Twelve Months to Thirty Percent: A Leadership Plan for Sustaining and Spreading Morning Discharges Across a Community Hospital's Medical Units
[Student Name]
University of Phoenix
DNP/730: Organizational and Systems Leadership
Week 8 Assignment
[Instructor Name]
[Date]
The hospital and plan are composites written for a model paper.
Over the past seven weeks, I examined late discharges as a systems problem, assessed culture on two units, chose a leadership approach, tested changes, built a driver diagram, addressed resistance and developed the discharge huddle team. This paper integrates that work into a 12-month leadership plan to reach and sustain 30% of discharges before noon on both medical units and spread the approach to the surgical units.
The Case for Change
Patients who wait longest in the emergency department for a bed die more often and stay longer once admitted (Singer et al., 2011). Our late discharges keep medical admissions in the emergency department most afternoons. Morning discharges are a patient safety goal for patients we never meet on our units.
Leadership Approach
The leadership review I relied on earlier (Wong et al., 2013) tied relational styles to patient results such as fewer deaths and fewer medication errors. My plan relies on relational leadership: involving staff in design, listening to concerns, recognizing effort and removing barriers, with clear goals and measures. On 5 West, trust-building continues before new demands.
Readiness
Weiner (2009) describes readiness as shared commitment and efficacy. The plan maintains commitment by sharing results that matter to staff, such as calmer afternoons, and maintains efficacy through protected huddle time, pharmacy and therapy support and coaching.
Phase One, Months 1 to 3: Stabilize 5 East, Launch 5 West
On 5 East, the unit adopts the tested changes as standard work: the 3 p.m. huddle, prescriptions filled the evening before and identified discharges seen first on rounds. On 5 West, the unit runs its own PDSA cycles with a coach from 5 East. Both units use the structured huddle tool and complete team training.
The plan's last line item is my own calendar: two huddles a week, every week, for a year.
Phase Two, Months 4 to 8: Reach the Target and Address External Constraints
The middle months are where improvement efforts usually stall, so this phase pairs targets with new work on constraints outside the units.
Both units aim for 25% by month six and 30% by month eight. With case management, I will negotiate with our three main skilled nursing facility partners to accept morning admissions, addressing the nested-system constraint identified in week one.
Phase Three, Months 9 to 12: Sustain and Spread
Sustainment includes embedding the huddle in the staffing grid, adding the discharge-before-noon measure to the monthly unit dashboard, including the huddle in new staff orientation and assigning ownership to each unit's manager. Spread to the two surgical units will follow the same pattern: local PDSA cycles adapted to surgical workflows, with a coach from the medical units.
Governance
A discharge steering group, co-chaired by me and the hospitalist director, will meet monthly with case management, pharmacy, therapy, transport and environmental services leaders. It will review measures, resolve cross-department barriers and approve spread. Unit teams own daily work; the steering group owns barriers no unit can solve alone.
Communication Across the Hospital
The emergency department will receive monthly data on boarding hours for medical admissions, so its staff see the effect of upstream change. The hospital newsletter will feature unit teams' work. Visible results for people who benefit, not only those who change, build broad support.
Standard Work
Standard work documents will describe each step: who holds the huddle, what the script asks, when prescriptions are filled, how families are contacted. Documents are written by the staff who do the work and reviewed every six months, so standards evolve with practice instead of freezing it.
Measures
The family of measures from the driver diagram continues: discharges before noon, emergency department boarding hours for medical admissions, huddle list accuracy and prescription readiness, with 30-day readmissions and patient readiness as balancing measures. Results are reviewed weekly by unit teams and monthly by the hospital's operations council.
Lessons Carried Forward
Three lessons from the first units shape the spread. First, protected time is non-negotiable. Second, each unit needs its own tests, not a copied process. Third, trust must be built before change is asked of a skeptical unit. These lessons are written into the spread guide for the surgical units.
Resources
Protected charge nurse time costs about 1 hour per unit per day. Pharmacy evening workflow required no new staff. Coaching and team training require about 40 hours of staff time. Estimated savings from shorter stays and fewer diversions exceed these costs.
Patient and Family Involvement
A patient advisor sits on the steering group, and a short survey asks recently discharged patients about the timing and preparation of their discharge. Patients' perspectives keep the goal grounded: morning discharge must feel prepared, not rushed.
Risks
Risks include census surges that erode protected time, hospitalist turnover and loss of attention after the target is reached. Responses include a rule that huddle time is protected unless the house is in crisis status, orientation of new hospitalists to the huddle and continued monthly review after the target is met.
Financial Case for Sustainment
The finance office estimated that reducing average length of stay by a quarter of a day on the medical units would free roughly 3,000 bed days a year, enough to reduce ambulance diversion hours. Presenting this estimate to the executive team secures ongoing support for protected huddle time when budgets tighten.
My Personal Actions
I will attend two huddles per week on alternating units, meet monthly with the hospitalist director and case management director, report progress at the operations council, recognize staff contributions publicly and keep my commitments in writing. Leadership attention, visibly sustained, signals that the change matters, while fading attention signals that it has become optional.
Developing Others
Sustaining the change requires more leaders than me. Both unit managers, four charge nurses and the hospitalist champion will receive coaching in running huddles and PDSA cycles, and each will lead one test during the year. Building improvement capability in others is how the plan outlasts my attention.
Evaluation of the Plan
At 12 months, success means both medical units sustaining 30% discharges before noon for three consecutive months, surgical units launched, readmissions unchanged and improved teamwork climate on 5 West.
What I Will Stop Doing
A leadership plan also names what the leader will stop. I will stop sending discharge reminders by email, which staff learned long ago to ignore, and stop reviewing individual clinicians' discharge times, which erodes trust. Attention goes instead to the huddle, the barriers and the team.
Conclusion
This plan integrates systems thinking, cultural assessment, relational leadership, the Model for Improvement, attention to readiness and resistance and team development into a 12-month effort to sustain and spread morning discharges. Because emergency department boarding carries a mortality cost, the goal is a patient safety goal. The plan defines phases, measures, resources, risks and the leader's own ongoing actions.
References
Singer, A. J., Thode, H. C., Jr., Viccellio, P., & Pines, J. M. (2011). The association between length of emergency department boarding and mortality. Academic Emergency Medicine, 18(12), 1324-1329. https://doi.org/10.1111/j.1553-2712.2011.01236.x
Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709-724. https://doi.org/10.1111/jonm.12116
How this DNP 730 Week 8 example is structured
The DNP/730 Week 8 work usually closes with a leadership plan for a practice change. This paper brings the course's concepts together, assigns each a role in the plan and specifies actions, timelines, measures and the leader's own behavior. Students search this week as DNP 730 Week 8, DNP730 Wk 8 or DNP/730 Wk 8; all three are the same assignment.
DNP/730 Week 8 questions, answered
What does DNP/730 Week 8 usually ask for?
Many sections close with a leadership plan that applies organizational and leadership theory to lead, sustain and spread a practice change.
Why include sustainment in a leadership plan?
Many improvements fade when attention moves elsewhere; planning for ownership, standard work, monitoring and continued leadership attention keeps gains in place.
What does the leader personally do in a plan?
The leader sets direction, removes barriers, protects time and resources, models the behaviors the change requires and keeps attention on measures and people over time.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official University of Phoenix document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.