You will collaborate with two of your classmates to share ideas and offer feedback and suggestions to one another in an informal setting. This collaboration within your group will assist you in further developing your Change Proposal to be submitted for feedback from your instructor next week.  Peers submission attached below.. please provide feedback and suggestions individually!! Peer 1: Victoria Lyons posted  IV. Implementation Plan Assess the factors that are likely to affect the implementation of your recommended activities Many stroke patients require rehabilitation after their hospitalization and many patients get readmitted from post-acute care facilities, educating these facilities could decrease the readmission rate however rehabilitation facilities are often short-staffed and may not have money for education amongst the staff Identify evidence-based rationales to propose how you will address them, incorporating your identified change theory. Your plan should encompass the following with evidence to support your rationale: Technological challenges Stroke patients require adequate follow-up care with their health provider team, tele-health is a great way to provide these follow-up appointments however stroke patients may not be able to navigate computers to be able to do these appointments as they frequently have deficits. Stroke health care providers would have to learn how to use tele-health and there may be push back to using it due to health care providers typically using hands on assessment skills, they may not find assessing patients this way adequate. Finding a group of health care providers that are willing to start treating patients this way is the first step. Institutional structures Changes in hospitals do not happen overnight. At my state run hospital it seems to take forever to get any changes made. Implementing education regarding how to reduce stroke readmissions would require research and then approval from many different committees to even be approved for implementation. Once approved then it has to be sent all to all hospital staff involved. Examples of committees that a hospital will have and that any changes would have to go through are finance, safety and quality, strategic planning, and audit and compliance committee (Price, 2018). Strategies for building buy-in-among different stakeholders, including nursing Doctors, nurse practitioners, physician assistants, physical therapists, social workers, and case managers will need to be on board with the change process. Historically nurses have a hard time with change. Financial trends and anticipation of the availability of human resource and project funding Implementing tele-health and training to decrease stroke readmission, mostly education and new ways to check that everything a patient needs, will cost money which the institution will have to be prepared to put into their budget. Institutions get penalized financially for readmis ...

1. You will collaborate with two of your classmates to share ideas
and offer feedback and suggestions to one another in an
informal setting. This collaboration within your group will
assist you in further developing your Change Proposal to be
submitted for feedback from your instructor next week.
Peers submission attached below.. please provide feedback and
suggestions individually!!
Peer 1:
Victoria Lyons posted
IV. Implementation Plan
Assess the factors that are likely to affect the implementation of
your recommended activities
Many stroke patients require rehabilitation after their
hospitalization and many patients get readmitted from post-
acute care facilities, educating these facilities could decrease
the readmission rate however rehabilitation facilities are often
short-staffed and may not have money for education amongst
the staff

2. Identify evidence-based rationales to propose how you will
address them, incorporating your identified change theory. Your
plan should encompass the following with evidence to support
your rationale:
Technological challenges
Stroke patients require adequate follow-up care with their
health provider team, tele-health is a great way to provide these
follow-up appointments however stroke patients may not be able
to navigate computers to be able to do these appointments as
they frequently have deficits.
Stroke health care providers would have to learn how to use
tele-health and there may be push back to using it due to health
care providers typically using hands on assessment skills, they
may not find assessing patients this way adequate. Finding a
group of health care providers that are willing to start treating
patients this way is the first step.
Institutional structures
Changes in hospitals do not happen overnight. At my state run
hospital it seems to take forever to get any changes made.
Implementing education regarding how to reduce stroke
readmissions would require research and then approval from
many different committees to even be approved for
implementation. Once approved then it has to be sent all to all
hospital staff involved. Examples of committees that a hospital
will have and that any changes would have to go through are

3. finance, safety and quality, strategic planning, and audit and
compliance committee (Price, 2018).
Strategies for building buy-in-among different stakeholders,
including nursing
Doctors, nurse practitioners, physician assistants, physical
therapists, social workers, and case managers will need to be on
board with the change process. Historically nurses have a hard
time with change.
Financial trends and anticipation of the availability of human
resource and project funding
Implementing tele-health and training to decrease stroke
readmission, mostly education and new ways to check that
everything a patient needs, will cost money which the
institution will have to be prepared to put into their budget.
Institutions get penalized financially for readmissions so
increasing efforts to decrease these would be a financial benefit
(Kripalani, Theobald, Anctil, & Vasilevskis, 2015).
Hospital or governmental policy constraints
It may be tricky for patients that have strokes that are on
Medicaid or Medicare and working around their insurance
policies. Within hospitals it takes time to get a policy
set into place.
Regulatory requirements

4. Some regulatory acts that would have to be taken into
consideration would be The Health Information Technology for
Economic and Clinical Health Act (HITECH) (Maryville
University, 2020) and the Medicare Access and CHIP
Reauthorization Act of 2015 (Maryville University, 2020). The
MARCA works with a payment model for quality of care,
reducing readmissions would help with reimbursements
(Maryville University, 2020).
Patient diversity
Educating patients on ways to decrease their admission will
have many different considerations. Reading levels, language
spoken, family support, use of technology, what disability they
have after their stroke. Understanding why groups of people
tend to get readmitted over others is an important way to
decrease admissions. Individuals less than 80 years of age had a
less chance of being readmitted over individuals over 80, this
was related to statin use (Poston, 2018).
References
Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E.
(2015). Reducing Hospital Readmission: Current Strategies and
Future Directions. Annu Rev Med, 1-18.
Maryville University. (2020). 5 Important Regulations In United
States Healthcare. Retrieved from Maryville University:
https://online.maryville.edu/blog/5-important-regulations-in-

5. united-states-healthcare/
Poston, K. (2018). Reducing readmissions in stroke patients.
American Nurse Today, 9-15.
Price, N. (2018, August 24). Board Structure of a Healthcare
Institution. Retrieved from Board Effect:
https://www.boardeffect.com/blog/board-structure-healthcare-
institution/
Peer 2:
Zachary Erickson posted
Victoria and Lisa,
My apologies for late submission this week. I know it doesn't
leave you much time for feedback and I will try to be more
prompt in the future.
My implementation plan is coming together but I look forward
to your thoughts on what to add and what to clarify. Let me
know what you think.
-Zak

6. Change Proposal: Work-Related Bullying
Implementation Plan Utilizing Lippitt’s Phases of Change,
(Mitchell, 2013)
Raising Awareness of The Need for Change
Create buy-in for the change process by appealing to direct and
indirect victims of WRB. Build enthusiasm by drawing attention
to commonalities and shared experiences.
Multimedia approach incorporating;
Visual printed media to spark collaboration and create a
dialogue
Initial email surveys to gain baseline data and identify areas of
greatest need
Opening anonymous reporting channels to increase
communication and involvement
Overcome technological hurdles is essential during this phase.
Identifying and utilizing existing resources within the
organization starts by reaching out to internal research, quality
management, and information technology departments to secure
support and time commitments for the development of
infrastructure changes that facilitate reporting and data
collection. This ties into the next phase of change.
Building a Relationship with The System

7. Presentation of a completed Change Proposal to nursing
leadership and members of administration.
Clearly stating the evidence-supported physical, psychological,
and financial costs to patients, staff members, and the
organization at large
Accurately estimating the time and resource commitment
necessary for program development and ongoing success
Building buy-in on an administrative level
Reaching out to unit managers to identify their perception of
WRB and its prevalence on their individual work environments
Involvement of employee health/occupational medicine staff as
partners in the reduction of workplace stressors through larger
behavioral changes.
Further promotion of the WRB reduction initiative among staff
members and identification of staff champions passionate about
these changes.
Defining the Problem
What does WRB look like?
Where is WRB occurring in this work environment?
What is the direct impact to staff members?
How does WRB impact our patients?

8. What are the long-term ramifications of allowing WRB to go
unaddressed?
Are there policies in place that address WRB? If so, do they
need to be modified?
Setting Goals and Action Planning
Time sensitive goals create milestones and improve evaluation
of program success. Program phases will be rolled out quarterly,
with the relationship building and collaborative planning
happening in the first quarter after program approval, followed
by the initial campaign to raise awareness in the second quarter,
and full program implementation on select units slotted for six
months after approval. Evaluation of successful change will
occur quarterly thereafter to measure program effectiveness,
make changes, and incorporate new work areas.
Action planning should be interdisciplinary and tailored to the
needs of individual work environments. Buy-in and early
adoption of the program is essential to the success of this phase.
Implementation
The operational model will be relationship-based and involve
several components
Psychodynamic education based on cognitive behavioral models
Cognitive rehearsal training, i.e. role-play, universal anti-
bullying phrases, resilience training
Policy enforcement training: building awareness and support for
new or changed policies

9. Coaching: using the established reporting system to identify
WRB trends and address areas of highest incidence
(Balevre, Balevre &
Chesire, 2018)
Weekly program updates with core program supporters and
monthly meetings with staff champions will identify areas of
success and areas in need of reevaluation.
Stabilization/Acceptance
Change program success depends on acceptance and
sustainability
This means consistent administrative support through the
enforcement of zero-tolerance policies that directly address
WRB events in a timely and supportive fashion.
Ongoing evaluation of staff awareness and involvement in
initiative. Monthly review of staff feedback and yearly
retraining as part of core safety measures.
Maintaining program flexibility and changing delivery of
training and monitoring strategies to best suit each work
environment.
Redefine the Role of the Change Agent
Once the change process is initiated, the change agent works to
keep others on track with program support and involvement.
Coordinate the feedback review efforts and continue to recruit
interested staff members to act as program champions.

10. Liaise with administration members and continue to “bridge the
gap” between program results and the impact on staff and
patients.
Share program successes both within the organization and with
the community.
References
Balevre, S., Balevre, P., & Chesire, D. (2018). Nursing
professional development anti-bullying project. Journal for
Nurses in Professional Development, 34(5), 277-282. doi:
10.1097/nnd.0000000000000470
Mitchell, G. (2013). Selecting the best theory to implement
planned change. Nursing Management, 20(1), 32-37. doi:
10.7748/nm2013.04.20.1.32.e1013