HA410 Unit 7 Protocol Adoption Change Plan Example

Approved Eleven Months Ago, Used for One Patient in Four: A Change Leadership Plan for a Composite Hospital's Nurse-Driven Protocol Letting Stable Patients Sleep Through Overnight Vital Signs, Sequencing Who to Approach First and What Each Conversation May Concede

[Student Name]

Purdue University Global

HA410: Health Care Leadership

Unit 7 Change Leadership Plan

[Instructor Name]

[Date]

The hospital, the protocol and every figure are composite and bracketed; the clinical criteria are simplified for a leadership plan and are not practice guidance.

The Gap

Eligible patients are adults whose early warning score has stayed low for a full day, no new oxygen requirement and no order excluding them. On the two surgical floors, the protocol is used for [68] percent of eligible patients; two charge nurses adopted it in the first month and taught their teams. On the four medicine floors, use is [24] percent. Patients on the medicine floors still report being woken at 0200 and 0400 for blood pressure checks.

Why It Matters

A study of adult medical inpatients found that hospital sleep was shorter and more fragmented than at home, with noise and overnight disruptions among the causes (Yoder et al., 2012). For stable patients, a vital sign check at 0200 may cost more in lost sleep than it gains in safety.

Diagnosis: Five Attributes, Seen by Each Group

Rogers (2003) names five attributes that speed or slow the spread of an innovation, and each is taken in turn below as the different groups experience it. Berwick (2003) applied this framework to health care and stressed that innovations spread through social networks, led by respected peers. Relative advantage: clear to the hospitalists and to patients; doubtful to night nurses, who fear missing a deteriorating patient; irrelevant to day nurses, who never see the 0200 check. Compatibility: poor on medicine floors, where a culture of "four-hourly vitals for everyone" is part of how nurses define safe care. Complexity: moderate; the eligibility check takes about [two] minutes, but it must be done at 2200 when night nurses are busiest. Trialability: high in principle, since one nurse can try it for one patient; in practice nobody has invited a trial. Observability: low; a patient who sleeps well produces no visible event, while a missed deterioration would be remembered for years. The protocol asks night nurses to take a visible risk for an invisible benefit, which is the hardest trade any change can ask for.

Adopter Categories on the Medicine Floors

Innovators: [three] night nurses who already use the protocol for most eligible patients. Early adopters: [two] respected night charge nurses who have not yet used it but have asked questions. Early majority: most experienced night nurses, who will follow the charge nurses. Late majority: newer nurses who follow whatever the unit does. Laggards: [four] senior nurses who have said openly that the protocol is unsafe.

The Sequence

First: the two night charge nurses on medicine. They are early adopters with influence. The conversation asks them to try the protocol for two weeks on their own patients and share what happens. What they may concede: the director will accept an added safety check, such as a pulse oximeter spot check without waking the patient at 0200, if they want it. Second: the hospitalist group, through its lead. Hospitalists can write the eligibility into admission orders, removing the 2200 check from night nurses. What they may concede: hospitalists can exclude any patient they are worried about. Third: the early majority, through the charge nurses' own report at a night staff meeting. The director attends but does not lead. Last: the laggards. Approaching them first would have turned their objections into the unit's position. By the time they are approached, most peers will be using the protocol. What they may concede: their concerns become the protocol's audit questions.

What the Director Will Not Concede

The eligibility criteria approved by the medical executive committee will not be loosened. The protocol remains nurse-driven; nurses can always choose to check vital signs if they are concerned.

Making the Benefit Visible

Observability is the weakest attribute, so the plan creates evidence. Each morning, day nurses will ask eligible patients one question: "How did you sleep?" Results will be posted weekly by unit, alongside any rapid response calls for protocol patients.

Measures

Protocol use among eligible patients by unit; patient-reported sleep; rapid responses and unplanned transfers among protocol patients; nurse confidence on a short survey at the start and at [three] months.

Risks

A single deterioration in a protocol patient could stop adoption across the hospital. The plan prepares for this: any such event will be reviewed openly within a week, and the review will ask whether the criteria were followed, not whether the protocol should exist.

Timeline

Weeks 1 to 2: charge nurse trial. Weeks 3 to 4: hospitalist order change. Weeks 5 to 8: staff meeting and spread. Weeks 9 to 12: conversations with remaining nurses and the first review of measures.

Conclusion

The protocol failed to spread not because nurses disagreed with the evidence but because it asked them to accept a visible risk for an invisible benefit. Sequencing the conversations through respected peers and making the benefit visible addresses both.

References

Berwick, D. M. (2003). Disseminating innovations in health care. JAMA, 289(15), 1969-1975. https://doi.org/10.1001/jama.289.15.1969

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.

Yoder, J. C., Staisiunas, P. G., Meltzer, D. O., Knutson, K. L., & Arora, V. M. (2012). Noise and sleep among adult medical inpatients: Far from a quiet night. Archives of Internal Medicine, 172(1), 68-70. https://doi.org/10.1001/archinternmed.2011.603