Leading change in public health Assignment

Leading change in public health
Leading change in public health

Leading change in public health

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Week 11 Project Leading Change in Public Health
Then discuss the following issues as they pertain to this particular chronic issue “Deep Vein Thrombosis Even (DVT)/Pulmonary Embolism (PE)”. It is not necessary that you discuss these in this sequence, but you will need to include all of these areas in your final paper. Do a literature search, as needed, for additional information on this issue.
Title: “Deep Vein Thrombosis Even (DVT)/Pulmonary Embolism (PE)”.
Address the following questions:
1. Describe the current reality.
2. What is unacceptable in this situation?
3. What is your public health vision for the situation? What are the outcome goals?
4. What are the barriers and facilitators of change? Make sure you consider the people, the personalities involved, as well as the organizational structure/culture.
5. How do you foster the change process?
6. What is the “creative tension”? What are the tensions that arise from the difference between current reality and the public health goal?
7. Create a logic model for this situation.
8. Describe the ethical implications or concerns of your team’s public health change model.
9. Set the metrics by which you would measure progress and success when addressing this public health issue.
10. Describe how you would ideally address any ambiguity and uncertainty arising from the leadership challenges of this change effort.
11. Provide a bibliography.


New risk factors for VTE (http://www.cdc.gov/ncbddd/dvt/features/keyfinding-blood-proteins.html)
Study explores levels of proteins important in blood clotting as possible new risk factors for VTE
(Published October 15, 2014)

Preventing HA-VTE (http://www.cdc.gov/ncbddd/dvt/features/keyfinding-pba-vte.html)
VTE is both a public health problem and a preventable patient safety problem.
(Published March 6, 2014)

Use of CT Scans in EDs (http://www.cdc.gov/ncbddd/dvt/features/ct-scans.html)
Diagnosis of PE associated with and trends in use of CT scans among patients with chest symptoms.
(Published: December 17, 2013)

New Study Findings: Hospitalizations of adults 60 years of age or older with venous thromboembolism (http://www.cdc.gov/ncbddd/dvt/features/keyfinding-hospitalizations-vte.html)

The journal Clinical and Applied Thrombosis/Hemostasis has published a new study that looks at the rates, trends, and factors associated with venous thromboembolism (VTE) diagnosis among hospitalizations of adults aged ? 60 years during the period 2001 to 2010.
(Published: September 6, 2013)

Key Findings: Venous Thromboembolism (http://www.cdc.gov/ncbddd/dvt/features/pediatricgenetics-keyfindings-vte.html)
Trends in Venous Thromboembolism-related pediatric hospitalizations, 1994-2009.
(Published: September 17, 2012)

This Is Serious Campaign
This campaign from the Vascular Disease Foundation and Spirit of Women®, in partnership with the CDC, raises awareness and action around the prevention of DVT and PE in women.

Clot Connect
Clot Connect’s mission is to increase knowledge of blood clots and clotting disorders by providing education and support services for patients and health care professionals.

National Blood Clot Alliance
The National Blood Clot Alliance (NBCA) is a patient-led advocacy group dedicated to prevent, diagnose and treat thrombosis and thrombophilia through research, education, support and advocacy.

Venous Disease Coalition
The Venous Disease Coalition (VDC) offers patient and health care provider information to increase awareness on the diagnosis, prevention and treatment of venous diseases.

Blood the Vital Connection (American Society of Hematology)
The American Society of Hematology (ASH) is the world’s largest professional society concerned with the causes and treatments of blood disorders. ASH provides hematologist-approved information on clotting disorders.

National Institutes of Health
The National Institutes of Health (NIH) mission is to employ science in the pursuit of knowledge to improve human health. The National Heart Lung and Blood Institute (NHLBI) is the section of NIH that provides information for professionals and the general public about blood disorders such as deep vein thrombosis.

Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality’s (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans. This guide from AHRQ describes ways to prevent and treat blood clots; symptoms; and medication side effects as well as when to go to the emergency room.
Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism
On September 15, 2008, Acting Surgeon General Steven K. Galson released The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism – 2008 at the Venous Disease Coalition’s Second Annual Meeting.
The North American Thrombosis Forum
The North American Thrombosis Forum (NATF) is a multidisciplinary organization founded with the objective of improving patient care through the advancement of thrombosis education.
CDC Travelers’ Health Yellow Book and DVT/PE
Preventive measures for travelers can be found in CDC’s Travelers’ Health Yellow Book.
Anticoagulation Forum
The Anticoagulation Forum provides information on VTE family-based research.

Please apply the Application Assignment Rubric when writing the Paper.

I. Paper should demonstrate an excellent understanding of all of the concepts and key points presented in the texts.

II. Paper provides significant detail including multiple relevant examples, evidence from the readings and other sources, and discerning ideas.

III. Paper should be well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with doctoral level writing style.

IV. Paper should be mostly consistent with doctoral level writing style.


Leading change in public health

VTE refers to venous thromboembolism. It includes deep vein thrombosis (DVT) and pulmonary embolism (PE).  Deep vein Thrombosis (DVT) occurs when blood clots form in the body’s deep vein DVT symptoms involve the affected limb and include pain, edema and discoloration. Pulmonary Embolism (PE) occurs when the clot breaks ups, blood may flow to the lungs. This often is a life threatening event. Symptoms associated include rapid heartbeat rate, unexplained chest pains and shortness of breath. VTE has recently attracted great concern in the public health sector.  Annually, 300,000- 600,000 people in US suffer from VTE.  One third of individuals with VTE are at risk of having recurrence after 10 years. One third of the diagnosed cases die within a month. Some end up with post thrombotic syndrome which could be severe that a person becomes disabled (Boulet et al, 2009).

Symptoms of blood clots are subtle and can easily be confused with sprained ankle, or muscle pull. PE may be misdiagnosed as a touch of pneumonia, onset of respiratory infection or asthma. For this reason, misdiagnosis or delayed diagnoses are common. After physical examination by physician,  D-dimer blood test, imaging studies using  Computer tomography (CT), Magnetic resonance imaging  (MRI), pulmonary angiography, and  ventilation/perfusion lung scan (V/Q scan is done. Treatment includes blood thinning medications and or Thrombectomy. Patients often recover within few weeks with minimal complications (Payne et al, 2014).

VTE in children is often as a complication of other chronic treatment and is associated to children mortality.  Recent studies indicate an increase in the frequency of VTE related hospitalization complications among US children between 1994 and 2009. Research estimates that 78,685 (0.14%) pediatric discharges were associated with VTE in which 3740   in-hospital death. Studies estimates that the annual incidences of VTE in children range from 0.7 to 2.1 per 100,000.  There are very few studies on VTE occurrence rates and risks associated for older adults. Every year VTE occur among older adults. For instance, the rate of hospitalization per 100,000 patients above 60 years was 581 in 2001 and 739 in 2010. Almost half of VTs cases are hospital associated VTE.  During 2007-2009, an average of 550,000 hospital stays had discharge associated with VTE (Yusuf et al, 2014).

VTE is also associated to several factors including venous catheterization, cancer, prolonged hospital stays. Blood clots often form when blood flow in veins is slowed due to vein injury or the blood is more clottable. Common risk factors for clotting could be immobilization due to hospitalization, bone fracture, catheter in a vein, major sugery, obese, and cancer. Some studies indicate that high levels of proteins in the blood facilitate blood clotting, and put people at greater risk for VTE. It has been suggested that high levels of factor VIII put white people at greater risk. Combined high levels of factor VIII and von Willebrand factor put African American at greater risk. More studies should be done on protein levels in risk models for VTE (Payne et al, 2014).

Various institutions have contributed massive support including Division of Blood disorders (in National center on Birth defects and developmental disabilities at the CDC. The support includes conducting investigations on epidemiology, causative factors, and effects of health in defined populations. This aims at developing effective strategies to diagnose, screen,   prevent and treat VTE. The groups intend to augment existing knowledge, and to implement effective systems to monitor VTE prevalence, drug use effectiveness. The Agency for Health care Research and quality (AHRQ) offers support by promoting a culture of patient safety by giving guides for patients on how to mitigate blood clots. They also issue forms and protocols to care providers to guide them during patient care. Additionally, CDC has funded two pilot programs to study the prevalence of HA-VTE over two years (Feng et al, 2013).

VTE is listed as a serious public health issue. Evidently, it is a national priority. Much of the morbidity and mortality associated with VTE is preventable if early and accurate diagnosis is made.  However, predicting which group sets are at a greater risk still remains a challenge. This calls for change in public health leadership approaches.  Therefore, experts should come together to educate, promote and guide all activities involving VTE diagnosis and prevention (Yusuf et al, 2013).

Public health capacity requires intensive knowledge base proceeded by integration of this knowledge into practice.  Leaders of public health need to gather to pin point their development needs. Being a multi-dimensional sector, all involved expertise have different skill package’s which will facilitate the needs of their population in order to attain improves health sector.  Acknowledging the complexity in public health acre, the capacity to address the primary care is vital. There is confusion experienced when distinguishing between management and leadership. Historically, Public health leaders have relied mainly on management than leadership, particularly in their roles.  Changes include shifting form individual leadership to collective leadership. Thus a model where leadership is collective should be empowered. However, change process is complex (Carr, 2007).

Despite the fact that individuals have great potential and innovative interventions to improve primary care, variety of regulatory policies limit the leader including professional barriers to expand nurse’s roles, health care system fragmentation, high turnover rates and other challenges associated with demographic. These barriers have occurred due to flaws in the US public health care systems. Studies involving nurses in planning and implementation of technology primary care system are few. In this framework, transition model would work best (Vrazel, 2013). This model involves three stages of change (Vrazel, 2013): stage 1 Letting go: this stage is marked with resistance because individuals are forced to let go something that was routine. Most individuals remain stuck in this stage for a while. Therefore, it is important to listen to their emotions and give them time to process their feelings.

Stage 2: The neutral zone: marked by confusion and uncertainty as individuals acquaint themselves with new systems. It is a bridge between old and new. Individuals need support and guidance. Short term goals and extra assistance is required

Stage 3: new beginning: marked by acceptance and vigor. People begin to build skills to work.

Additionally, Kotter’s step change model will enhance that steps necessary are undertaken, action needed done, and pitfalls avoided.  Successful leadership will create awareness and education to individuals, families and communities on VTE associated risk factors. It will ensure that the society know the signs and symptoms and the treatment available. This approach ensures that leadership is not isolated out in organization structures. It will ensure that involved expertise have support and energy from other partisans and will enable them accomplish set goals with ease. In summation, it is important to note that leadership change will have challenges if the organization is not receptive or ready for change (Carr, 2007).


Boulet, S.L. Et al (2012). Trends in venous thromboembolism related hospitalizations, 1994-2009. Pediatrics 130; 4:e812-e820

Carr, S.M. (2007) Leading change in public health- factors that inhibit and facilitate energizing the process. Primary health care research & development, 8; 207-215

Feng, LB., Et al., (2013) Trends in computed tomography use and diagnoses in emergency department visits by patients with symptoms suggestive of pulmonary embolism, 2001-2009. Acad Emerg Med, 20; 10: 1033-40

Payne, AB., Et al. (2014) High factor VIII, von Willebrand factor and fibrinogen levels and risk of venous Thromboembolism in Blacks and whites.  Ethnicity & Disease. Spring 24(2): 169-74

Vrazel,J. (2013) Managing change and leading through transitions: a guide for community and public health practitioners. Retreived on January 13th, 2015 from


Yusuf, H.R. Et al., (2013) Hospitalization of adults> 60 years of age with venous thromboembolism. Clin Appl Thromb Hemost 12(4)

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