An Innovative Strategy to Lead Clinical Practice Change to Achieve Quality Outcomes

PURPOSE: To delineate the clinical leadership professional development program, innovative clinical microsystem practice change methodology, and outcomes.   

EVIDENCE/LITERATURE REVIEW: The literature is replete with extensive literature on leadership, quality improvement and evidence based practice. However, there is extant literature on the “how to” of leading practice change to achieve specific outcome(s).

THEORTICAL FRAMEWORK:  The professional development program content was informed by concepts of interpersonal trust, change theory, best practices for execution, and a practice change tool kit.  

METHODOLOGY: A ten month program of professional development for twelve Nursing Unit Directors from four facilities was provided. It included ten monthly two hour seminars, and four 1:1 individual coaching sessions. The practice change tool kit incorporated The Four Disciplines of Execution (Covey and McChesney, 2012) adapted, and a comprehensive planning process including the following steps: Clinical opportunity and baseline and expected outcome(s), Stakeholder engagement, Evidence, Specific Nursing Practices - what the staff is "to do," Practice implementation addressing facilitators and barriers to the practice change(s), communication steps, and staff development, Concurrent practice monitoring, Cadence of accountability, and Clinical outcome results.

RESULTS: Three instruments were utilized to assess participant outcomes. They were Empowerment - Behavioral, Verbal and Outcome (Irvine, Leatt, Evans & Baker, 1999), Trust in Peers and Managment (Cook & Wall, 1980), and Transformational Leadership (Heutson & Wolf, 2011). With a very small participant sample, post program implementation findings represent trends only. Specifically, both self reported behavioral and outcome empowerment scores improved and trust in management and peers post program. The self reported perceptions of the transformational leadership practices improved. Qualitative post survey findings were very positive. The program’s clinical impact was demonstrated through each Director’s patient care project.  With their Unit Councils’ they developed, implemented, and evaluated a clinical practice change project to achieve a specific clinical outcome(s). Selected project titles included 1) Improving family satisfaction through face to face handovers from the post anesthesia care unit to the pediatric surgical unit, 2) Eliminating patient falls facility wide through a comprehensive practice review and implementation, 3) Preventing venous thromboembolism (VTE) through consistent achievement of VTE process outcomes 

CONCLUSION: The early results indicate that the professional development program led to important self reported learning by the Directors and in clinical care impact. Early results indicative of organizational impact are that the health system is spreading the microsystem practice change methodology across the four hospitals through their shared governance structure and through a new group of Directors participating in the program.

IMPLICATIONS:  The program and Microsystem Practice Change Method contributes to Nursing executives and clinical leaders armamentarium to achieve and sustain clinical outcomes.