Innovation to improve and maintain

Introduction

The purpose of this dissertation is to propose and implement an innovation to improve and maintain patients' confidentiality, while they are receiving treatment from clinicians in the UK Hospitals. Before implementing a change, it is crucial to discuss and understand confidentiality in the context of health and social care and its implication for patients' safety and wellbeing. This will be followed by evaluating the current state of confidentiality in the National Health Service (NHS) policies and practices and also identifying service gaps and poor practices as the drivers for the plan of innovation. After identifying the drivers for innovation, there will be a critical assessment of the innovation underpinned by Kurt Lewin's theory related to change management and the discussion of transformational leadership style, involved in the change process. Lastly, the step by step implementation of the planned innovation into practice will be discussed, and the potential outcomes of the suggested innovation will also be compared to the NHS current evidence-based practice in terms of patient safety and wellbeing. Confidentiality is defined as "the moral right to assist people in maintaining the privacy of what they entrust to others, which correlatively acquire the obligation to guard secrecy" (Beltran-Aroca et al., 2016, pp. 3). Medical information for patients is not only what the physician obtains during the comprehensive evaluations, clinical examinations and medical reports, but also his or her views related to family life, lifestyle, financial responsibilities and other behaviours (Zulman et al., 2020). Unreasonable disclosure of this information can negatively affect the credibility of the patients, opportunities, human integrity, and impact physician-patient trust (Sherwood et al., 2018). Respect for confidentiality is important in order to protect the well-being of the patients and to preserve the confidence of society in the doctor-patient relationship (Knight, and Papanikitas, 2018). However, confidentiality issues in health care are not limited to nurses and physicians alone. It is the responsibility of all healthcare professionals, including pharmacists, care assistants, lab technicians, administrative workers, trainees to name but a few (Burns, 2012). From an ethical point of view, reverence for the values of beneficence, autonomy is recognised as a primary reason for protecting the confidentiality of the patients, based on a fundamental concern for individuals (Buka, 2020). However, healthcare staff and, in particular, doctors, when obtaining information from patients to aid in the design of effective treatment, are predisposed to inadvertently compromise the confidentiality of patients by talking with the colleagues in public spaces cafeterias and careless interactions, during telephone conversations while accessing electronic data (Beltran-Aroca, 2016). Confidentiality is fundamental to the relationship of trust between the doctor and the patient. Patients whose confidentiality has been abused or who have had bad experiences with health professionals may, in the future, stop seeking medical assistance (Esmaeilzadeh and Sambasivan, 2017). If they do, they may not be able to reveal the physicians and nurses reliable details to their wellbeing (General Medical Council, 2017). Doctors and nurses have both ethical and legal responsibilities to protect the confidential details of the patients from unauthorised disclosure. However, sufficient exchange of information is an integral part of ensuring safe and efficient treatment (Sulmasy et al., 2017). Patients may be placed at risk if those delivering their treatment do not have access to appropriate, reliable and up-to-date information about them (General Medical Council, 2017). Important patient data are often utilised for purposes other than emergency treatment. Some of these are indirectly linked to patient care, in that they make it possible for the health care systems to operate effectively and safely. For example, a large amount of patient information is also utilised for different reason such as medical research, service planning and financial auditing (Berry, 2019).

Context and background

It is the responsibility of the National Health Service (NHS) England to secure and protect the patient identity and sensitive information in compliance with mandatory legal requirements (NHS, 2019a). Confidential information in the NHS may usually be regarded as personal health information of the patients. Other NHS confidential information includes personal information, such as employee records, occupational health records and NHS Confidential business information changes (Wilson and Khansa, 2018). The legal and confidentiality structure within the NHS UK has acknowledged the importance of maintaining confidentiality in the Human Rights Act, which incorporated the European Convention on Human Rights into UK law. Article 8 of the European Convention, the right to respect for private and family life states that “everyone has the right to respect for his or her private and family life' for his or her home and correspondence” (Equality and Human Right Commission, 2018). This further implies that, public officials should be careful not to meddle with these aspects of a person's life. In addition, the National Health Service strictly complies with the European Data Protection Regulation (GDPR) and the Data Protection Act (2018), which strictly regulates the use of "personal data" and sets out eight principles to ensure that, the personal data of the patients is handled lawfully, fairly and transparently (GDPR, 2018). Furthermore, Solove and Citron (2018) advocated that, for preventing a breach in confidentiality, patient’s personal data should be handled in such a way as to ensure adequate security of personal information, protection against unauthorised processing, accidental loss, and harm using appropriate technological or organisational controls. In order to improve control of privacy and confidentiality, the Computer Misuse Act (1990) makes it a criminal offence for health practitioners to have access to, without authorisation, patients, friends and family data, such as laboratory test results, and the treatment in which they are not personally involved (O'Doherty et al., 2016). The effect of this act is to discourage the misuse of the patients' information and keep all the details confidential. However, health professionals, working in a different organisation, are permitted to have access to patient data in a specific scenario, where patients are moved from one health system to another seeking improved welfare. In this case, Caldicott Guardians propose practical standards that guarantee the protection of patient-identifiable information during transfer to another hospital (Crook, 2003). All the registered health professionals by the NHS are under obligations to practice based on Department of Health (2003), which outlines four primary requirements that must be fulfilled in order to provide the patients with a confidential service. They include: preserving patient information, educating patients about how their information is used, allowing patients to determine if their information can be shared, and searching for effective ways to secure, educate and provide patients with choice (Reynolds and Mitchell, 2019). The confidentiality and privacy of the patients' are often supported as necessary in the healthcare profession by other professional bodies, such as the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC), which is responsible for controlling the physician’s and nurse’s practices to protect, promote and preserve the health and safety of patients (Brazier and Cave, 2020; NMC, 2018). There is a framework in the GMC and NMC guidelines to ensure confidentiality and data protection for all the patients in all aspects of care (Brazier and Cave, 2020; NM 2018). However, with all the legal frameworks and guidelines implemented for patient's wellbeing and safety, there have been reports on repeated breach of patients' confidentiality. For example, the UK data ombudsman confirmed a violation of confidentiality data involving 150,000 patients in the NHS. The NHS unintentionally released data on patients who objected to the disclosure of their information (NHS, 2020). A similar incident occurs within the Scottish health boards, with a total of 800 patients private data disclosed publicly from 2009 to 2013. In another incident, the patient’s personal detail, notes, and records were recovered inside the NHS buildings, parking lots, public transport, wrong addresses (Monti and Wacks, 2019). This seems to suggest that, all the policies and regulations implemented to safeguard patients' confidentiality in the healthcare sector are either not effective, or health professionals are negligent of their duties. Hartigan et al. (2018) reported experiences and complaints of the patients in the emergency department regarding a lack of privacy and confidentiality. Emergency Rooms may have a crowded atmosphere, therefore, making it difficult for workers to create a proper healthcare environment. Therefore, confidentiality and privacy violations are crucial in emergency departments (Koskimies et al., 2020). A variety of studies have examined confidentiality in the emergency room. A remarkable study in the United States showed, during the usual patient care process, that all the members of the healthcare team compromised patient confidentiality (Hartigan et al., 2018; Moss, 2017). Besides, the same study also revealed that, confidentiality and privacy were violated as a result of the physical layout of the emergency department with curtained walls (Hartigan et al., 2018). Some members of the healthcare team, who deliberately breached patient’s confidentiality, faced disciplinary measures or termination of appointed based on the severity of their violation (Hartigan et al., 2018). Another study found that, the patients, who were treated behind the curtains more frequently, assumed that they could overhear others and others personal information and details, and also see their body parts (Barlas et al., 2001). More recently, Australian authors also reported that, 41 per cent of the patients surveyed had overheard other patient's conversations with staff (Moss, 2017). Gaps in patients confidentiality identified within the UK trusts include a report by Big Brother Watch on how the NHS staffs have continuously breached patient's confidentiality (NHS, 2019a). Between 2008 and 2011, 268 cases involving infringement in patients' medical information occur annually. A minimum of 23 of this medical information was uploaded on social media platforms by the NHS staff. Furthermore, there were 57 events in which medical information was misplaced or stolen and 129 cases where NHS workers reportedly had access to colleagues and family members' private medical information (NHS, 2019b). As a result of a violation in data protection, 102 NHS staffs employment was terminated between 2008 and 2011. Also, Marsh and Reynard, (2009) identified infringements in patients confidentiality in 11 per cent of lift journeys made by the health professionals, when communicating with either colleagues or relatives during hospital ward rounds in the UK. In addition, patients in adjacent beds could overhear sensitive information about others shared by health professionals during the ward rounds (Bourke and Wessely, 2008). Jethwa et al. (2009) also reported a case of a health worker abandoning a patient's medical records on the train. Unlawful exposure of such highly sensitive information may damage the credibility of the patients or result in missed opportunities, financial burdens, and personal embarrassment (Beltran-Aroca et al., 2016). The consequences of failure in patients confidentiality during care in the UK implies that, the patient has continued to experience unnecessary damage and lack of optimal care that has led to inadequate quality of care and protection of life (Dixon-Woods et al., 2014 and Taylor et al., 2016). According to Dixon-Woods et al. (2014), patients, who experienced unlawful disclosure of their medical information, were distressed and expressed their lost in trust and dissatisfaction in NHS services. More importantly, patients used the online platforms (Twitter and Facebook) and online and paper-based feedbacks, established by the NHS to express frustration in the care received from the health professionals (Baines et al., 2018; Turk et al., 2020). They complained of negative attitudes of health professionals towards their privacies and confidentiality. The massive feedback on health professional failure in confidentiality could serve as a driver for transformative change in the NHS (Powell et al., 2019). These identified gaps in services, including a flaw in trust within the NHS as a result of failed confidentiality, which the recently proposed innovation attempt to address. A central plan of the innovation is changing in healthcare worker’s behaviour, which seeks to improve on existing emphasis by the NHS policies and prevention of negligence at the individual and public level. The Proposed innovation The innovation proposed in this dissertation is to change the behaviours of the service providers and health professionals towards patient's confidentiality during care in hospitals. The aim of the proposed innovation is to improve patient's satisfaction and safety in the care that they receive and the public trust in the NHS healthcare practice towards the patient data protection. For this change to be realistic, the existing health professionals must be willing to participate in behavioural change training, which addresses their attitudes towards patients care such as loud voices during communication, inadvertent exposure of patients' vital information on documents during ward rounds, laptops, and social networks. Behaviour Change Techniques (BCTs) “are the smallest components of behaviour change interventions that, on their own, have the potential to change behaviour” (Dixon and Johnston, 2020; Michie et al., 2018). Cradock et al. (2017) reported the utilisation of Behavioural Change Techniques as an evidence-based practice for behaviour change in health professionals' practice through training, education, and enablement. The Target of Behavioural Change Techniques can be conducted either by enhancing factors that facilitate change in behaviour or mitigating factors that inhibit change in behaviour (Carey et al., 2019). Putting this innovation in context, the Behavioural Change Techniques target is to either enhance or mitigate factors such as communication, which will affect the proposed change in the existing health professional behaviours towards patients' confidentiality during practice. This innovation is essential because it underpinned the NHS Outcomes Framework that emphasis that the health professionals must ensure patients' experience positive care in a safe environment and protected from avoidable harm (NHS, 2020). The intervention training will be conducted under the supervision of the members of senior management to ensure commitment of staffs to bring positive changes in their roles and responsibilities, while disseminating care, which will result positive patient outcome. This will be a face to face training and will be for duration of 12 weeks. Leaders will ensure appropriate action plans, which will be effective to meet the set goals, are in place by repeated practice and feedback from the trainee. The outcome of the training is to increase health professionals' communication skills and stimulate positive response by using reminder posters on patient's bedside, and ward curtains that read "my privacy is important for my wellbeing". Also, a reminder red alert poster to be placed on lifts and computers "remember patient information is confidential" to stimulate professionals' behaviour to be mindful of their discussion while on the phones and also log off from the computer immediately after the consultation. Also, confidentiality champion staffs would be recruited to ensure health professionals drop all handover sheets which contain patients vital information in a secure place append their names and signature on a register before leaving the wards and hospital premises. Confidentiality champions are hereby important, because they will prevent littering of patients information, on buses, trains, public areas and on social networks. This is a good practice that will ensure improvement in patients' confidentiality.

Management and Leadership

The success of the proposed innovation to improve efficiency in patients care is dependent on the type of the institutional leaders in charge of the management of healthcare practitioners. Leadership is defined as the relationship between the person(s) who leads and the person(s) who elects to follow in relation to the actions of a team or a group of people towards a common goal (Martin and Learmonth, 2012). There are several leadership styles mentioned, although six styles are more common: transformational leadership, transactional leadership, autocratic leadership, laissez-faire leadership, task-oriented leadership, and relationship-oriented leadership (Cuadadro et al., 2012). These leadership styles have their own benefits and inadequacies; for example, the autocratic leadership style is always about making decisions based entirely on the leader's opinion without any consultation. In comparison, the transformational leader does not decide the terms and condition at work alone; instead, they inspire and motivate their staffs and work in collaboration to make informed decisions for achieving a target goal. Similarly, transactional leaders also encourage staff creatively, but they are more focused on target goals. However, Khalili et al. (2016) explained that, there is a significant connection between transformational leaders and staffs creative thinking for innovation. For this dissertation, transformational leadership was chosen, because the transformational leadership style is defined by building strong relationships and enhancing encouragement among the staff members (Nanjundeswaraswamy and Swamy, 2014). Transformational leaders' role in the planned innovation is to motivate and stimulate the health professionals to understand the reason for the change in their behaviours and improve patient safety during consultations. They lead and collaborate with staffs to meet innovation set goals (Samad, 2012). Transformational leadership acts as a change agent, which gives instructions to healthcare professionals on how to improve work ethics with regards to confidentiality and quality of the patients' health (Xie et al., 2018). Quality of care for patients is a high priority in the NHS; therefore, a transformational leadership style is crucial for the development and implementation of the planned innovation, which further supports optimal care (Samad, 2012). Significant positive associations have been identified between transformational leadership styles, high level of patient satisfaction and a reduction in adverse reactions (Sfantou et al., 2017).

Role of a nurse

Nurses around the world are participating in creative initiatives on a regular basis; activities inspired by the need to improve patient outcomes and reduce health care costs. Many of these advances by nurses have contributed to major changes in the health care system for the patients, populations and health systems (Lowe et al., 2012).The primary responsibilities of the leader as a change agent is enhance the capacity to accept, lead and manage innovation by preparing and building staff capacities using different skill sets such as good communication, openness, and decision-making skills to implement the proposed innovation to improve nursing practice and positive patients outcome. The leader uses the skills to facilitate change in staff behaviours; perception, and inspiration which is complex in nature to drive organisational change (Farahnak et al., 2010). Furthermore, the role of a nurse leader as a facilitator for change also includes adhering to guidance to create behavioural expectations for the success of staffs during innovation. The change agent promotes the involvement of workers in decision-making, develops and nurture communities that value the input of other individuals, support innovation and strengthens the process of looking for the right solutions to problems (McNeill, 2017). The leader plays an inspiring role in expressing assurance and acknowledging staffs as contributors to the change process. Most importantly, the leader among the nurses must communicate effectively with the staffs and earn their trust. The leader will hereby play a key role in driving the proposed innovation by using their effective communication to convince staffs and other stakeholders to see the reason, why they need to participate in Behavioural Change Techniques training intervention improve their practice and protect patients’ confidentiality during a consultation in the hospitals. The nurse leader or manager will also facilitate and manage the 12 weeks Behavioural Change Techniques training and ensure that the staffs are fully committed to the guidance and meet expected targets. The nurse leader will also implement the change and monitor its progress using online designed questionnaires for patients' feedback and data auditing on a weekly basis as the innovation progresses.

Change Management Strategy

Effective communication and a clear understanding of the change process are essential for successful change management. An organisation structure with an effective leader can also play a role in change by encouraging positive change in staff attitudes, motivations, and understanding the rationale for change. Therefore the first step for change is to recognise and respect organisation culture, belief, and challenges to encourage cooperative behaviour for implementation of change (Alavi and Gill, 2017). In order to innovate and change within these organisations requires support and the utilisation of the various toolkits or frameworks to aid the process and evaluate the impacts of change. Innovation includes vision, structure, plan and collaboration with partners and stakeholders to assess the impact of care and services in order to transform care and services (McSherry and Douglas, 2011). In addition, it is important for the managers or agents of change to define the required changed theory or model to provide a basis for implementing, managing and accessing change (Mitchell, 2013). There are different change models; however, Kurt Lewin, Rogers and Ronald Lippitt are the three common models. Rogers and Ronald Lippitt models have modified Lewin theory to 5 and 7 phases of change, respectively. However, Lewin theory is probably the most well-known, user-friendly and straightforward (Patton et al., 2016). Kurt Lewin theory of change provides a basis for the interpretation of the actions of nurses during the period of change and enhance actions while changing the workplace' (Bakari et al., 2017). For the proposed dissertation, Kurt Lewin model of change framework was used to implement organisational change process in NHS practice to improve patients' confidentiality and health outcomes during care. Lewin’s model was chosen, because it focused on the involvement of the staff, including all workers who will be impacted by this transition and has shorter phases for change- unfreeze, change and refreeze (Bakari et al., 2017). The figure for Lewin change model is found in appendix 1. Lewin considered that in efforts to realise successful change, it was crucial to explore all options for transitioning from the current to the preferred future outcome, and afterwards compare the implications of each and find the most effective one rather than only heading for the intended outcome and pursuing the fastest route to it. Lewin's model urges healthcare managers to be mindful of two forms of resistance forces, one being social patterns or customs and the other being the development of an inner resistance to change. Both the forms of resistance forces are embedded in the interplay of the larger group with the individuals within them and only moving forces, which are sufficiently powerful to smash the customs, threaten the desires, or freeze the customs of the group can defeat the resistance forces. Since most members want to remain within the group's behavioural rules, individual resistance to change increases as a person moves beyond established group values. Putting the proposed change in the context, during the unfreeze stage, the nurses find it challenging to change their current mode of practice – behaviour during care to accept the projected novel way. Common behaviours that have become a norm in hospital settings include health professional talking at the top of their voice during communication, unintentional exposure of patients' vital information on documents during ward rounds, on laptops, and posting on social networks. At this stage, the identified stakeholder that will drive the change is the transformational leader; a senior nurse. The manager hereby plays a crucial role by providing convincing evidence, which will stimulate the nurses to accept the reason for the change in practice within health care organisation and encourage them to participate in Behavioural Change Techniques training at a reasonable cost to improve patients' outcome. After the first phase of imbalance, Lewis suggests that, the change phase is where the nurse leaders or transformational leader influences staffs to accept the novel approach to practice. Hussain et al., (2018) indicated that, this is the phase of reformation where forces for constructive and reactive organisational change, where transformational leader share knowledge and willingness to facilitate change in practice (Hussain et al., 2018). This change does not happen suddenly; people take time to embrace and commit to the process of change, because they are yet to understand the benefit of the change in practice. In the planned innovation, nurse leader will facilitate change in service delivery by organising a 12 weeks Behaviour Change Techniques training that introduces better communication skills and enablement for health professionals and eradicate any form of harm to patients care and wellbeing. In a situation where nurses are unwilling to participate in the change process, the nurse manager will provide evidence to support their involvement in the change of practice, benefits and outcomes for the hospital and patients. The last phase is the refreeze when a change has taken place, and the organisation has embraced it and implements a new way of practice. At this point, nurses are finding new ways to disseminate treatment to patients, as they struggle through their reservations about the change that has been taken place. Also, those who do not support the change progressively accept the new way of practice. After a while, this process will become a routine and internalise into the organisation. For the proposed innovation after the 12 weeks training, the existing health professionals will start attending to patients strictly adhering to confidentiality guidelines and painstakingly communicating with patients with due diligence, making sure that their needs are taking into consideration. There are also posters in the consulting rooms, wards and lifts as a signpost to remind them of the importance of patients' information in case they forget. This new behaviour may be strange and a struggle for the health professionals to accept. However, with time and encouragement from senior managers, the practice will be adopted as a routine.

Engagement with Stakeholders

There is a need to work in collaboration with different stakeholders for the success of innovation. Stakeholders are "any group or individual who can effect or are affected by the achievement of the organisation's objectives” (O' Rourke et al., 2016). Nurse leader’s responsibility is to present a clear structure, process, and strategy for the proposed innovation to stakeholders with its benefits for practice and patients' safety. The stakeholders include patients, nurse, clinical governors and the hospital management team. The nurse leader must present the proposed innovation to stakeholders for deliberation. Stakeholders’ deliberation is important for the identification of unique individual roles in the innovation process, the benefits of the proposed innovation and factors that will hinder the process (Whitehead et al., 2017). The nurse leader and other stakeholders usually make corporate decisions based on the ethical policies and legislation that support the proposed innovation for the improvement of patients' safety and confidentiality (Castro et al., 2019). To implement the proposed innovation, the nurse leader must facilitate the process by working with health professionals to create a friendly environment for the training of the staffs, by using limited resources to implement innovation within a given timeframe as depicted by the Gantt chart in appendix ii. Frontline nurses and midwives need to continue to explore and unlock the potential of innovation in enhancing the quality and demonstrating impact and outcomes of care and intervention as the future is dependent on their ideas, creativity and willingness to engage with change (McSherry and Douglas, 2011).

Resistance to the proposed innovation

It is not rare for workers to suggest that they are unable to settle on changes in their practice, and are thus particularly resistant to change. While everyone may not support change, people react to a series of changes that vary from lack of enthusiasm to open sabotage (Nilsen et al., 2019). Besides, resistance to change can be as a result of lack of competences of the leader to drive the change through innovation (Najafi et al., 2018) in a diverse and complex organisation culture (Szczepańska-Woszczyna, 2020). Some of these organisation problems include difficulties of staffs to embrace a novel creative concept, fear of change, poor communication and lack of resources for the proposed innovation. Leaders can face challenges in leading and managing innovative because staffs are used to an old custom standard of practices on a daily basis (Szczepańska-Woszczyna, 2020; Schoemaker et al., 2018). They are afraid that, distortion in their usual routine may demand more committed to work and increase the level of stress existing in the hospital settings (Brugha et al., 2018). Poor communication of the change process can discourage the staffs from showing interest and unwilling to learn a new approach to practice (Nicholls, 2018). All the resistance factors identified could affect the planned innovation in the hospital environment if these factors are not addressed at the planning stage of the innovation by the nurse leader and other stakeholders.

Management of resistance to innovation

Managers and executives need to understand how staffs can respond to new changes. The managers and leaders need to engage the staffs in the innovative process with clear communication to eliminate obstacles, which can emerge from the introduction of new changes (Schoemaker et al., 2018). Fazey et al. (2018) emphasised that, structured open communication further encourages positive collaboration and engagement among the staffs and stakeholders in the changed process. For the proposed innovation communication is vital, the leader will clearly present reasons why the confidentiality of patients must be protected to all stakeholders and distribute the designed posters in appendix iii; presenting the planned innovation process at a glance to all stakeholders. Furthermore, after identification and understanding the need for change, the nurse leader needs to gain full support from stakeholders and staffs before the implementation of the proposed innovation. In this instance the role of the nurse as a transformational leader to inspire and encourage both staffs and stakeholders and gain their support to implement the proposed innovation for patient’s safety and wellbeing (Marshall and Broome, 2020). Atkins et al. (2017) suggested that, the willingness of the majority of staffs and stakeholders to accept and implement the proposed innovation can reduce the potential reluctance of others when change is implemented. The nurse leader must support and encourage staffs by proposing behaviour change techniques training in the transition process so they can take control of the change and implement it in their practice. Successful and sustained innovation and change in practice as suggested by McSherry and Warr (2010), and Nightingale (2018) require the organisations like the NHS and individuals working within to create the following: organisational culture and working environment founded that ensure a sound vision, strategy, goals and insightfulness of people to generate and evaluate ideas. It is also essential to make links and network with external partner companies/stakeholders in developing robust structures and systems for sharing the important information (Lowe et al., 2012). McSherry and Warr (2010) point out that success in practice and innovation includes leadership teams that accept responsibility for training and development, recruitment and rewarding processes that promote innovation.

Evaluation and quality improvement

The evaluation of the change process is vital to inform the policy of good practice and encourage future participation of nurses in innovation. Evaluation of change in practice actually began when the innovation is implemented, and the nurse leader continues to measure the level of staff performance on a weekly basis. Online completion of the questionnaires by the stakeholders such as patients could be appraised for feedbacks to assess their perception of the new approach of the health professional. Evaluation of the proposed innovation could also be in the form of clinical audit; that evaluate feedbacks on patients confidentiality in comparison to the accepted standard of evidence-based practice (NICE, 2016). Ivers et al. (2012) suggested that, the use of audit and feedback lead to improvements in professional practice and patients' outcome. Using questionnaires and clinical audit to measure improvement in professional practise and patients' wellbeing and safety is the positive outcome is essential for policy planning and endorsement of the proposed innovation. However, the change agent leader is required to continue monitoring the change process for a period of time and make possible adjustment where required (Emmett and Nye, 2017). The change agent must also ensure that, the health professional is not dragged back to the previous way of practice. Ways to do this are to eliminate any process or practice that will make them revert back to the old method of practice (Alfred and Rosevear, 2000). The change agent must strive to do this by making it part of daily practice. When a standard has been established, and there have been clear indicators that it has had a positive effect, such as increased positive experience and satisfaction of care by patients, people are more likely to trust the services of the NHS.

Reflection on learning

Reflection is undeniably a key concept for nursing, encouraging discourse and shaping nursing practice and education. However, commencing training to be a qualified nursing professional seems to posit acquisition of theoretical knowledge and skills from classroom lectures, books, and achievement of good grades in all modules assessments is sufficient criteria for being awarded a degree in nursing. Nevertheless, during clinical placements, practical knowledge acquired stimulates a mix of curiosity and criticism on how theoretical and practical knowledge learned could be useful for patients' wellbeing in reality. For example, pondering and assessing the clinical-decisions, made by senior nurses to treat two patients, who suffered from similar ailment differs and both achieve positive outcomes. Also, as a trainee, it is difficult to question or challenge some of the existing practices in place as it has become a normal behaviour within the hospital organisational culture and this makes it difficult to implement change. As a change agent, it is possible to influence the practice of other staff by implementing evidence-based practice whilst working in a group with clear communication on how this decision is vital for patients' wellbeing and quality of life. The Nursing and Midwifery Council (2018) supported the use of evidence-based research by the nurses and midwives to inform practice responsibly with accountability. Therefore, it is important for the nurses to possess the ability to understand critique and analyse primary research to update their existing knowledge and skills in clinical practice. Realistically application of evidence-based practice in hospital settings may be a struggle because some of the nurses are overburden with the workload and can hardly create time for personal learning and development. Nursing manager can inspire and motivate the workers to attend and commit to training by reducing their workloads, prioritising daily activities and working within a timescale. Continuous professional development through organised training for health professionals allows one to undertake new task and identify areas for improvement. For example, the nursing leader allocates the staffs in different training group, based on their strength and facilitates the training to improve practice that will be beneficial for patient’s outcome. As a nursing student, it is important to listen and follow leader’s instruction that will contribute to one professional development. Leadership plays an essential role in the success of a hospital's innovation, as the types of leadership will determine how innovation is achieved. Leaders set the targets, provide a convincing rationale for change and organise the training appropriate to change of practice within an organisation. However, the achievement of success in a change in practice can be undermined by different factors. During training, one of the notable challenges to change is practice based behaviour. Nurses are comfortable in working in a particular pattern that is easier, faster with less cognitive ability. Also, nurses in a managerial position may enforce the staffs to work in a particular way that suits them. In contrast, transformational leaders stimulate and inspire practitioners by encouraging collaborative training as an intervention to change their behaviour towards care practice and improve positive patient outcome.

Conclusion and Recommendation

This dissertation proposed innovation to improve patient's confidentiality in hospital settings. Confidentiality of the patients during care is very vital in clinical settings for maintaining patient's safety and health outcomes in line with the NHS standard of care. Patient’s confidentiality has been breached due to inadvertent exposure of personal information during consultation in the wards, ignorant discussion of patients’ health condition by health professional while communicating with colleagues or family members at the hospital corridors or during transit on lifts with loud voices, misplacing patient sensitive information in public places and posting patient details on social platforms. The consequence of this behaviour exposes patients to potential risk of financial problem, loss of opportunities, personal embarrassment, distress, and reduced quality of life. The innovation focus is to increase health professional awareness, change their behaviour to improve their practice using posters as a reminder to uphold patient’s confidentiality during a consultation. However, change of staffs' behaviour may be challenging due to organisational culture and environmental practice. Furthermore, the involvement of nursing staff in training anchored by transformational leaders and stakeholders underpinned by behaviour change techniques (BCTs); evidenced-based training tools to inspire change in staffs approach to innovation. Furthermore, Kurt Lewin's change model 3 steps explained the implementation of change in healthcare practice and to improve patients' outcome. The proposed innovation is expected to reduce breach in patient confidentiality by using posters as a reminder to communicate with the staffs during ward rounds, consulting rooms and lifts. Also, the recruited of confidentiality champion staffs will ensure health professionals drop all patients’ written information before leaving the hospital to safeguard against littering of patients vital information in public premises and breach their confidentiality. The success of the proposed innovation will be under continuous review using patient feedback questionnaires and clinical audit tools. In conclusion, this dissertation recommends the use of effective leaders to encourage change in practice, which will improve the outcome of patients care. Besides, nurses should be willing to update their practical knowledge using evidence-based practice as part of their continuous professional development goal. Hospital environment should be supportive of any potential innovation project, which can add value to service provision and health care body of knowledge.

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Appendix ii: Gantt chart Activity