Running head: STRATEGIC PLAN FOR CHANGE
1
STRATEGIC PLAN FOR CHANGE
2
Strategic Plan for Change
Jennifer Zimmerman
Walden University- NURS 6201
December 29, 2017
Improving Patient Experience who are Undergoing
Chemotherapy from an Outpatient setting to an Inpatient Setting
1.
Introduction and Statement of the Problem
1.1.
What is the problem?
Outpatient chemotherapy sessions are sufficient in most
organizations, especially for those receiving curative intent
chemotherapy (Davidoff et al. 2013). The patients who meet the
set criteria end up receiving supportive care post induction
chemotherapy, as well as different cycles as other outpatients.
Outpatient management can be made safe and the transition to
inpatient more efficient, which is considered a challenge for
most healthcare organizations. The problem at hand in this
section has been adequately analyzed, which involves the
transition of patients receiving chemotherapy from outpatient to
inpatient in healthcare facilities.
1.2.
Why is it important enough to warrant a change?
Outpatient care especially for most patient has become a

familiar concept that is driven by increased healthcare costs and
more so, the increased demand for existing inpatient resources
in different organizations (Joana et al. 1987). Improved
supportive care in inpatient is also another reason for the need
to embrace the transition, and patient wishes to spend the least
amount of time, especially in waiting for service delivery in the
outpatient setting. With these concepts in mind, it is important
enough to warrant a change. Patient satisfaction ought not to be
ignored in different healthcare organizations. There is a need to,
therefore, be on the forefront in enhancing adequate care, and
embracing inpatient plans for the chronically ill patients.
1.2.1.
Scholarly Reference #1
Joana, L., Mary, H., Alan, M., Andrew, B., & Steven, C.,
(1987). Case Mix and Changes in inpatient and outpatient
chemotherapy. PubMed 8(4): 65-71.
In most healthcare settings, the therapy provided in outpatient
has been associated with substantial tumors, chemotherapy
involving high doses, and then followed by autologous stem cell
transplantation. Outpatient administration of consolidation
cycles has been reported, which emphasizes the major problem
in this scholarly soured. According to the authors, the transition
to inpatient to outpatient care should be considered and priority
to solve the efficiency problems at hand.
1.2.2.
Scholarly Reference #2
Hayes, J. (2014). The theory and practice of change
management. Palgrave Macmillan.
This source deals with theory and practice of change
management. Change management is an adequate practice in the
healthcare setting. There is a need for all healthcare
organizations to be at the forefront to ensure that healthcare,
both inpatient and outpatient are realized. The source provides

and explains outpatient inefficiency for chronic patients as the
worst problem in the medical profession. The problem under
consideration should not be shunned, hence the need to oversee
such transition professionally.
1.2.3.
Scholarly Reference #3
Michael, E. P, & Thomas, H. L, (2013). The Strategy That Will
Fix Health Care. Harvard
Business Review.
This source provides a recommendation on what should be done,
to solve the most intensive problem in the healthcare fraternity.
The source provides a common strategy that can be implemented
to deal with the problem at hand. Chemotherapy patients and
other chronically ill patients should be given the most effective
care, through enhancing efficiency in service delivery. The
transition, which is considered a problem, will be beneficial
only if correct measures are put in place, to ensure that
outpatient to inpatient transition does not affect service delivery
and patient satisfaction.
2.
Review of Literature
2.1.
Research Reference #1
Davidoff, A. J., Zuckerman, I. H., Pandya, N., Hendrick, F., Ke,
X., Hurria, A., Lichtman, S. M.,
Edelman, M. J. (April 01, 2013). A novel approach to improve
health status measurement
in observational claims-based studies of cancer treatment and
outcomes. Journal of
Geriatric Oncology, 4, 2, 157-165.
Davidoff et al. (2013) provide relevant information regarding

the issue of chemotherapy in outpatients, and the transition of
patients to inpatient care. The research is quantitative and aims
at describing the aspects which need to be considered, to
improve health status measurement especially in cancer
treatment and outcomes. The population under consideration
includes all chronically ill patients. Cancer treatment and
outcomes have also been identified, as well as the strategies that
can be used by healthcare organizations to increase efficiency in
the management of cancer treatment.
2.2.
Research Reference #2
Fisher, M. D., Punekar, R., Yim, Y. M., Small, A., Singer, J. R.,
Schukman, J., McAneny, B. L.,
... Malin, J. (January 01, 2017). Differences in Health Care Use
and Costs among
Patients with Cancer Receiving Intravenous Chemotherapy in
Physician Offices versus
in Hospital Outpatient Settings. Journal of Oncology Practice,
13, 1, 37.
Fisher et al. (2017) describe the basis of healthcare use and the
costs which are incurred by different groups of patients. The
focus population includes all patients with cancer, specifically
those than receive intravenous chemotherapy in physician
offices, versus in hospital outpatient settings. This source helps
identify the different cost-effective measures and weigh the
benefits which are realized by receiving efficient care
especially for the terminally ill patients in different
organizations.
2.3.
Research Reference #3
Foster, A. E., & Reeves, D. J. (June 01, 2017). Inpatient
antineoplastic medication administration
and associated drug costs: Institution of a hospital policy

limiting inpatient
administration. P and T, 42, 6, 388-393.
This is a quantitative study which aims at identifying the
associated drug costs for different patients in healthcare
organizations. The population under consideration includes
administrative departments of organizations, where the policies
limiting inpatient administration have been analyzed. This
source is credible for the research topic under consideration.
The authors have managed to utilize the evidence as provided in
different healthcare organization policies regarding inpatient
medication administration and service delivery, as compared to
outpatient service delivery.
2.4.
Research Reference #4
Mathews, M, Buehler, S. & West, R. (2009). Perceptions of
health care providers concerning
patient and health care provider strategies to limit out-of-pocket
cost for cancer care.
PubMed Central, 16(4): 3-8.
Mathews et al. (2009) aim at describing the prosecution of
different healthcare providers. This is in regards to the patient
and healthcare provider strategies that are present, to limit out
of pocket costs, especially for cancer care. This is a quantitative
research, which relies on information from semi-structured data
collected, from interviews. The population under consideration
includes twenty-one cancer care providers. Examples include
nurses, social workers, surgeons, and dieticians. The areas
under consideration include; Labrador and Newfoundland.
2.5.
Research Reference #5
Vegunta, R. K. R., Blue, B. J., Fernandes, H. D., Upadhyayula,
S., Burhanna, P., Rodin, M. B.,

& Poddar, N. (January 20, 2016). Impact of an inpatient
palliative consultation in
terminally ill cancer patients. Journal of Clinical Oncology, 34,
77.
Vegunta et al. (2016). Examines how patients respond to the
high costs of treatment, primarily related to subscription drugs.
This source examines the strategies which patients and their
providers use especially in cancer care. This qualitative article
is based on a more extensive study of cancer patients. The
collection method used includes surveys and qualitative
interviews with care providers.
3.
Synthesis of the Evidence
3.1.
Summary of potential actions derived from your evidence
review.
All the studies which were conducted based on the consulted
sources are all inclined to the treatment of chronic infections, as
well as patient management in both outpatient and inpatient
departments in different healthcare organizations (Fischer et al.
2017). Risk factors also need to be noted, for the sake of
maintaining credibility and efficiency in service delivery.
Transitional care involves a wide range of services and
environments. These are precisely meant to promote the safety
and timely passage of patients (Foster & Reeves, 2014).
Different levels of healthcare in different settings are put into
consideration. The high quality of care is expected and
considered important especially for patients with multiple
chronic conditions. Family caregivers are also in the picture
because a lot of quality and professional care needs to be
discharged at all times. A growing range of evidence suggests
the importance of noting the patient groups that are vulnerable
to breakdowns, especially in care. There is a great need for

transitional care services, especially from outpatient units to
inpatient care in different organizations (Hayes, 2013).
Poor handover of patients’ needs to be discouraged at all costs.
Low satisfaction with care and the high hospitalization rates
should be controlled for improved efficiency in medical and
healthcare organizations (Michael & Thomas, 2013). The option
of exercising specialized handover for patients should thus be
consulted for efficient service delivery and improved rates of
satisfaction among patients in different healthcare
organizations. Patients need to be treated most efficiently, and
the continuum of care emphasized.
3.2.
Recommendations to improve the problem.
A lot of factors are responsible for contributing to gaps in care,
especially during specific critical transitions in healthcare
organizations (Mathews et al. 2009). Fundamental problems
which need to be considered during the process include poor
communication, inadequate education of family caregivers,
incomplete transfer of information in the process, limited access
to services which are essential to the patients, and the lack of a
specific person delegated to a patient, to enhance continuity of
care.
Other aspects which exacerbate the problem includes cultural
differences and health literacy issues. The best
recommendation, in this case, is to suppose the adults especially
during hospitalization, and after their discharge is effected
(Numico et al. 2015). There is a need to have family caregivers
educated and made aware of the importance of paying attention
to their patients. Emotional needs should be studied during this
form of transition.

3.3.
The best action for your organization and make a succinct
statement of your recommended plan.
The best action is educating family caregivers, especially during
patient transition, and the whole problem under consideration
(Shirley, 2013). Family caregivers play a significant role
especially in supporting adopts during the transition and
hospitalization process. The level of engagement in decision
making especially about transition and is charge plans should be
communicated to patient relatives. With this in place, it will be
easier to ensure that quality preparations are made, for the next
stage of care. Caregiving both to family and professionals can
be rewarding, but can also be considered as a burden.
Episodes of illness need to be treated from a professional level.
Hence the continuum of care is very important. Nurses and
social workers need to be on the forefront primarily in attending
to emotional needs. If this recommendation is implemented,
assessment of emotional needs will be more efficient. At the
same time, it will be easier to minimize the negative impacts
and experiences of outpatient-inpatient transitions for different
groups of patients. A lot still needs to be done, to care for the
terminally ill patients.
4.
Suggested Courses of Action
4.1.
Restate the action you want to occur
Frequent transitions within an organization can have devastating
effects primarily on the health of the patient. For example,
medication errors may occur, which are common during such
periods inpatient care (Vegunta et al. 2016). The best models of
care should be embraced at this point, where the best course of
action is to educate the family members, on the importance of

the transition from outpatient to inpatient, empathizing with
their situation, and provision of professional advice while in the
facility.
4.2.
Outline how you will implement the change
Change is inevitable, but most likely to be faced with a lot of
reluctance and opposition if not well implemented an
introduced. I will implement the change through organizing
with different professionals, on how to initiate the transition
from outpatient to inpatient for the chemotherapy patient.
Liaising with the involved parties is bound to ensure that
everyone is on board, the importance of the process realized,
and coordination realized in the process (Vaunt et al. 2016).
4.3.
Change theory or Leadership strategy to guide the change
process.
A successful change process needs to begin by the development
of understanding, of why the change should take place in every
organization. Lewis change theory will help guide the change
process in the healthcare setting. The unfreeze stage involves
preparation of the involved parties to accept that the change is
necessary. This will be done through explaining the importance
of the transition for the benefit of the patient (Vaunt et al.
2016). The change itself takes place when people begin to
resolve all forms of uncertainty and look into newer and better
ways of doing things. Transitioning from the outpatient to
inpatient is initiated in this phase, which is effective. The
refreeze stage in this model helps embrace the change that has
taken place. Consistency is achieved, and internalization is also
embraced. Comfort is at this stage, realized by the patient and
relatives.

4.4.
Who, what, when, and where?
The involved parties include the relatives of the patient, the
family as a whole, and the patient in the hospital setting as well.
Primary and secondary caregivers are present in this case,
especially the nurses, practitioners, physicians and medical
service providers. This transition will only be valid after proper
information transfer is initiated and in a compatible healthcare
organization setting.
5.
Summary or Conclusion
5.1. Summarize the main ideas and arguments, pulling
everything together to help clarify the thesis of the paper.
Most patients try their best especially in minimizing the costs
related to healthcare, including rationing medications, and
choosing to be part of radical treatments. Lengthening the time
between appointments is also considered an option, or choosing
inpatient care (Vaunt et al. 2016). Healthcare providers, on the
other hand, respond to different financial concerns of patients,
through assisting them to access the best services, and by
changing the supportive chemotherapy programs and drug
prescriptions. Other aspects include shortening the treatment
protocols involving radiation. Most healthcare service providers
have resulted in admitting patients to the facilities, to follow up
more closely with physicians on their conditions. The best
option is to offer out of pocket services, which result from
cancer care. Cancer treatment is considered to be expensive
primarily due to the different phases of treatment follow-up
sessions (Vaunt et al. 2016). Transitions from outpatients to
inpatients should be handled most effectively. The best strategy
which should be prioritized is to deal with the education of
family caregivers, for enhanced service delivery.

References
Davidoff, A. J., Zuckerman, I. H., Pandya, N., Hendricks, F.,
Ke, X., Hurried, A., Littman, S. M.,
Edelman, M. J. (April 01, 2013). A novel approach to improve
health status measurement
in observational claims-based studies of cancer treatment and
outcomes. Journal of
Geriatric Oncology, 4, 2, 157-165.
Joana, L., Mary, H., Alan, M., Andrew, B., & Steven, C.,
(1987). Case Mix and Changes in inpatient and outpatient
chemotherapy. PubMed 8(4): 65-71.
Fisher, M. D., Punker, R., Yam, Y. M., Small, A., Singer, J. R.,
Schulman, J., Canny, B. L.,
... Malign, J. (January 01, 2017). Differences in Health Care
Use and Costs among
Patients with Cancer Receiving Intravenous Chemotherapy in
Physician Offices versus
in Hospital Outpatient Settings. Journal of Oncology Practice,
13, 1, 37.
Foster, A. E., & Reeves, D. J. (June 01, 2017). Inpatient
antineoplastic medication administration
and associated drug costs: Institution of a hospital policy
limiting inpatient
administration. P and T, 42, 6, 388-393.
Hayes, J. (2014). The theory and practice of change
management. Palgrave Macmillan. Mathews, M, Buehler, S. &
West, R. (2009). Perceptions of health care providers
concerning
patient and health care provider strategies to limit out-of-pocket
cost for cancer care.
PubMed Central, 16(4): 3-8.
Michael, E. P, & Thomas, H. L, (2013). The Strategy That Will
Fix Health Care. Harvard
Business Review.

Numico, G., Cristofano, A., Mozzicafreddo, A., Curcio, O. E.,
Franco, P., Courthod, G., Trogu,
A., ... Silvestris, N. (January 01, 2015). Hospital admission of
cancer patients: avoidable
practice or necessary care?. Plos One, 10, 3.
Shirey, M. R. (2013). Lewin’s theory of planned change as a
strategic resource. Journal of
Nursing Administration, 43(2), 69-72.
Vaunt, R. K. R., Blue, B. J., Fernandes, H. D., Upadhyayula, S.,
Burhanna, P., Rodin, M. B.,
& Poddar, N. (January 20, 2016). Impact of an inpatient
palliative consultation in
terminally ill cancer patients. Journal of Clinical Oncology, 34,
77.
The Case of Jeff: Pedophile in Institution
Jeff is a 35-year-old male who is an inmate in your maximum
security facility. Jeff has recently been transferred to your
facility from another facility, largely for protective reasons. Jeff
has come to you because he is very, very worried. Jeff is a
pedophile and he has been in prison for nearly five years. His
expected release date is coming up and he may very well get
released due to prison overcrowding problems and his own
exemplary behavior. He has been in treatment and, as you look
through his case notes, you can tell that he has done very well.
But there were other inmates at his prior prison facility who did
not want to see him get paroled. In fact, it is a powerful inmate
gang, and Jeff had received “protection” from this gang in
exchange for providing sexual favors to a select trio of inmate
gang members. Jeff discloses that while humiliating, he had to
do this to survive in the prison subculture, particularly since he
was a labeled and known pedophile. The gang knew this, of
course, and used this as leverage to ensure that Jeff was
compliant. In fact, the gang never even had to use any physical
force whatsoever to gain Jeff’s compliance. Jeff notes that this

now bothers him and he doubts his own sense of masculinity.
Jeff has performed well in treatment for sex offenders. But he
has also been adversely affected by noxious sexual experiences
inside the prison. You are the first person that he has disclosed
this to. Further, he is beginning to wonder if he may have
HIV/AIDS; he notes that he feels fatigued more frequently and
that he gets ill more easily. However, he makes it very clear
that he does not want to be tested until he is out of prison and
he does not want his fears known to others in the prison.
As you listen to his plight, you begin to wonder if his issues
with sexuality are actually now more unstable than they were in
prison. Though his treatment notes seem convincing, this is
common among pedophiles. But what was not known to the
other therapist was how Jeff had engaged in undesired sexual
activity while incarcerated. This activity has created a huge rift
in Jeff’s masculine identity. Will this affect his likelihood for
relapse on the outside? Will Jeff be able to have a true adult–
adult relationship on the outside? If not, will he be more enticed
to have an adult–child relationship? Does Jeff need to resolve
his concerns with consensual versus forced homosexual
activity? You begin to wonder.
Now as you listen, you realize that if you make mention of this,
then the classification system is not likely to release Jeff, and
this condemns him to more of the same type of exploitation
(gang members are in this prison, too; they just are of different
gangs but will eventually learn of his past and follow suit with
the prior gang). Oh, and if you do say something, will Jeff feel
that honesty and counseling are simply an exercise in
vulnerability and betrayal? Or do you not mention this
information and by the same token allow someone to be released
with a highly questionable prognosis.
You sit there listening to Jeff, who is on the verge of tears. You
begin to wonder what you should do and what ethical and/or
legal bounds you need to consider …
Bibliography
Bennett, L. A. (1978). Counseling in correctional environments.

New York: Human Science Press.
Brown, D., & Srebalus, J. (2003). Introduction to the counseling
profession (3rd ed.). Pearson Education, Inc: New York.
Bureau of Justice Assistance. (2004). Mental health courts
program. Washington, DC: Office of Justice Programs, United
States Department of Justice.
Clear, T. R., & Dammer, H. R. (2003). The offender in the
community (2nd ed.). Thompson/Wadsworth: Toronto, Ontario
Canada.
Egan, G. (2007). The skilled helper: A problem management
and opportunity development approach to helping (8th ed.).
Belmont, CA: Thompson Brooks/Cole.
Gladding, S. T. (1996). Counseling: A comprehensive
profession (3rd ed.). Englewood Cliffs, New Jersey: Prentice
Hall.
Gladding, S. T. (2007). Counseling: A comprehensive
profession (5th ed.). Englewood Cliffs, New Jersey: Prentice
Hall.
Kratcoski, P. C. (1981). Correctional counseling and treatment.
Monterey, CA: Duxbury Press.
Lester, D. (1992). Correctional counseling (2nd ed.). Cincinnati,
OH: Anderson Publishing.
Masters, R. (2004). Counseling criminal justice offenders (2nd
ed.). Thousand Oaks, CA: Sage Publications.
McNutt, R. (1999). Court for mentally ill offenders advocated:
Judicial officials at seminar told that treatment is lacking. The
Cincinnati Enquirer. Available
at: http://www.enquirer.com/editions/1999/11/10/loc_court_for_
mentally.html.
Schma, H. P., & Rosenthal, W. (1999). Therapeutic
jurisprudence and the drug court movement: Revolutionizing the
criminal justice system’s response to drug abuse and crime in
America. Notre Dame Law Review, 74, 439–555.
Schrink, J., & Hamm, M. S. (1990). Misconceptions concerning
correctional counseling. Journal of Offender Counseling,
Services & Rehabilitation, 14(1), 1989.

Walters, G. D. (2001). Book review. International Journal of
Offender Therapy and Comparative Criminology, 45, 129–131.
Watson, A., Hanrahan, P., Luchins, D., & Lurigio, A. (2001).
Mental health courts and the complex issue of mentally ill
offenders. Psychiatric Services, 52(4), 477–481.
Weed, L. L. (1964). Medical records, patient care and medical
education. Irish Journal of Medical Education, 6, 271–282.