D156 Leadership and Management E-Portfolio Template

Student Name

Western Governors University 

D156 Business Case Analysis for Healthcare Improvement

Prof. Name

Date

D156 Leadership and Management E-Portfolio Template

Instructions for Course Deliverables

The D156 Leadership and Management course requires students to complete a comprehensive Clinical Practice Experience (CPE) record in alignment with the Assessment Task Overview. The e-portfolio serves as a centralized repository for all required deliverables, including analytical tools, structured tables, and reflective narratives. Each phase of the course must be documented thoroughly to demonstrate leadership competencies, critical thinking, and evidence-based decision-making.

Students may enter their reflections and analyses directly into this template. Alternatively, previously prepared Word or PDF documents may be embedded within the template using the following procedure: place the cursor at the desired location, select “Insert,” choose “Object,” click “Text from File,” and then upload the appropriate document. This process may be repeated for additional files to ensure all course components are consolidated within the e-portfolio.

CPE Table: Estimated Time and Completion Dates

The table below outlines the estimated time commitment and completion dates for each required deliverable. This planning tool supports time management and ensures timely submission of all components.

Stakeholder Identification Table

Effective leadership initiatives rely on collaboration with key stakeholders who influence decision-making, policy implementation, and frontline practice. The following roles were identified as critical contributors to the project:

These stakeholders provide clinical oversight, operational support, informatics expertise, and managerial authority necessary for successful implementation of patient safety interventions.

Needs Assessment and SWOT Analysis

What are the key issues identified in the needs assessment?

The needs assessment revealed a concerning increase in patient falls occurring during shift change on medical-surgical units. These incidents include falls both with and without injury and are most frequently associated with handoff communication occurring away from the patient bedside. When reports are conducted at centralized nursing stations, staff visibility of patients is significantly reduced, increasing the likelihood of unobserved patient movement and environmental hazards.

Several contributory factors were identified. From a personnel perspective, registered nurses and Assistant Clinical Nurse Assistants often prioritize efficiency over direct patient observation during handoff. Environmentally, high patient acuity levels combined with crowded rooms and medical equipment limit situational awareness. Process-related challenges include staffing shortages and competing clinical demands that divert attention from fall prevention. Finally, existing interventions and policies require revision to better align with current best practices in patient safety and handoff communication.

What interventions are planned to address these issues?

To mitigate fall risks during shift transitions, the project proposes a structured transition to bedside reporting. Conducting handoffs at the bedside allows clinicians to visually assess patients, confirm safety measures, and engage patients in their care. This intervention is supported by targeted staff education sessions emphasizing the safety, communication, and accountability benefits of bedside reporting.

Additionally, assigning unit secretaries to manage non-clinical responsibilities—such as answering phones and coordinating logistics—will reduce distractions for clinical staff during shift change. This role delineation enables nurses to focus on patient assessment, safety checks, and effective communication during handoff periods.

SWOT Analysis Summary

The SWOT analysis evaluates internal and external factors influencing the success of the proposed intervention.

This analysis highlights that while organizational support is strong, sustained education and change management strategies are essential to address resistance and ensure compliance.

Impact Analysis

What benefits can be expected from implementing the improvement project?

The anticipated benefits of implementing bedside reporting are both organizational and nursing-specific. These benefits were evaluated using an impact scale ranging from 1 (low impact) to 3 (high impact).

Total Benefits Score: 10

These outcomes align with evidence-based practices that associate bedside handoff with improved patient engagement, safety outcomes, and cost containment.

What risks might the project pose?

Despite its benefits, the project presents identifiable risks that must be managed proactively.

Total Risks Score: 8

Addressing these risks will require leadership support, structured education, and clear communication regarding expectations and confidentiality practices.

What is the overall impact ratio, and what does it indicate?

The impact ratio is calculated by dividing total benefits by total risks:

Impact Ratio = 10 ÷ 8 = 1.25

An impact ratio greater than 1 indicates that the benefits outweigh the risks. This result supports the implementation of bedside reporting as a viable and favorable strategy for improving patient safety and reducing falls during shift transitions.

Video Reflection Summary

Engagement with clinical stakeholders and the preceptor highlighted the urgency of addressing falls during shift change, with approximately 3% of falls on medical-surgical units occurring during this vulnerable period. Current handoff practices conducted away from the bedside limit direct patient monitoring, as nurses are simultaneously managing reports, alarms, and call lights.

Transitioning to bedside reporting allows for real-time patient assessment, hazard identification, and prioritization of care. The needs assessment, supported by a fishbone diagram, categorized contributing factors into people, environment, process, and interventions, reinforcing the appropriateness of the proposed solution.

The SWOT analysis confirmed strong leadership support and policy alignment, while also identifying resistance to change and knowledge gaps as key challenges. The impact analysis demonstrated a favorable benefit-to-risk ratio, projecting outcomes such as reduced fall rates, shorter lengths of stay, cost savings, and improved patient satisfaction.

Although risks such as staff resistance and overtime concerns exist, these challenges are considered manageable through education, leadership engagement, and continuous monitoring. Overall, the project represents a meaningful leadership initiative that strengthens patient safety during critical care transitions.

References

Institute for Healthcare Improvement. (2020). Patient safety and fall prevention. https://www.ihi.org/resources/Pages/Tools/PreventingPatientFalls.aspx

Joint Commission. (2019). National patient safety goals. https://www.jointcommission.org/standards/national-patient-safety-goals/

Tucker, S. J., & Spear, S. J. (2018). Improving nursing shift handoff through bedside reporting: A patient-centered approach. Journal of Nursing Care Quality, 33(1), 27–33. https://doi.org/10.1097/NCQ.0000000000000275

Wong, C. A., Laschinger, H. K., & Cummings, G. G. (2019). The impact of bedside handover on patient safety: A systematic review. Nursing Outlook, 67(2), 136–145. https://doi.org/10.1016/j.outlook.2018.11.0031