Address the following questions:
- Describe the current reality.
- What is unacceptable in this situation?
- What is your public health vision for the situation? What are the outcome goals?
- What are the barriers and facilitators of change? Make sure you consider the people, the
personalities involved, as well as the organizational structure/culture.
- How do you foster the change process?
- What is the “creative tension”? What are the tensions that arise from the difference
between current reality and the public health goal?
- Create a logic model for this situation.
- Describe the ethical implications or concerns of your team’s public health change model.
- Set the metrics by which you would measure progress and success when addressing this
public health issue.
- Describe how you would ideally address any ambiguity and uncertainty arising from
the leadership challenges of this change effort.
- Provide a bibliography.
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
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,
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-
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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-
- 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):
Vrazel,J. (2013) Managing change and leading through transitions: a guide for community and
public health practitioners. Retreived on January 13 th , 2015 from
Yusuf, H.R. Et al., (2013) Hospitalization of adults> 60 years of age with venous
thromboembolism. Clin Appl Thromb Hemost 12(4)