Patient Outcomes and Sustainable Change

QUESTION: Reflecting on the “IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care,” describe the role of the DNP-prepared nurse in managing costs. Identify one common barrier to cost management and inappropriate resource use. Discuss a change theory and how it can be applied in nursing practice to integrate sustainable care delivery. Provide supporting evidence.
Bonnie Flores
Dec 8, 2022, 7:59 AM
The IHI Module TA 103 illustrated the inefficiencies in the healthcare system and further examined how each person in the system contributes to waste, thus impacting patients, providers, and communities. The United States spends more on healthcare than any other nation, which does not necessarily contribute to care that is of higher value, but rather points to our gross waste (Ciarametaro et al., 2021). As much as $265 billion healthcare dollars are wasted each year in the United States (Broussard et al., 2019). This is money that can be spent on research for disease, medications, education, housing, and building community centers to name a few. Much of the wasted resources come from medical errors, which amounted to nearly $20 billion dollars over a decade ago (Rathi et al., 2022). The cost is not merely in dollars spent, but in lives lost; therefore, all healthcare providers can be partners in helping to reduce financial waste, which will help improve patient safety.
The doctoral-prepared nurse can play a vital role in helping to mitigate waste and manage costs. For example, as a nurse leader education can be provided to staff and other managers on the unit cost per item on the nursing unit so that par levels can be used for each patient admission. Additionally, policies and procedures can be put into effect that limits unnecessary waste. As a leader of a unit council or shared-governance committee, the doctoral nurse can implement a cost-savings change project using a Plan-Do-Study-Act cycle and Kurt Lewin’s Change Model.
Lewin’s Model is a simple 3-step process, unfreezing, change, and refreezing (Abdel-shafy et al., 2019). In the unfreezing step, changes need to be identified, addressed, and education will be provided (Abdel-shafy et al., 2019). For example, if we want to do a cost-savings plan, we will identify where the waste is occurring. There is often much waste of supplies that are taken into patients’ rooms and then not used. Therefore, we identify that we need to limit the supplies that go into the room. Once all the staff education has been provided, we will move on to the next step… change. A process will be put into place where before supplies are taken into the room they can be placed on a cart outside the room and brought in as needed. Once the supplies enter the patient’s room, they are considered contaminated and must be discarded if not used, but those that do not go into the room can be returned to the supply closet. During this time, continuing education will be provided, cost of supply and supply usage will be tracked. The final step is the refreezing step, which is when the change is sustained, and the new process becomes the new standard of practice (Abdel-shafy et al., 2019). The greatest barrier to this potential project would be the resistance to change by the staff. There will be push-back that this will take extra time and may still lead to waste. However, once all staff are educated on the unit price of each item wasted and can see an actual number of how much money was saved, this has the potential to lead to a culture shift where all individuals on the unit become resource stewards, thus helping to ensure equitable appropriation of funding.
References
Abdel-shafy, I., Zapke, J., Sargeant, D., Prince, J. & Christopherson, N. (2019). Decreased Pediatric Trauma Length of Stay and Improved Disposition With Implementation of Lewin’s Change Model. Journal of Trauma Nursing, 26 (2), 84-88. doi: 10.1097/JTN.0000000000000426.
Broussard, B. D. (2019, October 7). Op-Ed: Humana study reveals $265 billion wasted on health care each year in the US. CNBC. Retrieved on December 7, 2022, from https://www.cnbc.com/2019/10/07/study-reveals-265-billion-wasted-on-health-care-each-year-in-us.html
Ciarametaro, M., Houghton, K., Wamble, D., & Dubois, R. (2021). The Dollar or Disease Burden: Caps on Healthcare Spending May Save Money, but at What “Cost” to Patients?. Value in Health, 24(3), 388-396.
Rathi, R., Vakharia, A., & Shadab, M. (2022). Lean six sigma in the healthcare sector: A systematic literature review. Materials Today: Proceedings, 50, 773-781.

Misty Walton
The ¨IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care” covered many vital topics to for nursing leaders, providers and healthcare employees to consider, especially with healthcare reform. The topics included points for the Doctor of Nursing Practice (DNP) prepared nurse to consider to help manage costs in healthcare and the equation to consider producing high valued care at the lowest possible cost (Institute of Health, 2022). The role of the DNP-prepared nurse in managing costs is to provide optimal education and information to the patient to empower them. The DNP-prepared nurse seeks innovative care models to reduce costs and improve outcomes through applying evidence based practice, while also advocating for policy changes as needed (Kleinpell, 2021).
There are numerous barriers to cost management and appropriate allocation of resources in healthcare that have also been highlighted more during the COVID-19 pandemic. The lack of feedback is one barrier that is identified in the module, as well as incentives for overuse. Focusing on understanding the barriers helps to develop action plans and goals to address them.
Becker et al., (2021) discussed the implementation and sustainability of the bedside shift report to improve the quality of care received, minimize adverse events and engage the patients. The application of Lewin´s change model will help to embed the bedside shift report into nursing practice. Lewin´s change model involves three steps, unfreezing, moving and refreezing (Abd El-Shathfy et al., 2019). The application of Lewin´s change theory will support the quality improvement project of bedside report through unfreezing to gain buy in from the stakeholders and educate to the process. This is the most challenging phase, which benefits from the leader sharing the drive is to prevent miscommunication and errors to improve patient quality and safety, which also reduces costs for the consumer and the oranization (Nelson & Chipps, 2021). The moving phase motivates the team to complete bedside shift report (Abd El-Shafy et al., 2019) . During the refreezing phase bedside shift report is sustained in practice through positive reinforcements and celebrating the wins. The key to success also lies in the development to on-boarding new teammates to the standard process of bedside shift report.

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