LEADERSHIP AND CHANGE THEORY SYNTHESIS ASSIGNMENT INSTRUCTIONS

Overview

The Doctorate of Nursing Practice (DNP) has its focus in clinical practice, translating research into practice, while the PhD focuses on generating “new” knowledge. For the DNP students, scholarly projects often focus on quality or practice improvement, which requires strong leadership around change against the status quo in healthcare settings. PhD students are often navigating educational systems and guiding students in various aspects of clinical preparation.

Instructions

You will write a 12–15-page research-based paper in current APA format that focuses on leadership and change theory. A clinical scenario will be provided in the course. From that scenario, The Institute for Healthcare Improvement’s (IHI) system, variations, theories and human behavior framework will be used. You will discuss the system, potential variations (such as human behavior and EI), 2 leadership theories and 1 applicable change theory. Potential leadership skills/traits/theories must be discussed to help improve the clinical problem.

Leadership and Change Theory Synthesis: Case Scenarios

You are a new DNP working in an outpatient multi-specialty corporate owned setting, the same center your scholarly project was completed in: Medical Center of the West (MCW).  Providers are employed by the healthcare system.  During your coursework and scholarly project completion, you observed some concerning scenarios among colleagues in the workplace that collectively require strong leadership intervention.

Colleague Scenarios:

36-year-old male APRN in neurology:  newly dx with pre-DM, has gained 20# over past 3 years since taking job at MCW.  Attributes this to long days, eating on the run, and no longer time for exercise.  States he hardly ever gets to see his wife and children due to demands of work, including several hours every night charting in the EMR.  He states he feels shorter tempered with administration lately as new initiatives are rolled out.  He states, “we are merely employees…they don’t seem to care about our expertise anymore, just tell us what to do”.

48-year-old endocrinologist: Previously owned and operated own practice with physician spouse, spouse fell ill necessitating closure of practice.  In addition to the MD degree, holds a master’s in social work giving her a highly relational, high touch/high care approach to patient care.  Hired as medical director of new Endo department.  During the 15-month tenure became increasingly frustrated at unanswered requests for support staff, inability to get standard of care devices such as professional continuous glucose monitors, and modern computers for insulin pump downloads. Staying until 7pm most nights, sometimes until 9pm.  No longer able to play organized sports after work, and states hardly ever saw her 12-year-old son.  After several frank and open discussions with administration without a mutually agreeable plan to address the issues, endo leaves the practice.

60-year-old Family Practice Physician/PCP: In practice x 25 years.  Quality of care, personal outlook on the medical system and self-care began slipping the past 2 years.  At the same time, elderly father’s health was slowly failing.  While previously the PCP would handle complex patients, he started referring common primary care health problems to specialists in effort to manage schedule and make it through the day.  Despite this, would have to take work home every night.  Decided to retire, notified administration, and was not allowed to work out notice due to “attitude.”

32-year-old Physician Assistant/PCP:  Worked 3 years for MCW straight out of school.  Satisfied and challenged the first 2 years.  Year 3 told had to see 4 more patients per day:  2 new, 2 established, resulting in longer days, less evening time with family.  The new patients were mostly medically complex and part of the state’s ACA Medicaid expansion, or patients seeking pain management.  Increasing regulations around pain medication prescribing due to the nationwide opioid crisis were forcing many providers in the state to stop pain management services.  The PA was verbally assaulted several times in year 3, and twice physically punched by patients who were denied opioids.  The 2^nd physical assault in addition to the longer hours were cited as reasons to change employers to a private dermatology practice.

50-year-old Physical Therapist: “I left the healthcare field.  I was expected to see the same number of patients with increasing paperwork and documentation time. I was spending double the time documenting as I was giving care”.

As you write your 12–15-page paper focusing on leadership and change theory, please consider the scenarios as a group.  You do not need to analyze each one individually, but rather look for common cues or themes.  Utilize the Institute for Healthcare Improvement’s Deming’s System of Profound Knowledge (System, Theories, Variations and Human Behavior) as the framework in consideration of needed change for improvement.

• What is likely going on here (and how do you know)?
• What are the clinicians experience ng?
• What (2) leadership theories would help guide you in addressing this problem?  Specifically apply them.
• From a healthcare system perspective what are potential contributing factors?  While you may not know everything about the system, research some known healthcare system issues.  As discussed in the IHI video, consider variations and human behaviors (including but in no way limited to VABEs).
• Choose a change theory and formulate a change plan to address and improve the problem.Leadership and Change Theory Synthesis Grading Rubric
  

  Leadership and Change Theory Synthesis Grading Rubric
  Criteria	Ratings	Pts
  This criterion is linked to a Learning OutcomeLeadership Theories, IHI: System, Variations, Theories, and Human Behavior	120 to >109.0 pts Advanced All elements of the assignment are accurately defined and thoroughly addressed. There is in-depth discussion of each element which goes beyond what was presented in the assigned readings. Examples and additional information are provided to enhance the assignment. 109 to >99.0 pts Proficient The assignment elements are accurately defined but the discussion is not thorough across all assignment elements. The information presented is adequate but does not go beyond the course reading. Minimal additional information or examples are provided. 99 to >0.0 pts Developing The elements of the assignment are inaccurately or incompletely defined. The information presented does not reflect assigned reading. No additional information or examples are provided. 0 pts Not Present	120 pts
  This criterion is linked to a Learning OutcomeChange Theory	90 to >82.0 pts Advanced Evidence of in-depth understanding and application of change theory to the clinical scenario. 82 to >74.0 pts Proficient Evidence of superficial understanding and application of change theory in the clinical scenario. 74 to >0.0 pts Developing Little evidence of understanding the intent or application of change theory. 0 pts Not Present	90 pts
  This criterion is linked to a Learning OutcomeProfessional Writing and Structure	90 to >82.0 pts Advanced Professional writing factors including current APA formatting, grammar, sentence structure and spelling are correct, and demonstrate professional, graduate level writing. Thoughts were well developed and clearly communicated. Peer-reviewed sources written within the past 5 years beyond the course materials enrich content. 82 to >74.0 pts Proficient Professional writing factors including current APA formatting, grammar, sentence structure and spelling mostly correct. Thoughts were mostly well developed and clearly communicated. Graduate level writing may need improvement. Peer-reviewed sources written within the past 5 years beyond the course materials enrich content to a limited degree. 74 to >0.0 pts Developing Professional writing factors including current APA formatting, grammar, sentence structure and spelling need work. Clarity of work needs improvement. Graduate level writing needs significant improvement and writing center help is indicated. Little supportive peer-reviewed literature used. 0 pts Not Present	90 pts
  Total Points: 300