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Running head: READINESS FOR CHANGE

Maple Alley Inn: Organizational Readiness for Change

Rebecca Avery, RN, Erik Bratz, RN, Ivana Devic, RN

Western Washington University

NURS 422 – Organizational Change for Quality and Safety in Healthcare

Bonnie Blachly MN, RN

Tom Carson, MN, RN

May 30, 2017

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READINESS FOR CHANGE

Maple Alley Inn: Organizational Readiness for Change

The RN-to-BSN program of Western Washington University (WWU), as part of their

cooriculum paired with the Maple Alley Inn (MAI) to implement a health education intervention

for disadvantaged populations. This new intervention was to compliment the primary services of

nutritional assistance in the form of free, healthy meals three times a week. Patrons who utilize

these services are typically homeless or of low-income and attendance varies between 80 and

150 guests. Frequently working with this population, the operation director, Anne Poulson, has

seen an increasing need to incorporate a health education component to their program. While

education seminars have been utilized in the past, the attendance rates from patrons have been

less than ten percent.

While health seminars for adult education have value and advantages, the disadvanages

to implementing formal courses require additional volunteer healthcare professionals to

facilitate. Assessment findings of the MAI program indicate that the agency is not ready to adopt

a formal teaching strategy. To meet the needs of the agency and their patrons, self-taught posters

are better suited for the current resources in place. These posters can also be presented

throughout the entirety of the meal service. In addition, posters reduce the need for specialized

staffing. The posters also utilize visual aids with minimal wording to better disseminate

information to patrons with low literacy competencies or when English is not the primary

language. Utilize visual aids instead of word-based instructions have been shown to decrease

confusion while increasing focus and retention (Osmar & Webb, 2015).

Change Theory and Planning Phase

The Lewin’s Change Theory Model best exemplifies the MAIs desire to implement

organizational change by utilizing the “unfreezing, change, and refreezing” concept (Appendix

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A). This model increases understanding on what factors inhibit and contribute to change, what

changes can be made, and how these changes can be sustained within the MAI program (Sare &

Ogilvie, 2010). To use Lewin’s model, influential factors need to be identified.

Lewin’s Model

As this stage of Lewin’s model is concerned, the MAI assessed that the health needs of

their guests were not being met. Lewin’s model recognizes this as the unfreezing stage or gap in

practice. With this disaparity identified, the MAI sought professional support from the WWU

RN-to-BSN program to assist in implementing a health education intervention. The goal of

implementing the teaching seminars was to increase the health literacy of the patrons and

improve quality of life. In addition, the proposed intervention would also avoid catastrophic

injury. The refreezing stage makes the adopted intervention the newly accepted standard: i.e.

weekly or monthly formal teaching seminars. As this relates to the MAI, the teaching seminars

would accompany meal services.

Plan Do Study Act (PDSA)

In addition to Lewin’s Theory, the Plan Do Study Act (PDSA) cycle was integrated. The

purpose of the cycle is to gain “valuable learning and knowledge for the continual improvement

of a product or process” (The W. Edwards Deming Institute, 2016). The “Plan” proposed by the

MAI was to implement a singular teaching seminar utilizing the current organization resources.

The “Do” concept is for the WWU’s RN-to-BSN students to create and conduct a class which

would address a health concern identified by the patrons. The “Study” or evaluation portion of

the intervention would be to distribute a patron survey assessing the effectiveness of the teaching

seminar. The “Act” or adjustment portion is to create new seminars, include new topics or alter

areas of focus according to patron’s health concerns.

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Organizational Readiness for Change

According to Lewin's Force Field Analysis Model, the key component to implementing

change includes increasing positive organizational attributes otherwise known as “driving

forces”, and decreasing barriers to change (Sare & Ogilvie, 2010). In order to identify these

components, patron and staff interviews were conducted.

Staff interviews identified several barriers to implementing health education. One, with

limited patron access to resources such as hygiene supplies, clean water, and medical supplies,

developing teaching plans that encompass treatment would be ineffective. In addition, there are

limited professional healthcare volunteers to conduct the seminars. Financially speaking, though

the program is primarily funded through the Opportunity Council, additional resources have not

been allocated to implement this change.

Several strengths were also identified from the staff interviews. Strong attributes of the

agency include weekly volunteers, dedicated staff, community support, and ample space

available for teaching seminars. In addition, the program has patron interest in health education,

though minimal, and consistent attendance. The program also has both active and retired

healthcare profession available to assist with their meal service, and have the potential to

facilitated the proposed intervention.

Information obtained from key informant interviews discovered several barriers to

implementing this change. Barriers included: low health literacy, hesitancy to seek professional

help, lack of trust toward healthcare personel, greater interest in treatment over education,

priority of meals over education, and a lack of access to medical supplies. In addition, there was

a wide range of health concerns that were identified making one teaching session too dense to

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implement. Strengths found within the patrons included motivation to learn, an openess to

discussing health issues, and support from fellow patrons of the MAI.

Working with the Lewin’s Force Field Analysis, to adopt change within this program

success is dependent on working around the barriers that have been assessed. For the goals

identified in the unfreezing stage, the MAI needs to adopt an intervention which does not rely on

additional staff or increased funding. Additionally, it should accommodate the needs of the

patrons while taking into account their learning abilties.

Recommendations

Maple Alley Inn's motivational factors for sustaining health education is increased health

outcomes for its patrons. By providing health information, patrons will increase their health

literacy, gain access to the services of Whatcom County, and sustain their quality of life.

Motivational factors from the agency’s internal structure include minimizing the need for

additional resources. Taking the identified barriers into consideration, implementing poster

boards does not require annual financial obligations or additional personnel.

Based on the assessments of both the MAI and its patrons, it was determined that

implementing weekly didatic seminars would not be in the best interest to achieve the identified

goals. These findings indicate the proposed intervention would require healthcare professionals

beyond their current staffing in order to conduct the teaching seminars. Therefore, to implement

an immediate and repeatable intervention, the use of a poster board has the potential to convey

the same information without the addition of further resources. The MAI has had success with

implementing didactic healthcare sessions, but to develop a one-time teaching session would

limit the number of patrons who could benefit. In addition, the Maple Alley program operates

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out of two locations that reach two separate groups. Producing a transportable poster board

allows dissemination to more patrons as opposed to reaching one group with a teaching seminar.

To determine the effectiveness of this intervention, it is recommended by this group that

evaluation surveys be available for people who utilize the poster boards (See Appendix C). This

will help to identify further gaps and methods to improve the dissemination of pertinent

information.

The group also proposes that MAI and the Opportunity Council continue to work with

WWU’s RN-to-BSN program in order to continue health education within the organization. The

next cohort should continue with this intervention but adapt it based on subject material obtained

by the poster evaluations. For subsequent WWU RN-to-BSN cohorts, a blank digital poster

board template has also been delivered with the intent to expand healthcare topics (See Appendix

D).

Conclusion

Though this agency is not ready to implement the initial education concept relayed to

WWU students of teaching health education, the organization has the potential to increase health

outcomes by implementing the recommendation through self-taught posters. Additionally, these

posters have the ability to be altered and more topics be added based on changing needs of the

patrons. Should the MAI maintain their relationship with WWU RN-to-BSN students, the

opportunity for growth with this intervention can continue for years to come.

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References

Osmar, K., & Webb, D. (2015). From idea to implementation: creation of an educational picture

book for radiation therapy patients. Journal Of Cancer Education, 30(1), 193-196.

doi:10.1007/s13187-014-0728-5

Sare, M., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health

care. Burlington, MA: Jones and Bartlett Learning.

The W. Edwards Deming Institute. (2016). PDSA Cycle. Retrieved from

https://deming.org/management-system/pdsacycle

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Appendix A

Reference:

[Kurt Lewin – change management model (1947)]. Retrieved on May 23, 2017 from

http://www.effdebate.org/uncategorized/the-constant-change/

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Appendix B

Logic Model

Resources/Inputs(In order to accomplish out set of activities, we will need the following: )

ActivitiesIn order to address our problem or

asset we will accomplish the

following activities

OutputsWe expect that

once accomplished these activities

will produce the following

evidence or service delivery

OutcomesWe expect that if

accomplished these activities will lead to the

following changes in 1-3 then 4-6

years

ImpactWe expect that

if accomplished these activities will lead to the

following changes in 7-

10 years

Self-taught poster boards addressing health issues amongst the homeless population such as burn injuries and foot care.

Gather evidence-based information on proper foot care and when to seek professional help when a burn injury is obtained.

Provide self-taught poster boards to the Opportunity Council that would eliminate the need for additional health care volunteers to teach health care topics.

If self-taught poster boards are effective, we hope that we can expand on the number of healthcare topics covered and that volunteers will not be needed.

Poster boards will help guide low-income populations to determine when to seek professional help and avoid catastrophic losses.

PeaceHealth vaccination donations, BTC students, Health Department Support

Secure financial or vaccination resources, Obtain bodies to administer vaccines, Have a provider available to oversee operation

This will ensure resources, bodies, and community support will be available to implement a clinic

This will lay the groundwork to provide vaccination clinic annually. We expect a reduction in critically ill homeless and lower income patients during flu outbreaks.

Same goal as 1-6 year changes, this foundational work will lead to annual vaccination clinic, and potentially expand the services

Map designer program

Develop a map of resources in Bellingham that will help new-comers to this community find what they need

We expect the transition to living here easier with a reference guide that locating services.

This map is meant to be fluid and can be adapted as services change. The goal is let this be available for years to come.

No changes

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FIND A PROCESS TO IMPROVE

The Maple Alley Inn is a service within Whatcom County that serves 3 meals per week to

low-income and/or homeless populations. With weekly direct contact, the organization

(partnered with the Opportunity Council) has elected to expand the services they provide to

incorporate healthcare-rated assistance at the meal services. To implement this additional

program with the current resources they have, they will require tools to and/or teaching aides that

do not require additional volunteer support on a weekly basis, reach as many of the homeless and

lower income population as possible, and have the greatest possibility of increasing this

population’s healthcare outcomes.

ORGANIZE TO IMPROVE THE PROCESS

This is a dedicated community resource that annually receives funding from the

Opportunity Council. However, additional resources have not been allocated for this new

implementation. The program currently has a retired RN available to assist with this program,

but they are currently utilized as a cook.

CLARIFY CURRENT KNOWLEDGE OF THE PROCESS

An interview survey of the Maple Alley program was conducted to determine basic

statistics about the people it serves. Between 80-145 people per meal utilize this program for

nutrition. An observational study was also conducted regarding the processes of the meal. Upon

observation, as soon as the food has run out, the guests of the program immediately depart

leaving little to no time for teaching seminars. In the past, teaching seminars have drawn interest

from 8-10 guests, less than 10% of the clientele, thus significantly decreasing the amount of the

population reaching the healthcare information.

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UNDERSTAND THE CAUSES OF PROCESS VARIATION

Barriers to implementing a teaching seminar about heath-related concerns have several

facets. One, there are very few appropriate resources available to low-income individuals that

prevent being able to properly care for health issues. There are very low health-literacy rates

among this population. Mental health issues hinder several guests from seeking healthcare

support. The topics of concern for health within this population are vast. There is limited staff

and volunteers available to teach a class on these topics. Lastly, the program tends to serve more

people at the end of the moth prior to the beginning of the month limiting the number of people

who would be attending a weekly seminar.

SELECT THE PROCESS IMPROVEMENT

Due to the vast obstacles to implement teaching seminars, the project has been shaped to

create self-taught teaching posters aimed at indicating specific skin conditions and when to seek

help. These topics were both indicated by staff and through client interviews to be important

teaching subjects. Should professional help be needed, a poster board map will also be created to

indicate where the services are that they need. In addition, to improve the healthcare services of

the Maple Alley Inn a flu vaccination clinic will put in place for Fall 2017.

PLAN THE IMPROVEMENT

Posters will inform guests about foot care as it pertains to trench foot, athlete’s foot,

ingrown toenails, and burns. Along with the posters will be a “teaching outline” if a volunteer is

found to present the information in a more formal way. A poster map outlining healthcare and

related services of Bellingham will also be made to indicate where their needs can be met. A flu

vaccination will also be set up for Fall 2017 to aide in providing healthcare services.

DO THE IMPROVEMENT TO PROCESS

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Poster boards are currently in the process of being constructed. The vaccination clinic

planning is underway with bodies and support from the Health Department and Bellingham

Technical College. Discussions are starting with PeaceHealth to allocate resources for this

program.

CHECK AND STUDY THE RESULTS

Surveys of effectiveness of posters will be available to those who wish to leave feedback.

The volunteers and staff of Maple Alley Inn should see a decline in the amount of questions and

concerns over these health issues, as they can be directed and guided by the posters. The

Opportunity Council’s agencies should see an influx of clients due to the increased information

available regarding their location, hours and representation on the map.

ACT TO HOLD THE GAIN AND TO CONTINUE TO IMPROVE THE PROCESS

Will continue to build upon areas of health concern, potentially adding teaching seminars

when enough volunteers are available. We will be providing the next RN-to-BSN cohort ideas

for where to expand on health education at this agency including creating and providing more

posters. Possible subjects including diabetes, lacerations, and medication management.

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Appendix C

Poster Board Feedback

Please Circle Your Answers

1. What poster board is being reviewed?

Foot Care Burns Resources of Bellingham

2. Did the poster address your concerns?

No Somewhat Neutral Mostly Yes

(1) (2) (3) (4) (5) (N/A)

3. Is it clear when to seek medical help?

No Somewhat Neutral Mostly Yes

(1) (2) (3) (4) (5) (N/A)

4. What additional information would be helpful pertaining to this topic?

5. What healthcare related topic would you like more information on?

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Appendix D

Blank Poster Templet Provided to the Opportunity Council

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