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Introduction
The insertion of PICC line is one of the most widespread medical procedures in the United States. The catheters allow care providers to measure patients hemodynamic indicators, in case it is impossible to do through non-invasive methods and to supply pharmaceutical and nutritious elements into an organism (McGee & Gould, 2003). Unfortunately, the use of PICCs is associated with multiple severe complications which are usually hard to treat.
To reduce health risks and to improve the overall patient outcomes, medical personnel should support the organizational transition to change through the creation of sound culture and the integration of safety values into everyday practice. The effective implementation of soft and hard components of change may encourage personnels professional growth and knowledge development, enforce compliance with safety norms and high standards of efficiency. Ultimately, it may foster the enhancement of treatment results by supporting the minimization of the occurrence of different catheter-related health problems.
Soft and Hard Elements of the Change
The major soft elements of change in a medical setting are its care providers, their theoretical knowledge and practical skills, style of professional behavior, and values that are accepted and shared by all staff members. These aspects of professional performance may be defined as intangible, but they still influence the work process directly and tangibly. The soft elements of change constitute organizational culture and, at the same time, their implementation and enforcement significantly depend on the level of cultural sophistication and strength.
According to Hahtela et al. (2015), the organizational environment substantially affects care providers self-efficiency, job satisfaction, and job stress level which, in turn, define the quality of provided service, patients length of stay and their perceptions of the received care. Team leaders and administrators should strive to create a favorable work environment in which each staff member may comprehend organizational mission and vision and consequently apply this understanding in practice.
However, for employee motivation, improvement of individual and organizational performance, enhancement of professional communication, and strengthening of team cohesion, it is important to implement strategies and structures.
These hard elements are meant to control personnels activities in a way that facilitates the transition to desired changes and enhancement of patient outcomes. Structures, models, and systems serve as the foundation for the support of corporate culture, as well as orderly compliance with professional standards and principles. In this way, the consideration of both types of change elements is essential to the success in the achievement of desired goals.
Implementation of the Elements
For minimization of PICC-related complications and reduction of catheter reinsertion rates at Kendall Regional Medical Center (KRMC), it is important to educate personnel regarding technical and ethical aspects of the profession, develop mission and vision that will embrace the organizational values and will stimulate their maintenance at the individual level.
According to Petree, Wright, Sanders, & Killion (2012), education and training are among the most effective methods for the prevention of catheter-related bloodstream infections. Moreover, the researchers suggest to use additional safety devices and to perform sterilization and preparation practices that may help to reduce health risks (Petree et al., 2012).
Beneficence and nonmaleficence are the main ethical values in medicine, and the compliance with safety norms or the provision of proficient and competent medical service should be the major rules and goals of any hospital. Therefore, staff education and development of an effective motivation system through the enhancement of culture the integration of new values and the creation of organizational mission and vision can help to support the prevention of PICC complications.
The implementation of a strategy is vital for the development of an effective medical system and monitoring of short-term and long-term results in change management. Strategies are meant to transfer vision and intangible values to reality, advance hospital performance, meet patient, and facility needs (Lippincott Nursing Center, 2009).
Strategies usually include a few steps: evaluation of internal and external environment; identification of gaps, risks, and strengths; formulation of desired goals and objectives, and design of a plan for their achievement. The strategic analysis and structuring, the organization of work processes, and the development of education plan facilitates understanding of needs for change and helps to identify the required resources, generate the achievable objectives, and assess the results. In this way, the implementation of strategies substantially supports positive changes.
A story about the Change
The proficient medical care provider is a major goal of any healthcare system, and it is associated with individual and public health improvement. Medical service includes health promotion and disease prevention activities, as well as the provision of psychosocial aid and care. Despite the identified objectives, the US healthcare system faces multiple challenges in the development of medical staff competence, the actualization of professional potential, staff motivation, and patient outcomes.
One of the current and essential health problems in the country is the high frequency of PICC-related complications. The researchers observed that over 15% of patients with PICCs have complications of mechanical (5-19% of cases), inflectional (5-26%), and thrombotic (2-26%) character (McGee & Gould, 2003). And it is possible to say that an insufficient level of nurses competence and the absence of safety culture and cultural motivation elements in hospitals interfere with the decrease of these negative indicators.
As stated by Wenfeng et al. (2014), the insertion of PICCs is a relatively simple procedure, but it still requires a high level of surgical expertise, the ability to forecast potential risks, and to take measures to prevent them. A program aimed at bridging the gaps in knowledge and practical skills can help KRMC to minimize the risks of PICC line complications. The staff members need to refine their proficiency, learn to distinguish between various potential complications, and improve their technical skills. In this way, the hospital will gain an opportunity to increase the quality of service and patient satisfaction which are the ultimate organizational goals.
Personnel education and efficient organization of work processes may be regarded as an initial stage in the development of safety culture that will positively impact staff perceptions and behavior. It is observed that hospitals with a sound safety culture are associated with communication patterns based on mutual trust, shared values, and recognition of the significance of patient safety, as well as confidence in the implementation of safety measures (Cappelen et al., 2016).
Based on this, by producing individual and group values, forming positive attitudes, and developing staff skillfulness, KRMC may create the environment which will define the commitment to professional standards and safety principles, positive style of teamwork and patient communication, and the overall outcomes of health management in the hospital.
Conclusion
Organizational change management is a challenging task that requires the investment of time and resources. The literature review helped to reveal that for the prevention of health complications and PICC line reinsertions, it is essential to consider both soft and hard elements of change, such as staff members skills and competence, cultural values and safety principles, as well as strategies and structures aimed to actuate the desired change. Organizational structures, values, and knowledge are integral parts of hospital culture, and their effective and integrated management can significantly facilitate favorable changes in professional performance and patient outcomes.
References
Cappelen, K., Aase, K., Storm, M., Hetland, J., & Harris, A. (2016). Psychometric properties of the Nursing Home Survey on Patient Safety Culture in Norwegian nursing homes. BMC Health Services Research, 161-11. doi:10.1186/s12913-016-1706-x
Hahtela, N., McCormack, B., Paavilainen, E., Slater, P., Helminen, M., & Suominen, T. (2015). The relationship of workplace culture with nursing-sensitive organizational factors. Journal Of Nursing Administration, 45(7/8), 370-376. doi:10.1097/NNA.0000000000000217
Lippincott Nursing Center. (2009). Nursing strategy: Whats your plan? Nursing Management, 40(3). 25-29.
McGee, D. C., & Gould, M. K. (2003). Preventing complications of central venous catheterization. New England Journal of Medicine, 348(12), 1123-1133. doi:10.1056/nejmra011883
Petree, C., Wright, D. L., Sanders, V., & Killion, J. B. (2012). Reducing blood stream infections during catheter insertion. Radiologic Technology, 83(6), 532-540.
Wenfeng, C., Haoyu, D., Liangfang, S., Man, Q., & Lianxian, H. (2014). A comprehensive intervention program on the long-term placement of peripherally inserted central venous catheters. Journal Of Cancer Research & Therapeutics, 10(2), 359-362. doi:10.4103/0973-1482.136657.
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