Organizational Change Plan - Part II
Crystal Muir
University of Phoenix
Creating Change within Organizations
HCS/587
Virginia Weatherston
July 16, 2014

Organizational Change Plan - Part II
Patient satisfaction scores related to pain management continues to be a struggle at Banner Hospital, so it is important that a new pain management process becomes implemented. If nurses become better educated on pain management and how to asses it, if pain goals are discussed and written on the whiteboards, and if pain assessments are included in hourly rounding, pain would be better controlled and patient satisfaction scores would increase. Change, however, is never easy to implement. Once change begins, monitoring the implementation process is important to evaluate the effectiveness, the quality of the change, and how it will affect staffing. Communication also plays a vital role in the implementing process, as keeping everyone informed and empowered is important in order for change to be successful.
The proposed solution to help implement the change would be to hold educational programs about pain management and assessments that each and every medical-surgical unit nurse would need to attend. The educational program will be held three times per week for each shift to complete. The program will be mandatory and each week a certain nursing unit will be assigned until all units/nurses have attended the educational program. The educational program for pain management and assessment will teach nurses about the pain process, how to assess it visually and through communication, and what interventions can be done to help manage it. The educational program will also teach nurses on how to use assessment tools for pain and how to explain the importance on educating the patient on an achievable pain goal.
The rationale for selecting this type of proposed solution is based on evidence based research. A research study showed that nurses’ knowledge on pain management and pain policies was extremely lower than expected. If each facility or unit would use a pain management policy such as a mandatory educational program it could significantly affect nursing to practice and create better pain management (Alley, 2001). In a research study conducted by Linkewich et al. (2007) an educational program for pain management was developed and evaluated to see if it was effective in changing the attitudes and practices of nurses regarding pain management. The findings of the program actually showed that nurses had a high satisfaction with the program with a better understanding of pain management after attending the program (Linkewich et al., 2007). Another evidence based research article showed proof that nurses did not usually assess pain, would give insufficient pain medications and where unaware of other interventions besides pain medications to manage pain. The findings of this particular evidence based research study are also the rationale that a conducting an educational program on pain management and assessment needs to be implemented (Francke, Garssen, Huijer Abu-Saad, & Grypdonck, 1996).
To monitor the implementation of integrating a pain management educational program would involve having each unit manager assuring that each nurse has completed the program. After each nurse on the unit has completed the program, the manager can delegate some of the responsibility to make sure that nurses are doing an adequate assessment of pain, are writing pain goals on the whiteboards and are assessing pain in hourly rounding. The unit managers can do chart audits to make sure pain is being assessed and reassessed after pharmacological or non-pharmacological interventions are given. The current charting system already places a reminder to reassess pain after pain medication is given, so making sure this reassessment is completed will be audited as well. If the patient’s pain score did not decrease, management will audit if other interventions where offered or given. The audits of making sure that pain goals are written on the patients’ whiteboards can be delegated to nursing assistants or volunteers by having them check the whiteboards up to three times per week. Audits on the pain goals will be assessed at the end of the month to see what each nurse’s percentage is on using the new process. The audits of assessing pain with hourly rounding can be completed by volunteers as well, or management when doing their daily rounding. To implement pain assessments in hourly rounding, a pain column will be added to the hourly rounding form. This column can be filled in by the nurse or nursing assistant on the hour that the patient’s pain was assessed. If pain is not an issue a simple check mark can by placed or a star along with the time if a pain intervention was needed. If it is the nursing assistant that is rounding on the patient and a pharmacological pain intervention is needed, it will need to be reported to the nurse. Otherwise the nursing assistant can aid in some non-pharmacological interventions such as re-positioning the patient. At the end of each month, hourly rounding forms will also be evaluated to make sure nurses and nursing assistants are using the forms. Once patient satisfaction scores related to pain management have successful rates, the hourly rounding forms can be removed. A researcher will be added to aid in monitoring and evaluating the process of pain knowledge among nurses along with proper assessments of pain. Evaluating the process of pain knowledge will be evaluated by questionnaires done before and after the educational program to make sure that the nurse gained an increase in knowledge. If a nurses knowledge did not increase based on the before and after questionnaire after taking the education program, a requirement for them to repeat the program will be implemented. Questionnaires will also be given out randomly to patients while hospitalized after the process has been initiating to evaluate the patients pain, to see if it was assessed, and if it was adequately managed. These results of the ongoing research and audits that will be conducted will give results on which units and/or nurses are lacking in managing pain so the unit managers can implement a more strict policy.
The daily ritual of a nurse will be impacted in the change as we are asking nursing to be more attentive to pain management that will reflect in charting and hourly rounding forms. The nurse will be required to sign up for the educational program on a day off, will need to discuss, explain and write pain goals on the patients’ whiteboards at the start of each shift, and continuously assess and treat pain throughout the day in hourly rounding. Nursing assistants will be required to be more attentive to pain management as well throughout their shift that will also need to reflect in the hourly rounding forms. Nursing assistants will need to manage time in their shift if they are asked to audit the pain goals on the whiteboards. Volunteers will need to do the same in managing time in their shift if asked to audit pain goals and/or hourly rounding forms. Management will play an important role assuring that staffing stays adequate during the educational program classes. Management will need to set aside time in order to audit charting, pain goal percentages, and hourly rounding sheets to make sure pain assessments are being charted and pain is being adequately treated. Management also needs to keep a positive authentic leadership style so staff will continuously accept and engage in the new changes (McColgan, 2012).
The communication techniques used to address any implementation issues that arise will be through proper communication. Management will listen to their employees, making all employees feel important and recognizing their contributions. These techniques will build trust between management and their staff along with promoting openness and developing a more productive implementation process. These techniques are done through management taking time to really ask how things are going, by really listening management can find out what works and what needs more attention. Promoting team work by having all staff working together to raise the patient satisfaction scores will help implement change because if staff helps change the scores for the better, they will also help to continue and support the new process. Providing regular feedback is another technique in proper communication that will aid in helping smooth over any implementation issues. Most often feedback is only used for the negative, pointing out what staff is doing well along with what areas still need improvement goes a long way in preventing resistance (Cornell, 1993).
Change is something that is not always easy to accept as it takes sacrificing time and requires commitment. However, in order for a hospital to survive it needs to compete to have better patient experiences over other community hospitals, so the desirability for patients to seek health care with them is greater. Banner Hospital needs to take measures to help reduce pain as this is important for giving patients a good patient experience during their hospitalization. Implementing a pain management education program, writing achievable pain goals on the whiteboards, and assessing pain in hourly rounding are the vital actions to improve these measures.

References
Alley, L. (2001). The Influence of an Organizational Pain Management Policy on Nurses’ Pain Management Practices. ONF, 28, 867-874.
Cornell, D. (1993). Say the words: Communication techniques. Nursing Management, 24(3). 42. Retrieved from http://serch.proquest.com/docview/231352985?accountid=458
Francke, A., Garssen, B., Huijer Abu-Saad, H., & Grypdonck, M. (1996). Qualitative Needs Assessment Prior to a Continuing Education Program. The Journal of Continuing Education in Nursing, 27, 34-41.
Linkewich, B., Sevean, P., Habjan, S., Poling, M., Bailey, S., & Kortes-Miller, K. (2007). Educating for Tomorrow:Enhancing Nurses’ Pain Management Knowledge. Canadian Nurse, 24-48.
McColgan, K. (2012). Managing change. The Journal of Preoperative Practice , 22, 10.