The healthcare setting chosen is the Veteran Affairs Hospital in New York (Manhattan Campus). The United States Department of Veteran Affairs deals with the provision of medical care, health, and wellness of the members of the United States Defense forces. The VHA (Veterans Health Administration) provides care to nine million veterans annually at 1255 facilities. The Manhattan VA Medical Center operates 24/7 and provides a wide range of services. The hospital provides surgery, emergency care, psychiatry, rehabilitation medicine, neurology, and inpatient and outpatient internal medicine services. The facility provides care for all veterans (spanning the diverse ethnicities and ages) and Patient and Family Centered Care Tool is one of the tools that is heavily used.
Area of Improvement
The main weakness identified in the evaluation is the patient’s access to his/her paper/electronic records. At the Manhattan VA Campus, the patients are denied access to their paper/electronic records. It is important to note that the VHA has been painfully slow in its adoption of integrated EHR (Electronic health records). The existing patient records are stored on VistA (Veterans Information Systems and Technology Architecture) (Bokhor et la., 2018). The systems are not integrated, and as such, there is not seamless information sharing, and neither is there any interoperability between the VA and the Department of Defense systems.
When it comes to, Patient and Family Centered Care Tool, the main issue in this strategy is to improve patient’s access to their paper/electronic health records. The approach chosen to enhance this facility in the Manhattan VA campus has two phases. The first phase deals with the physical provision of patient records (through the hard-copy files). This strategy allows physicians to hand the patients their records and reviewing them together physically. This will enable the patients to track their progress over the recorded visits. From this, strategies for better care can be developed.
The second part of the strategy involves the provision of access to electronic health records. The first thing to note here is the VA is currently using legacy systems to store patient information. As such, there are many issues to be considered when navigating the issue of access for patients. First, the system must be analyzed to assess whether it can support multiple concurrent users and whether it is secure enough. It is an expensive and tedious affair for the organization. Therefore, the best strategy is to promote the adoption of electronic health records (EHR). With the creation of EHR, patients will have facilities for users to log in and access their records from any remote location as long as they have the correct authentications and credentials.
System or Change Theory
The best theory to underpin the strategic implementation of proposed changes is Lewin’s change theory. This theory is also called the unfreezing-change-refreezing model. Under this model, Lewin contends that leaders must seek to acquire new knowledge and use it to replace the old knowledge. The theory stipulates that for change to be implemented within an organization, the leader of the process must begin by identifying the different forces acting within the organization and their potency (Allen, 2016). It is only after determining these forces that one can ascertain those to be strengthened or diminished to effect change.
There are two main types of forces that act within an organization; driving and restraining forces. The driving forces are tasked with pushing and facilitating change. In contrast, the restraining forces work to counteract the driving forces and frustrate efforts for change. Therefore, if a change is to occur, one can either choose to strengthen the driving forces or weaken the restraining forces.
Scholars continue to stipulate that Lewin’s model (also known as the force field model) has three main stages (unfreezing, change, and refreezing). The first stage (unfreezing) entails the establishment of the best technique to facilitate the development of change, especially among the people involved. The phase entails the ‘shaking up’ of the organization to create disruption that will facilitate the establishment of the driving and restraining forces (Allen, 2016). In the proposed strategy, the researcher needs to develop a multi-disciplinary team to effectively execute all three phases and ensure that change is successfully implemented. The team will begin by interacting with the members of the facility to evaluate the driving and restraining forces.
The second phase involves the promotion of change in the feelings, perceptions, and behaviors of the people. For the team to achieve this, they must persuade the members of the facility (VA hospital) that the current status quo is neither effective nor beneficial. They must also promote fresh perspectives on how change can benefit both the facility and its patients. The team should also work with the stakeholders of the facility to collect important information that can help in promoting the acceptance and implementation of change. The other significant activity is interacting with leaders in the facility and the organization and convincing them to support the proposed changes (Conroy, 2010). Success in this stage is dependent on effective communication between the team members.
The final step (refreezing) entails the implementation of change and its establishment as the new norm. After the change has been accepted and implemented, the team needs to stick around and help the people navigate and settle for the change. The main aim of this final stage is to develop a new norm and associate it with improved expectations. For example, in this case, the improved expectations are a leaner administration, improved quality of care, and enhanced productivity (both financial and human resource-wise).
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