Interdisciplinary Plan Proposal for Cedarwood Medical Center

At Cedarwood Medical Center, the focus is always on the achievement of better results at the patient level as well as better performance of the organization. Our priorities include rubbed discharge planning, which has been recognized to cause delays, befuddled communication of post-discharge care, and high rates of readmissions. These inefficiencies are enumerated in this proposal, and to address them, an evidence-based interdisciplinary approach that seeks to enhance communication and, consequently, the discharge planning process is presented: Interdisciplinary Plan Proposal for Cedarwood Medical Center.

This plan aims to establish a formal and coordinated team discharge plan to reduce the readmission rate and time to discharge and increase patient satisfaction. This plan shall improve the collaboration of nurses, physicians, pharmacists, and social workers as they deliver services to patients, drive improved patient outcomes, lower operational costs, and contain inefficiencies.

Interdisciplinary Collaboration

Specifically, this intervention aims to enhance the discharge planning sector since its execution involves a collective effort of different disciplines. The interdisciplinary team will include several key stakeholders.

Nurses

They are in charge of acting as a point of contact for patients with other caregivers within the health care system, educating the patient on the discharge instructions, and helping to arrange appointment schedules.

Physicians

They finalize medical treatment plans, decide whether to discharge a patient, and ensure that the patient’s medical condition is stable.

Pharmacists

They conduct medication reconciliation and ensure that patients are properly educated on post-discharge medications.

Social Workers

They assess social needs and arrange for home care, transportation, or any other necessary post-discharge support.

As a part of the implementation of the changes, interdisciplinary rounds will be conducted, and standardized discharge checklists will be implemented. Studies indicate that implementation of these technologies creates better communication, increases team cohesion, and decreases the chance of patient reincarnation (Heip et al., 2020). The values from TeamSTEPPS implementation will also increase interdisciplinary collaboration and communication to guarantee the assessment of the discharge plan is safe and specific to the patient.

To encourage team effort from an early stage in the discharge process, it is natural that every team member contributes their skills to implement the most effective discharge plan. This will help improve the quality of care, reduce patient wait time, and consequently increase patient satisfaction.

Change Theory and Leadership Strategy

The implementation of this interdisciplinary solution will be guided by Lewin’s Change Management Model, which consists of three stages: Unfreezing, Changing, and Refreezing (Stanz et al., 2021).

Unfreezing

The initial state entails sensitizing stakeholders and other members of the public about the inconsonant discharges that are already taking place. Leadership will use data regarding the current discharge process to mobilize stakeholders such as nurses, physicians, pharmacists, and social workers in an endeavor to gain their support. It is essential to have the same perception of the problem when asking for support for the change.

Changing

Based on the proposed framework and following the educative stage, the interdisciplinary discharge planning protocol will be implemented. Some of these tools will be the interdisciplinary rounds, the discharge-to-home checklist, and the computer-based tools that enable the tracking of discharge-related tasks. It will be possible to call meetings aimed at discussing these novelties and their implications for the work of all team members (Gonçalves-Bradley et al., 2022).

Refreezing

The last activity will be to integrate and institutionalize the changes in the discharge process into the policy framework and practice of the hospitals. Performance feedback, training and evaluation feedback, and other reinforcement methods will often be employed to guarantee the integration of the new practices as the ideal organizational culture for the long run. Notably, transformational leadership will play a key role in driving this change.

Transformational leaders ensure that people in the group are encouraged to participate in the change process because of the shared vision (Ystaas et al., 2023). In this case, transformational leaders will involve other members of the interdisciplinary team to own the discharge planning process. It will also facilitate communication, promote information sharing, and foster cooperation and transformation support to various populations in need of change.

Organizational Resources and Financial Budget

The success of this plan will require several key organizational resources, including human, technology, and financial resources.

Human Resources

Discharge begins with input from and requires collaboration with several professionals, including RNs, physicians, pharmacists, social workers, and administrative personnel. All the team members will need orientation to be ready and able to understand and participate in the interdisciplinary rounds as spelled out by the plan.

Technology

An electronic discharge tool will have to be implemented because communication and journaling tasks will have to occur. This tool will be integrated into the hospital’s electronic health record and will help to make sure that there is unity of understanding across all relevant disciplines as to what tasks are to be done upon discharge.

Financial Resources

The implementation of this plan requires financial investment for training, technology, and staff time. The proposed budget is as follows:

Training and Workshops

$12,000 for staff training on the new discharge protocols and interdisciplinary rounds.

Technology (EHR tool integration)

$18,000 will be used to integrate the new discharge tool into Cedarwood Medical Center’s existing system.

Staff Time (for interdisciplinary meetings)

$25,000 to account for the time spent in interdisciplinary rounds and coordination meetings.

Monitoring and Evaluation

$6,000 for data collection, monitoring progress, and evaluating the success of the intervention.

The total estimated cost for executing this project is $6,1000. The inability to correct the flaws in discharge planning will exacerbate delays, hospital readmissions, and unsatisfied patients, thus raising operational costs and even attracting penalties due to non-adherence to good-quality care.

Conclusion

Optimization of the discharge planning process is crucial for increasing cordial patient outcomes and good organizational performance at Cedarwood Medical Center. Lewin’s Change Management Model and transformational leadership will formulate this evidence-based interdisciplinary plan to improve communication, coordination, patient, and safety during the discharge phase. The success of this plan lies in proper resource allocation, such as training, funding for technology, and staff time. This plan will aim to lower readmissions, shorten discharge times, increase patients’ satisfaction, and, therefore, create a better and more efficient environment for satisfactory delivery of care. 

References

Gonçalves-Bradley, D. C., Lannin, N. A., Clemson, L., Cameron, I. D., & Shepperd, S. (2022). Discharge planning from the hospital. Cochrane Database of Systematic Reviews, 2022(2). https://doi.org/10.1002/14651858.cd000313.pub6

Heip, T., Van Hecke, A., Malfait, S., Van Biesen, W., & Eeckloo, K. (2020). The effects of interdisciplinary bedside rounds on patient-centeredness, quality of care, and team collaboration. Journal of Patient Safety, Publish Ahead of Print (18). https://doi.org/10.1097/pts.0000000000000695

Stanz, L., Silverstein, S., Vo, D., & Thompson, J. (2021). Leading through rapid change management. Hospital Pharmacy, 57(4), 422–424. https://doi.org/10.1177/00185787211046855

Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The Impact of Transformational Leadership in the Nursing Work Environment and Patients’ Outcomes: a Systematic Review. Nursing Reports, 13(3), 1271–1290. https://doi.org/10.3390/nursrep13030108

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For this assessment, you will create a 2-4 page plan proposal for an interprofessional team to collaborate and work toward driving improvements in the organizational issue you identified in the second assessment.

Introduction
The health care industry is always striving to improve patient outcomes and attain organizational goals. Nurses can play a critical role in achieving these goals; one way to encourage nurse participation in larger organizational efforts is to create a shared vision and team goals (Mulvale et al., 2016). Participation in interdisciplinary teams can also offer nurses opportunities to share their expertise and leadership skills, fostering a sense of ownership and collegiality.

You are encouraged to complete the Budgeting for Nurses activity before you develop the plan proposal. The activity consists of seven questions that will allow you the opportunity to check your knowledge of budgeting basics and as well as the value of financial resource management. The information gained from completing this formative will promote success with the Interdisciplinary Plan Proposal. Completing this activity also demonstrates your engagement in the course, requires just a few minutes of your time, and is not graded.

Demonstration of Proficiency

• Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
  • Explain organizational resources, including a financial budget, needed for the plan to be a success and the impacts on those resources if nothing is done, related to the improvements sought by the plan.
• Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
  • Describe an objective and predictions for an evidence-based interdisciplinary plan to achieve a specific objective related to improving patient or organizational outcomes.
  • Explain the collaboration needed by an interdisciplinary team to improve the likelihood of achieving the plan’s objective. Include best practices of interdisciplinary collaboration from the literature.
• Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
  • Explain a change theory and a leadership strategy, supported by relevant evidence, that are most likely to help an interdisciplinary team succeed in collaborating and implementing, or creating buy-in for, the project plan.
• Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
  • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
  • Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.

Reference

• Mulvale, G., Embrett, M., & Shaghayegh, D. R. (2016). ‘Gearing up’ to improve interprofessional collaboration in primary care: A systematic review and conceptual framework. BMC Family Practice, 17.

Professional Context
This assessment will allow you to describe a plan proposal that includes an analysis of best practices of interprofessional collaboration, change theory, leadership strategies, and organizational resources with a financial budget that can be used to solve the problem identified through the interview you conducted in the prior assessment.

Scenario
Having reviewed the information gleaned from your professional interview and identified the issue, you will determine and present an objective for an interdisciplinary intervention to address the issue.

Note: You will not be expected to implement the plan during this course. However, the plan should be evidence-based and realistic within the context of the issue and your interviewee’s organization.

Instructions
For this assessment, use the context of the organization where you conducted your interview to develop a viable plan for an interdisciplinary team to address the issue you identified. Define a specific patient or organizational outcome or objective based on the information gathered in your interview.

The goal of this assessment is to clearly lay out the improvement objective for your planned interdisciplinary intervention of the issue you identified. Additionally, be sure to further build on the leadership, change, and collaboration research you completed in the previous assessment. Look for specific, real-world ways in which those strategies and best practices could be applied to encourage buy-in for the plan or facilitate the implementation of the plan for the best possible outcome.

Using the Interdisciplinary Plan Proposal Template [DOCX] Download Interdisciplinary Plan Proposal Template [DOCX]will help you stay organized and concise. As you complete each section of the template, make sure you apply APA format to in-text citations for the evidence and best practices that inform your plan, as well as the reference list at the end.

Additionally, be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

• Describe an objective and predictions for an evidence-based interdisciplinary plan to achieve a specific goal related to improving patient or organizational outcomes.
• Explain a change theory and a leadership strategy, supported by relevant evidence, that is most likely to help an interdisciplinary team succeed in collaborating and implementing, or creating buy-in for, the project plan.
• Explain the collaboration needed by an interdisciplinary team to improve the likelihood of achieving the plan’s objective. Include best practices of interdisciplinary collaboration from the literature.
• Explain organizational resources, including a financial budget, needed for the plan to succeed and the impacts on those resources if the improvements described in the plan are not made.
• Communicate the interdisciplinary plan, with writing that is clear, logically organized, and professional, with correct grammar and spelling, using current APA style.

Additional Requirements

• Length of submission: Use the provided template. Remember that part of this assessment is to make the plan easy to understand and use, so it is critical that you are clear and concise. Most submissions will be 2 to 4 pages in length. Be sure to include a reference page at the end of the plan.
• Number of references: Cite a minimum of 3 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than 5 years old.
• APA formatting: Make sure that in-text citations and reference list follow current APA style.

Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and rubric criteria:

• Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
  • Explain organizational resources, including a financial budget, needed for the plan to succeed and the impacts on those resources if nothing is done to make the improvements sought by the plan.
• Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
  • Explain the collaboration needed by an interdisciplinary team to improve the likelihood of achieving the plan’s objective, including best practices of interdisciplinary collaboration from the literature.
• Competency 3: Describe ways to incorporate evidence-based practice within an interdisciplinary team.
  • Describe an objective and predictions for an evidence-based interdisciplinary plan to achieve a specific goal related to improving patient or organizational outcomes.
• Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
  • Explain a change theory and a leadership strategy, supported by relevant evidence, that is most likely to help an interdisciplinary team succeed in collaborating and implementing, or creating buy-in for, the project plan.
• Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
  • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
  • Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.