Riding the wave of change: Providing solid ground to support nursing with patient transitions to novel haemophilia therapies.

INTRODUCTION: Haemophilia nursing practice has experienced a shift in the past decade, as the historic chief focus on factor infusions shifted to extended half-life products, bispecific antibody therapies and other non-replacement therapies. This evolution has driven a need for changes in nursing practice in many haemophilia treatment centres. AIM: This article intends to provide insights to the haemophilia nurse to champion practice changes at their haemophilia treatment centres. METHODS: Two popular change theories, Lewin's three-step change model and Kotter's eight-step change model are discussed as a framework for haemophilia nurses to think, structure and be leaders in change. CONCLUSION: Examples of these models in practice could give guidance and examples to reflect on for haemophilia nurses needing to make changes in their practice settings. These models of change, alongside existing haemophilia nurse competencies and tools such as the shared decision-making tool from the World Federation of Hemophilia, can assist the nurse to be a capable change agent to usher in these new innovations.

Inclusion of gerodontology in dental curriculum: An urgent case for India.

The proportion of older adults is on the rise. Management of dental problems in this group is different from the general population, and hence requires special training. Gerodontology is yet to find its place in the Indian dental curriculum. A lack of training would result in inadequate care delivery. In this article, we share our views on the need for inclusion of the subject, potential challenges, and a guide for incorporation of gerodontology in undergraduate and postgraduate curriculum in the Indian dental institutes. We propose a framework based on the salient features of Kern's 6-step approach for curriculum development and Kotter's 8-step change management model. Some features are common to both the models. A combination of these models includes the following salient features: Problem identification and general needs assessment, beginning with a sense of urgency and targeted needs assessment, communication of the vision for change, working in guided coalitions and defining clear goals and objectives, adopting the relevant educational strategies, implementation strategies to enable change and generating short-term wins, evaluating the effectiveness of the curricular reform and sustaining and anchoring the change. The proposed framework may also be useful for countries where gerodontology is yet to be implemented.

Stakeholder Perceptions and Experiences of a College Live Mascot Program: a Study of Higher Education Ad Hoc Change.

Organizational change is a complex and critical issue in higher education today. Changes experienced across institutional systems have both short-term and long-term impact, making this phenomenon ripe for educational leadership research. Many universities and colleges have applied Kotter's (1995) eight-step change model prescriptively to implement academic initiatives, curriculum revisions, and strategic vision. However, Kotter's (1995) model has not previously explored ad hoc changes over time and has not been used to study a college live mascot program. Although a decreasing campus tradition, college live mascots have a relationship and impact on a student's experience and college identification, as well as university engagement with alumni and the public. Therefore, understanding how change is identified and experienced by campus stakeholders of a college live mascot program describe the various complexities and issues that initiate a climate for institutional change. To explain the evolution of a college live mascot program, oral histories across twenty years of campus stakeholders, including student trainers, campus administrators, and external consultants were analyzed using Kotter's (1995) model. The findings of this study affirmed that the steps associated with Kotter's (1995) change model, with a specific focus on the first three steps, are relevant for ad hoc changes, and offer implications for higher education change.

Mento's change model in teaching competency-based medical education.

BACKGROUND: Resistance to change is customary and is expected in any organization. However, most of the downsides of change can be avoided if the organization/individual prepares for the change by acknowledging guided strategies. In healthcare, change is the state of nature, which has also translated to medical education (ME). ME in the current era has undergone a shift from a traditional content-based curriculum to a competency-based curriculum. Recently, however, the broader social-accountability movement has accelerated this rate of transformation. One of the key challenges to educators harbingering this transformation to competency-based medical education (CBME) is to redesign the processes of teaching. AIM: Here we define a framework designed using Mento's model of change that will totally agree with introducing positive change in teaching in an institution undergoing transformation from a traditional content-based curriculum to a competency-based curriculum. METHODOLOGY: Using Schein's "unfreezing" as a guide term we critically reflected on the popular change-management models, to home in on Kotter's model of change to transform organizations. However, Kotter's change-model draws from Situational and Contingency Leadership Theories, which may not agree with academic organizations involved in ME. As such organizations adhere to Transactional and Transformational Leadership archetypes, where Leadership is constructively executed by "The Leader Team", we decided to adopt Mento's change-model for our study. Mento's model not only draws from the precepts of Kotter's model, but also incorporates axioms of Jick's and GE's change-models. RESULTS: Using Mento's model a framework was blueprinted to implement active learning (AL) strategies in CBME. Here we have elaborated on the framework using the exemplar of flipped teaching. The development of this framework required the design and execution of a faculty development program, and a step by step guidance plan to chaperon, instruct and implement change in teaching to harbinger CBME. Further, we have also reflected on the change process using Gravin's framework. CONCLUSION: To our knowledge this is the first report of the use of Mento's model of change in medical education. Also, the blueprinted framework is supported by acknowledged leadership theories and can be translated to implement any curricular change in CBME.

Interprofessional education and practice guide No. 9: Sustaining interprofessional simulation using change management principles.

Collaboration between teams is an essential component of patient safety in the complex ever-changing environment of healthcare. Collaborative practice requires training, which needs to start prior to registration for it to be established in the clinical workforce by graduation. Despite the perceived value and motivation of course coordinators, interprofessional training programs often struggle to sustain, due to various reasons related to logistics of timetabling, staff availability and/or absence of institutional support. We present a guide, outlining the lessons learned from implementing a sustainable change from our 6-year experience of the Women's Health Interprofessional Learning through Simulation (WHIPLS) program. The WHIPLS program was initially piloted to teach clinical skills in an interprofessional environment for pre-registration medical and midwifery students and has become a core component of the clinical curriculum. We describe the steps that were required to attain this outcome using the Kotter's 8-step plan for management change. The key lessons learned were identifying overlaps in course curriculum, planning for leadership and implementation, creating institutional "buy-in", aligning with national goals, focusing on the learner, translating into routine clinical practice, keeping the program simple, accepting innovation and considering a strategic evaluation.

Using a change model to reduce the risk of surgical site infection.

A surgical site infection (SSI) surveillance module completed in 2014 highlighted that infection rates for breast surgery inpatients and readmissions at an acute trust had increased to 2.2%, from 0.5% in 2012. The national benchmark for 2014 established by Public Health England (PHE) was 1.0%. This demonstrated a greater than fourfold absolute increase in SSI for breast surgery during these periods. The infection rate could have been due to chance, but warranted investigation. The results were presented to the breast team and used to drive practice transformation through audit and observation, identifying areas of change to improve patient safety. The project used a recognised 8-step model for leading change developed by John Kotter, a professor at Harvard Business School and world-renowned change expert. The project presented opportunities to promote infection prevention while implementing care improvement strategies and behaviour change in partnership with the breast team.

A collaborative approach to reduce healthcare-associated infections.

Healthcare-associated infections (HAIs) continue to be an ongoing issue for patients in acute hospital settings. Effectively preventing and controlling HAIs requires a collaborative approach compelling all healthcare staff to take up responsibilities and be involved. A surgical ward in an acute hospital aimed to implement comprehensive HAI prevention strategies by applying both Kotter's eight-step change model and the practice development principles into its current system. The project motivated staff to be involved and engaged in the assessment, implementation and evaluation of the project processes, and take ownership of the practice change. It focused on ensuring a clean environment, improving hand hygiene compliance, increasing staff's knowledge base regarding HAIs and enhancing active surveillance. The project achieved success in the reduction and prevention of HAIs as well as the development of a sustainable workplace culture.

Using an organizational change model to improve lung cancer surgery services over five years.

Background: Lung cancer is the most common cause of cancer death in the UK resulting in 21% of all cancer deaths. In 2016, local lung cancer surgery services required improvement due to under-representation in cancer resections and resource scarcity during the pandemic, which affected critical care bed availability and extended postoperative stays. The aim of this service improvement was to increase the number of lung cancer resection; develop minimally invasive techniques and reduce the use of Critical Care Unit beds by 35% (a subsequent goal). Methods: A five-year plan, guided by Kotter's 8-step change model, was initiated to address these issues. This model promotes sustainable change by setting clear goals, effective communication, and stakeholder involvement. Initial changes included hiring a thoracic surgeon experienced in uniportal video assisted thoracoscopy and enhanced recovery protocols. The team grew to three thoracic surgeons by 2020. The service increased operating theatre days and adopted new postoperative practices to reduce complications and hospital stays. Lung Cancer Multidisciplinary Team Meetings were consistently covered by thoracic surgeons, ensuring comprehensive care. Data on surgical activity were collected from departmental databases and national audits, with internal audits conducted regularly. Statistical significance was tested using chi-square tests with P values <0.05. Results: The number of surgical procedures more than doubled, with primary lung cancer resections increasing nearly three-fold from 12.8% to 29.8% over six years. Postoperative complications and mortality rates remained low. Critical care bed usage dropped significantly during the pandemic, with new protocols enabling safe recovery in general surgical areas. Conclusions: The successful expansion of thoracic surgical services was attributed to the dedicated minimally invasive surgeons, enhanced recovery measures, and skilled staff. The change model facilitated efficient and dynamic progress. With the introduction of lung cancer screening programs, the demand for surgical services is expected to rise. The effective change model will be re-applied to meet this demand. The organizational change model, focused on patients and staff, achieved sustained quality improvement in lung cancer care despite challenging conditions like the coronavirus disease 2019 pandemic.

Breaking the barriers: Methodology of implementation of a non-mydriatic ocular fundus camera in an emergency department.

Despite evidence that non-mydriatic fundus cameras are beneficial in non-ophthalmic settings, they are only available in a minority of hospitals in the US. The lag from research-based evidence to change in clinical practice highlights the complexities of implementation of new technology and practice. We describe the steps used to implement successfully a non-mydriatic ocular fundus camera combined with optical coherence tomography (OCT) in a general emergency department (ED) using Kotter's 8-Step Change Model. We prospectively collected the number of trained personnel in the ED, the number of imaging studies obtained each week during the first year following implementation, and we documented major achievements each month, as well as outcome measures, barriers to implementation and possible solutions. Between 12 and 42 patients were imaged per week, resulting in a total of 1274 patients imaged demonstrating sustained usage of non-mydriatic fundus camera/OCT in the ED one year after implementation. The implementation process was contingent upon multidisciplinary collaboration, extensive communication, coordinated training of staff, and continuous motivation. The future will likely include the use of artificial intelligence deep learning systems for automated interpretation of ocular imaging as an immediate diagnostic aid for ED or other non-eye care providers.

Change Management and Health Care Culture.

Change management in health care is the process of implementing new policies, procedures, and practices in order to improve the quality of patient care. It involves understanding the need for change, identifying the stakeholders involved, and developing a plan to implement and manage the change. Change management in health care requires a comprehensive and collaborative approach to ensure that changes are properly implemented, communicated, and monitored. It is essential for health care providers to be aware of the current trends in health care and to stay up to date with the latest technology in order to provide the best care possible.

A Change Management Approach to Promoting and Endorsing Ergonomics within a Dental Setting.

Musculoskeletal pain and disorders (MSDs) constitute a well-recognised occupational hazard to the dental community. Fortunately, they are preventable. Dental office ergonomics plays a key role in addressing these musculoskeletal challenges. An ergonomic improvement project based on Kotter's eight-step change model management theory was implemented within a dental practice. The project provided valuable evidence-based ergonomic interventions to prevent or reduce MSDs. The task force motivated staff to engage in strategies and interventions to enact an ergonomic vision. This case study represents an action plan to guide this ergonomic change. The key results of this project were an evidence-based ergonomics health promotional brochure, reduced sick leave attributable to MSDs, and workplace ergonomic checkpoints. The ergonomic change model represents an ongoing process where innovative trends and evaluative methods can be supported. Research limitations and practical implications were acknowledged.

Welcome back Kotter-Developing a National Allergy strategy for Australia.

Background: Allergic diseases have become an increasing health issue worldwide, being one of the fastest growing chronic diseases in Australia and other westernized countries. In 2013, allergic diseases were reported to affect 20% of the Australian population. Despite the high prevalence there was no national strategy to address these complex health issues, to enable the health system to manage the increasing number of patients. This project aimed to develop and implement a national strategy to improve allergy management in Australia, with a view of improving the quality of life of people living with or caring for someone with allergic diseases. Methods: The need for a national strategy to improve allergy management was identified. The Australasian Society of Clinical Immunology and Allergy (ASCIA) and Allergy & Anaphylaxis Australia (A&AA) worked together as partners to progress a national strategy using a theoretical model to underpin its development. Unrestricted education grants were sought to fund engagement with stakeholder organizations for both development and implementation summits. Several stages of advocacy were undertaken. Results: The National Allergy Strategy was developed as a partnership between ASCIA and A&AA. The Kotter's Change Management Model provided the basis for the steps undertaken to develop and implement the National Allergy Strategy. Two Allergy Summits, one for development and the other for implementation, were held. Several events were held to advocate for federal government funding. Five individual funding grants were achieved to implement National Allergy Strategy projects addressing the most urgent issues. Conclusion: The development of the National Allergy Strategy, a partnership between ASCIA and A&AA, was important in enabling successful advocacy for funding and implementation of important Australia-wide projects. The partnership has also helped facilitate engagement with key stakeholders to help advocate for funding and provide guidance and expertise in project implementation and resource development. The National Allergy Strategy has been successful in attracting funding to implement projects and develop resources urgently needed. The National Allergy Strategy has also provided a framework and a collaborative approach, for advocacy for further funding and future work to be undertaken.

How to facilitate a rapid response system in Japan: a promotion course based on TeamSTEPPS.

AIM: In Japan, the number of facilities introducing a rapid response system (RRS) has been increasing. However, many institutions have had unsuccessful implementations. In order to implement RRS smoothly, a plan that meets the needs of each hospital is needed. METHODS: Rapid response system teams from each hospital, including a physician and staff in charge of medical safety, from the RRS online registry were invited to attend a workshop. The workshop aimed to develop and implement RRS. The course curriculum was based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) developed in the USA. Participating facilities were required to formulate an RRS introduction plan referring to Kotter's 8-step change model to overcome barriers in the implementation of RRS. The change in medical emergency team activations comparing the intervention and control group hospitals was compared. RESULTS: Sixteen institutions were eligible for this study. After participating in the workshop, there was a tendency toward more frequent activation of medical emergency teams in the intervention group (P = 0.075). According to a self-evaluation from each facility, there is great difficulty in overcoming the 5th step of Kotter's model (empower people to act the vision). CONCLUSION: This step-by-step evaluation clearly identified a problem with implementation and provided measures for resolution corresponding to each facility. There was a major barrier to overcome the 5th step of Kotter's model in leading change, which represents the attitude toward implementing RRS in institutions.

Hospital-Acquired Infections Under Pay-for-Performance Systems: an Administrative Perspective on Management and Change.

PURPOSE OF REVIEW: The purpose of this review is to explore the impact of hospital-acquired infection on payment under pay-for-performance systems, and provide perspective on the role of administrators in infection prevention. RECENT FINDINGS: Hospital-acquired infections continue to pose a serious threat to patient safety and to the fiscal viability of healthcare facilities under pay-for-performance systems. There is mixed evidence that use of pay-for-performance systems leads to prevention of hospital-acquired conditions. Use of evidence-based guidelines has been shown to reduce hospital-acquired infections. Increasing use of pay-for-performance (PFP) systems results in potential loss of reimbursement for healthcare organizations that fail to prevent hospital-acquired infections (HAI). Healthcare administrators must work with front-line providers and infection control staff to establish and maintain evidence-based infection prevention policy. Additionally, infection control policy should be regularly updated to reflect best practices, and proper change management techniques should be employed in order to mobilize and empower staff to increase their ability to prevent hospital-acquired infections.

Application of Kotter's Theory of Change to Achieve Baby-Friendly Designation.

Creating an environment that optimally supports exclusive breastfeeding can require a cultural transformation. Our initial attempt at obtaining Baby-Friendly Hospital Initiative (BFHI) designation was unsuccessful when surveyors determined insufficient enculturation of BFHI practices. Using Kotter's theory of change, we overcame the barriers, enhanced our practices, and effectively transformed the culture, and our facility ultimately became the first maternity hospital in Pennsylvania to obtain BFHI designation. Nursing leadership was essential to this process. Our experience serves as a template for others seeking to achieve Healthy People 2020 goals related to breastfeeding.