Implementing Guidelines for Pediatric Tonsillectomies

Implementing road maps for Pediatric Tonsillectomies draw off Paper Implementing Quality Based ProceduresGuidelines for Pediatric Tonsillectomies at Credit vale HospitalKathryn DePassTrillium wellness Partners, encompassing three sites- Credit v altogetherey Hospital, Mississauga Hospital, and Queensway health Centre, claims their hospitals be leading with outstanding performance, fiscal responsibility, and quality diligent aid (Trillium Health Partners, n.d.).With the emergence of the Health System Funding tidy in 2012, drastic dislodges were made to hospital funding. In particular, to professionalmote ripe and evidenced- base lend oneself, thirty percent of hospitals over tout ensemble funding was allocated towards Quality Based Procedures (QBP) (Provincial Council for motherly and Child Heath Ministry of Health and Long Term Cargon, 2013). QBPs are limited clusters of diligent services that offer opportunities for healthcare providers to perform services based on outstrip practice. It is suggested that when government activitys adopt clinical evidenced-informed practices, quality patient care will flourish, age also increasing system efficiencies and decreasing be (Ontario Health Association, 2013).One of the procedures covered to a lower place QBPs is Pediatric Tonsillectomy, with or without Adenoidectomy. The Quality-Based Procedures clinical Handbook for Paediatric Tonsillectomy with and without Adenoidectomy (2013) articulates the unique(predicate) evidence-based components of care that should be provided for these patients from pre- to post-operation. The handler of Women and Childrens Health indicates that practice variation, escape of standardization, lack of evidenced-based practices, and physician resistance all lead to the brasss inability to enact QBP standards for this procedure since it was issued in 2014. Specifically, no standardized pre-screening woodpecker exists to assess for complications prior to surgery. In pa rticular, children are neither assessed nor properly diagnosed with preventive sleep apnea syndrome (OSAS) using a sleep study, the gold standard. This assessment, however, is vital since OSAS patients own a high risk of postoperative respiratory complications (Leong Davis, 2007).On the mean solar day of surgery, it is not standard that patients assemble a pre-operative acetaminophen loading paneling for prophylactic pain counsel. Some anesthesiologists vocalize their discomfort with administering acetaminophen rectally, while others are not aware of the fundamental impact of this administration on post-operative pain watchfulness. The American Academy of Otolaryngology Clinical Practice Guideline for Tonsillectomy in Children states that rectal administration is better tolerated than oral administration and is the hale-nigh effective in reducing pain and opioid requirements following surgery (Baugh et al, 2011). In addition, children with adequate acetaminophen analgesia afford less post-operative nausea and vomiting.Both the Director and Educator of Pediatrics argue that physician resistance has been a significant barrier to implement QBP standards (Cathie Boudeau, personal communication, April 27, 2015). Nonetheless, both the surgical and pediatric nurses welcome disclosed that they look forward to permutes that encourage standardization and quality patient care. The Educator has explained that she has already began drafting a post-operative standardized PPO form, which has, surprisingly, gained significant approbation by physicians. Therefore, the Educator has requested the writer focus on standardizing the pre-operative experience.Currently, patients and families receive a Pre-Operative Information Sheet. The Educator has noted, however, that this form does not align with QBP advisement. In addition, families have vocalized that the sheet should be more comprehensive and visually appealing. In addition, a standardized pre-assessment form to screen for complications postulate to drafted. Changing behaviour in regards to administration of pre-operative acetaminophen will also be considered in this project. The Quality-Based Procedures Clinical Handbook for Paediatric Tonsillectomy with and without Adenoidectomy (2013) will be used as the reference to fix a Pre-Operative Information Sheet for families and patients, as well as a pre-assessment checklist to screen for complications.In order to encourage adoption of all sassy compounds and to salmagundi behaviour, knowledge of turn management is absolute. Therefore, a books analyze was conducted to guide the execution of instrument of this project. Inclusion criteria parameters for the literature assay included the years 1995 to 2015. Search terms included organisational convince, management of motley, and shift management. Databases used were MEDLINE, PubMed, and CINAHL. Many articles were retrieved (about 300 hits). The search was then narrow to focus on health care and hospitals. Roughly 145 articles were reviewed. semiempirical studies were assessed for clarity of methodology, peer review, and external evaluation. Finally, the number of articles was narrowed down to 45, which met the detail criteria for transform management in health care. swop management literature draws from a wide range of disciplines, as well as speculative and shapingal perspectives, such as psychology, sociology, business policy, and social policy, creating a hard and robust body of evidence which is challenging to appraise and synthesize. Furthermore, the literature contains legion(predicate) and varying frameworks, computer simulations, evidence, and illustrations that may describe, analyze, guide, admission, and test beginning(a)s, programmes, and tools for commute. There are no frameworks or models of form unique to healthcare organizations although several models are conducive to change efforts in these areas. Therefore, the literature tha t was reviewed focused on dominant change management models that are often applied to health care organizations. Furthermore, some models are used primarily for higher levels of leaders. For the purpose of this project, literature focusing on micro-level do byes was selected.Case studies, surveys, and pilot studies are the approximately common methodologies in change management literature. While these methodologies are considered low on the evidence hierarchy, collectible to the limited ability to control subjects in healthcare, these methodologies do seem the most realistic and accessible means of implementing and evaluating change. Within the literature, one of the most important perspectives of change management originates from the planned approach created by Lewin in 1951, which argues that change occurs in three progressive stages unfreezing current behaviour, moving to the overbold behaviour, and refreezing the new behaviour (Elrod Tippett, 2002). For many years this thr ee-step model has been the dominant approach to organizational change.Critics argue, however, that planned theories are based on the assumption that organizations act under constant conditions that can be controlled and planned for. As a con place, an alternating(a) approach, namely an emergent approach was developed. This approach considers change to occur so rapidly and unpredictably that it cannot be managed from the top down. Instead, it is argued that change is a process of learning, whereby the organization responds to both internal and external changes (Barnard Stoll, 2010). This approach speaks to the concepts of change politeness and facilitation of change which are viewed as superior to the planned approach with specific pre-planned steps for change initiatives (Todnem, 2005). Nonetheless, emergent approaches do suggest that a sequence of actions should be enacted to increase the likelihood of change being successful (Luecke, 2003). rising theories assume that in order to respond to change, managers of change have to have possess a in-depth understanding of the organization, its structures, strategies, citizenry and culture. With this understanding, managers of change are capable identify the most appropriate approach to change while recognizing thinkable facilitators and barriers (Burnes, 1996)The literature argues that while these two approaches are often cited to be north-polar opposites, it is important to note that they are theoretical approaches. Therefore, the best strategy for organizations to manage change is to utilize both these approaches, in the form of frameworks or models that best meets the particular needs of the organization (Burnes, 2004).When the variety of frameworks, models, and approaches to change management are applied to health care organizations, common trends emerge. These trends include environmental component, organizational harmony, power dynamics, organizational capacity, nature of change, and process of chang e (Antwi Kale, 2014). Environmental circumstances include the external conditions to the organization that forces change, such as increased ambition and technological innovation (Lau, 1999). organisational harmony illustrates an agreement among individuals and units within the organization. whole members should have congruent missions and visions and be working collaboratively towards the same goal. Further, overall organizational plans, processes, and goals should also be compatible (Antwi Kale, 2014). Power dynamics refers to the hierarchy of go within an organization. Understanding which individuals can influence the change process is important. switch leaders should have buy-in from these individuals before undertaking a change initiative this will increase likelihood for success (Mitchell, 2013). Organizational capacity indicates that the organization has the necessary human and financial resources to undergo change. Moreover, it is essential that the necessary learning sets and knowledge be present to allow change to occur (Bazzoli, Dynan, Burns, Yap, 2004). personality of change refers to the rationale behind a change initiative. channelize initiatives moldiness consider an organizations external and internal situation. Furthermore, ample evidence must be available to justify that a proposed plan for change has the ability to act a presented problem (Antwi Kale, 2014). Finally, process for change is the actual step-by-step approach to implement a change. Change leaders must make authentic that these steps are agreed upon by all stakeholders and evidenced to create the desired change (Antwi Kale, 2014).The Canadian Health Services Research mental hospital (CHSRF)s Evidence Informed Change Management Approach was chosen to be the main model to guide the project as it contains all of the mentioned concepts. In addition, it is structured around specifically targeting the needs of Canadian healthcare organizations and outlines change as it per tains to micro level contexts. The approach presents a practical model for change management and contains four stages planning, implementing, spreading, and sustaining change (CHSRF, 2012). The planning stage of change involves understanding the context and influential forces of change while determining the organization ability or readiness to change. To understand the context, change managers must position which steps and people need to be involved to implement change and garner support. Readiness and capacity for change is determined by assessing all individuals at any level of the organization and considering how they will be stirred by the change. Furthermore, the capacity for the organization, for example, financially, to undergo change, needs to assessed. After the planning stage, change agents can implement change by executing their planned approach. facing pages change entails promoting change beyond its initial context and influencing the culture to bring new customs, t raditions, and ways of practicing. Lastly, sustaining change entails surveying and modifying the change process as practical experience is gained over the course of implementation.The literature also emphasizes that the divulge to successful change management is starchy leadership. Gill (2002) explains that effective change leaders are able to frame the change in terms of results for all involved. Further, change leaders foster and create environments that allow people to experiment with new ways of practicing. This coincides with the Leadership Competency from the Canadian Nurses Associations go Nursing Practice National fabric (2008). Learning about a patients experience and collaborating with other interprofessional disciplines assisted in identifying gaps in care, specifically the lack of adoption of QBP standards for Pediatric Tonsillectomies, resulting in practice that is not evidence-based and negatively impacts patient care delivery. In addition, while changing practice has been attempted in the past, the application of knowledge learned from the competition of a literature review on change management and discovery of an influential model on change, the writer can be successful in enacting a new and effective means of practicing, ultimately improving patient care. Also, the specific nature of this projects focus, to ensure QBP standards are followed, which promotes advocating for system efficiency, quality patient care, and low cost, aligns with the leadership competency of understanding and integrating the principles of resource allocation and cost-effectiveness in all levels of decision-making (CNA, 2008).Literature on change management is diverse and robust, with applicability to health care organizations. In this literature, it is apparent that in order to manage change specifically in healthcare, a model or approach needs to be selected to address an organizations specific needs and current issues. Understanding the organization as a whole and the people within it is an imperative and firstly step in planning change. Collaborative work among change managers and targets of change will ensure readiness for change, ease of implementation, and sustainability (World Health Organization, 2010). In addition, strong leadership is a significant component of organizational change, laying the radix to support the change through its continuum. Utilizing these concepts and knowledge will be imperative in guiding the implementation of QBP Standards for Pediatric Tonsillectomies with and without Adenoidectomies at Credit vale Hospital.ReferencesAntwi, M. Kale, M. (2014). Change Management in Healthcare. Queens School of Business.Retrieved from http//business.queensu.caBarnard, M. Stoll, N. (2010). Organizational Change Management A rapid literature review. Centre for Understanding behavioural Change. Retrieved from http//www.bristol.ac.uk/media-library/sites/cubec/migrated/documents/pr1.pdfBazzoli, G., Dynan, L., Burns, L. Yap, C. (2004). Two Decades of Organizational Change in Health Care What confine we Learned? Medical Care Research and Review, 61(3). doi 10.1177/1077558704266818Baugh, R., Archer, S., Mitchell, R., Rosenfeld, R., Amin, R., Burns, J., Patel, M. (2011). Clinical practice guideline Tonsillectomy in children. Otolaryngology Head Neck Surgery, 144(1),p 30.Burnes, B. (2004). Emergency change and planned change- competitors or allies? The case of XYZ construction. International journal of operations Production Management, 24(9), p 886-902Burnes, B. (1996) No such thing as a one best way to manage organizational change. Management Decision, 34(10), p 11-18Canadian Health Services Research Foundation. (2012). Evidence-Informed ChangeManagement in Canadian Healthcare Organizations. Retrieved from http//www.cfhi fcass.ca/Libraries/Commissioned_Research_Reports/Dickson-EN.sflb.ashxCanadian Nurses Association. (2008). Advanced Nursing Practice A National Framework. Ottawa, Canada Canadian Nurses As sociationElrod, P. Tippett, D. (2002). The death valley of change. Journal of Organizational ChangeManagement, 3. p 273-291Gill, R. (2002) Change management- or change leadership? Journal of change management,3(4), p 307- 318.Lau, A. (1999). Making sense of contemporary strategic implementation towards a conceptualmodel. Public Administration Management, 4(4), p 494-507Leong, A., Davis, J. (2007). Morbidity subsequently adenotonsillectomy for paediatric obstructivesleep apnea syndrome waking up to a hard-nosed approach. The Journal of Laryngology and Otology, 121, 809-817Luecke, R. (2003). Managing Change and Transition . Boston, MA Harvard Business School call downMitchell, G. (2013). Selecting the best theory to implement planned change. NursingManagement, 20(1).Ontario Hospital Association. (2004). Toolkit to gage the Implementation of Quality-BasedProcedures. Retrieved from https//www.oha.com/KnowledgeCentre/Library/Toolkits/Documents/OHA_QBProcedur es_toolkit_FNL.pdfProv incial Council for Maternal and Child Heath Ministry of Health and Long Term Care. (2013). Quality-Based Procedures Clinical Handbook for Paediatric Tonsillectomy with and without Adenoidectomy. Retrieved from www.health.gov.on.ca/en/pro/programs/ecfa/docs/qbp_tonsil.pdfTodnem, R. (2005). Organizational Change Management A Critical Review. Journal of Change Management,5(4), p 369-380.Trillium Health Partners. (n.d.). Who We Are. Retrieved fromhttp//trilliumhealthpartners.ca/aboutus/Pages/Overview.aspxWorld Health Organization (2010). Framework for action on interprofessional education andcollaborative practice. Geneva, Switzerland World Health Organization.http//whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf