Consultative Change Recommendation

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Providing consultation to a healthcare organization or to its managers is a process that includes a wide range of activities that help solve organizational, managerial, and other issues. External consultation is necessary in order to conduct a reliable, objective assessment of the activities of a healthcare institution. Based on the data obtained, personnel and managerial decisions can be made, and a plan of organizational changes can be developed (Cleaveland & Harper, 2020). The purpose of the consultation was to interview a nurse leader and learn about the strengths and weaknesses of the institution, hospital’s distinguishing characteristics, and determine growth points for the institution. In addition, it was necessary to understand what policies and procedures are in place that allow meeting quality improvement standards.

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The consultation process centered around an interview with the Emergency Department (ED)/Special Care (SCU) manager from Central Harnett Hospital. The purpose of it was to get an understanding of the manager’s role in the hospital and what values and mission of the organization are. During the discussion, such topics as patient and employee education, resources, goals, and policies were raised. Data for evaluation were gathered during the interview; after that, the author did research to come up with suggested change. The purpose of this paper is to communicate the findings from the interview, make an analysis of the gathered data, and propose suggested organizational change.

Description of Organization and Organizational Analysis

Central Harnett Hospital provides both primary and secondary care to clients from “central and western parts of Harnett County as well as the Fuquay-Varina community” (Harnett Health, n.d., para. 5). Its address is 215 Brightwater Drive Lillington NC 27546. The hospital offers 50 inpatient nursing rooms, an emergency unit, surgery suites, imaging, ultrasound, and other diagnostics (Harnett Health, n.d.). Central Harnett Hospital provides thirteen specialty services apart from physician services and urgent care. The exact number of employees is not known due to the fact that it was not requested during the interview, and there is no available data on the hospital’s website. The main types of services available to the community are emergency, outpatient surgery, imaging, and inpatient nursing services (Harnett Health, n.d.). The hospital has an organizational structure close to divisional one.

Primary Needs of Organization’s Population

The hospital provides services mainly to the population of Harnett County living in the western and central parts of this area. In addition, the institution serves the members of the Fuquay-Varina community (Harnett Health, n.d.). The demographics of the organization’s population are varied; however, the hospital mainly serves middle-aged patients belonging to White, Black or African American, White, Non-Hispanic, and Hispanic ethnicities. The area in which the institution is located implies that the population is coming from a rural farming community and the staff needs to be able to address the needs of people belonging to different ethnicities (Harnett Health, n.d.).

The primary needs of the population include components such as physical and mental health. The physical health needs of the population include the current state of the functional capabilities of organs and systems of the body, their adequate response to environmental influences. Also, it implies an adequate level of physical development – this is the process of formation and subsequent change throughout the life of an individual of the functional properties of their body and the physical qualities and abilities. The needs of the population include healthy physique indicators that characterize primarily the biological forms or morphology of a person (Cleaveland & Harper, 2020). The primary health risks in the service area encompass problems in the functioning of the cardiovascular, respiratory, and central nervous systems, digestive and excretory organs.

Problems with the state of various body systems (cardiovascular, respiratory, muscle, etc.) and their reaction to the physical load is another risk group for hospital patients (Cleaveland & Harper, 2020). As noted above, the population lives in rural areas, therefore, patients experience problems with adaptation to the effects of various environmental factors – their physical, mental, and functional capabilities of the body need to respond to such external influences as diseases, injuries, accidents, environmental, and social crises. Mental health is another primary need of the hospital’s population, and developing mental illnesses and conditions is another primary risk for the population.

The difference between the size of the hospital (number of beds) and the number of people requiring healthcare services, results in the fact that individuals need to turn to private healthcare institutions to receive help. This results in a situation where people need to be transferred to other hospitals (Cleaveland & Harper, 2020). This implies additional costs for both sides and also the need for patients to cover costly services.

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Nurse Leader Interview Summary

A nurse leader in an organization is a team member who is held accountable for making important decisions in situations that are significant for the team. The role of a nurse leader is to play a regulatory role in the team. Effectiveness of managerial activities and the regulation of relationships in the team are the main factors in the work of a nurse leader (Cleaveland & Harper, 2020). Such specialists need to take into account both global scientific approaches to the evolution and implementation of the nursing process, and the actual conditions of a healthcare institution. An important condition for the organization of nursing care is the use of conceptual models of nursing.

Role of the Nurse Leader

The interviewed ED/SCU manager is accountable for doing the audit of charts, creating work schedules, providing assistance in disciplinary action, and making sure staff members comply with accrediting boards. In addition, the nurse reviews the structural organization of nursing services (Nobles et al., 2019). She provides the process of training and retraining of nursing staff (basic knowledge necessary to perform professional functions) and attracts specialists to training. The manager participates in the distribution of financial and other resources needed for the successful implementation of the nursing process and determines the priority areas for the distribution of funds, the necessary volumes of technical equipment, the use of the facilities (Nobles et al., 2019). The specialist determines the availability of staff for the implementation of the nursing process – the number of nurses per shift, their work schedule, the use of corporate culture formation techniques, the requirements for the internal culture. To achieve the desired result, the nurse manager can use a whole range of managerial techniques that are consistent with the corporate culture of the Central Harnett Hospital.

The leader’s role aligns with the roles defined in “The Essentials of Master’s Education in Nursing” in so that the specialist understands that one of her main responsibilities lies in ensuring safe and quality patient care. In addition, the manager noticed that a decline in job satisfaction has been observed recently among the nursing personnel and that the number of sick calls has increased. The core of her practice reflects that the aspects of clinical care are in line with the population-focused approach (Nobles et al., 2019).

Organization’s Characteristics (Strengths and Weaknesses)

Central Harnett Hospital is constantly revising its approach to delivering patient-centered care. At present, its main strengths include the fact that the hospital’s mission, vision, and core values are propagated through policies and day-to-day interactions (Harnett Health, n.d.). As stated by the nurse leader, organizational policies are constantly reviewed to ensure that they are using the most recent evidence-based practice and aligned with the accrediting organizations. In addition, compassion for the population is another strong side of the hospital. It is important for the staff to connect with the patients, and the fact that specialists and patients know each other (since this is quite a small community) provides an opportunity to build a different level of patient-provider communication.

Importantly, current weaknesses are also related to the type of environment in which the hospital operates. As mentioned above, the hospital is located in a rural farming community with many ethnicities, and staff members cannot build effective connections with various ethnicities since patients do not feel that their culture is adequately represented within the health system. Another area for improvement is patient-provider communication (Nobles et al., 2019). The education level of patients varies, and patients can present to the emergency department with a condition that does not require urgent care. The team needs to sympathize and educate patients on their health and help them to improve it.

Evidence-Based Practice Activities and Quality Improvement Projects

The manager and the team participate in quality improvement efforts on a daily basis (Nobles et al., 2019). Hospital’s team meets twice a week with risk management to determine new ways to improve current processes and help decrease sentinel events and near misses. Apart from that, the hospital works closely with Emergency Medical Services and providers to review case studies to ensure that the team is delivering the best possible care. In addition, policies are constantly reviewed based on the most recent evidence. The institution has monthly audits on scanning medications and monthly meetings on falls.

Recommendation for Organization Change

The analysis of the information obtained from the interview with the nurse leader, as well as research on the topic showed that it is necessary to increase health literacy of patients through education in order to achieve a shift from urgent-medical type of visits to the hospital to the preventive principle (Penner, 2017). A contemporary understanding of the role of the patient in healthcare and preventive measures provides that to make an informed decision regarding the need to receive medical care and show responsible behavior towards health, patients need to have reliable and complete information. From the results of the interview, it follows that the health awareness of the patients is not at the desired level, which leads to the fact that patients who do not need urgent care present to the department because they cannot analyze their condition (Penner, 2017). It is necessary to determine differences in the level of health awareness by socio-demographic (gender, age, education, profession), medical-social and individual (information sensitivity) factors, which will allow a more effective approach to patient education.

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The suggested recommendation is that the manager should explain to the nursing staff the importance of educating patients about how they can get information about their condition or how they can understand if they need to get urgent care. This will allow increasing the general level of health awareness of the community in which the hospital functions (Penner, 2017). It is necessary to achieve the expansion of information competence of patients, both in the spectrum of obtaining information (traditionally the most significant for patients is information related to therapeutic and diagnostic measures and actions in urgent situations) and in the ways of obtaining it. This will not only increase patient satisfaction with the quality of care provided, but also make care more patient-oriented.

A factor limiting the informational competence of patients is their personal limitations and informational sensitivity (Weberg et al., 2019). An analysis of the literature suggests that patients can be divided into two main types: patients who require a special mode of information delivery and patients who can receive education in the usual mode, without restrictions. It is necessary to actively form the health awareness of patients through education, taking into account their limiting factors and individual characteristics.

Rationale for Recommended Change

It is worth noting that in the process of providing services, the interaction between the patient and the staff is crucial (Weberg et al., 2019). The justification of how the change will address the weaknesses of the organization and the needs of the community is directly related to the fact that, at present, staff cannot interact effectively with the representatives of different ethnicities, and patients’ concerns about their conditions are not addressed properly. At the moment, as noted by the nurse manager, staff needs to take the time to sympathize and educate the patient on their health and help them to improve it and not complain about it behind their back. The implementation of various types of activities in the process of group work leads to the transformation of the patient into a partner and increases their motivation for participation and cooperation.

Relations with patients are an important factor in the process of care because medical care includes not only specific procedures but also the implementation of effective professional communication based on the care of a person, expressed in attention, empathy, emotional support, and education, which are core values of the hospital (Harnett Health, n.d.). Personal qualities, behavior, and attitude of a patient and the nursing team are directly dependent on each other. The ability to communicate with the patient is one of the specific skills of nursing personnel and it follows didactic rules. Communication and patient education predispose them to share their complaints and problems and deliver health-related information as accurately as possible.

The proposed organizational change will address the issue of insufficient communication between the patient and staff. For the patient to be able to get information about their condition and participate in the process of care, they need to be educated on how to ask specific health-related questions. Patients who cannot formulate their questions due to cultural differences or other reasons may feel unsatisfied with the quality of care and be unwilling to collaborate on treatment (Nobles et al., 2019). Factors determining the understanding of information include education, general culture and lifestyle, current state of the patient, and so on. If a patient does not understand the healthcare information, they are not able to be a participant in the process of care.

To be able to make communication and interaction between medical personnel and patients effective, staff needs to possess the knowledge of human behavior and get training in listening methods. Nurses may show some degree of intolerance to a patient’s desire to be heard (which was provided as an example of an area for improvement for the Central Harnett Hospital). However, all participants in the process should understand that the relationship between nursing personnel and patients is directly related to medical activity (Nobles et al., 2019). They affect the diagnosis and treatment, the psychosomatic symptoms in patients, their self-awareness and, to a large extent, their involvement in collaboration. The most common factors hampering the connection between the medical staff and the patient on the part of the patient are the socio-cultural characteristics of the patient, their emotional state, level of stress, illness, age, and so on (Nobles et al., 2019). Since the needs of the population include not only physical but also psychological well-being, nurses should be able to communicate with patients belonging to different ethnicities effectively so that patient education can actually take place.

Evaluation of Change Effectiveness

In order to measure the effectiveness of the proposed organizational change, an adapted version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) will be used. This survey is used to conduct multicenter studies on the quality of care in institutions (Centers for Medicare & Medicaid Services, 2020). Such analytical systems are helpful in assessing the quality of medical care comprehensively in terms of its safety, effectiveness from the point of view of patients, cost, cumulative socio-economic effects, as well as legal, ethical, and political implications in general. A distinctive feature of this survey is the focus on priorities and the difference in tactics of making managerial decisions based on the results of a comprehensive analysis.

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To measure effectiveness, the survey will be adapted in order to conduct a detailed analysis of patient satisfaction with the interaction with nursing staff. Based on the results, organizational, clinical, and regulatory measures will be planned to increase the effectiveness and quality of nursing care. An adapted questionnaire will be offered to patients after discharge and will cover a cohort of those who receive outpatient medical services, that is, in primary care settings. The results of the study will then be compared with the results of other hospitals (Centers for Medicare & Medicaid Services, 2020). After the analysis, regular educational sessions for the nursing personnel will be initiated to make the process of care more patient-oriented through communication and education.


Thus, it can be concluded that Central Harnett Hospital has specific strengths that allow it to deliver high-quality care to patients. Nevertheless, one of the main areas for improvement is patient education that can be implemented through effective communication. The suggested organizational change implies staff education on the importance and effective approaches to patient-provider interaction. To measure the effectiveness of change and patient satisfaction, an adapted version of the Hospital Consumer Assessment of Healthcare Providers and Systems survey will be used. The current approaches will be revised based on the results of the survey.


Centers for Medicare & Medicaid Services. (2020). HCAHPS: Patients’ perspectives of care survey. CMS. Web.

Cleaveland, K. A., & Harper, K. J. (2020). Prepare and pursue board opportunities: A practical guide for nurse leaders to serve on a board. Nursing Economic$, 38(2), 94-97. Web.

Harnett Health. (n.d.). Central Harnett Hospital. Harnett Health System. Web.

Nobles, K., Barber, J., James, D., & Wingo, N. (2019). Driving innovation in health care: Clinical nurse leader role. Journal of Nursing Care Quality, 34(4), 307-311.

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company.

Weberg, D., Porter-O’Grady, T., Mangold, K., & Malloch, K. (2019). Leadership in nursing practice (3rd ed.). Jones & Bartlett Learning.

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