Abstract
The ultimate goal of any healthcare facility is to ensure patient satisfaction. A 30-bed unit facility is facing the challenge of patient satisfaction due to poor communication and early discharge. This project aims to improve patient satisfaction levels using commit-to-sit strategies. The approach requires caregivers to sit beside patients’ beds during regular visits and communicate with them effectively. Communication hindrances limit the intervention’s implementation. The intervention will require training the hospital staff, hiring additional staff, and availing resources to facilitate training. The success of the intervention will be measured through reduced readmission, patient satisfaction, cost-benefit analysis, and adherence to the medication plan. Nurse leaders need to be involved in the implementation process because they understand other caregivers and can ease tensions that might arise from their change resistance. Nurses should also advocate for their interests during the implementation of the intervention; nurse satisfaction directly affects patients’ satisfaction.
Keywords: commit to sit, patient satisfaction, patient-nurse communication, the health belief model, stakeholders
The targeted population in this intervention is a 30-bed unit ambulatory surgery center (ASC). Patients in the hospital have complained of poor communication with their caregivers and hurried discharge, affecting their satisfaction level. Consequently, the ASC administration seeks to improve customer satisfaction to 79.2%. Unfortunately, it has only managed to attain a satisfaction level of 67.7%. Hence, the ASC needs a better plan to improve customer satisfaction.
The recommended intervention plan is the commit to sit strategy. Care providers, such as physicians and nurses, must sit beside patients as they interact. Effective communication between patients and nurses has resulted in improved patient satisfaction. Patients feel the nurses’ caring demeanor is high when engaged through regular communication. Therefore, one-on-one communication will have positive satisfaction levels.
The need for the intervention is critical in addressing the identified problem. The approach will improve patient satisfaction and patient loyalty. Besides, the hospital’s operations and rating will increase after the intervention’s success. Thus, the commit-to-sit intervention will benefit all the stakeholders in the health settings within the case study.
Implementing the commit-to-sit approach will rely on the hospital’s leadership and management practices. The nurse leaders and administration departments will set goals, allocate resources, and influence junior employees to implement the intervention effectively. Technologies will be crucial in training staff and monitoring nurse operations. The stakeholders that the intervention will affect include nurses, patients, other caregivers, government, and insurance companies. The implementation is expected to take one year.
The intervention’s success is vital for the ASC’s efficiency and patient outcomes. Consequently, its key performance indicators include patient satisfaction, reduced hospital visits, and adherence to treatment plans. Cost-benefit analysis and feedback from patients and stakeholders will reveal the intervention’s effectiveness. The information retrieved from the performance indicators will be used in improving the approach and for future reference.
Problem Statement
Need Statement
For many years, healthcare organizations have shifted their focus from excellent services to care that satisfies patient needs. As a result, hospitals, especially ASCs, prioritize patient-centered care to make patients more satisfied in healthcare settings. Initially, hospitals focused more on the number of patients visiting their facilities. However, with the passage of policies such as the Affordable Care Act of 2010, the focus of most hospitals has shifted to quality care rather than the quantity of patients served. The media and healthcare agencies have also pushed hospital owners to observe patient-centered care. Healthcare services that are patient-centered need to respect patients’ preferences, provide emotional support, offer coordinated and integrated care, emphasize physical comfort, and ensure continuity and transition in care delivery. The commit-to-sit approach is relevant because it promotes personalized care.
Population and Setting
The targeted population is an ASC with a capacity of 30-bed units. Although the hospital has complex infrastructure and facilities, its level of patient satisfaction is relatively low. The hospital management was committed to improving the rate to 79.2% but scored a lower approval level of 67.7%. The patients complained about the hospital management, including the poor communication between them and practitioners. In some instances, they experienced hurried discharge, compromising their well-being. The facility offers surgical and medical diagnosis services for the intermediate care level and needs an effective strategy to combat possible consumer dissatisfaction. Therefore, streamlining communication between patients and caregivers is one of the practicable strategies.
Intervention Overview
The recommended intervention was the commit-to-sit approach, emphasizing the need for a closer relationship between patients and advanced care nurses at the ASC. The intervention is an initiative that healthcare practitioners have formulated to improve active listening and compassion towards patients. The healthcare provider must sit beside the patients during care delivery and initiate effective communication. The two parties can discuss medication information, education, plan of care for that particular day, the patient’s needs, and other relevant medical conversations. The intervention increases the understanding between the patient and the caregiver, reducing any possibility of hurried discharge.
Comparison of Approaches
Varied possible approaches to improving patient satisfaction included health promotion, education of caregivers, and quality improvement. Health promotion is the education of patients on various aspects of health, including hospital programs, disease prevention mechanisms, and their healthcare rights. The edification increases satisfaction because patients understand the hospital’s programs. Caregivers can also receive training on improving care delivery and patient support. Quality improvement involves refining service delivery through quality assurance, continuous improvement, and quality control. Hence, the three methods were other possible interventions for the ASC.
Initial Outcome Draft
The commit-to-sit intervention’s general intention is to increase patient satisfaction. After the ASC’s clients are gratified by better relations with practitioners and personalized care, other outcomes will include reduced readmission, enhanced safety, and increased loyalty. Therefore, the intervention is expected to boost patient experience.
Time Estimate
The operation timeline is expected to be one year, including essential practices such as planning, employee communication, and change implementation. Additional nurses will be recruited in the first three months, with the following two characterized by training on the intervention. Further, the ASC’s wards will be fitted with monitoring technologies during training. The next three months will be the monitoring and implementation stage. The trained nurses will execute the intervention while monitoring the results. The remaining months will be for the improvement of any limitations realized during the monitoring stage.
Literature Review
Commit-to-sit is a common intervention used by different hospitals to improve patient communication. Nastasi (2019) explores measures for improving customer satisfaction. Continuous decline in patient satisfaction was typical in the hospital setting. However, the introduction of the intervention showed a positive direct relationship between its application and patient-nurse communication. The improvement in patient outcomes was the approach’s ultimate objective. Consequently, the study revealed that hospitals that introduce commitment to sit realized positive outcomes in patient satisfaction. Additionally, the study by Kleytman and Youssef (2021) explored the relationship between patient outcomes and the introduction of commitment to sit in healthcare settings. Their study showed that committing to sit improves patient-nurse communication, aiding care delivery. Since nurses regularly communicate with patients, having a commit-to-sit communication tactic positively affects the latter’s health. Thus, research shows the commit-to-sit intervention as a viable tool in promoting nurse-patient interactions.
Further studies ascertain the commit-to-sit strategy’s viability in acute care settings. According to Quiambao (2020), using Duffy’s Quality Caring Model in implementing commit to sit yielded positive nurse-patient results. The research engaged 46 participants for three months to realize the relationship between the commit to sit initiative and improved communication between patients and nurses. The unit patient satisfaction survey revealed that satisfaction increased by 3% due to regular interaction between caregivers and clients. The healthcare goals revealed through the research included the effective teams that assisted in pain elimination, shorter periods of hospital stay, and rarity in readmission cases. Therefore, the study supports the research hypothesis that committing to sit improves communication between patients and caregivers in acute centers, increasing customer satisfaction.
Apart from healthcare providers, friends and relatives are vital to a patient’s recovery. Golden et al. (2022) examined the perception of patients and internal medicine trainees sitting beside the bed. The result revealed that about 70% of visitors who see patients prefer sitting at the bedside. For example, patients find it more satisfying when their loved ones sit beside them. However, most of the participants who declined to sit beside the participants stated that they did so due to the absence of chairs. In this case, the study has shifted focus from caregivers to those visiting the patients. The morale and hope for recovery increased when patients saw their loved ones sitting beside them. The positive results on patient satisfaction reveal that patients want caregivers positively communicates and engage them. The study supports communication as a way of improving patient recovery.
Communication is a critical tool in healthcare delivery. Jaeger et al. (2019) examined how the inadequacy of professional interpreters affected healthcare delivery in Swiss hospitals. The researcher used an online cross-sectional questionnaire to survey adult and pediatric care providers. Accredited interpreters were also involved in the study. The results showed that many hospitals in Switzerland are experiencing the challenge of cultural differences, which ultimately affect patient-nurse communication. As a result, introducing interpreters is the most effective way of addressing such cultural barriers. Hospitals that use professional interpreters realized success, including better financial coverage and increased awareness of primary care provision. The study reflects the research’s primary aim by explaining how language barriers affect communication in hospital settings. The introduction of commit to sit as a strategy of patient-caregiver communication depends on the language usage. The intervention’s success requires patients and caregivers to have a common language or use an interpreter.
Intervention Plan
Poor communication between patients and caregivers has led to several cases of substandard care. Although hospitals can acquire complex infrastructure and facilities, patient satisfaction depends on the quality of care and close interpersonal relationships that the former develop with their caregivers. According to Nastasi (2019), using the commit-to-sit strategy in pediatric hospitals led to a 50% increase in satisfaction scores compared to other interventions. As a result, improved communication through a commitment to sit in any hospital setting has positive results for patients. Numerous customer complaints, including evidence of reduced satisfaction rates, characterized the case under study. The end of the patient complaints will depend on the efficacy of the commit-to-sit strategy.
Components of the Intervention Plan
The intervention will focus on health promotion, education of caregivers, preventive care, and quality improvement. Health promotion is one of the main strategies for improving quality care as it helps public members understand different healthcare dynamics. Hospitals often neglect caregiver needs and focus on patient-centric care, leaving practitioners more strained with demanding expectations and strict deadlines. Health promotion should emphasize enhancing caregiver welfare and improving interpersonal communication with patients. When clinicians are motivated, their relationship with patients improves. Consequently, the components of health promotion should include providing emotional support, negotiating check-ins to improve work balance, and ensuring they focus on their healthcare needs. Besides, improving the quality of care includes additional aspects such as adaptive leadership, analysis, and financial alignment. Adaptive leadership influences teams and continuously boosts care quality (Granger, 2023). Analytics is critical in showing organizational progress toward quality care and improved communication. Further, it reveals the effectiveness of the commit-to-sit strategy in increasing patient satisfaction. Finally, financial alignment and budgets should focus on serving the intervention’s needs. Thus, all the intervention components should be emphasized.
Implementing the intervention plan should serve the cultural needs and characteristics of the targeted population. Cultural beliefs have a more significant influence on how patients understand care needs. As a result, culture and communication have a strong connection, where the interpretation of gestures and body movements differs depending on a specific culture. Consequently, caregivers must know what they must tell the patients during communication. For instance, some cultures do not allow caregivers to mention death to patients under palliative care. Concepts of culture, such as stereotypes, language barriers, and cultural differences, should inform caregivers’ communication decisions (Curtis et al., 2019). These aspects require practitioners to be culturally sensitive. Thus, culture is a determinant of successful communication.
Various significant weaknesses are associated with different interventions. Apart from improving communication through commit-to-sit strategies, other possible interventions include health promotion and commitment to quality care. A significant limitation of improved communication is the language barrier and cultural differences (Curtis et al., 2019). Some patients might prejudice caregivers, hampering communication. Conversely, the limitation of health promotion is the cost involved and the need for trainers. Health promotion will also disrupt normal hospital operations. Similarly, introducing quality care is costly, and the hospital might be unable to afford it in the short run. Improving communication through a commitment to sit is attainable with few resources and within a shorter period.
Focusing on cultural needs is also an essential factor in implementing the intervention. Communication is a subject of culture, and nurses must avoid prejudice and the misuse of nonverbal cues, which might hinder patient-nurse interactions (Curtis et al., 2019). The assumption that guided this recommendation is that the hospital treats patients from different cultures. Further, caregivers have different cultures, which affect their levels of interaction. Cultural needs form the basis of the commit-to-sit intervention.
Theoretical Foundation
The health belief model is the most viable communication theory for understanding effective communication between caregivers and patients. For instance, it has been critical in guiding various disease prevention programs and health promotion. The key element of this model is that patients make decisions based on their individual beliefs. Factors affecting patients’ actions would include their perception of sustainability, severity, benefits of actions, and barriers to action (Anuar et al., 2020). Implementing the theory takes different stages, including assessing patient beliefs through gathered information, conveying the consequences of health issues, and communicating to the target population. In this case, the communicator will assess patients’ beliefs about closer interpersonal communication before engaging them. Communication in a hospital setting has numerous challenges, especially the available barriers. The theory will guide the development and implementation of the commit-to-sit strategy because it assesses the needs of patients before embarking on the communication process.
Stakeholders, Policies, and Regulations
The familiar stakeholders in healthcare settings include patients, caregivers, pharmaceutical companies, health insurance companies, the government, unions, employers, and the community. All the parties have different expectations that the intervention should address. Consequently, consultation is one of the most essential practices before introducing any internal policy or intervention. As a result, stakeholders need to be recognized as necessary in the healthcare setting. Insurance companies have strict policies on who benefits from the coverage, especially on the type of sickness and the period of hospitalization. Initiating the commit to sit strategy should be independent of such cover policies because the coverage burden would shift to patients. Next, caregivers intend to ensure that patients receive the best quality care. However, their needs should also be prioritized in delivering superior services. The hospital should only overburden healthcare workers with additional communication responsibilities with adequate compensation and motivation. Stakeholders’ satisfaction is vital.
Patients and the government are the most valuable stakeholders as they directly influence the implementation of commit-to-sit strategies. Although committing to sitting measures give patients an extra period for interpersonal communication and reduce their rushed discharge, their cultural beliefs must guide the intervention’s implementation. On the other hand, governments formulate healthcare policies based on their ideologies. Equalitarianism ideology requires the government to offer equality in healthcare, while libertarians give patients the liberty to choose where to seek treatment. Equalitarian governments regulate healthcare stakeholders and ensure healthcare is accessible to all patients. As a result, they would emphasize the implementation of commit-to-sit strategies. Thus, patient values and government policies influence the intervention.
Healthcare policies, laws, and governing bodies are also factors in implementing the intervention. Policies such as The Hospital Readmissions Reduction Program (HRRP) and the Affordable Care Act of 2010 emphasize quality care to patients (Ibrahim & Dimick, 2019). The intervention complies with these policies. The governing bodies and unions advocating for patients’ needs include the Asthma and Allergy Foundation of America (AAFA), the American Nurses Association, and the American Medical Association (AMA), advocating for patients’ improved care. The laws and policies support commitment to sit strategies.
The intervention is assumed to affect the above stakeholders because they are directly involved in healthcare settings. Patients need professional services, caregivers require a conducive working environment, and unions demand better policies. The government, pharmaceutical companies, and insurance companies directly affect healthcare costs. The introduction of the commit-to-sit initiative emphasizes patient-centered care, which other stakeholders advocate (Kleytman & Youssef, 2021). Hence, the intervention will directly or indirectly affect all the stakeholders.
Ethical and Legal Implications
Ethical issues that healthcare practitioners should consider when implementing the commit-to-sit intervention include patient confidentiality, informed consent, and euthanasia. Patient confidentiality requires caregivers to protect the information they acquire from clients unless the latter recommends them to share. Disclosing medical information about the patient’s healthcare, especially from information retrieved during communication, would be unethical. Another challenge is informed consent. Patients need to be informed about the commit-to-sit program before its implementation. Individuals who do not want the initiative should not be coerced. Further, euthanasia cases have raised concern, especially in patients with terminal diseases. Deliberate termination of one’s life should depend on states’ laws on physician-assisted suicide. Ethics ensure a professional relationship between patients and caregivers.
Legal factors in healthcare settings include antitrust issues, false claims and whistleblowing, and malpractices. Practitioners should work closely to achieve coordinated care. Fraud and abuse by physicians should receive legal attention, while health malpractices should receive prosecutors’ attention. The laws will protect the rights of patients to receive quality care.
However, one of the challenging laws to overcome is the antitrust law. Although the statute was designed to improve competition and ensure quality service delivery, it allows healthcare practitioners to engage in malpractices. Most hospitals intend to generate profits in a reasonably competitive environment. Overemphasis on patient-centered care, one way of increasing patient satisfaction and profit generation, might strain the hospital resources used to serve other stakeholders. For instance, the hospital might underpay or overwork its staff to ensure they work longer hours and meet patient needs. Moreover, the internal policies might not allow staff to air their grievances. The knowledge gap that could improve this analysis is the previous court cases on ensuring antitrust laws limit malpractices for wealth and ways the society can make healthcare more human rather than being a capitalist venture.
Implementation Plan
Improvement of communication between patients and caregivers enhances quality care. Previous studies have shown that the introduction of commit to sit enhances communication and improves the perception of patients about the quality of care. During the commit-to-sit session, patients can access formal information recorded in documents. Adherence to treatment plans and reduced readmission cases improve whenever communication is enhanced. Stakeholders, planning, and resources are essential for the intervention’s success.
Management and Leadership
Commit to sit strategy requires appropriate leadership and management measures. The leaders’ essential skills include problem-solving, team building, innovation, and vision. The hospital practices strategic and visionary leadership. Besides, the management practice that leaders will embrace is visionary leadership, which ensures team members comply with the set goals. Leaders will set attainable and measurable goals, ensuring all team associates focus on attaining the predetermined short- and long-term goals. Leaders will also inspire teamwork by encouraging and delegating responsibilities to team members. Transformational leadership, which emphasizes teamwork and innovation, would be appropriate because of change management (Aitken & Von Treuer, 2021). Hiring additional nurses and helping in training them to commit to sit will also be the management role. The practices are only possible with effective leadership.
Additionally, introducing the commit-to-sit strategy will involve change management. The process will involve specific steps, including planning, implementation, evaluation, and closure (Etemadian et al., 2021). Planning entails identifying the healthcare gap, articulating goals, and outlining the timeline of the operation. The leaders will ensure that the involved parties are adequately informed of the intervention need, alongside sharing its vision and goals. The proposed strategies will have a positive effect on the healthcare organization.
The role of the nurse in the intervention is indisputable. The project assumes that nurses spend most of their time with patients, the intervention’s primary target. Resistance is inevitable in organizational change (Aitken & Von Treuer, 2021). Consequently, having a leader from the individuals impacted by the change minimizes the possibility of resistance. Therefore, nurses have a significant role in ameliorating possible discontent from their peers.
Delivery and Technology
Introducing the commit-to-sit strategy requires the ASC to educate available nurses and hire additional ones. Implementing the plan may entail presenting additional technologies to increase the monitoring of different wards. Since the hospital is a 30-bed unit, the management will hire another ten nurses and spend money on training the current clinicians. Additionally, the hospital requires monitoring devices in the ward to monitor how nurses communicate with patients. Hence, delivery methods will be vital in successfully introducing the commit-to-sit strategy.
Training nurses on committing to sitting will be online and will involve an instructor. The process will entail slide notes, audio, and videos with communication concepts. Trainees will require smartphones, computers, and other internet devices. Online training will have various benefits, including convenience and self-paced (Wei & Chou, 2020). Further, learners will be able to create their own time to read about communication improvement. Instructor-led training will include hiring a trainer and organizing the learning sessions. Technologies needed for instructor-led training include a MacBook, YouTube, the internet, and a projector for note projection. The technologies would help the trainer to improve the learning process by ensuring constant engagement with nurses. Smart beds will also help management assess the technology’s implementation. The facilities are modern technologies that monitor patients’ recovery and improve communication between patients and nurses. The management can use them to detect how nurses are implementing commit-to-sit approaches.
The assumptions of delivery methods are based on the strategies for introducing change in an organization. Etemadian et al. (2019) explore ways of initiating change in a hospital setting. The intervention embraces training, introducing additional technology, and hiring additional employees. The implementers assume that nurses might not embrace change; therefore, they must be trained and new ones recruited. The assumption that the patient number will increase also influences recruiting additional staff.
Stakeholders, Policies, and Regulations
Various stakeholders are involved in healthcare settings. The most important stakeholders are patients, nurses, pharmaceutical companies, the government, health insurance companies, workers’ unions, hospital owners, and the community. Since stakeholders’ expectations differ, the management needs to serve them. Consultation is one of the most essential strategies of policy introduction. Stakeholders remain crucial to any healthcare setting, especially in introducing an intervention. Firstly, insurance companies use strict laws and policies on beneficiaries of their coverage, especially on the kind of disease to be covered and the length of hospitalization. Introducing the commit-to-sit intervention requires the ASC to consider such cover policies since the burden of cover might be left on patients.
Next, nurses ensure that those in the ward receive quality care. In delivering quality services, their welfare should also be prioritized. The hospital management should avoid overburdening healthcare workers with other communication roles and inadequate compensation. Although nurses will implement the initiative, their interest should be a priority of the hospital management.
Patients remain the most valuable stakeholders because all other parties emphasize their needs. Even though committing to sit intervention will give patients and nurses additional opportunities for interpersonal communication and limit cases of rushed discharge, cultural beliefs will guide its implementation. Hence, patients are the target population in implementing the commit-to-sit strategy.
Another stakeholder is the government, which has the ideology for policy intervention. Administrations can have equality or liberty policies. Equalitarianism guides the government in offering equality in healthcare while relying on the libertarian administration to allow patients to choose where to seek medical attention. Further, equalitarian governments control healthcare operations and ensure their accessibility to all patients. Hence, such an administration would support the implementation of commit-to-sit strategies.
The introduction of the commit to sit strategy depends on the existing laws and policies guiding American health. The statutes, such as the Affordable Care Act of 2010 and the HRRP, prioritize patient needs (Ibrahim & Dimick, 2019). Patient-centered approaches are critical measures that each hospital must implement. Other organizations, such as The National Union of Healthcare Workers, require healthcare organizations to offer conducive working conditions for nurses, which will help them provide patient-centered care. Thus, the intervention is predicated on existing laws.
A mandatory commitment to sit interventions in all hospitals is a possible policy. The national and local governments should initiate measures to improve communication between patients and nurses. A mandatory communication policy will compel hospitals to develop strategies for increasing interpersonal communication between nurses and patients.
Different assumptions informed the selection of the above stakeholders in implementing the intervention. Firstly, patients and caregivers are directly involved in the communication and are directly affected by the intervention. Pharmaceuticals, governments, trade unions, and health insurance companies determine the healthcare cost (Santoro & Shanklin, 2023). As a result, they will determine whether the intervention is expensive or affordable to the ASC through various policies. Hence, the stakeholders should work in unison.
Timeline
Introducing a commit-to-sit strategy will involve various milestones. According to Lewis (2019), organizational change introduction requires planning, communication with employees, and the actual implementation. Commit to sitting is the change the ASC requires in addressing patient dissatisfaction and will be undertaken within one year. Planning involves determining resources, communication with patients entails winning the customers’ needs, and monitoring implementation encompasses checking weaknesses and recommending improvements. The first three months will include recruiting additional nurses, while the next one will involve training nurses on committing to sitting strategies. Training sessions will run for two months, during which the management will fit the hospital with the necessary technologies. For instance, fitting the wards with smart beds will be within the stated period. The subsequent three months will be the monitoring stage, where the management will determine possible drawbacks in the project implementation. In case of limitations, the administration will recommend improvements. Having a clear timeline would facilitate the timely actualization of all project objectives.
Evaluation Plan
Health literacy remains a critical population health aspect. Nurses in different healthcare segments, especially the ASC, can use the commit-to-sit strategy to promote wellness. However, continuous evaluation is vital once the intervention has been implemented as it helps scrutinize its effectiveness, ensuring necessary changes and resources are introduced promptly to achieve the desired objectives. The ASC facilitates same-day outpatient care services, meaning practical commit-to-sit interventions would lower hospital visits and boost patient experiences by promoting self-care. Consequently, reviewing how practitioners spearhead the approach would enable the hospital to formulate a practical continuous quality improvement (CQI) process and leverage new technologies to enhance care delivery. Therefore, creating an evaluation plan for the commit-to-sit intervention in an ASC would ensure that the hospital attains its objective of reducing hospital visits and promoting population health.
Intervention Plan Outcomes
The project’s primary outcomes are reducing hospital visits, enhancing adherence to treatment plans, and boosting the general health literacy of ASC patients. Ideally, ASCs prioritize cost-effective and high-quality care to address the medical needs of patients from different socioeconomic statuses (Ubaldi, 2019). Consequently, the commit-to-sit intervention’s purpose in attaining the outlined outcomes entails health promotion among ASC patients, ensuring they understand the significance of different treatment approaches. Common services in ASCs include laceration repairs and excisions. The former involves stitching or closing wounds, which may result from falls or cuts by sharp objects, while the latter entails removing problematic tissues or tumors. The commit-to-sit strategy may help ASCs actualize the desired outcomes by sensitizing patients about the possible causes of wounds and suitable ways to prevent them, reducing hospital visits.
Further, nurses have an opportunity to educate patients on the efficacy and side effects associated with specific excisions, emphasizing the need to observe the specified treatment plans. Besides the ASC-specific healthcare needs, practitioners may also apply the commit-to-sit intervention to inform patients of ongoing inoculations or government-sponsored healthcare programs to prevent imminent pandemics. Health literacy also significantly reduces hospital visits as citizens see how different social determinants of health impact their well-being and the measures required to address them. An alternative outcome is boosting nurse-patient relationships, whose significance is aiding personalized care. However, its demerit is the language barrier and negative patient attitudes. Thus, the intervention plan outcomes include reduced hospital visits, heightened adherence to medication plans, and health promotion.
Evaluation Plan
Evaluating the commit-to-sit intervention’s efficacy in an ASC is vital in facilitating CQI, health promotion, and management needs. The plan outlines the desired objectives, key performance indicators (KPIs) and metrics, and methods needed to garner qualitative feedback from patients and nurses, along with the timing of cost-benefit analyses and reporting findings to relevant stakeholders. The anticipated outcomes are reduced hospital visits, improved adherence to treatment plans, and health literacy.
Crucial KPIs for the outcomes include nurses’ frequency in utilizing the commit-to-sit intervention, which would be half of the ASC patients one handles daily, the number of clients visiting the hospital with a recurrent condition, and the public’s awareness of prevailing healthcare issues. The latter can be attained from the U.S. Department of Health and Human Services (HHS) healthcare statistics per region. At the same time, the rest can be documented in internal reports and electronic health records. Feedback from patients and nurses can be attained through surveys, responses through a suggestion box, and patient and staff portals. Cost-benefit analyses help compare the intervention’s impact on patient well-being and resource utilization with the actual expenses used to actualize it. Finally, the reports shared with stakeholders, including the ASC management and government agencies, help formulate viable CQI strategies, health promotion policies, and organizational guidelines to help nurses apply the commit-to-sit approach effectively. The assumption is that the intervention’s findings are shared with relevant HHS agencies to aid policymaking. Thus, the evaluation plan ensures that all project outcomes are attained.
Reduced readmission is the most significant evaluation practice that will reveal the intervention’s success. Readmission increases the chances of mortality and is often costly to patients (Ibrahim & Dimick, 2019). The ASC’s ability to reduce readmission reveals its quality healthcare levels. Since committing to sit focuses on quality care, readmission rates remain a significant performance indicator.
The assumptions that guided the evaluation plan are factors determining patient satisfaction. The anticipated outcomes include reduced readmission, improved adherence to treatment plans, and patient health literacy. Ibrahim and Dimick (2019) revealed that a readmission reduction occurs when quality healthcare is provided. Engaging with patients would ensure they understand the healthcare requirements for recovery.
Discussion
Advocacy
Nurses can leverage their advocacy competence to propose viable strategies to improve healthcare quality and experience during the ASC commit-to-sit intervention. Firstly, the practitioners interact directly with ASC patients, helping determine the most prevalent health hazards in a community. For instance, wounds and different orthopedic issues may be more common due to falls. As a result, nurses may advocate policies that prompt the government to initiate and spearhead sensitization programs on fall causes alongside suitable preventive measures to reduce the need for minor surgical operations. Further, implementing the commit-to-sit intervention helps nurses experience most of the challenges firsthand, positioning them effectively to offer valuable insights that promote positive change. Hence, nurses’ advocacy role ensures the strategy’s improvement.
The intervention plan promotes nursing and interprofessional collaboration. Evidence-based practice (EBP) is indispensable in an ASC. Consequently, EBP requires nurses to seek viable insights from experienced colleagues to address some of the challenges endured while executing the commit-to-sit intervention, including information shortage and negative attitude. Further, partnership with physicians, coverage entities, and government entities is needed to help actualize all project goals and promote population health. Nursing and interprofessional collaboration are crucial for the intervention’s success.
Future Steps
Several strategies may be adopted to improve the commit-to-sit intervention in ASCs to impact patients seeking minor surgical operations significantly. Firstly, training nurses on the intervention’s practical application would impart the necessary knowledge of its significance and possible dynamics. One viable tool that practitioners may be taught is the acknowledge, introduce, duration, explanation, and thank you (AIDET) communication resource, which leverages direct conversations with surgical patients and their families to provide critical information regarding their conditions and suitable treatment procedures (Meehan, 2021). The process helps reduce anxiety and ensures all post-operation modalities are observed. Further, ASCs may acquire appropriate emerging technologies, such as language translation apps and point-of-care tools, to facilitate nurse-patient interactions. According to Jaeger et al. (2019), the language barrier is a major challenge for practitioners handling patients from diverse ethnicities, making translating services inevitable in commit-to-sit interventions. The assumption is that nurses are unfamiliar with the intervention, and the ASC does not have diverse personnel to handle diverse languages. Therefore, training nurses and adopting translating technologies would improve the program.
Reflection on Leading Change and Improvement
The project has positively impacted my capacity to steer change in personal practice and future leadership positions. For instance, I have learned that successful projects should have precise planning, execution, and evaluation procedures. Further, I have understood the significance of effective leadership strategies in managing change, such as being visionary and transformational. Training is also vital to change management as it equips the workforce with the required skills to handle new processes and tasks. The knowledge from the project is essential for my practice, especially the ability to offer personalized care and future leadership positions, which require practical approaches to manage change. Advancing my education, attending seminars and workshops, and reading current nursing journals would facilitate my personal growth. Participating in the commit-to-sit intervention has enhanced my clinical competence.
The completed intervention, implementation, and evaluation plans can be transferred into personal practice to steer quality improvement in other contexts. For instance, the project has helped me understand my role in leading change and defending policy, which requires effective communication skills. These can be attained by identifying practice gaps that require innovation to address and improve patient outcomes. Further, proper leadership strategies should be adopted to manage change and should be logical and practical to give a professional outlook (Hassmiller & Wakefield, 2022). One should also outline a clear plan of what needs modification, the necessary approaches to achieve it, and crucial metrics to measure its effectiveness. Thus, applying the concepts learned from the project can promote quality improvement in organizational change management and advocacy.
References
Aitken, K., & Von Treuer, K. (2021). Leadership behaviors that foster organizational identification during change. Journal of Organizational Change Management, 34(2), 311-326. https://www.emerald.com/insight/content/doi/10.1108/JOCM-01-2020-0029/full/html
Anuar, H., Shah, S. A., Gafor, H., Mahmood, M. I., & Ghazi, H. F. (2020). A systematic review of the Health Belief Model (HBM) use in health behavior. Malaysian Journal of Medicine and Health Sciences, 16(11), 2636–9346. http://medic.upm.edu.my/upload/dokumen/2021010809001826_2020_0366_.pdf
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition. International Journal for Equity in Health, 18(1), 1–17. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1082-3?fbclid=IwAR2M64CokYxJ6i2Z2FBN9dKftUbv8AWgWgMMSIWMoyW_OPV1o3dtrjHJCws
Etemadian, M., Mosadeghrad, A. M., Soleimani, M. J., & Hedayati, S. P. (2019). Leader characteristics in hospital change management: A case study. Hakim Research Journal, 22(3), 212-229. https://hakim.tums.ac.ir/browse.php?a_id=1997&sid=1&slc_lang=en
Golden, B. P., Tackett, S., Kobayashi, K., Nelson, T., Agrawal, A., Pritchett, N., … & Berry, S. A. (2022). Sitting at the bedside: Patient and internal medicine trainee perceptions. Journal of General Internal Medicine, 37(12), 3038–3044. https://link.springer.com/article/10.1007/s11606-021-07231-4
Granger, A. (2023). Adaptive leadership in healthcare: A Pilot Study. Journal of Business Studies Quarterly, 12(4), 14–21. https://search.proquest.com/openview/dc951ca70df2c55a7dfc77e9ea3b068c/1?pq-origsite=gscholar&cbl=1056382
Hassmiller, S. B., & Wakefield, M. K. (2022). The future of nursing 2020–2030: Charting a path to achieve health equity. Nursing Outlook, 70(6), S1-S9.
Ibrahim, A. M., & Dimick, J. B. (2019). A decade later, lessons were learned from the hospital readmission reduction program. JAMA Network open, 2(5), e194594-e194594. https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2734796
Jaeger, F. N., Pellaud, N., Laville, B., & Klauser, P. (2019). Barriers to and solutions for addressing insufficient professional interpreter use in primary healthcare. BMC Health Services Research, 19, 1-11. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4628-6#:~:text=Professional%20interpreter%20use%20can%20be,Examples%20of%20successful%20interventions%20exist.
Kleytman, I., & Youssef, M. (2021). Commit to sit to improve patient satisfaction. Journal of Obstetric, Gynecologic & Neonatal Nursing, 50(5), S2. https://www.jognn.org/article/S0884-2175(21)00144-1/abstract
Lewis, L. (2019). Organizational change: Creating change through strategic communication. Hoboken, NJ: John Wiley & Sons. https://books.google.com/books?hl=en&lr=&id=PsB9DwAAQBAJ&oi=fnd&pg=PA1&dq=the+process+of+organizational+change+management&ots=LrIVQPv4Xn&sig=WSLwAWOzgStI1H5ku482oa_LXX4
Meehan, O. V. (2021). AIDET and commit to sit implementation in the outpatient surgical setting. Unpublished Dissertation, The University of San Francisco.
Nastasi, K. J. (2019). Implementation and evaluation of the Commit to Sit initiative on patient satisfaction. University of Louisiana at Lafayette. https://search.proquest.com/openview/3fd9594734e4e890d6382e022a52f276/1?pq-origsite=gscholar&cbl=18750&diss=y
Quiambao, C. (2020). Enhancing nurse-patient communication through commitment to sit. Doctoral dissertation, Walden University. https://search.proquest.com/openview/c33e311b3fa3a4b381e05b596891f32b/1?pq-origsite=gscholar&cbl=18750&diss=y
Santoro, M., & Shanklin, R. (2023). Human rights obligations of drug companies. In Rights at Stake and the COVID-19 Pandemic (pp. 43–53). Routledge. https://www.taylorfrancis.com/chapters/edit/10.4324/9781003270195-9/human-rights-obligations-drug-companies-michael-santoro-robert-shanklin
Ubaldi, K. (2019). Challenges facing the ambulatory surgery center market. Association of periOperative Registered Nurses Journal, 109(4), 428-430
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