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Can a Nursing Change Model Help Improve Performance and Outcomes Related to Transitions of Care and Readmissions?

Transitions of care and especially readmission rates have long been on the minds and featured heavily on the dashboards of the nation’s healthcare leaders. Hospitals are consistently working to develop strategies that would help them reduce readmissions and ensure safer care for patients. Publicly-reported measures that show hospital performance on transitions of care measures and financial penalties for poor performance on those measures have served to further focus attention on the issue.

While practices such as collaborative clinical leadership, regular inter-disciplinary meetings, and thorough communication of the patient’s clinical needs are helping to improve performance on the transitions of care measures, there is another factor that may often be overlooked. How prepared is the patient for the transition? Are they able to embrace new therapies, changes in therapies, new medications, or the location in which those treatments occur? Organizations who wish to continue to improve performance on transitions of care measures need to understand how to help patients embrace the changes that will help ensure a safe and healthy transition.

Learning from Change to Improve Healthcare Outcomes

Change is the baseline in healthcare. The need for change in healthcare can be driven by clinical innovations, regulatory requirements, and the pressures of shifting rules regarding reimbursement. When the topic is change models for healthcare (and other industry segments) Lewin’s Change Theory will usually be mentioned early in the discussion. The model is deceptively-simple with just three phases, but more complex when one takes a deeper dive into the driving forces that can drive or inhibit change.

The three stages in Lewin’s change model in nursing are:

  1. Unfreezing – In this stage, leaders need to identify and help the team let go of old behaviors, beliefs, and processes that were counterproductive.
  2. Change – In the second stage, processes, behaviors, and thoughts are changed to embrace new processes, behaviors and thoughts that are more productive.
  3. Refreezing – In the third and final stage, the new processes are incorporated to the point of becoming the new standard.

In addition to the three stages of change, it is also important to understand the forces that Lewin believes influence whether or not change occurs and the pace at which it happens. Driving forces are those that push towards or facilitate change. Restraining forces represent opposition or hindrance to change. Finally, equilibrium occurs when the first two forces are equal and no change can take place. Equilibrium can be disturbed when the strength of one of the two forces is changed.

Changing Patient Behaviors  

Lewin’s model comes to mind most often when leaders think about managing organizational change, but once the stages and forces are described, it is clear that it can be used to address changing patient behaviors in pursuit of improved outcomes, particularly the critical ones—those that might be responsible for an un-scheduled hospital readmission, which can have a devastating impact on the patient, family, and organization involved.

  • Unfreezing Patient Behaviors – Whether the patient is being discharged with a newly-diagnosed chronic condition or simply needing to manage their post-operative health, there may be a need to unfreeze certain behaviors. The staff will first need to identify those restraining forces that might inhibit needed change. Are there medications that are no longer appropriate and new ones that will be more beneficial? Are there lifestyle changes that will need to be made? Does the patient understand these changes? Is there support from the patient’s family and caregivers for new treatments and therapies? Have all concerns or questions been addressed?
  • Changing Patient Behaviors – Plan the changes. If the patient will be on new medications, have arrangements been made to get those medications and has the patient been educated on how and when to take them? If physical therapy, home health, or other therapies will begin or continue after discharge, has the patient and family been appropriately connected with those resources? It is also important to educate throughout the hospitalization and through to the discharge process to help patients and family members embrace these changes.
  • Refreezing Patient Behaviors – In this stage, the patient will need ongoing strategies to reinforce the changes to the point where they become habits. When possible, family members should be included.

Learning about change models and how to encourage change in patients is an important part of nursing training. HealthStream provides multiple options for healthcare organizations to improve outcomes through employees’ clinical development, from improving perinatal outcomes and supporting responsible opioid administration to decreasing ED errors and helping the MedTech industry provide new pharmaceutical and medical device training. In addition, access to HealthStream’s CE options for nurses helps healthcare providers support their lifelong learning.

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