Implementation and Evaluation
Introduction

This is part 3 of the quality and sustainability paper. Part 1 outlined the descriptive method of assessing quality and safety measures in nursing science. It was concluded that administrative data could be used to determine the effectiveness of quality or safety program since safety is the most fundamental aspect of nursing science (Twigg, Pugh, Gelder, & Myers, 2016). In part 2, analysis and application of safety programs were explored and Kenneth E. Waldenberg Health Care facility was used as a model in the analysis. The findings of the paper was that leadership plays a key role in sustaining quality improvement programs in any health care organization (Stetler, Ritchie, Rycroft-Malone, & Charns, 2014). In this third part of the quality and sustainability paper, a change theory that will support the implementation of a quality and safety program will be discussed.

Change Theory

Healthcare facilitates are required to implement new process or technologies that improve patient safety and quality of care (Hughes, 2007). There exists a formula through which quality and safety programs such as telehealth services can be adopted and implemented in a health care facility. Health care managers should, therefore, consider the impact of quality and safety program changes before implementing a program change to ensure a smooth transition. Failure to assess the impact of quality or safety program may lead to unnecessary disagreements between various health stakeholders. So, healthcare managers should consider the various change theories that can be used to implement a quality or safety program successfully.

This paper will focus on John Kotter 8-Step change management model because it provides the most appropriate framework that Kenneth E.Waldenberg healthcare facility can use when introducing specialist care via telehealth services. The steps in this model are 1) create urgency, 2) form a powerful coalition, 3) create a vision for change, 4) communicate a vision, 5) remove obstacles, 6) create short-term wins, 7)build on the change, and 8)anchor the change (Campbell, 2008). Each of these steps is explained below.

Step 1: Create Urgency

Healthcare managers must create a compelling case for change. They must make people understand why the change is necessary. They must also encourage people to move from the current state to the future (Stetler et al., 2014)

To create a sense of urgency in Kenneth E. Waldenberg which is preparing to implement telehealth services, a healthcare manager can identify a facility that has successfully implemented telehealth services. The manager could then schedule times when Kenneth's staff (administrators, physicians, residents, and nurses) could visit the facility so that they could benchmark with their counterparts. During the visits, they could ask questions and share their experiences. In this way, Kenneth's staff will get the opportunity to see the program in action, interact with colleagues who are using telehealth on a daily basis, and gain firsthand knowledge on how telehealth services can benefit their facility. This visits will also help increase the sense of urgency among staff members and prevent negative attitudes that is usually associated with change (Campbell, 2008).

Step 2: Forming a Powerful Coalition

Within quality or safety programs, it is not possible for the health manager to do all the work and communication. A manager needs a team/coalition of people who will help drive the necessary change within an organization. So, a manager has to identify key people within the organization who can act as change leaders (change champions) because they will guide the telehealth program throughout the remaining steps (Hughes, 2007).

According to Kotter, change champions should have a well-defined skillset (Campbell, 2008). First, change leaders should have relevant knowledge about new technologies that are emerging in the health care industry. For example, a change leader should know the benefits of telehealth services, various quality and safety approaches, and measures of reducing health care costs and medical errors. Knowledge on these issues is crucial because it helps team members develop the vision of the telehealth program (Hughes, 2007).

Secondly, change leaders should be able to \"establish credibility...…to step 7 (Campbell, 2008). It step also helps sustain the sense of urgency and momentum among the team members.

Step 7: Build on the Change

A manager needs to repeat steps 1 to 6 for a while for it to be embedded within the organization. It means that the management should keep communicating the vision, removing obstacles, and keep completing tasks. Change can only be realized if Kenneth's health care facility management maintains their consistency when implementing telehealth services.

Step 8: Anchor the Change.

This is the last step in Kotter's change management model. A manager must ensure that the change sticks. It means that it should be embedded into the organization procedures, operational models, and to people's day-to-day work (Lennox, Maher, & Reed, 2018)

Conclusion

Kotter change model is not a step-by-step approach to successfully implementing a new safety or quality program in a health care organization. It is an iterative model in that one step can be used to accomplish another step. For example, step 6 can be used to achieve the first step. That is a series of complete tasks which provides short-terms wins can be used to create a sense of urgency.

This model can also be categorized into three distinct phases. Phase one comprises of steps 1, 2, and 3, and it is popularly referred to as \"creating a climate for change\" phase (Campbell, 2008). Under this phase, Kenneth management has to provide a compelling case on telehealth services should be implemented. Phase two comprises of steps 4, 5, and 6, and it is known as \"engaging and enabling the whole organization\" phase (Campbell, 2008). The design of the quality program is presented in phase. It includes the vision statement of Kenneth health care facility as well as strategies to be used to achieve the vision. The last phase is \"implementing and sustaining the change\" and comprises of steps 7 and 8. In this phase, the expected outcomes of the telehealth program are outlined, which include improved specialist care.…