Door-to-Balloon Time Reduction: Negotiations

The paper indicates reasons for each stakeholder in supporting the proposed plan for improving the door-to-balloon time in the STEMI patients at Kendall Regional Medical Center.

STEMI patients and families

Reasons for Supporting

Promise for improved care outcomes
Promise for timely interventions

Reasons for Not Supporting

Failure to understand the issues involved in providing consent
Failure to involve them in designing and implementing the change effort
Inability to understand the symptoms of STEMI, leading to delay in seeking treatment

Negotiation Strategies

Engaging in honest communication with patients and family members to explain the importance of consenting and to request for their involvement (Aarons et al., 2014)

Emergency department physician

Reasons for Supporting

Ability to apply evidence
Having a positive attitude toward the EBP intervention
Adequate training in the STEMI area
Management support

Reasons for Not Supporting

Noninvolvement in designing and implementing the change effort (Majid et al., 2011)
Desire to maintain the status quo

Negotiation Strategies

Collaboration and sharing important information with the physician so that he or she may see the benefits of the change effort (Irwin, Bergman, & Richards, 2013)

Paramedics/Emergency response team

Reasons for Supporting

Ability to apply evidence
Adequate training in the STEMI area
Management support

Reasons for Not Supporting

Inability to prioritize due to the heavy workload
Lack of time
Attitudinal problems
Lack of institutional support
Noninvolvement in the change effort

Negotiation Strategies

The rank-ordering strategy can be used to ensure the paramedics understand what is needed and can use the limited time to support the practice change.
Collaboration and sharing of information can be used to address attitudinal and noninvolvement issues (Duiveman, 2012)

STEMI team

Reasons for Supporting

Ability to apply evidence
Adequate training in the STEMI area
Availability of protected time to learn and implement EBP (Majid et al., 2011, p. 234)
Management support

Reasons for Not Supporting

Difficulties in understanding the statistical analyses for various STEMI tests (Pan et al., 2014)
Role ambiguity
Lack of resources
Lack of knowledge about EBP (Majid et al., 2011)

Negotiation Strategies

The strategy is to gain access to the team leader to convince him or her to mentor members of the STEMI team using the EBP advocate framework (Irwin et al.,)

PBX operator

Reasons for Supporting

Support by other players
Adequate training on what needs to be done to contact and prepare stakeholders so that ball to balloon (D2B) time is significantly reduced

Reasons for Not Supporting

Lack of skills and knowledge on the change effort
Noninvolvement in the change effort

Negotiation Strategies

Honest communication can be used to address the issues

Invasive cardiologist

Reasons for Supporting

Ability to apply evidence
Adequate training and time to learn and implement the change effort
Management support

Reasons for Not Supporting

Insufficient evidence that the practice change will improve patient outcomes
Desire to maintain the status quo
Insufficient time
Noninvolvement of the change effort
Lack of institutional support

Negotiation Strategies

Collaboration and compromise strategies can be used to bring the invasive cardiologist to the negotiating table and ensure that an agreement or settlement is reached on issues that may be influencing their decision not to support the change project (Irwin et al., 2013).
The accommodation strategy can be used to yield into some of the demands of the cardiologist so that the project can be implemented successfully (Melnyk & Fine-Overholt, 2015)

References

Aarons, G.A., Fettes, D., Hurlburt, M., Palinkas, L., Genderson, L., Willging, C., & Chaffin, M. (2014). Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice. Journal of Clinical Child & Adolescent Psychology, 43, 915-928. DOI: 10.1080/15374416.2013.876642

Duiveman, T. (2012). Negotiating: Experiences of community nurses when contracting with clients. Contemporary Nurse: A Journal of the Australian Nursing Profession, 41(1), 120-125.

Irwin, M.M., Bergman, R.M., & Richards, R. (2013). The experience of implementing evidence-based practice change: A qualitative analysis. Clinical Journal of Oncology Nursing, 17, 544-549. DOI: 10.1188/13.CJON.544-549

Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.L., Chang, Y.K., & Mokhtar, I.A. (2011). Adopting evidence-based practice in clinical decision making: Nurses perceptions, knowledge, and barriers. Journal of the Medical Association, 99, 229-236. DOI: 10.3163/1536-5050.99.3.010

Melnyk, B.M., & Fine-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.). Baltimore, MD: Lippincott Williams & Wilkins.

Pan, M.W., Chen, S.Y., Chen, C.C., Chen, W.J., Chang, C.J., Lin, C.P.,&Chen, Y.C. (2014). Implementation of multiple strategies for improved door-to-ballon time in patients with ST-segment elevation myocardial infarction. Heart Vessels, 29, 142-148. DOI: 10.1007/500380-013-0336-2.

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