Improving the Assessment and Triage of Patients with Mental Illness ...

establishing a sense of urgency as a crucial element to garnering attention and cooperation of
staff. He suggests that the retention of external consultants to highlight the urgency to the key
stakeholders would be beneficial. However as muted previously, due to internal hospital
financial constraints any cost implications would possibly have immobilised this particular
project and accordingly, Kotter’s suggestion was not adhered to. In any event, the
overwhelming consensus from the feedback gathered, was that staff were already aware of
the necessity of change and anxious that it be introduced with haste.
October 2010
The first step before the change project was put in motion was to obtain support and
permission from the relevant authorities. The Director of Nursing, Assistant Director of
Nursing, three ED consultants, one Psychiatric consultant, Information Technology (IT)
management and Practice Development were all contacted prior to commencement of the
project. Meetings were requested and letters were written to all the above which contained
details on the proposed change and a Project Impact Statement (Appendix J). Involvement of
top level management was seen as essential as they are responsible for both internal and
external processes and are generally make the final decisions. Fayol as cited in Evans (2001)
suggested that power to issue instructions as wielded by those in authority should be used in a
responsible and appropriate manner. All but one level of senior management agreed to
meetings in relation to the proposal however due to demanding schedules it was December
before a general consensus was reached for the project to proceed. The initiation of the
project was arranged for January 2011.
Once their permission and support was granted the frontline clinical nurse managers
and staff within the ED was consulted regarding the proposed change which was outlined
using a power point presentation to explain the aims and objectives of the proposed change
management project which were:
• Development of Nursing Assessment Documentation (Appendix A).
• Introduction of a Mental Illness Triage Tool Wall Chart (MITT)(Appendix K)
• Development of a computerised pop-up screen for triage(Appendix L)
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