to de-identify the patient due to privacy issues

2. Who is your audience (who is your project being presented to i.e. ward staff – nurses/health professionals?)
3. Produce a brief outline of what it is you wish to convey to your audience. For this section you may wish to consider: what are your suggested/recommended changes to practice?
4. Identify which format you intend to use for your presentation and briefly discuss why you have chosen this format. You may choose from one of the following formats:
a. powerpoint
b. brochure
c. e-poster
d. Support your choice with evidence from literature – include references for this step (e.g. what is the best format to use for ward staff – nurses as an in-service; or what is the best format to use for the wider health community, if you were presenting at research week?)
5. Identify and discuss the method you will use to evaluate that your message has been received and understood by your audience.
a. In your discussion explain why you have chosen this method to evaluate the impact of your presentation on your audience. Therefore, if you choose to use an evaluation tool that has already been published, you will need to discuss why you have chosen that tool and why it is appropriate for your project. Or, alternately if you develop your own evaluation tool with questions for your audience, then discuss why those questions are the most appropriate and relevant to assess your project.
b. Some examples of evaluation approaches include:
i. on-line or paper surveys such as questionnaires,
ii. in-depth interviews with an individual member, or
iii. interviews with a focus group.

 Changes in clinical practice are critical for ensuring the superior patient-centric care to the patient. The changes in clinical practices should be based on the high-quality practices called evidence-based practices. Due to the increase of health care expenditure along with the negligence of clinical professionals exponentially decreases the quality of the care that patients received on daily basis. Therefore, implementation of the changes in clinical practices for the sake of patient’s safety is crucial in clinical premises. However, changing the direction and guidelines of clinical practices is major issues since other factors play the huge role in the change. This paper will illustrate the barriers and facilitator to change in clinical practices, the impact of barriers and facilitator in an implementation of the changes considering the case study.

Barriers to changes in clinical practices:

Changes in the clinical practices become massive challenges in a majority of the health care centers due to certain barriers that hinder changes. It is specifically challenging because of the complex relationship between organizations, patients, professionals, and carrier. In order to develop a successful strategy for changing the traditional clinical practices, the elimination of these barriers are crucial (Lynn et al., 2017).  Evidence shows that in the majority of the cases health care professionals are unaware of the current evidence-based researches and its guidelines. Even if they are familiar with current researches, they are unaware of the changes needed in clinical premises. Conflict in the opinion regarding the evidence bases practices also observed between two healthcare professionals (Aij et al., 2015).

 Therefore, a massive gap created in the clinical setting regarding the best patient-centric care. Motivation is the fundamental part of the clinical setting for ensuring the best patient-centric care. Lack of motivation within health professional due to low incentives, penalties for minor clinical fault hinders the changes and influence their priorities and commitments in the clinical settings (Hallum-Montes et al., 2016). To deliver best patient-centric care the health professionals need to acquire certain skills and practice them in clinical practices.

However, a significant number of health care professionals lack the sound knowledge and skills to ensuring the best care. Subsequently, it affects the patient’s safety and the quality of providing care (Niven et al., 2015). Lack of communication between individuals from every layer of the healthcare practices is the biggest flaw of the clinical setting and building effective communication between every healthcare professional resolve the issues in the clinical setting (Volkow et al., 2014). Clinical expenditure is also a huge hindrance in the changes that decrease the quality of the care.

Facilitator to changes in clinical practices:

Facilitator to changes in clinical practices:

Progressions of the changes in the clinical practices are slow as compared to the other practices since it ensures the patient safety along with the best care. A quantitative study performed by researches that suggested that effective leadership in the clinical setting enhances the changes in the clinical practices for the sake of the patients (Lynn et al., 2017). Effective clinical leadership ensures the superior care, help in sustaining the improvement in the clinical setting and provide a vision to every health care professional for best patient-centric care (Higgs et al., 2017).

Access to the resources of the evidence-based researches along with the advanced technology to apply those knowledge’s acts as the facilitator for the changes in clinical practices (Lynn et al., 2017).Despite the conflict regarding the evidence-based practices, the critical thinking of every health professional from different layers of clinical setting facilitate the changes in the clinical setting and ensure the best care. Studies of audit in clinical practices highlighted the importance of technology in monitoring changes of clinical conditions along with the record keeping for maintenance of ethical guideline which acts as the facilitator (Tsai et al., 2015).

Accumulated evidence suggested that Communication between every member of the multidisciplinary team in the clinical premises and sharing of opinion facilitate the effective changes in clinical practices (Lynn et al., 2017).

Influence of the barriers and facilitator in the case study:

This case study represents the clinical condition of a 33 years woman who with cholelithiasis. The case study shows the lack of hospital management and communication gap between health professionals give rise to the serious health conditions of Ysabel. The quality of the care delivered to the patient has been compromised which is one of the major national health and safety standards by Medline. The barriers and facilitator play the massive role in influencing the changes in the quality of the care in the clinical setting.

Barriers such the lack of awareness of current researches in health care professionals hinders the opportunity of applying new researches to treat patients (Tsai et al., 2015). In this context, doctors and nurses were not aware of the current situation of the patient and consequently ended up delaying the care procedure. Lack of motivation within the clinical professionals significantly influence the quality of care since the health care professionals tend to neglect the priorities of the patients and this, in turn, leads to serious conditions of Ysabel (Hallum-Montes et al., 2016).  

Influence of the barriers and facilitator in the case study:

Since a significant number of individuals lack the sound knowledge and skills to manage certain medical conditions, often ended up increasing medical errors during patient care as observed in this case (Slade et al., 2015). Lack of communication between the health professionals breach the national safety care and lower the quality of the service (Nelson, R., & Staggers, N. 2016). In this case study, nurses and doctors had the poor communication between them and they refuse to provide information to the patient’s family which leads to the serious health condition.

On the other hand, Access of the resources of the evidence-based researches provides an opportunity to every health professionals to make decisions for the patient. In this case study, the operation was successful due to the access to evidence-based researches and advanced technology (Li et al., 2015). However, lack of communication between health professional staffs leads to the issue. While a patient’s family wanted to know about the health of the patient, but nurses did not respond to the message which delayed in the care (Nelson  & Staggers, 2016). Health Informatics-E-Book: An Interprofessional Approach. Elsevier Health Sciences. Due to the certain barriers, patiently suffers the health conditions and quality of the care decreased.

Conclusion:

Implementing changes in clinical practice are critical for ensuring the superior patient-centric care to the patient. It is specifically challenging because of the complex relationship between organizations, patients, professionals, and carrier. Progressions of the changes in the clinical practices will be fast if barrier can be resolved and facilitator can be retained for the sake of patient-centric care.

Feedback interview questions:

In order to understand the efficiency of the project plan, a set of interview questions can be designed for evaluating the health care professionals. This evaluation questions will be applied for target audience such as the doctors, managers, registered nurses and human resources (Castillo-Montoya, 2016.)

 Sample interview questions:

1. Tell me about a time when a patient’s family was dissatisfied with your care. How did you handle that situation?
2. What approach do you take in communicating with people who do not know medical jargon? Give an example of a time you explained medical terminology to someone who is not medically trained.
3. Describe a time you provided effective patient or family education.
4. Talk about a time a patient or their family were particularly pleased and appreciative of your care.
5. Give an example of a time you had to interact with a hostile patient. How did you handle the situation and what was the outcome?
6. Describe a time you were faced with a patient who chose not to communicate or disclose important information. How did you handle the situation and what was the outcome?
7. Describe a time when your facility was undergoing some change. How did that impact you, and how did you adapt?

References

Aij, K. H., Simons, F. E., Widdershoven, G. A. M., & Visse, M. (2015). Experiences of Leaders in the Implementation of Lean in a Teaching Hospital: Barriers and Facilitators in Clinical Practices. Lean Leadership Health Care: enhancing peri-operative processes in a hospital, 129. RETRIVED FROM https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=4185&context=dissertations

Castillo-Montoya, M. (2016). Preparing for interview research: The interview protocol refinement framework. The Qualitative Report, 21(5), 811-831.

Hallum-Montes, R., Middleton, D., Schlanger, K., & Romero, L. (2016). Barriers and facilitators to health center implementation of evidence-based clinical practices in adolescent reproductive health services. Journal of Adolescent Health, 58(3), 276-283. Retrieved from : https://www.sciencedirect.com/science/article/pii/S1054139X15006667

Higgs, J., Jones, M. A., Loftus, S., & Christensen, N. (2018). Clinical Reasoning in the Health Professions E-Book. Elsevier Health Sciences. Retrieved from : https://books.google.co.in/books?hl=en&lr=&id=kO9oDwAAQBAJ&oi=fnd&pg=PP1&dq=Higgs,+J.,+Jones,+M.+A.,+Loftus,+S.,+%26+Christensen,+N.+(2018).+Clinical+Reasoning+in+the+Health+Professions+E-Book.+Elsevier+Health+Sciences.&ots=czHdJZMFmi&sig=zC0MM5CkwERDbZgYmzlha5wpZ4g#v=onepage&q=Higgs%2C%20J.%2C%20Jones%2C%20M.%20A.%2C%20Loftus%2C%20S.%2C%20%26%20Christensen%2C%20N.%20(2018).%20Clinical%20Reasoning%20in%20the%20Health%20Professions%20E-Book.%20Elsevier%20Health%20Sciences.&f=false

Li, W., Liang, W., Zhang, L., & Tang, Q. (2015). Performance assessment system of health, safety and environment based on experts' weights and fuzzy comprehensive evaluation. Journal Of Loss Prevention In The Process Industries, 35, 95-103. Retrieved from : https://doi.org/10.1016/j.jlp.2015.04.007

Lynn, B., Hatry, A., Burnett, C., Kan, L., Olatunbosun, T., & Bluman, B. (2017). Identifying Primary Care Physicians Continuing Education Needs by Examining Clinical Practices, Attitudes, and Barriers to Screening Across Multiple Cancers. Journal of Cancer Education, 1-8. . Retrieved from : https://link.springer.com/article/10.1007%2Fs13187-017-1240-5

Nelson, R., & Staggers, N. (2016). Health Informatics-E-Book: An Interprofessional Approach. Elsevier Health Sciences.Health Informatics-E-Book: An Interprofessional Approach. Elsevier Health Sciences. Retrieved from : https://books.google.co.in/books?hl=en&lr=&id=eROwDQAAQBAJ&oi=fnd&pg=PP1&dq=Nelson,+R.,+%26+Staggers,+N.+(2016).+Health+Informatics-E-Book:+An+Interprofessional+Approach.+Elsevier+Health+Sciences.Health+Informatics-E-Book:+An+Interprofessional+Approach.+Elsevier+Health+Sciences.&ots=1AFE_mcKmh&sig=xjR9kg6I1uZV0dI9Pqn2vm5LGHo#v=onepage&q=Nelson%2C%20R.%2C%20%26%20Staggers%2C%20N.%20(2016).%20Health%20Informatics-E-Book%3A%20An%20Interprofessional%20Approach.%20Elsevier%20Health%20Sciences.Health%20Informatics-E-Book%3A%20An%20Interprofessional%20Approach.%20Elsevier%20Health%20Sciences.&f=false

Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015). Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC medicine, 13(1), 255. Retrieved from : https://doi.org/10.1186/s12916-015-0488-z

Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., ... & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), 12-20. Retrieved from : https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20084

Tsai, T. C., Jha, A. K., Gawande, A. A., Huckman, R. S., Bloom, N., & Sadun, R. (2015). Hospital board and management practices are strongly related to hospital performance on clinical quality metrics. Health Affairs, 34(8), 1304-1311. Retrieved from : https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2014.1282

Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-assisted therapies—tackling the opioid-overdose epidemic. New England Journal of Medicine, 370(22), 2063-2066. DOI: 10.1056/NEJMp1402780