HA515 Unit 9 Cross-Department Change Plan Example

Twenty-Six Hours From Order to Evaluation and Nobody Owns the Wait: A Cross-Department Change Plan Giving a Composite Hospital's Rehabilitation, Nursing and Case Management Managers Eight Weeks, One Shared Measure and Four Coordinating Routines

[Student Name]

Purdue University Global

HA515: Leadership and Management in Health Care

Unit 9 Cross-Department Change Plan

[Instructor Name]

[Date]

The hospital, the departments and every figure are composite and bracketed; the plan is a course model, not clinical guidance.

The Situation

Many medical patients cannot go home until a therapist judges whether they can walk safely and what equipment they need. Last quarter, [41] percent of discharges that needed a therapy recommendation were delayed past noon on the planned day because the evaluation had not happened. The wait splits into four segments, each controlled by a different department:

1. Order to rehabilitation triage: [5] hours; rehabilitation.

2. Triage to scheduled visit: [9] hours; rehabilitation, using a priority list that does not know expected discharge dates.

3. Scheduled visit to patient seen: [8] hours; nursing, since patients are often off the unit, sleeping after a sedating medication or receiving care.

4. Seen to recommendation documented: [4] hours; rehabilitation.

Why Coordination Fails

Gittell's research on relational coordination, developed partly in surgical care, found that care was better and stays shorter where staff across roles shared goals, shared knowledge and mutual respect and communicated frequently, accurately and in a problem-solving way (Gittell et al., 2000). Here, rehabilitation does not know which patients are expected to go home; nursing does not know when therapists will come; case management learns of the delay only on the morning of discharge. Each department is doing its own work well; the wait lives in the gaps between them, where nobody shares the same picture of which patient comes first.

Why a Short Plan

Three peer managers can change routines within their own authority in weeks, without restructuring, new staff or a hospital-wide initiative. A short, modest plan is more likely to be done, and its results can justify a larger change later.

The Four Changes

1. One shared measure: hours from therapy order to documented recommendation, reported daily to all three managers.

2. A morning priority list: by 08:00, case managers send rehabilitation a list of patients expected to go home in the next 24 hours who still need an evaluation.

3. A readiness signal: nurses mark patients "ready for therapy" in the electronic record when they are on the unit and able to participate; therapists check the flag before walking to the room.

4. A ten-minute daily huddle at 08:30 of the rehabilitation lead, two charge nurses and a case manager to agree the day's order.

What Each Manager Gives and Gets

Rehabilitation gives up some control over its visit order and gets a list that tells it which visits matter most today. Nursing gives a minute per patient to set the readiness flag and gets fewer therapists arriving when patients are away. Case management gives an early-morning list and gets fewer discharges that slip to the afternoon. Each manager can explain the trade to staff in terms of their own work.

What the Plan Does Not Do

It does not add therapists, change physician ordering or move rehabilitation under another department. If the eight-week test shows that the wait is still long after coordination improves, the next step would be a capacity review of therapy staffing, which this plan's data will inform.

Responsibility Table

Shared measure: quality analyst builds the report; all three managers review daily. Priority list: case management manager. Readiness signal: nursing directors of the two medical units; informatics adds the flag. Huddle: rehabilitation manager leads; charge nurses and case manager attend.

Timeline

Weeks 1 and 2: build the report and the readiness flag; agree the huddle time. Weeks 3 to 8: run all four changes on two medical units; review weekly. Week 8: decide whether to spread to the other medical units.

Measures

Outcome: median hours from order to recommendation; percentage of therapy-dependent discharges completed by noon. Balancing: therapist productivity, to make sure prioritizing discharges does not leave other patients unseen. Run charts with each change dated will show whether shifts are real (Langley et al., 2009), and runs of points can reveal a shift within weeks (Perla et al., 2011).

How Staff Will Hear About It

Each manager will explain the plan at their own staff meeting in week 1, using the same one-page summary, and the three managers will attend one joint meeting with charge nurses, therapists and case managers from the two pilot units.

Risks

Patients not expected to go home may wait longer; the balancing measure watches this. The huddle may lapse once early results look good; the rehabilitation manager will track attendance and report it weekly.

Limits

Two units and eight weeks may not show seasonal effects, such as winter respiratory surges, when therapy demand rises sharply.

Conclusion

The wait for therapy evaluations belongs to no department, so the plan gives it to all three through one measure and four shared routines, tested in eight weeks.

References

Gittell, J. H., Fairfield, K. M., Bierbaum, B., Head, W., Jackson, R., Kelly, M., Laskin, R., Lipson, S., Siliski, J., Thornhill, T., & Zuckerman, J. (2000). Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: A nine-hospital study of surgical patients. Medical Care, 38(8), 807-819. https://doi.org/10.1097/00005650-200008000-00005

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895