By regulating this time and moving it into the morning, say 1100, patients can plan transportation, nurses can be staffed to help discharge, housekeeping can clean the rooms and the beds can be made available for the afternoon’s incoming patients. Patient satisfaction is lessened daily by making people wait to go home. By not providing them with a scheduled time, their busy lives, already impacted by having themselves or a family member in the hospital are further inconvenienced by not being able to plan when they are leaving. C. 1. a. Applying change theory to this problem allows for a systematic approach to a solution. The first of the 7 steps of Lippitt’s change theory is to diagnose the problem. Patients are not given a predetermined time for discharge preventing them from planning appropriately. The discharges in the hospital happen too late in the day, slowing down the movement of patients through the system and costing money (Sullivan, 2013). The motivation to change the situation comes from the drive for patient-centered care and the increased flow of patients through the hospital. The staff in the ED and PACU are directly affected by the holding of patients waiting for admit beds. Their jobs would be made easier if their departments were freed from holding admits. The hospital would see an increase in revenue and a decrease in poor reviews from people forced to wait to go home or wait to be seen in the ED. The third step, is to “assess the change agents motivations and resources”(Sullivan, 2013). The change agent in this case would have to be the hospital administration and
LEADERSHIP C158 9 physicians. Most of the timing and subsequent delays in discharge are due the schedules of the physicians responsible for discharge. In the case of most of the surgeons, discharges happen at the end of their surgery schedule for the day instead of the beginning. Most of the other physician discharge their patients after clinic hours. The hospital administration and Chief of Staff would have to direct the house physicians to change this practice for the better of the patients and hospital. The resources available are the authority of the Chief of Staff and the Board of Directors of the hospital backed up by the statistics showing the benefits of such a change. In the next step, “selecting progressive change objects”, a plan in written outlining the steps and methods for change and the desired results. By identifying particular groups of physicians to begin the implementation of the new process, the change agent can try out the change on a small group and show the success to other groups. In the case of a lack of success, the methods used can be adjusted before trying again. In our case, the surgery team would be a good place to start. By writing for discharges the night before, as long as certain criteria are met, patients can be discharged without waiting for the physician to stop by in the morning, or evening. Providing one resident from the team each morning to visit those patients needing
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