CH18 Performance Improvement Programs Case Study
Performance Improvement programs and effective project management require an understanding of the four phases of the project life-cycle: initiation, planning, execution/implementation, and closure. It is important to have each phase of the project mapped on a timeline and to be sure the project team has the appropriate members with the right skills to ensure a successful program. Using a case study from the text, students will demonstrate their ability to review and evaluate a performance improvement program by arranging the information provided into a timeline and devising a team with the appropriate skills and knowledge to work the plan.
Read Chapter 18 in the text, and focus your assignment on the Case Study on pages 461-462.
Answer the following questions based on the case study:
Draft a timeline showing the major phases of the project cycle (see Figure 18.1) and the key tasks for each phase.
Develop a team of up to seven representatives from different departments to serve on a multidisciplinary project team. Construct a list of the types of individuals you would want to serve on this project team.
What departmental areas of the healthcare organization should be represented on the team?
What specific skills, knowledge, and expertise should team members possess?
Your submission should include your timeline (use the Gantt chart in Figure 18.3 as a guide), as well as a minimum of 2 additional pages that answers questions 2, 3 and 4.
Please prepare the paper in APA style, including cover and reference pages, with an introduction and conclusion.
Your references should include the textbook and at least two other outside resources.
Quality Improvement Project Example
Preceptorship and orientation are among the most profound interventions for ensuring that newly employed nurses cope with new practical roles and healthcare environments. In this sense, these strategies promote an effective learning environment where new nurses can translate theoretical knowledge into functional competencies. According to Phuma-Ngaiyaye et al. (2017), preceptors play a significant role in facilitating collaboration for practical learning by planning and organizing orientation, meetings, preparing clinical placements for nursing students, and promoting confidence through in-service monitoring.
Despite the potential benefits of preceptorship and orientation in improving confidence and enabling new nurses to cope in complex environments, time factors and engagement levels compromise their effectiveness. According to Ke et al. (2017), preceptorship and orientation are often short-term engagements between experienced clinicians and novice nurses. Therefore, these interventions may overlook nurses’ emotional, psychological, and social needs during transitions to functional roles.
As a result, healthcare organizations need to extend engagements between experienced clinicians and new nurses to incorporate mentorships programs to enhance knowledge and guarantee much sought-after emotional, psychological, and emotional support. Consequently, this paper seeks to expound on the importance of mentorship programs for new nurses by summarizing findings for literature, elaborating on plan implementation, and providing recommendations to healthcare organizations.
Literature Review Summary
Plenty of scholarly sources explain the challenges facing newly employed nurses during clinical transitions and suggest various interventions for addressing practical constraints, problems of organizational cultures, and meditate mismatches between theoretical knowledge and real-life competencies. Although scientific studies may suggest various interventions for promoting confidence and transforming knowledge for new nurses, some overriding solutions are preceptorship, prolonged orientation, and mentorship programs.
Before delving into an in-depth summary of diverse contentions from literary works, it is essential to evaluate various themes, including problems facing new nurses, intentions to quit, and the effects of nurse turnover on the quality of care. Undoubtedly, these thematic areas fundamentally validate the importance of embracing evidence-based practice to enable new nurses to conform with the new organizational culture and translate abstract knowledge to clinical practice.
Challenges facing nurses during their transitions
Transitioning from a nursing graduate to a newly employed nurse is an important stage for career development. It enables novice nurses to channel their knowledge and skills to clinical practice. Therefore, this stage is inevitable for all nurses endeavoring to pursue careers in different clinical specialties. Despite the importance of clinical transitions, many scholarly sources refer to this stage as the most challenging for newly registered nurses due to the complexities and challenges of navigating new workplace environments.
In a scholarly project, Palermo (2020) defined a nurse’s transitions to practice as “the period when a newly graduated nurse transitions from the role of a student into a role of a professional nurse” (p. 13). Before settling on this definition, the researcher reviewed literature from five articles to determine the essence of this period for addressing nurse shortage and promoting quality of care. Following an in-depth analysis of scholarly journals, Palermo (2021) concluded that nurses’ transition from graduates to professionals is a profound process for promoting safe staffing and averting the effects of nurse turnover if appropriate measures for enabling effective transitions are adequate.
In a longitudinal, non-randomized control study conducted by Zhang et al. (2019) in China between 2013 and 2014, the researchers identified reality shock as one of the problems facing new nurses. According to Zhang et al. (2019), reality shock may manifest through various aspects, including failures to conform to new workplace cultures, the individual perceptions of conflicting correlations between theoretical knowledge and practice, and confidence issues when delivering care in new clinical settings. In this sense, this challenge compromises the new nurses’ ability to translate abstract knowledge into real-life activities.
Similarly, Salem Alghamdi & Ghazi Baker (2020) revealed that “transition from theoretical knowledge to real-life practice is often challenging, emotionally exhausting, and stressful for nurse in acute settings” (p. 3082). Following an in-depth analysis of responses from 95 new Saudi nurses, the researchers identified positive correlations between preceptorship and orientation, enabling inexperienced nurses to understand clinical practices and translate theoretical knowledge into practical competencies.
New nurses are susceptible to organizational pressure and unable to channel skills and knowledge to solve clinical problems. According to quasi-experimental, descriptive, quantitative research by Schroyer et al. (2020), increased pressure in stressful and complex situations may hinder the learning process for inexperienced nurses.
The investigators conducted this research in a not-for-profit 325-bed acute care hospital in Northern Indiana to evaluate the effectiveness of nursing orientation and training programs in helping new nurses to cope with organizational pressure. The study revealed that the success of nursing preceptorship and mentorship programs depends on leadership styles, institutional expectations, and institutional structures. Further, the researchers concluded that new nurses’ challenges in complex environments should prompt healthcare organizations to consider practical measures for promoting career development.
Intentions to quit and the problem of nurse turnover
Often, novice nurses’ ability to thrive in new clinical settings depends on organizational strategies to bolster their confidence, provide much sought-after emotional, psychological, and social support, and address mismatches between institutional cultures and individual expectations. Supposing these measures are insufficient, new nurses may contemplate abandoning professional duties due to the complexities of navigating new systems.
Intentions to quit result in poor productivity and subsequent nurse turnovers, exposing organizations to additional challenges, including nurse workload, adverse health outcomes, and ineffective succession planning. Many scholarly studies elaborate on the consequences of organizational failure to transform professional perceptions and retain new nurses.
In a cross-sectional study conducted by Gabregziabher et al. (2020) in Axum comprehensive and specialized hospital Tigray, Ethiopia, the researchers revealed that high nurse turnover leads to poor quality of care, compromised care coordination, and low patient safety. Also, Gabregziabher et al. (2020) suggested that the decision to abandon professional duties exposes the “residual” staff to increased workloads and burnout since they struggle to provide care in understaffed departments.
After evaluating responses from 148 nurses in Axum hospital, the investigators revealed that 64.9% of total respondents had the intentions to leave the organization due to a combination of multiple factors, including role dilemmas, incompetent leadership, unreliable physician-nurse relationships, and cultural incivility (Gabregziabher et al., 2020, p. 2). Undoubtedly, findings from this study expose the potential causes of early retirement and intentions to leave for new nurses. Therefore, the analysis can influence evidence-based practice for addressing challenges facing newly employed nurses to ensure their retention and job satisfaction.
Although many scholarly studies focus on explaining the effects of nurse turnover and intentions to quit at an organizational level, it is essential to assess their potential consequences on the global scale. According to Daouda et al. (2019), high nurse turnover rates inflict economic burdens on countries. In this sense, the annual costs dealing with nurse turnover in the US are about $20 561 and $26 652 in Canada. Daouda et al. (2019) conducted this cross-sectional study in ICUs of Paris-area hospitals to investigate the consequences of nurse turnover to the overall quality of care delivery and organizational sustainability.
The researchers revealed that high turnover and staff shortages are among the most profound casual factors for workplace stress and increased cases of medication errors. In the current global healthcare systems, medication errors are among the leading cause of adverse healthcare concerns, including deaths, life-threatening conditions, lengthy hospitalization, and increased care costs. Therefore, this study provides insights into the importance of addressing intentions to quit professional responsibilities before they lead to nurse turnover.
Nursing orientation, mentorship, and job satisfaction for newly employed nurses
The existing literature vividly explains the importance of enabling new nurses to cope in complex workplace environments by addressing the prevailing stressors during transitions from graduates to professionals. In this sense, preceptorship and mentorship programs capitalize on the interactions between experienced clinicians and novice nurses to promote technical assistance, information exchange and enhance emotional, psychological, and social support avenues.
Zhang et al. (2019) contend that “preceptors are experienced nurses who possess a high level of knowledge, clinical proficiency, and professionalism, and work with new graduate nurses to facilitate and expand their clinical education through preceptors sharing experiences in patient care with technology” (p. 2). Undoubtedly, the ability to capitalize on interpersonal relationships between preceptors and nurses presents opportunities for clinical decision support and enhanced confidence for new nurses.
Similarly, Ke et al. (2017) conducted a systematic quantitative review to assess the importance of nursing preceptorship on thematic areas such as enhancing nurses’ competencies, enabling professional socialization, job satisfaction, and retention for new nurses in Taiwanese clinical settings. Following an in-depth analysis of six articles, the study identified correlations between preceptorship, preceptor experience, and enhanced responsibilities to problem-solving, stress management, and job satisfaction.
However, the researchers presented the importance of strengthening socialization and engagements between experienced clinicians and new nurses by extending preceptorship programs beyond nine months. As a result, the study validated the importance of embracing mentorship programs to promote lengthy interactions between expert mentors and mentees effectively.
Do mentorship programs enable organizations to retain new nurses?
One of the apparent differences between preceptorship and mentorship programs is that the latter facilitates long-term and holistic interactions between experienced clinicians and newly registered nurses. This distinction alone is essential for promoting job satisfaction by availing opportunities for socialization, in-service job facilitation, and interprofessional relationships. Feyissa et al. (2019) contend that “although mentorship is sometimes used interchangeably with preceptorship, it is different in that it involves a longer period and deeper relationships between mentor and mentee than preceptor and preceptee” (p. 990).
In this sense, the length of implementation for a nursing mentorship program determines its effectiveness in enhancing confidence and translating abstract knowledge to real-life activities for new nurses. Also, effective mentorship programs for newly employed nurses promote nurse retention and job satisfaction since their entail functional areas, including bedside teaching and training, organizational learning, evidence-based practice, and clinical case reviews. Undoubtedly, these components promote professional experiences, enhance confidence, and bolster the ability to deliver quality care.
Mentoring new nurses result in job satisfaction, translating theoretical knowledge to clinical practice, and confidence to deliver quality care amidst healthcare organizations’ complexities. Also, this approach helps healthcare organizations to avert the effects of nurse shortages and turnover. Therefore, it is essential to develop a strategic plan for implementing mentorship programs to address challenges facing newly registered nurses.
The first step for implementing a strategic plan for nursing mentorship programs is by preparing and consolidating necessary resources for initiating organizational change. In this sense, it is fundamental to assess organizational needs in terms of staff needs and other resource deficiencies. As DaCosta (2020) notes, planning for change enables the plan implementor to circumvent organizational inertia and address external factors that affect change implementation. Organizational inertia refers to the inability of organizations, groups, and individuals to embrace change due to the prevailing status quos strengthened by workplace norms, behaviors, and cultures.
While organizational issues may act as the primary impediments to the change process, it is essential to evaluate external considerations related to the strategic plan. For instance, DaCosta (2020) argues that understanding the practical and legal consequences of a decision promotes informed decisions for realizing change. As a result, proper planning would enable implementors to understand organizational needs before commencing the implementation phase.
Apart from need assessment and planning for necessary resources, other interventions for ensuring change mainstreaming are interpersonal collaboration, team building, leadership commitment, and effective communication. According to DaCosta (2020), building teams for implementing change entails various processes, including sharing ideas, gaining supporters, stakeholder engagements, and communicating new ideas to appeal for support.
Implementing mentorship programs for newly registered nurses means the culture of standard orientation and preceptorship interventions. As a result, change agents must explain the validity and essence of favoring mentorship programs instead of normal orientation and preceptorship. At this point, change advocates, including nurse leaders and advanced practice registered nurses (APRNs), should embrace research and obtain proven contentions to convince other stakeholders about the potential benefits of mentoring newly employed nurses.
The final steps for the intervention plan change implementation and sustenance since they entail actualizing the change and sustaining new norms and expectations. The two stages are broad and would take a substantial amount of time for the overall strategic plan. In this sense, the implementation stage for nurse mentorship programs will involve active interventions, including one-on-one learning engagements between experienced clinicians and novice nurses, class scheduling and attendances, in-service mentorship and other support systems, and process monitoring and evaluation. On the other hand, sustaining change regarding nursing mentorship programs will encompass strengthening new norms and culture through replicating the interventions.
Stakeholders and Change Theory
Stakeholder engagement is crucial for guaranteeing a successful implementation of nursing mentorship programs for new nurses. DaCosta (2020) further assert that change process implementors must seek support for new initiatives by communicating with relevant stakeholders about the plausibility of embracing new improvement initiatives.
In this sense, the effectiveness of mentorship schedules for newly employed clinical nurses depends on how the implementation team and professionals will consolidate efforts and align their competencies to the quality improvement initiative. Nurse Leaders, registered nurses, organizational management, newly registered nurses, and team leaders must embrace a collective mindset by ensuring that their responsibilities complement the objectives of the strategic change plan.
Nurse Leaders and advanced practice registered nurses (APRNs) are responsible for spearheading the enlightenment phase of the change process by educating the organizational staff members about the importance of mentoring newly-recruited nurses. Also, they should embrace timely and effective communication regarding the change process to convince other stakeholders about the legality of mentoring new nurses and the potential benefits of strengthening such a norm.
Finally, they are responsible for conducting regular monitoring and summative evaluations for the quality improvement initiative by utilizing their expertise in key performance indicators to ascertain the essence of implementing the project. As a result, they should form teams and develop coalitions with staff members to oversee the effective implementation of mentorship programs.
The organizational top management helm bears the mantle of providing necessary technical, financial, and institutional support to the strategic plan for quality improvement. For instance, leadership commitment is consistent with motivating employees and stakeholders to own mentorship programs and embrace them to improve healthcare quality. Another significant role for institutional leadership is to ensure that the organizational structure allows change implementation and sustenance.
The management structure determines lines of authority, stakeholder duties, levels of interprofessional collaboration, and process coordination efficiency. Palepu et al. (2020) contend that effective management structure should encourage transformational leadership, enhance mentor-protege relationships, and avail opportunities for interdisciplinary collaboration. Consequently, embracing a proper management structure and leadership style would enable the organization to dismantle bureaucracies and top-down frameworks by favoring employee participation, team performance, and effective communication.
Similarly, institutional leaders should collaborate with other stakeholders in assessing institutional resource needs and deficiencies that may hinder the implementation of change. In this sense, they are responsible for selecting mentors, availing technical and financial resources, and ensuring that the strategic plan complies with set guidelines and external regulations.
On the other hand, mentors, registered nurses, and trainees should form coalitions to ensure flexible scheduling, maintain service delivery patterns, and provide monitoring and evaluation team information. Notably, effective communication between these stakeholders is fundamental in enabling proper record-keeping, timely reporting, and process coordination to implement mentorship programs successfully.
Kurt Lewin’s change theory is a fundamental model for initiating, implementing and sustaining change since it provides essential steps for mainstreaming quality improvement initiatives in organizations. According to Hussain et al. (2018), Lewin’s theory presents unfreezing, change implementation, and refreezing as the primary steps for implementing change in institutional settings.
The unfreezing stage entails processes by change agents and implementors to identify internal impediments and address underlying restraining factors that may compromise quality improvement initiatives. When implementing mentorship programs for newly employed nurses, it is essential to assess contextual issues and solve organizational inertia that manifests through behaviors, cultures, and norms.
The change implementation stage entails channeling efforts, resources, competencies, and activities for positive organizational change by translating plans to actions. During the implementation stage of mentorship programs for newly employed nurses, it is essential to navigate this stage by enacting class schedules, conducting a continuous assessment, providing resources for project continuity, holding regular meetings with stakeholders to discuss the trajectories of the quality improvement initiatives, utilizing feedback from mentors and protege, and proper record-keeping processes. Undoubtedly, these activities determine the success of strategic plans and the plausibility of strengthening new norms.
Finally, the refreezing stage encompasses interventions for sustaining change following a successful implementation of quality improvement initiatives. Hussain et al. (2018) also note that the refreezing new norms is essential for promoting advanced activities and maintaining newly-acquired standards. After implementing mentorship programs for new nurses, the organization should sustain such interventions to ensure talent retention and address new nurses’ intentions to quit.
Resources Needed to Implement Plan
Adequate resources are prerequisites for implementing approaches for quality improvement in healthcare organizations. In this sense, enacting mentorship programs for novice nurses will require the organization to align physical/technical, human, intellectual, and financial resources with the strategic plan. Physical resources entail tangible aspects, including equipment and infrastructure necessary for mentorship programs. For example, it is essential to avail technologies, printing systems, and supplies for performance measurement and evaluation forms.
On the other hand, human resources encompass intangible assets, including leadership skills, managerial support, competencies, and team performance that enable people to implement change. Often, intellectual resources fall in the human resource category since they refer to nonphysical factors that support organizational objectives. However, they include additional attributes such as data awareness, corporate branding, copyrights, and partnerships with external stakeholders.
Finally, financial resources consolidate all budgetary allocations, including cash budgets, operating capital, cash, and expense budgets. These resources are essential for ensuring the smooth implementation of change initiatives by catering for purchases, supplies, remunerations, salaries, and other emerging expenses. When implementing mentorship programs for newly employed nurses, it is essential to allocate sufficient financial resources to avert drawbacks, including last-minute purchases and unsatisfactory remunerations for mentors and other stakeholders participating in change implementation.
An evaluation plan for quality improvement initiatives is crucial for providing insights into the effectiveness of the change process. In this sense, progressive and summative evaluations are consistent with the business principle of making returns on investment. Organizational investments in improving process quality entail providing resources, allocating adequate time, and channeling collective efforts to embrace progressive approaches. On the other hand, returns are the actual outcomes of implementing quality improvement initiatives.
It is essential to assess whether they align with the proposed outcomes and project expectations during and after enacting mentorship programs for newly employed nurses. In this case, the implementation team must evaluate if mentoring new nurses promote their confidence, ability to translate theoretical knowledge to real-life practice, and conformity to organizational objectives.
Therefore, it is vital to conduct monthly evaluations to identify strengths, weaknesses, and areas of improvement for nursing mentorship programs. Also, the implementation team should consider conducting post-implementation evaluations, especially 1-2 years after the completion of mentorship initiatives, to determine their variability and the plausibility of replicating the programs to ensure continuity.
During monthly evaluation exercises, it is possible to embrace Kirkpatrick’s process assessment model to identify the immediate impacts of mentorship programs on new nurses’ experiences, competencies, and confidence. Kirkpatrick’s evaluation framework requires the evaluation team to assess four themes; reactions, learning outcomes, behaviors, and results Heydari et al. (2019). Reactions entail mentees’ perceptions and mindset regarding training and mentorship programs. It is possible to investigate how they perceive these interventions by obtaining their feedback and responses to the schedule. Supposing nurses view nursing mentorship schedules and engagements as insightful and relevant to their career development, implementing them is crucial.
Learning outcomes and behavior are complementary indicators of the effectiveness of training and mentorship programs. For instance, learning entails acquiring the knowledge, skills, confidence, and attitudes necessary for proper quality care delivery. Also, it manifests through a commitment to attending mentorship schedules. On the other hand, behavior encompasses the overall changes in performance by implementing the newly-acquired knowledge and competencies. Frequently evaluating learning outcomes and behavioral transformations would provide insights into the effectiveness of mentorship programs in enhancing new nurses’ confidence, competencies, and abilities to thrive in complex healthcare organizations.
Finally, evaluating project outcomes is the goal for the implementation team because it enables them to assess the returns on investment for implementing training and mentorship programs for newly employed nurses. According to Heydari et al. (2019), the evaluation process for quality improvement initiatives entails assessing how such projects influence key performance indicators (KPIs).
As stated earlier, the primary objectives of implementing mentorship programs for new nurses are to safeguard their retention and avert challenges that face them during student to professional transitions. As a result, the implementation team should evaluate the plausibility of these programs in addressing intentions to quit, conformity issues, and enhancing operational confidence. If nursing mentorship initiatives fulfill these indicators, it is essential to replicate and sustain them as new norms.
Apart from incorporating Kirkpatrick’s evaluation model when conducting frequent and post-implementation assessments for mentorship programs, it is essential to consider Patricia Benner’s novice to the expert framework. Based on Thomas & Kellgren’s (2017) assessment, Benner categorized nurses in five levels, including novice, advanced beginners, competent, proficient, and expert, depending on their practical and decision-making competencies.
Since newly registered nurses fall in the novice category, Benner’s model enables experienced clinicians to monitor their progress as they ascend the competency hierarchy. For example, mentorship programs for newly employed nurses should allow them to advance their problem-solving and decision-making abilities to the competent level or above. Therefore, this model offers ideal guidelines for conducting post-implementation evaluation by categorizing new nurses in any of the five groups depending on the impacts of mentorship programs.
Plenty of scholarly studies propose mentorship programs for new nurses as effective interventions for addressing challenges during student-to-professional transitions. Compared to preceptorship and orientation, mentorship allows for lengthy socialization between mentors and mentees and enhances the support system, addressing confidence and conformity issues. The success of mentorship programs relies massively upon various approaches, including organizational need assessment, aligning mission to the strategic objectives, allocating adequate resources, developing collaboration between stakeholders, and process evaluation.
Nurse leaders, advanced practice registered nurses (APRNS), registered nurses (RNs), organizational leadership, mentors, and trainees should ensure that their respective responsibilities align with the project objectives. For example, APRNs and nurse leaders are responsible for educating others and utilizing their expertise to convince staff members about the importance of mentoring new nurses. Further, they are responsible for collaborating with other stakeholders to develop reevaluation and frequent assessment strategies.
Since the organization must realize returns on investment for implementing mentorship programs, the implementation team should conduct pre-implementation, ongoing assessments, and post-implementation evaluation using Kirkpatrick’s evaluation framework and Benner’s novice to expert model to identify whether the project is consistent with strategic objectives. Also, stakeholders should consider Kurt Lewin’s change theory when implementing mentorship programs because it proposes interventions for addressing restraining factors, change enactment, and sustenance.
While organizations endeavor to promote effective student-to-professional transitions for new nurses, scholarly studies recommend that institutions address new nurses’ challenges. Novice nurses face complexities as they balance between conforming to new situations, delivering quality care, and translating theoretical knowledge to real-life practice. Therefore, some viable recommendations for effective mentorship programs include proper pre-implementation planning, adequate resources for mentorship programs, stakeholder engagement and education, team performance, timely evaluation processes, and process reflection.
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