NURS 8210 Week 11 Technology Leadership Synthesis Example

What the Leader Did at Each Phase: A Synthesis of Technology Leadership Through One Human Milk Scanning Rollout, From Decision to Year Two

Student Name

College of Nursing, Walden University

NURS 8210: Transforming Nursing and Healthcare Through Technology

Instructor Name

Month Day, Year

What the Leader Did at Each Phase: A Synthesis of Technology Leadership Through One Human Milk Scanning Rollout, From Decision to Year Two

Introduction

A course on technology can end by describing what technology does. This synthesis describes what the leader does. It follows one composite change through its whole life: a health system's introduction of barcode scanning for expressed human milk across its three NICUs, the same rollout the course's evaluation plan addressed. The change is used here as a thread through five phases, decision, preparation, go-live, stabilization and sustainment, and at each phase the synthesis names the leadership act that determined whether evidence reached practice or stalled in configuration. The argument is that technology projects succeed or fail on a small number of such acts, most of which are ordinary and easy to skip.

Phase 1: Decision

The leadership act at the decision phase was securing a nursing seat, with a vote, on the steering group. The request for milk scanning came from nursing, but the budget and technical decisions sat with pharmacy, informatics and finance. Without a nurse in the room, the project would likely have been scoped as a labeling purchase, with scanning at the milk room and not at the bedside, since bedside hardware was the expensive part. The nurse leader's argument was that the safety event happens at the bedside, so the check must happen there too.

Greenhalgh et al. (2004) found that the spread of innovations in health service organizations depends partly on whether the innovation is seen as relevant by those who must use it and on their involvement in decisions. A nursing seat was the practical form of that involvement. It also meant that later trade-offs, such as how many scanners each unit would receive, were argued by someone who knew how many feedings happen at the same hour.

Phase 2: Preparation

The act at the preparation phase was insisting that the workflow be walked, feeding by feeding, before the build was finished. Nurses on each unit traced the path of a container from the mother's pumping room to the refrigerator, the warmer and the bedside, and found places where the planned scan points did not match practice: milk warmed in a different room, containers split into syringes for small feeds, and twins whose containers were stored together. Each finding changed the build. Without the walk-through, these mismatches would have surfaced at go-live as scanning failures.

The walk-through also set the evaluation's baseline expectations. The steering group agreed before go-live on what would count as failure, which later protected the project from arguments about whether the results were good enough.

Phase 3: Go-Live

At go-live, the leadership act was treating early resistance as information about workflow, not as noncompliance. In the first weeks, some nurses kept a spare label at the station and scanned it instead of the container. The easy response was a reminder email. The more useful response was to ask why. The answer was that container labels on frozen milk became wet and would not scan. The fix was a different label stock.

This pattern is well documented. Koppel et al. (2008) studied workarounds to barcode medication administration and found that they often arose from problems with hardware, labels, workflow and organizational policies, not simply from staff carelessness. A leader who reads workarounds as data finds fixable causes; a leader who reads them as defiance loses both the information and the staff's trust.

Phase 4: Stabilization

In stabilization, the leadership act was refusing to declare success before the effectiveness data arrived. Three months after go-live, reach was high on two units and adoption looked complete. There was pressure to announce the project finished and release the go-live team. The nurse leader held the announcement until the first effectiveness data were in, including intercepted wrong-milk scans and confirmation that no misadministration had occurred with the scanner bypassed. Declaring success on reach alone would have measured whether nurses scanned, not whether infants were safer.

Aarons et al. (2014) describe implementation leadership as including proactive, knowledgeable, supportive and perseverant behavior. Perseverance is the least visible of these, because it often means continuing to ask about a project after others have moved on. In this phase it was the most important.

Phase 5: Sustainment

The act at the sustainment phase was building the change into ordinary structures so that it did not depend on the people who launched it. Scanning competency was added to NICU orientation and annual competencies, the milk scanning report was added to each unit's monthly quality review and a named owner was assigned for the label stock and scanner replacement. A year later, when the original project nurse had moved to another role, reach remained high. Changes that depend on a champion usually fade when the champion leaves; changes built into orientation, reports and budgets tend to last.

Sustainment also required watching for new failure modes. Eighteen months after go-live, the system changed its label printer vendor, and scan failures rose on one unit within a week. Because the monthly report already showed reach by unit, the drop was noticed and traced to the new labels before any feeding error occurred. The report's value lay less in the numbers it showed during calm months than in the fact that someone was looking at it when conditions changed.

Capabilities the Phases Demanded

Looking across the phases, the leader needed capabilities of the kind the TIGER recommendation framework describes when it sets out core informatics competency areas for nurses in different roles, management among them (Hübner et al., 2018). The framework's point that competencies differ by role applies here: a nurse leader does not need an analyst's skills but does need to understand how information moves through care and how its quality and safety are managed. None of the acts above required technical skill in configuring the scanner. They required knowing enough about the technology to ask good questions, about workflow to find mismatches, about measurement to hold the right data and about organizations to make the change outlast its champions.

Professional Commitments

Three commitments follow from this synthesis. Within twelve months of taking a DNP-prepared position, I will ask for a voting nursing seat on any steering group for technology that nurses must use, and I will explain why in terms of where the safety event happens. Within six months, I will build a workflow walk-through into the preparation phase of the next technology project I lead, with each finding logged against a build change. And within the next year, I will write declared success and failure criteria into every project charter I sponsor, before go-live, so that success is judged against effectiveness and not only against use.

References

Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014). The Implementation Leadership Scale (ILS): Development of a brief measure of unit level implementation leadership. Implementation Science, 9, Article 45. https://doi.org/10.1186/1748-5908-9-45

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

Hübner, U., Shaw, T., Thye, J., Egbert, N., Marin, H. F., Chang, P., O'Connor, S., Day, K., Honey, M., Blake, R., Hovenga, E., Skiba, D., & Ball, M. J. (2018). Technology Informatics Guiding Education Reform - TIGER: An international recommendation framework of core competencies in health informatics for nurses. Methods of Information in Medicine, 57(S 01), e30-e42. https://doi.org/10.3414/ME17-01-0155

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423. https://doi.org/10.1197/jamia.M2616