Introduction
There are new healthcare reforms and/or changes in recent years that aim at providing quality and/or cost-effective patient care delivery. As much as 1/3 of all hospital readmissions are deemed unnecessary and could be avoidable with strategic improved transitional care delivery (Bates et al., 2014). Preventable 30-day readmissions could be very costly to hospitals; these have led such organizations no choice than to provide quality patient care delivery that prevent unnecessary readmissions. However, it will be impossible to effectively prevent unnecessary readmissions without access to transitional care post hospital discharge (Pesko et al., 2018). At the writer’s current workplace, there is a transitional coordination team/department that follows up on Medicare patients who are flagged as high risk for readmission. However, the same is not said about charity care, some self-pay, and other undocumented patients. Unfortunately, the hospital is experiencing a high readmission rate in such populations lately due to lack of access to transitional care. This has led the writer to propose that the existing transitional coordination department should be expanded to cover the identified patient populations (charity care, some self-pay, and other undocumented patients) who fall into the red flag for potential readmissions.
Background
The proposed practice change is to be implemented at Robert Wood University Hospital (RWJUH) in New Brunswick, New Jersey (NJ). The proposal is to expand the existing transitional coordination department to cover the identified patient populations (charity care, some self-pay, and other undocumented patients) who fall into the red flag for potential readmissions. It is worth noting that the facility’s current transitional coordination department only covers Medicare at risk patients. The above practice change is extremely essential and will promote quality and cost-effective care to the patients. The switch to value-based incentives in the healthcare industry aims at improving quality of care. With the value-based purchase (VBP), hospitals are incentivized based on many factors; reimbursements are linked directly to quality care delivery and prevention of unnecessary readmissions (CMS, 2015). Most 30-day readmissions are preventable. Bates et al. (2014) maintained that as much as 1/3 of all hospital readmissions are deemed unnecessary and could be avoidable with strategic improved transitional care delivery.
In addition, the Centers for Medicare and Medicaid Services (CMS) has outlined its expectations of hospitals and suggested resources for avoiding readmissions, which includes safe and effective discharge and transitional care plans (CMS, 2015). To improve patients’ safety, quality care, and avoid financial penalties from reimbursement agencies, including the CMS; it is necessary to establish and/or implement effective and safe transitional care programs for at high risk patients. Such efforts will potentially decrease unnecessary 30-day readmissions. With innovation, comes the ease of information; and with a click of a button, patients could easily compare hospital ratings and their readmission rates; giving patients a choice. A high rate of 30-day readmission rates could steer potential patients away from seeking their medical needs at the hospital. Therefore, extending the existing transitional coordination program to other at-risk patient populations, such as identified above is essential.
The transition from volume based to value-based purchasing within the healthcare industry, comes with accountability and responsibility ( )??? The move to value-based purchase (VBP) in the healthcare industry aims at improving quality of care. The Centers for Medicare and Medicaid (CMS, 2015) noted that under the value-based purchase (VBP), hospitals are incentivized based on many factors, some of which include quality patient care and patients’ satisfaction with provided services. Current reimbursement protocols warrant the need for quality improvements (IHI, 2018). Moreover, Brition (2015) maintained that with pay for performance (P4P), providers are rewarded for quality patient care outcomes. P4P has encouraged healthcare organizations to provide the best quality care to patients; while decreasing length of stay (LOS) by preventing potential hospital acquired infections and other conditions, as well as preventing unnecessary readmissions (CMS, 2017). Ineffective discharge teaching, poor communication/collaboration between homecare nurses and doctors, lack of proper understanding of discharge education, and lack of access to transitional care are among the factors that increase hospital readmission rates (Hari & Rosenzweig, 2012; Pesko et al., 2018). This is very true because patients who do not have access to outpatient primary care, tend to utilize Eds for medical issues that could be safely taken care of at doctors’ offices.
Moreover, the quest for improved quality care leads to the need of proactiveness within the healthcare industry. Therefore, it is imperative that healthcare leaders establish proactive measures that promote quality and cost-effective patient care delivery; while minimizing unnecessary readmissions. The writer’s proposed practice change of extending such needed transitional care to all at-risk patient populations will help decrease unnecessary readmissions. For example, a transitional care collaboration between a large teaching community hospital and a community-based healthcare center produced a thirteen percent and a thirty-eight percent decline in cost and post-op readmission rates respectively; leading to higher satisfaction scores (Cochrane & DiEmanuele, 2018).
Knowledge Transition Theory
The diffusion of innovation theory by Everett M. Rogers would be used in implementing the proposed practice change. The diffusion innovation theory is chosen not because it is widely used in prior change projects, but more so because it will be the appropriate process solution in this proposal. Rogers’ diffusion theory is the process of interacting and/or introducing new ideas through communication channels into a work unit, organization, or society over time. It is more of a general process and assessing the nature of the change project at hand, the diffusion theory will be more successful in achieving the proposed change than any other theory. The diffusion theory has four main components namely innovations, communication channels, time, and social system. It also has five key adoption steps, which includes knowledge, persuasion, decision, implementation, and confirmation. Each of the components as well as key adaptation steps of the diffusion of innovation theory will be beneficial in the implementation of the proposed project.
Theory Development
Everett M. Rogers, a professor of communications developed the diffusion theory and has been in existence for quite some time and been widely used over the years. Rogers developed this critical theory based on the belief that diverse individuals adopt and/or adjust to new ideas or innovations differently within a social system. The theory developer also believed that multiple elements can affect how individuals adopt to change over time. The diffusion of innovation theory by Rogers was originally developed in 1962 ( )???. Rogers (1995) maintained in his book that the diffusion of innovations theory offers individuals or organizations more options at finding solutions to identified problems. The author also went on to claim that proposed projects should have persuadable elements that will encourage the people to adopt to such projects. This is because the theorist believes that individuals react and/or adopt to new ideas or innovations differently. In simple words, the background of the diffusion of innovation theory is spreading new ideas or innovations through culture and the different adaptation pace individuals experience. There are four main elements of the diffusion of innovation theory namely innovations, communication channels, time, and social system.
The action of the diffusion of innovation theory is seen through Rogers’ process of diffusion. Such process consists of five key adoption steps, which includes knowledge, persuasion, decision, implementation, and confirmation (Rogers, 2003).
Theory Analysis
The article by Mitchell et al. (2010) classified the forty-seven knowledge transitional models into 4 thematic areas as listed below. (1) EBP and transformational knowledge operations (2) strategic transformation that promotes adoption of new idea or knowledge, (3) applicational and inquiry exchangeable knowledge and synthesis, and (4) the creation, explanation, and distribution of research. Based on the detail analysis given by the authors, the diffusion theory falls under strategic transformation that promotes adoption of new idea or knowledge. This is because the aim of the diffusion theory is to help individuals within a unit or organization adopt to new proposed idea or innovation. The diffusion theory even allows room or time for laggards to slowly adopt. The theory also allows for strategic planning, solution, outcomes, and/or appraisal of results.
Knowledge Transition Strategy
Organizational change is the process whereby an organization modifies its operational procedures, structure, strategies, and/or culture to influence a needed transformation or improvement; which could be continuous or accomplish over time (Phillips & Gully, 2014). However, employee anxiety, frustration, and/or resentment could be the initial reaction to organization change (Bolman and Deal, 2017). To avoid and/or decrease the anxiety of proposed innovations or ideas, Rogers (2003) suggested that both the expected positive and consequences should be clearly communicated to the members of the social system. Rogers’ diffusion of innovation theory is useful in the process of interaction and/or introduction of new ideas; utilizing communication channels into a work unit, organization, or society over time. Although some scholars argue that the diffusion theory is a general process, it will still be useful in the proposed change practice. This theory describes how a proposed change diffuses through a group of people on a given unit over a period of time.
The main components of the diffusion theory include the following, innovations: the process of introducing something new, which in this case is the proposed change of extending transitional care at-risk patients as a means of minimizing unnecessary readmissions. The communication channels will be used as the means of communicating the proposed practice change to the case management department and administrative stakeholders. All gathered data and supporting evidence-based practice literatures, as well as the steps involved will be communicated to the responsible staff. The identified stakeholders for the project will be strongly encouraged to share any creative ideas and/or information. The communication channels will also promote effective intra and inter departmental communications.
Ultimately, the time component will be used to set the period it will take for the proposed practice change to be implemented. There will be clear and strategic time frame for each step in the planning, as well as implementation stage. Time will also help to identify the five kinds of adopters with their approximate percentages as outlined by Rogers; these include innovators – 2.5%, early adopters – 13.5%, early majority – 34%, late majority – 34%, and laggards – 16% ( ). Through the social system, all appropriate stakeholders to be involved in the project will be identified. The diffusion theory encourages the proposal of a specific goals. The goal in the proposed practice change is to involve all at-risk patients in the existing transitional care coordination program at the facility, as a means of reducing and/or eradicating unnecessary readmissions. The diffusion theory also indicates that there are risk takers, opinion leaders, early adopters, late adopters, and laggards. Having this knowledge will allow the key implementers to identify change champions in the project, as well as exercise more patience and time for the laggards.
Additionally, through the five key adoption steps of the diffusion change theory, the following will be useful during the planning and implementation of the proposed practice change. 1) Knowledge: involved personnel become more aware of the relevance of extending transitional care follow-up to all at-risk patients; as a preventive measure in minimizing or eradicating unnecessary readmissions. They will also be presented with EBP literatures and strategies on the projects. 2) Persuasion: the personnel and/or stakeholders will form a favorable or unfavorable attitude toward the proposed practice change. Favorable attitude is the hope of this proposal. 3) Decision: all involved stakeholders will engage in activities that lead to a choice to adapt to or reject the proposed change. 4) Implementation: the department/hospital will acquire the proposed practice change and put it into practice over time. 5) Confirmation: the director and manager of the case management department, the chief financial officer (CFO), as well as other administrative stakeholders will be able to evaluate the results of the proposed practice change and their final reaction of the project over time.
Summary

References
Mitchell, S., Fisher, C., Hastings, C., Silverman, L., ; Wallen, G. (2010). A thematic analysis of theoretical models for translational science in nursing: Mapping the field. Nursing Outlook, 58(6), 287-300. doi:10.1016/j.outlook.2010.07.001

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