Part 1

Eric is a nurse practitioner at one of 10 primary care clinics within a large multi-specialty organization. He has been with the organization for 8 years. Currently, the organization’s culture is focused on the function of care delivery specifically, the volume of daily patient visits. Patients are scheduled every 10 minutes with a no-show rate of around 20%. The current practice is to schedule based on the no-show rate and expected number of daily patient visits to meet profit goals. Overbooking the schedule based on the average number of patients who are “no shows” for their appointments each week is the norm. On a good day, the overbookings and scheduled patients would equal enough patients to meet the profit goal while the no-show time slots would allow time for Eric and his colleagues to catch up. On most days, despite numerous efforts to maximize scheduling, the overbooked patients tend to arrive in clusters which results in lengthened patient cycle times (check-in to check-out). All patients for the day are eventually seen meeting the expected number of patient visits; however, the workday is often extended. The providers, nursing, clerical staff, and patients leave the clinic frustrated. Patient and employee satisfaction scores have begun to decrease over the past three (3) quarters while the number of patient visits and profits remains unchanged. Eric has also noticed turnover among the providers and nursing team members.

Part 2

Based on his assessment, Eric determined that a change in the culture of the organization was needed to focus more on value (the patient access experience) and less on the function (number of patient visits) within the clinic. Eric and his colleagues believe the focus should shift from seeing a certain number of patients per day to fostering teamwork, growth, and positivity. The goal is to increase the overall morale among the clinical staff and providers with the hopes of reducing overall clinic cycle times and increasing the percentage of specific measures of quality. The organization’s leadership team listened to Eric and his colleagues’ concerns and asked Eric to assemble a team to develop a plan for the proposed change.   

Part 2 Instructions:

  1. Using Lewin’s theory of change, discuss the actions the APRN may employ for change based on the scenario (refer to the table below).
  2. Provide a rationale for each action discussed based on the information provided in the scenario.
  3. Suggest strategies the APRN might use for each action discussed.
Stage 2: ChangeDevelop a planSet goals and objectivesIdentify areas of support and resistanceInclude those individuals who will be affected by the change in its planningSet target datesDevelop appropriate strategiesImplement the changeBe available to support others and offer encouragement through the changeUse strategies for overcoming resistance to changeEvaluate the changeModify the change as needed

Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change – ScienceDirect

Lewin’s 3 Stage Model of Change Explained – BMC Software | Blogs

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