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Phase 4: Action Plan and Financial Implications

Table of Contents


Development of an Action Plan

At this juncture in the planning process, you have not only identified a need and defined the desired outcome for your project, but you have also assessed the various internal and external factors which influence the problem. All of this information will play an important role as you develop a plan of action to facilitate change.


Strategic Interventions to Facilitate Outcome Achievement

Much like a nursing care plan, a plan to guide change includes a detailed work schedule of activities, tasks, and interventions which are all designed to facilitate achievement of the stated outcome. These activities, tasks, and interventions can be referred to as an action plan, and will also include target dates for completion.


Clear Communication

The purpose of an action plan is to clarify for you (the project leader), your faculty or mentor and any other pertinent stakeholders, the specific plan of activities, tasks, and interventions which will be implemented, and when they are targeted to take place. If more than one person is involved in the implementation, the action plan can also serve as a communication tool to keep everyone on the same page, and may even denote ‘who’ is responsible for doing ‘what’, and ‘when’ those activities will be carried out.


Outputs and Deliverables

Within your action plan, you may have outputs or deliverables which are a necessary element in your planned change project (for example, the development of a new policy, staff education program, or teaching tool). You will include these outputs or deliverables within the action plan, as well as a date by which they should be attained or completed. Like other activities or interventions, outputs serve to facilitate achievement of the overarching project outcome. For example, a revised policy on catheter care and mandatory staff in-service sessions may facilitate achievement of an outcome geared toward the reduction of CAUTI on a particular unit.


Essential Resources

As you develop your action plan, consider the resources which will be necessary to actualize the plan. These may be

human resources, financial resources, and/or material resources

. Making note of the necessary resources will inform the project budget.


Helpful Reminders

As you develop an action plan, consider the following:

  • What steps need to be taken to facilitate outcome achievement?
  • What are the target dates for action steps, and who is responsible?
  • What stakeholders need to be engaged in the process, and how will that engagement take place?
  • What resources will be needed (human, financial, material)?
  • How will these resources be secured and what expenses will be involved?
  • Are there any special steps needed to assure that the necessary resources are available for use?
  • Are there specific outputs that will be needed to facilitate the achievement of the overarching project outcome (such as a new policy or other deliverable)?
  • If so, are they clearly incorporated into the action plan?


Consideration of Financial Resources

Managing fiscal resources is critical for efficient operations at the unit or organizational level. MSN-prepared nurse leaders are involved in managing the financial aspect of planned change projects that may involve stakeholders and resources both internal and external to the organization. Understanding the relationships between available resources, revenue, and expenses can influence efficiency of a project, and its future sustainability.

Just as with any personal budget that you might use, budgeting for planned change initiatives requires intentional planning. The advanced practice nurse must gather information in order to construct a solid budgetary plan to project the expenses that will occur.


Identifying Resources and Projecting Cost

Budgeting for the project is important as you plan for action steps and interventions. To initiate the process of budgeting for a planned change project it is important to forecast or project the expenses that will be involved. This will require you to:

  • Identify the resources necessary to implement the planned change project

    • Financial resources
    • Material resources
    • Human resources
  • Project or ‘forecast’ the expense or cost for the necessary resources


Identifying Sources of Funding

As you prepare a budget for the project, consider the funding sources available. Who will pay for the necessary resources to carry out the initiative? Will costs be absorbed by the organization? Are donations of resources a possibility? Will it be necessary to reallocate funds from other revenue streams to cover the project expenses?


Addressing Variance within Budgeted and Actual Expenses

Once the planned change project is underway, the advanced practice nurse will be responsible for managing the cost of the initiative. To facilitate this process, the nurse will note the

actual expenses

incurred for the necessary resources. When the actual cost differs from the projected cost, a

variance

occurs. Any variance that occurs between the projected and actual budget must be analyzed. As revenue and expenses deviate from the projected numbers, adjustments in the budget may be required.


Think About It

While the budgeting process may seem straightforward in terms of forecasting expenses and revenue, an effective budgeting process requires the nurse leader to anticipate and address variables that impact the budget in unexpected ways. As you forecast a budget for the planned change project, consider the following:

  • What human, financial, and material resources are needed for your project?
  • What expenses are associated with the required resources?
  • What variables might impact the cost of the project resources?
  • Should a variance occur, how might you address the situation?
  • In what ways might a cost-benefit analysis demonstrate the long-term value of your planned change project?


Practicum Application and Activities

To be effective, an action plan should specify the activities and interventions that will be carried out in order to facilitate achievement of the project outcome. Also included on the action plan are target dates for implementation, along with a designation of the person(s) responsible.

Budgeting for the planned change project is necessary for efficient use of resources. In the early phases of any project, it is important to forecast or project the expenses necessary to carry out the action plan. During implementation, careful monitoring of actual expenses can help the nurse leader to identify and address variance that may occur.

Review the

Johns Hopkins Appendix I

located in the MSN Toolbox area of the course. Proceed with the following activities. Document your practicum-related activities on the Practicum Log:

  • Prepare a plan with specific talking points to meet with your faculty (and practicum mentor if available) regarding an action plan and financial considerations for the planned change project. Think about how each activity and intervention can facilitate achievement of the project outcome.
  • Meet with your faculty (and practicum mentor if available) to discuss the action plan and financial considerations for the planned change project.
  • As the opportunity allows, identify, communicate, and collaborate with stakeholders impacted by plan of action.
  • Complete the

    Johns Hopkins Appendix I

    document.
  • Validate your work on Phase 4 with your faculty (and practicum mentor if available) as needed.
  • Revise your work as necessary.
  • Submit the

    Johns Hopkins Appendix I

    completed with your time log, once Phase 4 completed.

Phase 4: Action Plan and Financial Implications Table of Contents Development of an Action Plan At this juncture in the planning process, you have not only identified a need and defined the desired ou
Johns Hopkins Nursing Evidence-Based Practice Appendix I Action Planning Tool 1. Complete the following activities to ensure successful translation: ☐ Secure a project leader. ☐ Identify change champions. ☐ Consider whether translation activities require different or additional members. ☐ Schedule time to complete milestones. ☐ Identify critical milestones and related tasks. ☐ Identify observable pre or post measures. 2. Identify barriers to the success of the change, and then identify strengths that can be leveraged to overcome barriers. Barriers Resources or Strengths Plan to Overcome Barriers by Leveraging Strengths as Appropriate Barriers Resources Plan Barriers Resources Plan Barriers Resources Plan Barriers Resources Plan Barriers Resources Plan 3. Consider whether or how this change will affect the following: ☐Electronic health record ☐Workflow ☐Policies and/or procedures 4. Confirm support and/or availability of funds to cover expenses. (Check all that apply) ☐ Personnel costs ☐ Supplies/equipment ☐ Technology ☐Photocopying ☐ Education or further training ☐ Content or external experts ☐ Dissemination costs (conference costs, travel) ☐ Other: Enter test 5. Identify critical milestones and related tasks: Enter Milestone 1 Enter Milestone 2 Enter Milestone 3 Enter Milestone 4 Tasks Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task Task T Directions for Use of the Action Planning Tool Purpose of form This form is used to guide you as you create an action plan. Activities to ensure successful translation These are all activities that must be completed as you plan the change. Consider pre- and post-observable measures that can be used to determine whether the change was successful. In addition, identifying critical milestones allows the team to see whether they are on track to accomplish the goals. Identify strengths/resources and barriers to the success of the change This analysis allows teams to identify barriers to implementation and potentially mitigate them using inherent strengths and resources. You may find specific challenges that will likely impact the ability to deliver on the action plan. Though these obstacles can get in the way, knowing about them up front is helpful so that you can engage support and create a plan to address them. Consider whether or how the change will impact workflows and processes Be mindful of the impact of the change downstream. For example, will changes need to be made to the electronic medical record to accommodate the change, or will this change impact the workflow of any other staff who have not been considered? Confirm support and/or availability of funds to cover expenses Use this as a guide to prompt thoughtfulness about financial obligations that may be a part of the rollout. Identify critical milestones and related tasks Consider all the categories of work (milestones) necessary to implement this change. What tasks must be accomplished first for each milestone in order to move forward? When must they be completed to stay on track? For example, if a milestone is to implement a protocol, list all tasks to accomplish it. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing