D226 Task 1 Comprehensive Healthcare Change Proposal

D226 Task 1 Comprehensive Healthcare Change Proposal

Student Name

Western Governors University 

D226 BSNU Capstone

Prof. Name

Date

Introduction

BSNU Capstone Course Task One: Comprehensive Healthcare Change Proposal

This paper addresses Task One of the BSNU Capstone Course by presenting a structured healthcare change proposal designed to improve emergency department (ED) operational efficiency at Mike O’Callaghan Military Medical Center (MOMMC). The proposal outlines a clinically focused staffing redesign intended to enhance early cardiac symptom recognition and reduce delays in diagnostic interventions. An organizational sponsor responsible for oversight and approval is identified, and sponsor feedback is integrated into the proposal. Supporting evidence from national clinical guidelines is used to justify the proposed change and demonstrate alignment with value-based care principles. The paper also identifies key stakeholders, details an implementation strategy, and concludes with a professional reflection on the author’s role as a nursing change agent throughout the process.

Organizational Context

Mike O’Callaghan Military Medical Center (MOMMC) is a federal military treatment facility operating under the Defense Health Agency (DHA) and the Department of Defense (DoD). The hospital is located on Nellis Air Force Base in Las Vegas, Nevada, and serves active-duty service members, retirees, and other DoD beneficiaries. The author is employed at MOMMC as a civilian contractor and registered nurse within the emergency department, providing direct insight into departmental workflows and clinical challenges.

The MOMMC emergency department consists of twenty treatment beds and two trauma bays and is designated as a Level III trauma center. Staffing includes a blended workforce of active-duty military personnel, civilians, and contractors, comprising physicians, registered nurses, medics, and administrative personnel. While the facility primarily serves military-affiliated patients, its trauma designation has resulted in an increased volume of civilian emergency medical services (EMS) transports from the surrounding community.

Although staffing patterns are generally stable due to the civilian workforce, temporary shortages may occur when military personnel deploy. Approximately 40% of the ED staff are civilians or contractors, which helps mitigate staffing disruptions and maintain continuity of care during deployment cycles.

Change Proposal Description

What is the current process for patient registration in the emergency department?

Under the current workflow, patients entering the emergency department are received at the front desk by two registration technicians. These staff members are responsible for completing a full patient registration prior to clinical triage. Because registration technicians do not possess medical training, symptom recognition is limited to patient self-reporting, which can delay identification of time-sensitive conditions such as acute coronary syndromes.

What change is being proposed?

The proposed change involves relocating registration technicians from the front desk to the back of the emergency department, where they will function in a combined unit clerk and registration capacity. In their place, a medically trained team consisting of one registered nurse and one medical technician will staff the front desk. These clinicians will perform rapid patient registration, brief symptom screening, and immediate prioritization of high-risk presentations.

What is the purpose of this change?

The primary objective of this change is to significantly reduce door-to-electrocardiogram (EKG) times, particularly for patients presenting with symptoms suggestive of ST-Segment Elevation Myocardial Infarction (STEMI). National guidelines require that a 12-lead EKG be obtained within 10 minutes of arrival for patients with chest pain or cardiac-related symptoms. The current registration model delays this process by placing non-clinical staff at the point of first contact. Assigning medically trained personnel to this role allows for rapid symptom recognition, expedited EKG acquisition, and earlier activation of life-saving interventions.

Impact of the Proposed Change

Aspect	Current State	Proposed Change	Expected Outcome
Front Desk Staffing	Two registration technicians	One RN and one medical technician	Immediate clinical assessment and prioritization
Door-to-EKG Time	40–60% compliance within 10 minutes	Target of 100% compliance	Improved cardiac outcomes and guideline adherence
Patient Throughput	Delays during registration	Streamlined registration and triage	Reduced wait times and improved flow
Role Utilization	Registration staff performing clinical gatekeeping	Administrative staff focused on clerical duties	Improved role alignment and efficiency

Clinical evidence supports the urgency of early cardiac intervention. The American Heart Association and the American College of Cardiology emphasize that delays in EKG acquisition directly affect morbidity and mortality in STEMI patients (Dechamps et al., 2016). Coronary artery disease remains a leading cause of death in the United States, accounting for approximately 500,000 deaths annually (Butt et al., 2020). This staffing realignment ensures that clinical expertise is applied at the earliest point of patient contact, thereby improving safety, outcomes, and regulatory compliance.

Feedback from the Organizational Sponsor

Brian Hubbard, RN, BSN, MPA, was selected as the organizational sponsor due to his extensive clinical and leadership background, including experience as an ICU nurse, cardiac catheterization nurse, and nursing supervisor at MOMMC. His expertise provided valuable insight into both operational feasibility and clinical impact.

Mr. Hubbard emphasized the importance of leveraging objective data to support change and acknowledged the ongoing staffing challenges faced by military treatment facilities. He recommended implementing the proposed staffing model as a 60- to 90-day pilot program prior to permanent adoption. During this pilot phase, nursing staff and medics would temporarily assume one to two additional shifts per month, which may initially generate staff resistance.

To mitigate this concern, Mr. Hubbard stressed the importance of early and transparent communication with staff, focusing on the long-term benefits of improved patient outcomes, enhanced workflow efficiency, and eventual stabilization of staffing demands.

Potential Barriers and Mitigation Strategies

Barrier	Description	Mitigation Strategy
Staff Resistance	Increased shifts and training requirements	Early engagement, education, and shared decision-making
Administrative Resistance	Hesitancy from DHA/DoD leadership	Use of performance data and accreditation standards
Skill Gaps	Limited experience with rapid registration	Targeted training and competency validation

Staff engagement and education are critical to overcoming resistance. Emphasizing patient safety, ethical responsibility, and regulatory compliance can foster acceptance and shared ownership of the change initiative.

Value-Based Care Enhancement

This proposal directly supports value-based care by aligning staffing resources with patient acuity and clinical urgency. Placing medically trained personnel at the point of entry enables earlier recognition of emergent conditions, faster initiation of diagnostics, and improved coordination of care. Key value-based outcomes include reduced door-to-EKG times, improved patient throughput, enhanced satisfaction, and decreased risk of adverse cardiac events. Collectively, these improvements promote higher-quality care while optimizing resource utilization.

Key Stakeholders and Collaboration

Stakeholder	Role and Responsibility
Staff Nurses and Medics	Execute new workflows and provide direct care
Registration Technicians	Manage clerical and administrative functions
Emergency Department Nurse Manager	Oversee staffing and operations
ED Medical Director	Provide clinical oversight
Registration Director	Ensure registration compliance
Chief Nurse	Provide executive nursing leadership
Hospital Commander	Approve organizational resources
Staffing Chief	Authorize staffing document changes

Monthly interdisciplinary meetings will be used to review Genesis charting data, monitor performance metrics, and address staff feedback.

Resources and Cost Considerations

The proposed change relies entirely on existing internal resources, including leadership support, charge nurses, and current staff. Because military personnel are salaried rather than hourly, the staffing redistribution will not result in increased payroll costs. No external funding, equipment, or technology investments are required.

Implementation Plan

Phase	Description
Planning	Stakeholder engagement and proposal finalization
Milestones	Weekly and monthly data collection
Implementation	Staff education and pilot rollout
Evaluation	Continuous monitoring with a 90-day review

Ongoing evaluation through monthly reporting will ensure sustainability and guide future process refinements.

Expected Outcomes

Outcome	Description
100% EKG Compliance	All eligible patients receive EKGs within 10 minutes
Improved Clinical Outcomes	Reduced complications from delayed treatment
Enhanced Patient Satisfaction	Shorter wait times and improved care experience
Financial Stability	Increased civilian utilization and revenue potential
Accreditation Compliance	Meets chest pain center standards

The proposal is grounded in nursing ethical principles, including nonmaleficence, beneficence, and fidelity to patient-centered care.

Use of Technology

The Genesis electronic health record system will serve as the primary tool for tracking door-to-EKG times, patient flow metrics, and clinical outcomes. Real-time data analysis will support decision-making, reinforce accountability, and provide evidence for continued improvement initiatives.

Measuring Success

Success will be evaluated using objective clinical metrics, patient satisfaction surveys, and qualitative staff feedback. Sustained staff engagement and morale will be critical indicators of long-term viability and cultural integration of the change.

Reflection on the Role of the Change Agent

With more than two decades of emergency nursing experience, the author identified workflow gaps that directly affect patient safety and outcomes. By applying evidence-based practice, professional credibility, and collaborative leadership, the author serves as a change agent advocating for system-level improvements. Effective communication, stakeholder engagement, and ethical responsibility underpin the success of this proposal.

Potential for Broader Application

If successful, this staffing model may be scalable across other DoD emergency departments. Standardizing rapid clinical assessment at the point of entry could significantly enhance emergency cardiac care across military treatment facilities nationwide, improving both operational efficiency and patient outcomes.

References

Butt, T. S., Bashtawi, E., Bououn, B., Wagley, B., Albarrak, B., Sergani, H. E., Mujtaba, S. I., & Buraiki, J. (2020). Door-to-balloon time in the treatment of ST segment elevation myocardial infarction in a tertiary care center in Saudi Arabia. Annals of Saudi Medicine, 40(4), 281–289. https://doi.org/10.5144/0256-4947.2020.281

Dechamps, M., Castanares-Zapatero, D., Berghe, P. V., Meert, P., & Manara, A. (2016). Comparison of clinical-based and ECG-based triage of acute chest pain in the emergency department. Internal and Emergency Medicine, 12(8), 1245–1251. https://doi.org/10.1007/s11739-016-1558-8

D226 Task 1 Comprehensive Healthcare Change Proposal

Hunsaker, B. (2024, November 10). Personal communication [Personal interview].