Organizational Change Project
Nursing 688, Organization of Nursing and Health Care Delivery Systems George Mason University
November 17, 2011
The hospital where I have dedicated my twelve year nursing career has gone through a massive change. When I started working there in 1999, it was a small, independent 168 bed community not-for-profit hospital. The expectations of healthcare today were and continue to be a costly venture to a non-corporate facility, which is why the hospital was struggling financially. It simply could not meet the needs of the growing community. As a result, it was purchased by a corporate healthcare entity based in North Carolina that owned several other hospitals. This merger brought about massive changes to the community hospital. Their policies, practices, benefits and overall mission and vision have been redefined. The introduction of the newly adopted mission, “We exist to improve the health of communities, one person at a time” (Novant health, n.d.) and, the vision, “We, the employees and our physician partners, will deliver the most remarkable patient experience, in every dimension, every time” (Novant health, n.d.) were one of the first initiatives undertaken. In alignment with this new vision, the culture of the community hospital was going to have to change. In the Spring of 2010, “Bundle One” was first introduced. They defined a bundle as a package of solutions with collective impact. (Novant health, n.d.) The premise was that with each of these solutions working together they became more powerful and created something special for the patient. Included in this bundle were the following: First Do No Harm; Standards of Excellence; Bedside Reporting; and, Ask Me 3 Teach Back. Each of these initiatives had been tested across the other hospitals in the system, the healthcare industry and throughout the country. The focus of this paper will be on the part of the “bundle one” series called Ask Me 3 Teach Back (AM3). AM3 is a discharge teaching process that takes into account the educational needs of the patient. In nursing school we are taught that patient education and teaching is a primary role of a nurse. However, we are also taught medical terminology, disease process and anatomy/physiology. We tend to take that knowledge for granted and forget that it is not always shared by our patients. As many as 27 million American adults, one in five, are likely to be unable to read basic discharge instructions (Remshardt, 2011). The National Center for Educational Statistics estimates that approximately 40 million U.S. adults have literacy skills at the “lowest level.” (Remshardt, 2011) The strong promotion of health literacy across the United States was the driving force behind this change in discharge teaching. The Healthy People (2011) project is a government program aimed at health promotion and disease prevention that has included improving health literacy as one of their objectives for 2020. Everyone in the U.S. is susceptible to low health literacy (reading, understanding and acting upon health information) regardless of age, race, education or income. According to the U.S. Department of Health and Human Services, literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, education level or racial/ethnic group. (Vernon, et al, 2007) The change was to adopt the practice of AM3 as the standardized discharge teaching process hospital-wide. The goal was to keep the patients in the center of care, support more effective communication and allow staff to develop authentic relationships with the patients. This was an integral part of the foundation being formed to achieve the organization’s new vision. The Ask Me 3 Teach Back process was developed by The Partnership for Clear Health Communication as a solution to improve America’s silent crisis of low health literacy. (Vernon, et al, 2007) The program encourages patients...
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