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Change Theories and Healthcare Innovations
Jenna Best Ellis
Liberty University
BUSI 505
August 7, 2021
Respectfully submitted to: Professor Lawrence Johnson
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Abstract
There have been significant advances in healthcare technology that have allowed for
improved communication between physicians and their patients to address and provide improved
patient outcomes. Advances in technology has shown many benefits for patients at risk for falls,
heart failure, diabetes, hypertension, and gastrointestinal disorders. Nurse leaders play an
important role in implementing changes to improve patient outcomes. Change theories examine
how the process of implementing will happen. It is important that nurse leaders understanding
theories of change to understand what to expect when introducing new initiatives.
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Change Theories and Healthcare Innovations
There are many factors that have an impact on the need for change within the healthcare
environment. These factors include the increase healthcare costs, nursing shortages, new
technology, and the growing elderly population. With the continued advancements in healthcare
technology, understanding and application of change theories are necessary to implement in
healthcare informatics that will allow for improved communications between physicians and
patients which will ultimately improve overall patient care (Wagner, 2018).
Change Theories
Change is essential to providing quality patient care in a constantly evolving field of
healthcare. Nursing leaders must execute the ability to maneuver change throughout their
environment. Successful change initiatives incorporate the application of change theories to use
the best process available to achieve a desired outcome. Application of the appropriate change
theory will allow for a more sustainable change within the organization. Change theories provide
the necessary framework to implement, manage and evaluate change within the desired
environment (Shirey, 2013).
Planned Change Theory
Theorist Kurt Lewin developed the Planned Change Theory that encompasses
recognizing why individuals and organizations act in certain ways and what resources would
strengthen or weaken an action of change. There are three phases of planned change theory:
unfreezing, moving, and refreezing (Shirey, 2013). The unfreezing phase involves getting ready
for change by recognizing an opportunity for improvement. The nurse manager will assess their
current environment with the desired state to determine what gaps are present. The moving phase
requires a plan of action for implementing change. This phase requires the manager to engage
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associates in the plan of change. Often, people are hesitant to change which is what makes this
phase often difficult. Lastly, the refreezing stage requires nurse leaders to institutionalize
changes into current practices and policies. This theory is the oldest change management theory
and still is used in practice today (Shirey, 2013).
Diffusion of Innovation Theory
Innovation is defined as new ideas, thoughts, and practices and includes the adoption of
these ideas. On the other hand, diffusion includes the sharing of these new innovations and
applying them in real world situations. The Diffusion of Innovation Theory seeks to understand
how innovations are adapted within different cultures and populations (Dearing & Cox, 2018).
Diffusion is defined as “a social process that occurs among people in response to learning about
an innovation such as a new evidence-based approach for extending or improving health care
(Dearing & Cox, 2018, p.183-4).” This theory has been assessed in understanding the rate of
how new ideas are adopted and applied.
Diffusion is impacted by the advantages and disadvantages of innovations and the
characteristics of those adopting innovation. There are five different people explained in the
Diffusion of Innovation Theory based on their willingness to adopt an innovation. These five
people include innovators, early adopters, early majority, late majority, and laggards. Innovators
are the first to accept change and adopt new ideas. They are not afraid to take risks and going
against the social norms. Early adopters adopt an idea because the innovation or ideas has more
advantages than disadvantages. The early and late majorities adapt because of the social pressure
to do so. Those in the early and late majority categories are part of the general population. Last to
adapt are the laggards. Laggards are typically set in their ways which make them slower to adapt
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change. In most cases they are forced to adapt to the new idea or innovation because it is used by
the majority population (Dearing & Cox, 2018).
Stages of Change Model
The Stages of Change Model, otherwise known as the Transtheoretical Model for
Change, focuses on understanding the decision-making process that leads a person to adapting
change. There are five stages of this change model: precontemplation, contemplation,
preparation, action, and maintenance (Raihan & Cogburn, 2021). The precontemplation stage
usually involves an individual that is typically in denial that change is needed. People in this
stage focus more on the negatives of changing rather than the advantages. Contemplation stage is
the stage when needed change is recognized and the pros and cons are assessed logically. Those
in this stage often remain indecisive on implementing changed behavior. The next stage of
change is the action phase. Change happens in this phase and plans are developed to help
overcome potential obstacles. When a person jumps to this stage without preparing for possible
obstacles can lead to potential failure. The maintenance phase is when the change behaviors are
sustained. There is often a fear in this phase of relapsing but evaluating the progress that has
been made keeps the individual from relapsing. Contingency plans should be created in this
phase and are helpful in preventing relapse. Termination is the final stage of this change model
and is often difficult to achieve. The termination stage is not typically achieved because this
stage requires individuals to have zero desire to return to their old habits and requires zero
temptation to return to their old habits. It is common for most people to remain in the
maintenance phase rather than progressing to the termination phase (Raihan & Cogburn, 2021).
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Use of Change Theories
Application of change in the field of nursing is essential in promoting quality patient
care. Change agents are individuals who initiate and guide change within an organization. Nurse
leaders are often change agents that implement new ideas and processes for nurses to apply in
their practice that leads to improved patient outcomes. The responsibilities of change agents are
to assess the need for change, collaborate with others to incorporate the need change and educate
others on the process of change. Often there is resistance to change so it is imperative that nurse
leaders anticipate potential barriers to change and take action to remove these barriers. Leaders
must have a clear understanding of change theories and learn to constructively address the
reasons for resistance to improve overall patient outcomes. (Wagner, 2018).
Innovations in Healthcare Informatics
Healthcare informatics is defined as “the integration of healthcare sciences, computer
science, information science, and cognitive science to assist in the management of healthcare
information (Sweeney, 2017, p. 1)”. Healthcare professionals utilize informatics in both the
inpatient and outpatient settings for a variety of different reasons. This can vary from vital sign
machines, to monitoring blood pressures and blood sugars, to developing fall prevention
programs, and to monitoring the effects of a specific treatment plan. These are just the few ways
that healthcare informatics can be applied in patient care. Overtime we have only continued to
advance in technology that optimizes our abilities to provide efficient, high-quality care.
Healthcare informatics is important because it allows for the analysis of data collection and
provides healthcare providers with the opportunity to provide the appropriate treatment plan to
enhance patient outcomes (Sweeney, 2017). In this paper, a variety of innovations in healthcare
technology are discussed and their impact on improving patient outcomes.
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Continuous Blood Sugar Monitoring
Patients with uncontrolled diabetes are at higher risk for developing other co-morbidities
and even mortality (Boyce, 2020). As technology has continued to advance, there has been a
shift from the traditional blood glucose monitoring checks towards continuous glucose
monitoring. One example of this method is the FreeStyle Libre. These continuous glucose
monitoring devices have been shown to be beneficial and can detect and alert those that are at
risk for developing a hypoglycemic or hyperglycemic event. These continuous glucose
monitoring devices attach to the subcutaneous tissue in the arm or abdominal tissue and provide
continuous glucose readings using interstitial tissue. Much research has been done on the impact
that continuous blood glucose monitoring has been beneficial in blood glucose control in
pediatric patients. The continuous monitoring of blood sugar levels allows for tighter control of
insulin administration (Boyce, 2020).
The advantages of this method are that the patient does not have to endure the painful
sticks checking their blood sugars, there are minimal supplies used, and the physician can
analyze their blood glucose trends to adjust their medication regimen based on results.
Continuous glucose monitoring devices have allowed patients to feel more in control of their
diagnosis. Continuous blood glucose meters remain a leading technology for diabetes diagnosis
and treatment (Boyce, 2020).
Remote Blood Pressure Monitoring
Remote blood pressure monitoring involves a cuff that is placed at the wrist that
measures a patient’s blood pressure. There are many factors that can impact a patient’s blood
pressure, such as environment, stress, and physical activity. These wearable devices can assess
the impact that these factors have on blood pressure reading. Typically, a patient’s blood
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pressure is higher in the morning and lower at night. However, these wearable devices can detect
consistent increased blood pressure readings that can place a patient at an increased risk of
stroke, cerebral hemorrhage, and other organ damage. (Kario, 2020).
Oscillometric measurement of blood pressure using wrist-cuff devices have been proven
to cause less discomfort for patients than transitional blood pressure cuffs. One area where
remote blood pressure monitoring has been shown to be significantly useful is in pregnant
women. Hypertension in pregnant women can result in preeclampsia. Over 40 million women
are affected by preeclampsia each year. Preeclampsia, also known as toxemia, and causes strain
on organs such as the liver and kidneys not working appropriately. Preeclampsia can lead to
premature births in babies. Therefore, closer monitoring of maternal blood pressure readings can
allow for appropriate prevention and treatment which can reduce maternal morbidity, mortality,
and premature births (Ganapathy, Grewal, & Castleman, 2016).
Remote blood pressure monitors can send readings to an “app” on their phone and to the
physician. The results allow for the physician to monitor trends in blood pressure readings. The
advantages of remote blood pressure monitoring include the fact that patients can take control
over their own health, medical knowledge is not necessary because interpretation of results are
easy to understand, and compliance can be monitored (Ganapathy et al., 2016).
Innovations in Fall Prevention
Wearable sensors have been helpful in determining mobility patterns in elderly patients.
Elderly patients are more susceptible to falls that can result in hip fractures, brain injuries, and
even death. Wearable sensors can be worn around wrist, ankle, or waist. These sensors can
assess a patient’s ability to move around obstacles and is helpful in implementing interventions
and exercise routines for preventing falls. Data can be sent from smartphone applications to
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physicians that will provide information to the physician that will allow them to prescribe the
appropriate exercise regimen for that patient. Remote monitoring devices can also detect when a
patient has fallen to prevent them from lying on the floor for long periods of time with no one to
help get them up (Lord & Close, 2018).
It is estimated that one-thirds of patients above 65 years old experience a fall each year
and it can cost approximately $14,000 to treat each patient admitted for falls (Lord & Close,
2018). Palarum LLC® developed PUP (“Patient is Up!”) socks. These socks use real time using
sensors on the bottom that determine weight distribution and mobility patterns. The nursing staff
is provided with a SmartBadge that connects to the socks and provides alert to the three closest
caregivers to alert them that a patient that is at higher risk for falls is up unattended. Once
someone has attended to the patient, the SmartBadge alarm deactivates. Palarum collects real
time data that can monitor falls and initiative appropriate programs for fall prevention (“Palarum
SmartSocks”).
Heart Failure
The standard analysis of patient status in patients with heart failure is typically in the
hospital setting, outpatient office, and implantable cardiac devices. However, wearable devices
can provide real time data in heart failure patients. These can be worn as watches, clothing, and
cutaneous devices that allows for the transmission of data to the physician. These wearable
devices allow for the analysis of current treatments and eligibility for future treatments.
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Figure 1. Utilization of wearable devices in heart failure patients. From Devore et al, 2020,
https://doi.org/10.1016/j.jchf.2019.08.008
Figure 1 above describe the progression and application of wearable devices in heart
failure patients. It can range from monitoring weight loss in patients with obesity in Stage A HF.
Wearable devices in Stage B HF patients can assess the progression of valvular disease and their
increased risk for developing heart failure. In Stage C, this incorporates continuous heart rate
monitoring and assists in providing appropriate therapies for patients with heart failure. Lastly,
wearable devices with Stage D HF can monitor blood oxygenation levels and speed settings of
left ventricular devices (DeVore, Wosik, & Hernandez, 2019).
An example of wearable technology includes smartwatches, such as an iWatch, that can
detect irregular heart rhythms using photoplethysmography. Photoplethysmography utilizes a
light source and a photodetector at the cutaneous level to determine changes in blood circulation.
Although this data isn’t always accurate, Apple did advance its program to be able to alert a
patient with detection in irregular rhythms such as rapid atrial fibrillation and bradycardia. The
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future of wearable devices in heart failure patients will be able to determine fluids levels in the
lungs through a wearable vest (DeVore, Wosik, & Hernandez, 2019).
Wireless Capsule Endoscopies
Wireless capsule endoscopies were developed in 2000 and have only continued to grow
in popularity. Wireless capsules have been helpful in transitioning from the traditional form of
endoscopies that can be painful and place the patient at risk for having to intestinal walls.
Utilizing these small capsules allow for no pain, no sedation and no air insufflation that is
common after a traditional endoscopy procedure. This method works by having a patient
swallows a tiny pill-shaped capsule that allows for the physician to capture images through the
gastrointestinal tract. These wireless capsules contain a camera, light, and a radio frequency
transmitter that allow for real time analysis. It takes about eight hours for the capsule to travel
throughout the gastrointestinal tract and the capsule can capture anywhere between 50,000-
80,000 images. These images can allow for the diagnosis of bleeding, lesions, tumors, ulcers, and
other diseases of the gastrointestinal tract such as Ulcerative Colitis. The advantages of wireless
capsule endoscopies are that it is relatively inexpensive, non-invasive, and is an out-patient
procedure that allows for the patient to continue to do their daily activities versus the traditional
method having to undergo sedation (Pogorelov et al., 2019).
Application of Changes in Healthcare Innovations
Effective change intitaitves require the nurse leader to understand the process and tools
involved that will allow for improved patient outcomes. The areas of healthcare innovation
discussed in this paper are just some of the areas that a leader can focus their attention and gain
knowledge on the tools and processes to implement change within the healthcare environment.
These advances in technology can not only facilitate the shortage of nurses and other ancillary
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staff members but can also facilitate patient comfort, communication between providers, and
improved patient outcomes. It is essential that the nurse leaders understand change theories that
will allow the leader to implement, manage and assess the change initiative (Wagner, 2018).
Conclusion
Healthcare technology continues to advance to improve patient outcomes and provide
more efficient communication between physicians and patients. Application of new innovations
in healthcare technology can lead to significant changes when providing patient care. Many of
these technological advances allow the physician to assess the patients current clinical condition
and provide the appropriate treatment plan. Nursing leaders play a vital role in implementing
change within an organization. Change theories help leaders understand what to expect in the
process of implementing change. There is often resistance to change, therefore, it is imperative
that nurse leaders have a clear understanding of change theories to facilitate changes in
healthcare technology and their application to patient care.
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