MHA 599 Week 3 Change Leadership and Communication Plan Example

Messages, Messengers and Moments: A Change Leadership and Communication Plan for Bringing Home Blood Pressure Management to Rural Clinics

[Student Name]

University of Phoenix

MHA/599: Capstone: Leading the Organization Through Change

Week 3 Assignment

[Instructor Name]

[Date]

The health system, its clinics, coalition and communication plan are composites written for a model paper; research findings come from the sources cited.

At the first meeting to discuss the home blood pressure program, a family physician from one of the composite Montana health system's rural clinics spoke bluntly to the project director: we always hear about new programs from Billings after the decisions are made. The comment framed this capstone paper. Leading the change would require building support from the people who would carry it out, starting before decisions were final.

Diagnosing Readiness

The project director used a consolidated framework for implementation research that organizes influences on implementation into five domains, the intervention itself, the outer setting, the inner setting, characteristics of the individuals involved and the process of implementation, with 37 defined constructs such as evidence strength, patient needs, culture, leadership engagement and planning (Damschroder et al., 2009). Assessing each domain helped identify what would help or hinder the program.

The Intervention

The program's evidence is strong, its advantage over current care is clear and it can be piloted. Its complexity is moderate: devices, protocols, billing and new roles must all work together.

The Outer Setting

Patient needs are high, Medicare payment exists for monitoring services and the system's shared savings arrangement rewards better control. Cellular coverage is weak in parts of the service area.

The Inner Setting

The clinics' cultures differ. Some have long-tenured clinicians wary of changes from Billings; others welcome support. Leadership engagement at the system level is strong, but clinic-level leaders have not yet been involved.

Individuals

Clinicians' beliefs vary: some see pharmacist management as help, others as intrusion. Pharmacists are enthusiastic about the expanded clinical role. Medical assistants worry about device setup time.

Process

No plan yet existed for engaging clinic leaders, which the physician's comment confirmed.

Building a Guiding Coalition

In a national collaborative of hospitals working to improve heart attack care, the teams that got furthest were those whose steering groups mixed professions and ranks, let members genuinely shape decisions and could argue productively; how big the group was and how often members changed did not seem to matter (Bradley et al., 2018). The program's coalition includes two rural physicians, including the one who spoke up, a nurse practitioner, two pharmacists, a medical assistant, a clinic manager, a tribal health representative, a patient with hypertension and the project director.

Authentic Participation

The coalition decides key design questions, including protocol limits, which patients to enroll first and how clinicians receive updates. Its decisions are not rubber stamps for choices already made.

Inclusive Leadership

Hierarchy can keep medical assistants and patients quiet. Work with newborn intensive care teams showed that people lower in the professional pecking order felt less safe speaking up, and that leaders who actively sought and valued everyone's ideas made the whole team feel safer, shrinking that gap (Nembhard & Edmondson, 2006). The coalition's chair asks medical assistants and the patient member for their views first on each question. The medical assistant's concern about setup time led to the most important design change.

The Design Change That Came From Listening

Because medical assistants reported that setting up devices during visits would delay clinics, the coalition moved setup to a separate short appointment with a community health worker or a telephone call, a change that removed a major source of resistance.

The Communication Matrix

The plan sets messages, messengers, channels and timing for each audience.

Clinicians

Message: pharmacists will manage medication adjustments under protocols you helped write, and you will see summaries, not every reading. Messengers: the physician coalition members. Channels: clinic meetings and one-on-one conversations. Timing: before the pilot and monthly after.

Pharmacists

Message: this is a new clinical role with clear protocols and support. Messenger: the pharmacy director. Channels: training sessions and a pharmacist working group.

Nurses and Medical Assistants

Message: device setup happens outside clinic visits, and your role is identifying eligible patients. Messengers: the medical assistant and clinic manager members. Channels: huddles and short guides.

Patients

Message: check your blood pressure at home, and a pharmacist will help adjust your medicines without extra trips. Messengers: clinicians and community health workers. Channels: visits, phone calls and printed guides in plain language.

Tribal Health Programs

Message: the program will be designed with you and delivered with community health representatives. Messenger: the chief executive and the tribal health representative on the coalition. Channels: meetings with tribal health boards.

Leaders and the Board

Message: the program addresses a strategic priority with measurable results and a sustainable model. Messenger: the project director and chief medical officer. Channels: executive and board quality committee meetings.

Timing the Messages

The sequence mattered. Clinic leaders and the coalition heard first, three months before the pilot, when design questions were still open. All clinicians and staff at the pilot clinics heard next, in person, six weeks before launch. Patients were contacted only after clinicians were ready to answer their questions. The board heard at the start and at each milestone.

Messengers Matter More Than Memos

The project director noticed that clinicians trusted each other far more than they trusted emails from Billings. When the physician who had complained at the first meeting presented the protocols to her colleagues, questions were detailed and constructive. The plan therefore puts peers, not executives, at the front of clinic communication.

Language and Culture

Patient handouts used short sentences and everyday words, and patients at two clinics tried them out before printing. For reservation communities, community health representatives reviewed materials and advised on wording, and the program uses their preferred terms and images.

Anticipating Resistance

Likely resistance includes clinicians' concerns about autonomy and liability, patients' doubts about devices and clinic managers' concerns about workload. Each has a response: protocols clinicians approve, simple devices and dedicated setup, and staffing from the program rather than clinics. Resistance is treated as information that may improve the design.

Feedback Loops

Monthly surveys of clinicians and staff, a shared inbox for concerns, coalition members' reports from their clinics and patient calls after enrollment bring concerns back quickly, and the coalition reviews them at every meeting.

What Went Wrong Early

Not all communication worked. An early email to clinic staff about device ordering used technical language and generated confused replies. The coalition replaced it with a one-page guide and a five-minute huddle presentation by the medical assistant member, which answered the questions the email had raised.

Measuring Communication

The plan measures whether clinicians can describe the program and their role, clinician support scores, enrollment rates and concerns raised and resolved.

Conclusion

A physician's complaint that decisions arrived from Billings shaped a plan built on diagnosis, inclusion and two-way communication. A consolidated framework identified what would help or hinder the change, research on guiding coalitions and inclusive leadership shaped the coalition and a communication matrix tailored messages, messengers and channels to each audience. Listening before deciding produced a better program and more support for it.

References

Bradley, E. H., Brewster, A. L., McNatt, Z., Linnander, E. L., Cherlin, E., Fosburgh, H., Ting, H. H., & Curry, L. A. (2018). How guiding coalitions promote positive culture change in hospitals: A longitudinal mixed methods interventional study. BMJ Quality & Safety, 27(3), 218-225. https://doi.org/10.1136/bmjqs-2017-006574

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50. https://doi.org/10.1186/1748-5908-4-50

Nembhard, I. M., & Edmondson, A. C. (2006). Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27(7), 941-966. https://doi.org/10.1002/job.413