| Course | HLTH 4313 Leading and Decision-Making in Health Services |
|---|---|
| Module | Module 4 |
| Paper type | Change management plan |
| Length | 1,260 words, about 5 pages plus title and reference pages |
| Format | APA 7 student paper |
| School | American College of Education |
| Program | B.S. in Healthcare Administration |
| Updated | September 2026 |
Free sample paper for HLTH 4313 Module 4
Two Machines and Fourteen Skeptics: An ADKAR Change Management Plan for Adding Ultraviolet Disinfection to Discharge Cleaning in a Hospital's Environmental Services Department
Student Name
American College of Education
HLTH4313: Leading and Decision-Making in Health Services
Module 4 Assignment
Instructor Name
October 26, 2026
The Change
Our composite 300-bed hospital has purchased two ultraviolet-C disinfection devices, mobile units placed in a vacated room once manual cleaning is finished, which emit ultraviolet light that inactivates bacteria on exposed surfaces. The infection prevention committee has decided they will be used after discharge cleaning of rooms that housed patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci. As night supervisor of environmental services, I am responsible for making the change work on my shift.
The evidence behind the decision is strong but specific. In a cluster-randomized crossover trial at nine hospitals, Anderson et al. (2017) found that adding UV-C to standard quaternary ammonium disinfection of rooms vacated by patients with target organisms lowered the incidence of those organisms among the next patients admitted to the rooms, with a relative risk of 0.70. The same trial found that adding UV-C to bleach cleaning did not change the incidence of Clostridioides difficile infection. The committee's decision follows the evidence: the devices will be used for rooms of patients with MRSA or VRE, not as a replacement for bleach in C. difficile rooms.
Why a People Model
Equipment changes in hospitals often fail not because the equipment does not work but because people do not use it as intended. A UV device adds ten to twenty minutes to a room turnover, during which the room cannot be used and nurses waiting for a bed may call repeatedly. Crew members who see the device as a slowdown, or who worry that it signals their manual cleaning is not trusted, may skip it on busy nights. The trial's benefit was achieved when the devices were actually used, and a device left in a closet produces none. Research on environmental services also suggests that the conditions of the workers shape cleaning outcomes. Litwin et al. (2017) associated outsourced cleaning in California hospitals with higher infection rates and traced the link to cleaners who are paid and trained less and kept at a distance from the clinical team. A new device handed to a detached crew is likely to meet the same fate as the rest of their work: done when watched, skipped when not.
I chose the ADKAR model, described by Hiatt (2006), because it focuses on individual change. It holds that each person affected by a change must move through five stages in order: first becoming aware that the change is needed, then wanting to take part, then learning what to do, then being able to do it in the real setting, and finally having the change reinforced so it lasts. A change stalls at the first stage a person has not reached, so the model helps a manager find out where each crew member is stuck rather than repeating the same message to everyone. Organization-level models such as Kotter's eight steps are useful for hospital-wide change, but this change lives or dies with fourteen people on one shift.
The Plan, Stage by Stage
Awareness. In the first week, the infection prevention nurse will present the trial's findings to the night crew in a fifteen-minute huddle, with a translated summary in Spanish and Haitian Creole. The message will be concrete: in a trial like ours, the next patient in a room was less likely to pick up a resistant organism when UV was added, and the crew's manual cleaning is still the first and most important step.
Desire. Desire depends on what the change means for each person. I will ask the crew what worries them. If the answer is time, I will agree with the bed placement coordinator that UV rooms are flagged at the start of the shift so that nursing expects the delay; if the answer is trust, I will say plainly that the device only works on surfaces that have already been cleaned, because shadows and dirt block the light. Two respected veterans will be asked to be the first operators and to report honestly on what they find.
Knowledge. The manufacturer's trainer will teach operation, placement for shadowed areas, safety rules for ultraviolet exposure, and documentation. Every crew member will operate the device under supervision on three rooms before being signed off.
Ability. Knowing how to run the device is different from fitting it into a busy night. For the first month, I will build UV rooms into the shift plan, assign a specific crew member to each device, and be present on the floor for the first cycles each night to solve problems as they come up, such as a room with no outlet near the door.
Reinforcement. Each month, the crew will see the number of UV cycles completed against eligible rooms and, each quarter, the unit infection data from infection prevention. Crew members who complete cycles consistently will be recognized by name at the huddle, and missed cycles will be reviewed without blame to find the reason. Reinforcement is where most changes quietly die, because the launch gets attention and the fourth month does not.
Resistance and Stakeholders
Resistance is expected and useful as information. From the crew, the likely objections are time, fear of ultraviolet exposure and a sense of being second-guessed; the plan addresses each. From nursing, the likely objection is delay in bed availability, especially for boarded emergency patients. The emergency department and bed placement leaders will be briefed before launch, and the plan limits UV use to a defined group of rooms rather than all discharges, which keeps the added time manageable. From the finance team, the question will be whether the devices justify their cost, which is why the plan tracks use rates and infection data from the first month.
Communication Plan
A change on one shift still affects people on others. The day and evening environmental services supervisors will be briefed before launch, since rooms flagged for UV at shift change must be handed over clearly, and a short line will be added to the shift handoff form listing any room awaiting a UV cycle. The house supervisors will receive a one-page summary explaining why a room may be held for up to twenty minutes after cleaning. Patients and families will not usually see the devices, but a small card on the door during a cycle will explain what is happening and that the room is safe to enter afterward. Each communication will be tested with two members of its audience before it is used, because a message that makes sense to the planner often confuses the people who receive it.
Measuring Adoption and Effect
The plan will be judged by two kinds of measures. Adoption: the percentage of eligible rooms that receive a documented UV cycle, with a target of 90% by the end of the third month, reported by shift so that problems on nights are not hidden in a daily average; and the average added turnover time for UV rooms. Effect: the rate of new MRSA and VRE acquisition among patients admitted to rooms previously occupied by patients with those organisms, tracked by infection prevention and compared with the year before. The effect measure will take a year or more to interpret because the numbers are small, so adoption is the measure I will manage week by week. If adoption falls below 80% in any month, I will use the ADKAR stages to find where the crew is stuck, since the model's value lies in diagnosing the problem as much as in planning the launch.
References
Anderson, D. J., Chen, L. F., Weber, D. J., Moehring, R. W., Lewis, S. S., Triplett, P. F., Blocker, M., Becherer, P., Schwab, J. C., Knelson, L. P., Lokhnygina, Y., Rutala, W. A., Kanamori, H., Gergen, M. F., & Sexton, D. J. (2017). Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): A cluster-randomised, multicentre, crossover study. The Lancet, 389(10071), 805-814. https://doi.org/10.1016/S0140-6736(16)31588-4
Hiatt, J. M. (2006). ADKAR: A model for change in business, government and our community. Prosci Learning Center Publications.
Litwin, A. S., Avgar, A. C., & Becker, E. R. (2017). Superbugs versus outsourced cleaners: Employment arrangements and the spread of health care-associated infections. ILR Review, 70(3), 610-641. https://doi.org/10.1177/0019793916654482
HLTH 4313 Module 4 instructions, in plain terms
The fourth module of HLTH 4313, in many sections, asks for a plan to lead an organizational change using a named change model. Expect to describe the change and why it is needed, choose a model such as Lewin's three stages, Kotter's eight steps or ADKAR, apply every stage or step to your change, address resistance and stakeholders, and explain how you will know the change worked. Some prompts supply a change, while others leave the choice to you. The usual length is three or four pages in APA 7. If your instructor names the model in the Canvas prompt, use that one even if another seems to fit better.
How the HLTH 4313 Module 4 example is put together
The example begins with the change and the evidence behind it, reported precisely enough that the reader knows where UV will and will not be used. It then argues that the change is about people rather than machines and chooses ADKAR because fourteen individuals on one shift must each adopt it. The heart of the paper takes the five stages in order, giving each one specific actions that fit the crew, such as translated summaries for awareness and a named operator for ability. A resistance section addresses the crew, nursing and finance separately. The last section distinguishes adoption, which can be managed weekly, from infection outcomes, which take a year to read.
Where the points sit in the HLTH 4313 Module 4 rubric
Change management rubrics usually weight the application of the model most heavily. Full credit requires every step or stage applied to the specific change with concrete actions, not a restatement of the model. Graders also look for a justified choice of model and for attention to resistance, stakeholders and communication. An evaluation criterion rewards measures that show whether people actually adopted the change, and many rubrics give credit for evidence that the change itself is worthwhile. The example earns that with a randomized trial reported with its limits. Organization, clarity and APA 7 accuracy, including a correct reference for the model's source, round out the grade.
HLTH 4313 Module 4 help from the desk
Change plans lose points most often when the model's steps become headings with generic text beneath them, such as create urgency or communicate the vision, with nothing specific to the change. A second problem is skipping the last stage, reinforcement or refreezing, which is where changes fail in practice. Resistance is often described as a character flaw instead of information. Students also measure only outcomes that take a year to appear and forget adoption. Make sure the evidence for the change supports what you are actually doing. For a Module 4 plan built around your own change and the model in your prompt, a custom sample can be drafted by the desk.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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HLTH 4313 Module 4 questions, answered
What does HLTH4313 Module 4 usually ask for?
HLTH4313 Module 4, in many sections, calls for a change management plan built on a named model such as Lewin, Kotter or ADKAR, applied step by step to a real or realistic change in a health care organization. Your classroom's instructions decide the change and model.
What is the ADKAR model?
A model of individual change with five stages, awareness, desire, knowledge, ability and reinforcement, that each person must pass through in order. It helps managers find where each person is stuck.
Does UV disinfection reduce hospital infections?
In one multicenter randomized trial, adding UV-C to standard disinfection lowered acquisition of target resistant organisms in the next patients, but adding it to bleach did not reduce C. difficile infection.
Where can I find a free HLTH 4313 Module 4 sample paper?
This page provides the complete Module 4 change management plan for adding UV disinfection to discharge cleaning, including the title page, five sections, the notes alongside each and two references.
How do I measure whether a change was adopted?
Track use directly, such as the share of eligible cases where the new practice was done, reported by shift or unit, separately from longer-term outcome measures that take time to show an effect.