Running head: STRATEGY ANALYSIS 1

Leadership Strategy Analysis: Bedside Reporting

Erica Gamble, Rachel Prudhomme, Rebecca McMurphy, Anna Rudd, and Derek Sibley
Ferris State University

STRATEGY ANALYSIS 2

Abstract
The purpose of this work is to provide an analysis of leadership strategy, as well as, identify a
clinical activity for further review. Strategies to make changes to current practices are analyzed
and evaluated in regards to data collection, implementation and evaluation.



















STRATEGY ANALYSIS 3

Leadership Strategy Analysis: Bedside Reporting
Throughout clinical experiences it has been noted that change-of-shift bedside report has
not always taken place. Oftentimes, report is given verbally outside of the patients room, at the
nurses station, or via a recording device. Implementing a standardized approach to hand-off
communication is a key component of one of the 2007 National Patient Safety Goals for
Hospitals established by the Joint Commission (Laws & Amato, 2010, p.70). Information
management as well as facilitation and support are two leadership strategies that would be useful
in implementing a bedside change-of-shift report (Yoder-Wise, 2014).
Clinical Need
Traditionally, change-of-shift reporting has been performed away from the bedside
either with an audio taped or verbal report (Laws & Amato, 2010, p.70). A downside to this
traditional way of reporting is that information is often lost, repetitive, and irrelevant (Laws &
Amato, 2010). Furthermore, these issues often left nurses less informed about their patients
leading to a decrease in quality of care, as well as a lack of patient input in their own care plan
(Laws & Amato, 2010). Benefits of bedside report include immediate confirmation of the verbal
report, patient input in their plan of care, as well as patient reassurance of continuity of care
(Laws & Amato, 2010). In order to facilitate bedside reporting and improve patient outcomes,
leadership strategies are necessary in order to bring about change.
The leadership strategies that influence quality improvement, in regards to bedside
reporting, are facilitation and support as well as information management (Yoder-Wise, 2014).
Facilitation and support strategies typically are used to reassure and assist those in the change
situation who do not accept a change because of anxiety and fear (Yoder-Wise, 2014, p.337).
Moving from a traditional way of reporting to a bedside report can be a stressful or anxiety
STRATEGY ANALYSIS 4

inducing situation for nurses (Laws & Amato, 2010). Information management by the change
agent focuses on delivery of the right information to the right place at the right time (Yoder-
Wise, 2014, p.338). By working together, patients witness a safe, professional transfer of
responsibilities (Laws & Amato, 2010, p.71). The oncoming nurses ability to immediately
confirm the previous shifts report by visualizing the patient and getting a baseline assessment to
compare against changes during the shift allows for more accurate information transfer (Laws
& Amato, 2010, p.70-71).
Interdisciplinary Team
In order to successfully implement this change the involvement of nurses, nurse aides,
charge nurses, nurse managers as well as administrative personnel. First, administrative approval
would need to be granted to implement this change. Nurse managers and charge nurses would be
the forerunners of educating the nurses and nurse aides in the new bedside report protocol.
Finally, nurses and nurse aides would be directly involved in actively performing bedside report
protocol.
Data Collection
Data collection would involve the use of patient and nurse surveys, regarding their
satisfaction with the use of bedside report. Questions on the survey for patients will include, but
are not limited to: was bedside report completed, did you feel involved in your plan of care, and
did the nurses address your concerns during change-of shift report. Questions on the survey for
nurses will include, but are not limited to: did you feel that bedside change-of-shift report took a
longer period of time to complete, did you feel that bedside report improved quality and safety
outcomes for the patient, and do you feel that your concerns were addressed during bedside
report. The information obtained from these surveys would be compiled into one line graph,
STRATEGY ANALYSIS 5

with both results plotted, in order to facilitate ease of comparison. In order to ensure reliability
and validity of the survey, the implementation of Cronbachs alpha as well as other tools will be
used. Facilitation and support strategies and information management strategies directly correlate
to the use of surveys by addressing the needs and feelings of all parties involved. Thereby,
decreasing anxiety and fear, as well as, providing a forum for the right information to be
delivered at the right time.
Outcome Identification
The short-term goal for this strategy implementation is for all nurses working on the
medical-surgical floor at Spectrum Health Big Rapids Hospital to exclusively use the bedside
report technique during change-of-shift, by three months after education of proper use of this
technique. This corresponds with quality improvement outcome goals set forth by the Joint
Commission (Laws & Amato, 2010). The long-term goal for this initiative would be to
implement the bedside report protocol throughout the entire hospital.
Implementation Strategies
The use of Kurt Lewins 3-stage model of the change process in human systems,
known as the unfreezing-change-refreeze modelcan be used as a theoretical framework to
guide the implementation of the bedside change-of-shift report initiative (Hagman, Oman,
Klwiner, Johnson & Nordhagen, 2013, p.315). The first stage is unfreeze, which involves
creating the motivation to change (Lewin's Change Management Model). In order to implement
the bedside change-of-shift report in this first stage, education on how to conduct a bedside
report would be given. The second stage, the change stage involves promoting effective
communication and empowering others to embrace new ways of learning and doing (Lewin's
Change Management Model). This stage correlates to the strategy of facilitation and support, by
STRATEGY ANALYSIS 6

encouraging those involved to implement the bedside report initiative. The final stage, the
refreeze stage involves the realization of the benefits that the change caused allowing for the
organization to return to a sense of stability (Lewin's Change Management Model). This stage
correlates to the completion of nurse and patient satisfaction surveys. This allows for patients
and nurses to reflect on the implementation of the bedside report initiative. Furthermore, in order
to ensure the stability of the implementation of the bedside report initiative, positive
reinforcement tools can be implemented.
Lewins Change Management Model, which we would implement, coincides with
Imogene Kings goal attainment theory (Taylor, Lillis LeMone & Lynn, 2011). This theory
explains that nurses and patients communicate to set and attain goals (Taylor, et al., 2011).
Nurses and patients need to communicate and set goals effectively in order to ensure the
implementation of the bedside report initiative (Taylor, et al., 2011). The nurses and patients
each provide a different outlook that contributes new ideas, in regards to their overall care
(Taylor, et al., 2011).
Evaluation
The results from the nurse and patient surveys would be analyzed in order to discern the
level of satisfaction with care, as well as other factors. From these surveys, further changes could
be made in order to continue improving care. Furthermore, if The Joint Commission determines
that we have met the standard of implementing effective hand-offs, we can further evaluate our
progress regarding bedside report.
Conclusion
As previously stated, end of shift report is performed in settings away from the bedside,
and in a variety of different methods. Through the use of research and theory regarding
STRATEGY ANALYSIS 7

evidenced based practice, our group believes the implementation of our data collection method,
implementation strategies, as well as evaluation techniques, bedside report can become the new
standard of practice throughout all healthcare settings. This would help to provide for more
positive patient and nursing outcomes.



















STRATEGY ANALYSIS 8

References
Hagman, J., Oman, K., Klwiner, C., Johnson, E. &Nordhagen, J. (2013). Lessons learned from
the implementation of a bedside handoff model. Journal of Nursing Administration,
43(6), 315-317.
Laws, D., & Amato, S. (2010). Incorporating bedside reporting into change-of-shift report.
Rehabilitation Nursing, 35(2), 70-74
Lewin's Change Management Model. (n.d.). Understanding the Three Stages of Change. from
http://www.nwacademy.nhs.uk/sites/default/files/86_1722011_lewin_s_change_manage
ment_model.pdfr keyword
Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: the art and
science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.
Yoder-Wise, P. S. (2014). Leading and managing in nursing (5th ed.). St. Louis, Mo.: Elsevier
Mosby.