Financial Impact and Sustainability

Current Financial Impact

The immediate financial impact of the project implementation of the standardized narcotic waste process impacts both the organization and the patients of the organization. The total cost to implement is $1,600: $300 for training materials and pocket cards; $800 for 30-minute staff training sessions at four different times; $100 for printing the documentation forms; and $400 for weekly audit time. These expenses are being funded through a combination of the unit’s operational budget allocation ($1,000) and a special quality improvement grant ($600) secured from the hospital’s patient safety initiative fund: Financial Impact and Sustainability.

The funding allocation was approved after presenting a detailed cost-benefit analysis to both the unit administration and the hospital’s quality improvement committee. The human resource costs are in the form of staff time used for training and documentation. The material resources include physical tools for documentation and educational materials.

The project has already realized a positive financial return via time saved investigating narcotic discrepancies. Estimated savings of $3,000 per month are based on three main sources: reduction in staff time used to investigate medication discrepancies, decreased risk of regulatory fines, and prevention of lost medications. This rapid return on investment has been crucial in maintaining administrative support for the initiative. These gains in efficiency are most dramatic in the reduction of investigation time that had previously consumed significant nursing hours that can now be freed up for direct patient care activities.

Future Financial Impact

The future financial impact of the project appears very promising due to the reasons for sustainability. The projected ongoing costs include maintaining the training materials at $100 quarterly for updates and replacements, continued audit time at $400 per month, and periodic refresher training sessions at $200 quarterly. These ongoing expenses will be funded through two primary sources: first, through the reallocation of cost savings achieved from reduced investigation time and medication loss prevention, which will cover approximately 70% of ongoing costs; second, through the unit’s annual operational budget, which has now incorporated these expenses as a standard line item for quality and safety maintenance.

The unit manager has secured a written commitment from hospital administration to maintain this funding structure for at least the next three fiscal years, ensuring the long-term sustainability of the program. The implementation team has further highlighted opportunities for further optimization by converting some training materials to digital formats and incorporating audit processes into workflow systems.

Long-term financial benefits will rise accordingly with increased staff efficiency and reduced error rates. Assuming continued reduction in investigation time, near elimination of regulatory compliance issues, and optimized medication management, the estimated annual savings could be as high as $36,000 per year. This standardized process should also reduce potential liability costs related to medication errors, although those savings are more difficult to quantify precisely. The team has also identified some possible secondary financial benefits, such as reduced insurance premiums due to better risk management and increased staff satisfaction leading to reduced turnover rates, which could result in additional cost savings through reduced recruitment and training expenses.

Modifications Due to Financial Considerations

These financial constraints have brought about several changes to the original design of the project in an effort to still sustain project effectiveness. First, training approach adjustments have gone to video recording of sessions so that not as many live training sessions would be required, which also cuts overtime and related employee costs. A hybrid model of training is cost-effective but will facilitate easier access for all shifts.

Second, the initial plan for printed documentation materials was, where possible, changed to electronic formats. This reduces ongoing printing costs while maintaining accessibility. The pocket cards remain in physical form due to their importance for point-of-care reference, but other documentation has been integrated into existing electronic systems.

Thirdly, it reorganized the audit process to fold into the usual charge nurse activities and reduced some personnel previously dedicated solely to auditing while maintaining effectiveness of the oversight. Such a modification aids in keeping the costs lower but with sustained monitoring of compliance rates.

Sustainability Planning

The sustainability of this project well extends beyond when the coursework completion for NUR-495 occurs. Salient components of this include the process of two-nurse verification, documentation compliance, and staff education. These will be essential in maintaining the regulatory compliance for standards of patient safety as provided by both the DEA and the Joint Commission requirements (Environmental Health & Safety, 2024).

Some of the specific resources and stakeholder collaborations established for the sustainability of this project include ongoing pharmacy department liaison support, as well as integration into unit management through regular compliance monitoring. According to Hussein et al. (2021), the success of a healthcare quality project is determined by the persistence of organizational commitment to the change and integrated business processes reflecting that.

The quarterly review meetings featuring nursing leadership, pharmacy representatives, and compliance officers will assess the compliance data, emerging challenges, and process adjustments. In addition, because the project was integrated into the unit’s regular quality improvement initiative, ongoing attention and resources were assured. Training sustainability will be ensured through the hybrid learning system put in place, with refreshing of materials every quarter to reflect any changes in regulation or improvement in process. New staff orientation programs have been revamped to include detailed covers of the narcotic waste procedures, so that correct knowledge transfer will occur with changes in staff.

As Heagney (2022) emphasizes, the success of project sustainability often relies on clear ownership and accountability structures. In that regard, clear roles have been assigned in the design to account for continued monitoring and maintenance of the program, where charge nurses are responsible for day-to-day oversight and the unit manager for executive sponsorship.

References

Environmental Health & Safety. (2024). DEA controlled substances program manual. University of Oregon. https://safety.uoregon.edu/sites/default/files/manual_dea_controlled_substances_program_2023_rev.pdf

Heagney, J. (2022). Fundamentals of project management (6th ed.). AMACOM.

Hussein, M., Pavlova, M., Ghalwash, M., & Groot, W. (2021). The impact of hospital accreditation on the quality of healthcare: A systematic literature review. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-07097-6

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Getting Started

Throughout the NUR-495 course, you will actively engage in strategically planning for and managing a planned change project within the scope of your current professional role.  For this field-based project, you will identify a specific problem or need to serve as the foundation for a faculty-guided capstone experience.  Project-related experiences are integrated throughout the course, and will involve application of strategic planning and management processes.

As you consider the activities necessary to implement your capstone project, you will find many similarities between the “planning and implementation” phases of the nursing process to the “work schedule” used to guide the capstone project.  In both cases, these steps serve as an action plan to direct specific activities and tasks that will facilitate achieving a specific outcome.  In the case of your capstone project, the work schedule you developed in Workshop Three serves as a dynamic plan to communicate the activities and tasks that are necessary to perform to successfully achieve your project outcome. 

During Workshop Four, you identified potential threats or challenges to the capstone project, as well as a contingency plan to address those concerns.  This week, you will specifically focus on the financial impact of the capstone project and the sustainability of the planned change within your organization over time.

Upon successful completion of the course material, you will be able to:

• Assess the financial impact and sustainability of the capstone project.
• Implement the activities of your strategic plan necessary to complete the capstone project.

Resources

• Textbook: Fundamentals of Project Management
• Website: United States Department of Labor Sustainability Toolkit

Background Information

As discussed in Workshop One, the planned change process is rather iterative in nature, with dynamics that are organic rather than static.  For this reason, we tend to think of a planned change project as a work in continual process.  With each workshop, you will polish and fine-tune aspects of your plan as part of the learning process.  Each facet of the planned change process will be unpacked, examined, and critically applied to your capstone project. 

As you advance in the course, each workshop will bring an opportunity to carefully reflect upon and streamline your work.  When the capstone course ends, your final project documentation will accurately articulate the planned change process that you have created and managed.

In the previous workshops, you considered a variety of factors that affect the change process, established a problem statement, plan for evaluation, and detailed work schedule to guide the capstone project.  In addition, you examined potential threats and challenges to the capstone project.

In this workshop, you will assess the present and future financial impact of the capstone project, as well as any modifications to the plan that may result from financial constraints.  In addition, you will consider the sustainability of the project, identifying specific measures and resources necessary to maintain the change once the formal work of the capstone is complete.

Please note: Eight hours of workshop time is allocated for your efforts in this assignment since this work does not directly pertain to your 7.3 Capstone Project Presentation.

Instructions

1. Review the rubric to make sure you understand the criteria for earning your grade.
2. Review chapter 20 in Leading and Managing in Nursing.
3. Review Chapter 12 in the Fundamentals of Project Management textbook.
4. Visit the Department of Labor’s Trade Adjustment Assistance Community College and Career Training Program Sustainability Toolkit page at https://taaccct.workforcegps.org/resources/2016/07/25/13/22/Resource_TAACCCTSustainabilityToolkit.
   1. Please go to the “Related Content” on the left side of the webpage, select and read the “TAACCCT Sustainability Toolkit.
5. Revisit the capstone work you completed in the previous workshops, as well as any instructor feedback that you received.
6. Navigate to the threaded discussion and respond to the following:
   1. What is the current financial impact of your capstone project on the organization and the patient?  Explain current costs involved with project implementation, and how those expenses are being funded.  (Be sure to include the cost of both human and material resources, as well as savings realized through the initiative.)
   2. What is the future financial impact of your capstone project on the organization and the patient?  Explain projected costs necessary to sustain the change project, and how those expenses will be funded.  (Be sure to include the cost of both human and material resources, as well as savings projected for the future.)
   3. Identify and explain any modifications to the capstone project that are necessary because of financial considerations.
   4. Describe the project-related activities you want to sustain after your NUR-495 coursework is complete, and explain how sustaining these elements of the project will benefit the organization.  Include specific resources, stakeholders, and collaboration necessary to sustain your change initiative.
   5. Cite and reference a minimum of one source for your initial posting.
7. Your initial post is due by the end of the fourth day of the workshop.
8. Read and respond to at least two of your classmates’ postings by the end of the workshop.  You are encouraged to respond to instructor follow-up questions directed to you.
9. Your postings should also:
   1. Be well developed by providing clear answers with evidence of critical thinking.
   2. Your observations should add greater depth to the discussion by introducing new ideas.
   3. Provide clarification to classmates’ questions and provide insight into the discussion.
   4. Be posted on two different days during the workshop.