In the hospital setting, evidence based practice was recognized as needing to be implemented in relation to the hospital’s adoption of new surgical site measures that should be instituted before and following colorectal surgery. Of course, a multitude of change models exist through which such an innovation could be implemented, including Lewin’s model of change, as well as Duck’s change curve model. However, because of the complex characteristics of this organizational change, the change model most effective to implement will be Roger’s diffusion of innovations model. The present proposal examines the implementation of this change model in a hospital unit.
Roger’s diffusion of innovations model is a change model with four main inputs that are theorized to lead to effective organizational change. The first input is the innovation itself. The second element is the way this input is communicated throughout the business or institution. The third input is the changes and amendments that take place across time. Finally, the fourth input is the social system in which such change occurs. As noted, in this change instance the innovation is more effectively implementing ER protocol before and following colorectal surgery.
Specifically, the innovation is that institutions of bundle options to reduce colorectal surgical infections, including the use normothermia, normoglcemia, oxygen delivery, and appropriate antibiotics. This innovation has been recognized by empirical studies published in peer reviewed journals to have been effective in improving patient conditions following their adoption (Rosenthal 2016). Particularly, when these procedures were implemented, patients in the hospital significantly experienced shortened stays (Thea et al., 2016). Additionally, in one study that implemented this technique, the researchers found that it reduced post-operative insulin resistance with no effect on in-hospital complications over control.
As noted the second input is the communication of this innovation through the hospital unit. In this particular instance, communication of the innovation will occur through the staff being informed of the importance of the change through a meeting that will be scheduled in which stakeholders (those potentially involved in the change) will attend. Hospital staff administration responsible for the surgical unit(s) that will be involved in the implementation of this change will attend and aid in the dissemination through the distribution of brochures, as well as participating in the Power Point lecture. The third element of the present change model is time. From this perspective, time constitutes a critical element as it will be through time that the project is put into place. The time component will be critical in determining the potential amendments that need to be adopted, as well as the impact this innovation has on organizational efficiency. Further, time will be an essential component in leading one to consider whether or not evidence-based results will occur just as effectively in this instance as they have been purported to in the peer reviewed literature.
The final dimension of the change model is the social system. In this instance, the social system will play a critical role in the speed through which the change can be implemented as well as the maintenance of this change over time. In this respect, the organizational culture – embodied through the social system – will play essential roles in the evidence-based practice being adopted by the staff. While the staff can be informed of the importance of this change, and administrative personnel can work to enforce such policies, it will ultimately be hospital nurses and doctors who are responsible for implementing and maintaining these changes in the surgical units. Ultimately, the effective adoption and institution of these four change elements will characterize the innovation’s early-stage use in the unit.
- Rosenthal, Marie. 2016. “Duke Protocol Reduces Colorectal Surgical Site Infections By
75%”. Generalsurgerynews. http://www.generalsurgerynews.com/In-the-News/Article/10-14/Duke-Protocol-Reduces-Colorectal-Surgical-Site-Infections-by-75-/28406/ses=ogst. - Thiele, R. H., Rea, K. M., Turrentine, F. E., Friel, C. M., Hassinger, T. E., Goudreau, B. J., … &
McMurry, T. L. (2015). Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. Journal of the American College of Surgeons,220(4), 430-443.
