D226 Task 1 Comprehensive Healthcare Change Proposal

Student Name

Western Governors University

D226 BSNU Capstone

Prof. Name:

Date

BSNU Capstone Course Task One: Healthcare Change Proposal

This paper represents Task One of the BSNU Capstone Course and aims to present a detailed healthcare change proposal. The focus is to identify an organizational sponsor who will review and approve the proposed change. The paper includes feedback from the sponsor, supporting data for the proposal, and justification of how the change will improve value-based care. It also identifies key stakeholders critical to the success of the proposal and outlines an implementation plan. Finally, a reflective statement will discuss the author’s role as a change agent and the influence exerted throughout the change process.

Organizational Context

The organization where this change proposal will be implemented is the Mike O’Callaghan Military Medical Center (MOMMC), a military treatment hospital under the Defense Health Agency (DHA) and the Department of Defense (DoD). MOMMC is located at Nellis Air Force Base in Las Vegas, Nevada. The author serves as a civilian contractor and registered nurse in the emergency department.

MOMMC’s emergency room consists of twenty beds and two trauma bays. It is staffed by military personnel, civilians, and contractors including doctors, nurses, medics, and administrative staff. While the hospital primarily serves military members and DoD beneficiaries, its Trauma Level III designation has increased civilian patient transport by emergency medical services from the Las Vegas community.

Staffing at MOMMC is generally stable due to the mix of military, civilian, and contractor personnel. However, staffing shortages may occasionally occur when military personnel are deployed to fulfill national security needs. Approximately 40% of the emergency room staff comprises civilians and contractors to maintain consistent coverage during such times.

Change Proposal Description

Current Process:
Patients currently check in at the emergency room’s front desk, which is staffed by two registration technicians responsible for completing full patient registrations before triage.

Proposed Change:
The proposal recommends relocating the registration technicians to the back of the emergency department to fulfill unit clerk and registration duties. Instead, a medical technician and a registered nurse would be positioned at the front desk to perform quick registrations and rapid symptom assessments.

Purpose of Change:
The main goal is to reduce the “door-to-EKG” time, particularly for patients showing signs of ST-Segment Elevation Myocardial Infarction (STEMI), thereby enabling immediate identification and intervention. Current registration staff lack medical training, leading to delays in recognizing STEMI symptoms and completing EKGs within the national standard of 10 minutes post-arrival.

By placing medically trained staff at the initial point of contact, the emergency department can improve timely recognition and treatment initiation for high-risk cardiac patients. Registration technicians would then focus on administrative tasks better aligned with their expertise.

Impact of Proposed Change

Aspect	Current State	Proposed Change	Expected Outcome
Staffing at Front Desk	Two registration technicians	One medical technician and one registered nurse	Faster symptom recognition and quicker EKG administration
Door-to-EKG Time for STEMI Patients	40%-60% within 10-minute standard	Increase to 100% compliance	Improved patient outcomes and meeting accreditation standards
Patient Flow	Delays due to non-medical front desk staff	Streamlined registration and triage process	Improved throughput and patient satisfaction
Role of Registration Technicians	Full patient registration	Back-end registration and administrative support	Better alignment with staff expertise

According to the American Heart Association and American Cardiology Guidelines, a 12-lead EKG must be performed within 10 minutes of ED arrival for patients presenting with chest pain or cardiac symptoms (Dechamps et al., 2016). Coronary artery disease accounts for approximately 500,000 deaths annually in the U.S. (Butt et al., 2020).

This change aligns staffing resources with clinical needs, supporting timely care and potentially reducing morbidity and mortality in cardiac patients.

Feedback from Organizational Sponsor

Brian Hubbard, RN, BSN, MPA, was selected as the organizational sponsor due to his extensive experience as an ICU nurse, cardiac catheterization nurse, and nursing supervisor at MOMMC. He provided valuable insight into staffing challenges and emphasized the need for data-driven decisions.

He recommended a 60 to 90-day trial period of the proposed staffing model before officially requesting changes to the staffing document. This trial would require nurses and medics to work an additional 1-2 shifts per month temporarily, which may encounter staff resistance.

The sponsor highlighted the importance of engaging staff early to explain the benefits of the change, emphasizing improved patient care and future staffing stabilization.

Potential Barriers and Strategies

Barrier	Description	Mitigation Strategy
Staff Resistance	Increased work hours and training demands	Transparent communication, education on patient benefits, and staff involvement in planning
Administrative Resistance	DoD and DHA reluctance to increase staffing	Present statistical data and alignment with accreditation requirements to justify change
Skill Gaps	Staff unfamiliar with quick registration process	Provide targeted training and ongoing support

Staff buy-in will be essential to overcoming resistance, with education sessions focused on patient outcomes and regulatory standards.

Value-Based Care Enhancement

The proposed change supports value-based care by fostering multidisciplinary collaboration to optimize patient outcomes. By positioning medically trained personnel at initial patient contact, the emergency department can:

Decrease door-to-EKG times, especially for STEMI patients
Enhance early recognition and management of emergent cases
Improve overall patient throughput and satisfaction

This approach benefits not only cardiac patients but also all emergency room visitors by reducing wait times and ensuring timely care initiation.

Key Stakeholders and Collaboration

The success of this change depends on involving key stakeholders:

Stakeholder	Role
Staff Nurses and Medics	Implement change and provide patient care
Registration Technicians	Support registration and administrative duties
Emergency Room Nurse Manager	Oversee nursing operations and staffing
Emergency Department Medical Director	Provide clinical oversight and guidance
Registration Director	Manage registration processes
Chief Nurse	Support nursing leadership and resource allocation
Hospital Commander	Authorize organizational support and resources
Staffing Chief	Approve staffing document changes

Regular monthly meetings will be held to discuss progress, review data from the Genesis charting system, and address feedback. Key metrics such as door-to-EKG time, patient length of stay, and satisfaction scores will guide decision-making.

Resources and Cost Considerations

The implementation relies primarily on existing internal resources, including collaboration among management, charge nurses, and staff. Flexibility and willingness to adopt new roles are essential among staff.

Since military personnel are not compensated hourly, the staffing change represents an administrative adjustment rather than an increased payroll expense. No additional external resources or financial investments are required.

Implementation Plan

The implementation will follow four phases:

Phase	Description
Planning	Ongoing engagement with stakeholders and finalizing the proposal
Milestones	Weekly and monthly data collection to monitor door-to-EKG times and patient flow
Implementation	Immediate rollout after staff briefing and training on quick registration
Evaluation	Continuous data monitoring with a 90-day comprehensive review to justify permanent staffing changes

The evaluation phase will be continuous, with monthly reporting to management to sustain improvements and inform future adjustments.

Expected Outcomes

Outcome	Description
100% Compliance	Patients meeting chest pain criteria receive EKGs within 10 minutes
Improved Patient Outcomes	Enhanced treatment timeliness reduces complications
Increased Patient Satisfaction	Faster service and better care experiences
Financial Benefits	Increased patient volume from civilian cases leading to revenue gains
Accreditation Maintenance	Meet or exceed chest pain center standards

The proposal also aligns with nursing ethical principles of nonmaleficence (preventing harm) and fidelity (commitment to patient care), ensuring that patients receive prompt and effective treatment.

Use of Technology

Technology plays a critical role in tracking the effectiveness of the change. Data collected via the Genesis electronic charting system will allow real-time analysis of door-to-EKG times and other key metrics. Additionally, data-driven success stories can be used for internal promotion and community outreach to encourage patient utilization.

Measuring Success

Success will be evaluated through:

Continuous improvement in statistical performance data
Patient satisfaction feedback regarding check-in and care processes
Staff morale and acceptance of new workflows

Positive staff engagement will foster an environment of compassionate care and sustain long-term change.

Reflection on Change Agent Role

As a seasoned emergency room nurse with over 20 years of experience, the author has identified critical system gaps affecting patient care. Leveraging extensive clinical knowledge and previous exposure to best practices, the author acts as a change agent by proposing practical solutions to improve patient flow and outcomes.

The influence stems from professional credibility, data-supported rationale, and collaboration with stakeholders to advocate for improvements in emergency care delivery.

Potential for Broader Application

If successful, this staffing model and rapid recognition protocol could be expanded across the DoD healthcare system. It could serve as a benchmark for improving emergency cardiac care in other military treatment facilities, enhancing patient outcomes and operational efficiency nationwide.

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