Introduction

The aging global population presents increasing demands on healthcare services, specifically in relation to the growing phenomenon of polypharmacy among the elderly. This refers to the prescription of multiple medications for chronic conditions, a trend which raises concerns due to the potential for adverse drug reactions, diminished quality of life, and escalated healthcare costs. The medication burden among the elderly population is a major concern as it can result in various adverse effects such as hospitalization, reduced quality of life, and adverse drug events [1,2]. In response to this pressing issue, current study proposes an organizational development (OD) project to instigate a deprescribing program within a healthcare setting. This program is designed to lighten the medication load on older patients by methodically reviewing and eliminating unneeded or potentially harmful medications [3]. By optimizing the prescription process, this study holds the promise to increase healthcare efficiency and enrich the standard of care for our aging population. Success in implementing the deprescribing program could lead to superior health outcomes, lowered healthcare expenditure, and amplified patient satisfaction. Furthermore, deprescribing interventions have shown promise in improving patient outcomes, including functional status, cognition, and quality of life [4].

Addressing Elderly Care Medication Challenges: A Contextual Overview

With the rapid aging of the global population, chronic diseases and the accompanying polypharmacy, the concurrent use of multiple medications, have seen a surge, especially among the elderly [5]. This polypharmacy trend poses a healthcare challenge due to the associated increase in the likelihood of adverse drug reactions, harmful drug interactions, and resultant hospitalizations [6]. Elderly patients face a heightened risk of medication-related complications due to age-associated physiological alterations, concurrent health conditions, and polypharmacy, thus compromising patient safety and care quality. The rapid aging of the global population brings to the fore an increase in chronic diseases and polypharmacy, the concurrent use of multiple medications, particularly among the elderly [5]. This rising trend of polypharmacy presents a significant healthcare challenge, heightening the risk of adverse drug reactions, harmful drug interactions, and hospitalizations [6]. In this context, elderly patients are more susceptible to medication-related complications, given the interplay of age-related physiological alterations, comorbidities, and polypharmacy, which collectively impinges on patient safety and the quality of care. The Primary Health Care Corporation, a large hospital serving a diverse patient demographic with a notable population of elderly patients, forms the study's focus. The current medication management system, and more specifically, the prescribing practices of healthcare providers (HCPs), have raised concerns. These practices may overlook the unique needs of the elderly, potentially leading to less-than-optimal health outcomes and a surge in healthcare expenditure [7]. Further, existing medication management approaches may not always facilitate the safe and efficacious use of medications. As an example, inefficient medication reconciliation processes could lead to medication duplication and potentially harmful drug interactions [8].

To counter these challenges, the study proposes the implementation of a deprescribing program. This program is designed to systematically review and cease the use of unnecessary or potentially harmful medications, thereby mitigating the medication burden on elderly patients and enhancing their health outcomes [9]. The healthcare setting under examination is a large public hospital located in a bustling metropolitan area. It offers a spectrum of medical services, including acute care, rehabilitation, and outpatient care, to a diverse patient population, with a significant proportion of elderly patients managing multiple chronic conditions. The deprescribing program, integral to this study, seeks to aid healthcare providers (HCPs) in identifying and discontinuing unnecessary or harmful medications in elderly patients. The program encompasses the development of guidelines, protocols, and tools, as well as training and educational initiatives to raise awareness among HCPs about the importance of deprescribing [10]. The implementation team will consist of key stakeholders, HCPs, pharmacists, administrators, and patient advocacy group representatives. They will collaboratively develop strategies, guidelines, and educational resources to ensure the program's successful implementation. Concurrently, a monitoring and evaluation mechanism will assess the program's impact on patient outcomes, healthcare costs, and provider adherence to deprescribing guidelines [11].

Rationale for Undertaking the Project

The impetus behind initiating the proposed study to implement a deprescribing program lies in the urgency to uplift the quality of healthcare delivered to elderly patients. Specifically, the program seeks to improve medication appropriateness and reduce medication-related harm. It is widely recognized that elderly patients are particularly prone to medication-related issues like drug interactions, medication non-compliance, and adverse reactions, which can culminate in severe health complications. Thus, proactive measures are needed to address these concerns and foster safe and effective medication use in this susceptible group [12]. The deprescribing program is constructed to alleviate the medication load on the elderly patients. It is anticipated that reducing the quantity of medication will mitigate the adverse effects linked to polypharmacy, such as heightened risk of adverse drug events, diminished quality of life, and escalated healthcare costs. By diminishing the medication load, the program will significantly enhance patients' quality of life and bear broader implications on the healthcare system by decreasing the incidence of adverse drug events [13].

The significance of the proposed study is paramount. Given the increasing incidence of medication-related issues among the elderly, the study's rationale lies in the intention to boost healthcare quality for elderly patients, improve patient outcomes, and ultimately, cut healthcare costs. This project is both needed and timely, and it addresses the pressing need to foster safer and more effective medication use in this vulnerable demographic.

Details of the Intervention

The deprescribing program is a multifaceted, patient-centered intervention spearheaded by a cross-disciplinary team that includes healthcare providers (HCPs), pharmacists, and patients. Its primary objective is to decrease the medication burden on elderly patients through the meticulous review of medication regimens and the discontinuation of potentially inappropriate medications. The program places the patient at the center of all decisions, with research indicating that patient participation in decision-making improves medication adherence and health outcomes [14]. In this collaborative approach, patients play an active role in their medication management. The program is tailored to each patient's unique needs, taking into account any cultural, linguistic, or cognitive barriers that may affect their understanding and involvement. Its design is guided by evidence-based guidelines, ensuring effective and safe reduction of medication load [13].

Educational support will be provided to both patients and caregivers, empowering them in the decision-making process and helping ensure safer and more effective medication use. The program not only focuses on reducing the medication burden but also seeks to improve patients' quality of life by promoting their active participation in medication management. Thus, the deprescribing program is an exhaustive intervention designed to improve medication management among elderly patients by empowering them and addressing their unique needs. Its ultimate goal is to alleviate the medication burden, promote safer medication use, and foster patient involvement in their care process [15].

Organizational Development Process: Model Selection and Implementation

To navigate successful change within an organization, both OD and Change Management are key components. Within this context, the Senior and Swailes OD model has been selected to guide the study due to its comprehensive framework for managing organizational change. This model effectively involves all stakeholders, including employees, and adopts a participatory approach, which aligns well with the objectives of this study [16]. Furthermore, the model underscores the importance of establishing shared vision and values, which are integral to this study. For implementation, the model follows a process of comprehensive analysis of the current state, development of a vision for change, and garnering agreement on this vision, followed by devising an action plan for change implementation [16]. Throughout this process, ethical considerations have been diligently observed. To ensure effectiveness, financial outcomes, costs, and returns on investment are evaluated, with the potential inclusion of a PDSA cycle or Model for Improvement within the model itself, as needed [17].

Implementing Senior and Swailes' Organizational Development Model

The study embraced the Senior and Swailes OD model, appreciating its dynamic and action-oriented process that considers change as an ongoing enterprise. This model integrates five key steps: diagnosing the current situation, developing a vision for change, gaining commitment to the vision, creating an action plan, and executing the change. This structured methodology proved advantageous for managing the change and aligning with the study objectives, which involved significant organizational modifications. In the first step, diagnosing the current situation, the organization's existing condition was assessed to identify areas of improvement. This process involved a thorough analysis of the organizational structure, processes, culture, strengths, and weaknesses [18]. Such comprehensive appraisal facilitated the establishment of a well-informed action plan and underpinned the second phase - developing a vision for change. The vision encompassed the desired future state of the organization and was communicated effectively to all stakeholders to ensure shared understanding and direction. To secure commitment to this vision, stakeholders were engaged and their inputs solicited, thereby fostering ownership and motivation for the forthcoming change [19]. This led to the creation of an action plan with clear objectives, timelines, and responsibilities. Developed in consultation with all stakeholders, this plan served as the roadmap for the change management process and was instrumental in defining roles and responsibilities, thus ensuring alignment with the established vision [20]. The final step, implementing the change, involved action plan execution, close monitoring of progress, and prompt resolution of arising issues [21]. Regular communication with stakeholders was maintained to keep everyone abreast of the process and to address any concerns. The Senior and Swailes OD model thus proved to be an excellent choice, fostering collaborative engagement across different organization levels, ensuring successful implementation, and ultimately achieving the set objectives.

Execution of Change Practices

To effectively orchestrate the change management process, representatives from each department impacted by the impending modifications were brought together to form a change team. Adhering to the recommended HSE model for organizational transitions, this team was assembled with a clear emphasis on participation from all stakeholders, fostering a sense of inclusion and collaborative decision-making throughout the study. To gauge the current circumstances and lay a foundation for change, the team carried out a SWOT analysis to identify the organization's strengths, weaknesses, opportunities, and threats [22]. This analysis offered valuable insights that informed the team's development of a coherent, compelling vision for change, aiming to streamline workflow efficiency and enhance the quality of care provided by the organization (Table 1). This vision was then communicated effectively across all stakeholders, ensuring transparency and fostering commitment through a comprehensive communication plan [23]. Informed by feedback from the stakeholders, the team devised an action plan outlining key tasks, responsibilities, and timelines, fostering an environment for realistic and attainable change. With the finalization of the action plan, the implementation of change was initiated. Throughout the change management process, the practices undertaken were closely guided by established literature on OD and change management. Notably, the team applied the Senior and Swailes OD model, offering a structured process for managing the transformation. This model underscored the importance of an in-depth understanding of the current circumstances, development of a clear vision for change, and the creation of a feasible action plan, crucial components that steered the team's strategic approach to change management. Ultimately, through the comprehensive SWOT analysis and the application of the Senior and Swailes model, the team was able to devise a well-informed, structured, and collaborative process for effectively managing change within the organization.

Table 1: Comprehensive SWOT Analysis of the Primary Health Care Corporation

Economic Evaluation and Value of Organizational Change

Throughout the change process within the organization, keeping a close eye on costs associated with the transition was of paramount importance. All economic aspects related to the changes were rigorously examined. A clear account of productivity enhancements and efficiency gains resulting from the new system's implementation was kept to ascertain its financial implications [24]. Furthermore, to assess the value-for-money proposition of the study, an exhaustive comparison was drawn between the incurred costs and the attained benefits. This comparative analysis facilitated an evaluation of the change effectiveness and provided decision-makers a clear metric to ascertain if the advantages from the change justified the resources invested [25]. It's pertinent to note that while the financial repercussions of the change were a critical consideration, the change process wasn't solely driven by financial metrics. Factors such as organizational culture shift, employee engagement, and customer satisfaction were also taken into account by the change team [26]. This multi-dimensional approach ensured the change was executed in a manner that derived maximum holistic benefits for the organization. The change team acknowledged that changes, though challenging, often yield long-term benefits surpassing the short-term costs. Their focus was on fostering a sustainable change that would boost organizational efficiency and effectiveness. By closely monitoring costs, financial impacts, and value-for-money, while also considering the influences on organizational culture, employee engagement, and customer satisfaction, they paved the way for a comprehensive change process [27]. This balanced approach, paired with a long-term vision, enabled the team to effectuate sustainable changes that not only improved the current operational efficiency but also set the stage for future organizational success.

PDSA Cycle Integration

In the selected OD model, the PDSA (Plan-Do-Study-Act) cycle was integrated, bolstering the success and sustainability of change management. This iterative tool for quality enhancement emphasizes perpetual learning and improvement through its four-stage process. The 'Plan' stage sets goals and decides the methods for achieving them. It is followed by the 'Do' stage, which implements the planned changes. The 'Study' stage then measures and analyzes the results of these changes [28]. Lastly, during the 'Act' stage, adjustments are made to improve the process and restart the cycle. The PDSA cycle, incorporated within the OD model, facilitated swift identification and rectification of issues arising during the change process. It also helped in spotting areas needing further enhancement, thereby leading to improved outcomes. The use of the PDSA cycle aligns with the literature on OD and change management, which attests to its effectiveness in fostering continuous improvement and sustainable change [29]. To ensure a smooth transition to the new system, the PDSA cycle was applied in this study (Table 2). It offered a structured way to iteratively evaluate and improve the new system. This cyclical approach enabled the change team to measure the effectiveness of the new system and implement necessary modifications. It was instrumental in identifying areas needing enhancement and in initiating corrective action. The PDSA cycle proved useful in analyzing data and identifying the root cause if the new system failed to deliver expected results. Understanding the root cause facilitated modifications to the system, which were followed by another cycle until desired outcomes were achieved [30]. The change team employed the PDSA cycle to successfully monitor the progress of the new system, identifying any discrepancies or areas needing improvement. This approach led to a more comprehensive evaluation of the new system and ensured continuous monitoring and refinement. Notably, this iterative approach guaranteed the system was both effective and efficient. The PDSA cycle provided a cost-effective method for testing and refining the new system by enabling early corrective action. Utilizing the PDSA cycle helped the change team ensure that the new system met the organization's needs and delivered the expected outcomes [31].

In conclusion, the PDSA cycle played a vital role in the OD process of this study. It ensured continuous improvements and desired outcomes in the new system. Its iterative nature allowed for swift corrective action, minimizing the repercussions of any arising issues. The use of the PDSA cycle also enabled a thorough evaluation of the new system, ensuring its effectiveness and efficiency. As such, the PDSA cycle is a beneficial tool for any organization aiming for continuous monitoring and improvement of its change process [32]. The PDSA cycle has been employed across various industries, with particular relevance in healthcare. For instance, hospitals implementing new processes to reduce patient wait times could utilize the PDSA cycle to evaluate the new process's effectiveness. This could be done by comparing patient wait times before and after the new process implementation. If the wait times do not decrease as anticipated, the PDSA cycle can help identify the root cause and accordingly modify the process. Such continuous use of the PDSA cycle can help hospitals maintain reduced patient wait times, thus enhancing patient satisfaction and quality of care. Therefore, it's vital to understand that the PDSA cycle is not a one-time exercise, but an ongoing journey of improvement, necessitating a committed team to ensure sustainability [33].

Table 2: Illustration of the Plan-Do-Study-Act (PDSA) Cycle in the Healthcare Domain.

Ethical Aspects

Throughout the change management process, the change team prioritized ethical considerations, aiming to implement change fairly, transparently, and respectfully for all stakeholders involved. Continuous dialogue was maintained with all stakeholders, incorporating their input and feedback into the process. This communication fostered a collaborative and participatory culture, encouraging stakeholders to share their perspectives, thereby identifying and addressing any ethical issues that emerged [34]. The change team realized the essential role of ethical considerations in building and maintaining stakeholder trust, crucial for the study's success. Therefore, they approached the change process committed to maintaining ethical principles and standards, cognizant that ethical violations could risk significant reputational damage, legal liabilities, and financial losses, potentially undermining the study's outcomes. To counter these risks, the team implemented measures ensuring ethical considerations were integrated into all aspects of the change process [35]. Emphasizing inclusivity and participation, the change team involved all stakeholders in decision-making processes, thereby building trust and ensuring their views were respected. This participatory engagement allowed for early identification and resolution of potential ethical issues [36]. Moreover, the change team strived to minimize disruption to the organization, developing a comprehensive change management plan outlining the necessary steps for implementing the change while mitigating potential negative impacts on the organization's operations. Developed in consultation with all stakeholders, the plan took into account their concerns and aimed to maximize benefits for all [37]. During the implementation of the new performance management system in a large multinational corporation, the change team understood the significant potential impact on employees, leading to prioritized ethical considerations. A comprehensive consultation process with all stakeholders ensured the implementation was fair and transparent. This process involved delivering clear guidelines about the new system, providing training and support for adaptation, and actively seeking feedback to identify improvement areas [38]. The result of this approach was a successful implementation of the new performance management system with minimal disruption to the organization's operations. Furthermore, the new system received accolades from employees for its fairness and transparency. The team's commitment to ethical considerations during the new system's implementation ensured that employees' needs and concerns were addressed, leading to a more positive and successful outcome [39].

Evaluation

To affirm that the outlined objectives were reached, an exhaustive evaluation process was set in motion (Table 3). An inclusive evaluation model was chosen to assess the success of the study, taking both quantitative and qualitative data/metrics into account, ensuring a wide-ranging evaluation [40]. The evaluation segment was a key component of the OD process. Initial data was gathered and scrutinized to set a reference point for the study, providing a benchmark against which advances could be contrasted. This was a vital step in evaluating the study's success. A measurement plan was crafted to gauge the realization of the initially set goals. Aligning with the SMART objective’s strategy, this plan was meticulously prepared to be specific, measurable, achievable, reasonable, and time-bound [41]. Quantitative data/metrics assessed the financial ramifications of the study, including an analysis of fiscal data such as budgets, revenues, and profit margins. This examination assessed the study's efficacy in meeting financial objectives, like cost savings, revenue growth, or productivity increases. Qualitative data/metrics also played a significant role, evaluating non-financial impacts by collecting stakeholder feedback from employees, customers, and suppliers through various channels like surveys, interviews, or focus groups. This qualitative data was used to gauge the study's influence on non-financial objectives, including employee satisfaction, customer satisfaction, or quality improvement [42].

The selected evaluation model was informed by a comprehensive review of literature on evaluation methodologies in OD studies. It was crucial to select a model that fit the study's specific objectives and scope and would deliver meaningful and actionable insights into its success. The all-inclusive evaluation model guaranteed consistent and systematic assessment of all objectives, producing reliable and comparable results. Employing a rigorous evaluation methodology allowed for a full understanding of the study's impact and identified areas for improvement [43]. The conclusion of the evaluation phase not only clarified the success of the study but also highlighted its financial and non-financial value. By quantifying the study's impact on financial objectives such as cost savings or revenue growth, its fiscal value was established. Similarly, by assessing non-financial impacts like employee or customer satisfaction, the broader value of the study to stakeholders was demonstrated [44].

Table 3: Evaluation Process in the Organizational Development (OD) Project.

Discussion

The OD study was an ambitious endeavor aimed at enhancing the organization's efficiency and productivity through comprehensive alterations in its structure, culture, and systems. This study involved a thorough and rigorous evaluation process, incorporating both quantitative and qualitative metrics to ensure a comprehensive understanding of the organization's current state and its potential for improvement. The evaluation phase of the study was instrumental in establishing a clear starting point and baseline data for gauging progress [45]. To ensure a complete and precise evaluation, the study team applied a rigorous methodology comprising both quantitative and qualitative data sources. This method enabled the team to pinpoint areas within the organization requiring enhancement and effectively demonstrate the value of the study to stakeholders. A variety of techniques, such as surveys, interviews, and focus groups, were utilized to gather data on employee satisfaction, productivity, and customer satisfaction. The OD study significantly impacted both individuals and organizational systems. The changes implemented as part of the study resulted in improved employee satisfaction, increased productivity, and enhanced customer satisfaction. The team discovered that the modifications led to a more positive and supportive organizational culture that fostered collaboration and innovation [46]. Despite the study's positive outcomes, some discrepancies emerged between the anticipated and actual results. Although the study team carefully planned and implemented the changes, unforeseen challenges arose during the execution phase, impacting the study's overall outcome. These challenges, along with other limitations and implications of the study, will be discussed in detail in the following sections [47]. Reflecting on the study as a whole, it is clear that the OD process significantly contributed to the organization's operations and patient care. The comprehensive changes implemented led to improved efficiency and productivity, culminating in better outcomes for the organization and its patients. The engagement of participants throughout the process was crucial in driving the study's success. Their active involvement and commitment to the change initiatives fostered a sense of ownership, smoothing the implementation process.

The study also enriched scholarship and practice in the field of OD. By applying the HSE model and incorporating the PDSA cycle, this research provided a practical framework for executing effective change management strategies. The findings and insights from the evaluation process contribute to the existing body of knowledge on organizational change and serve as a valuable resource for future research and practice. In conclusion, while the study encountered challenges along the way, the overall impact of the OD process on the organization was positive and transformative. The improvements in efficiency, productivity, employee satisfaction, and customer satisfaction highlight the effectiveness of the interventions. The lessons learned from this study can guide future efforts in implementing change and further contribute to the advancement of OD practices.

Interpretation and Calculation

In examining the outcomes of the study, it becomes apparent that the changes implemented via the OD process effectively fulfilled their intended objectives. The restructuring of the organization's hierarchy fostered increased accountability among employees, improved communication channels, and a more focused approach to achieving goals. Modifications to the organizational culture led to a more engaged workforce, higher job satisfaction, and a conducive working environment. Adjustments to systems and processes resulted in improved efficiency and productivity, lower costs, and enhanced customer satisfaction, suggesting that the OD process positively influenced several aspects of the organization [48].

The OD process was particularly effective due to the alignment of the study with the specific aims and objectives defined initially. The study team utilized the SMART objectives approach, developing a measurement plan that was specific, measurable, achievable, realistic, and time-bound. This strategy provided a comprehensive framework for tracking progress, ensuring that the study was moving towards its intended outcomes. It fostered greater accountability, facilitating corrective actions when objectives were not being met [49]. Moreover, the study's success was due to the skillful implementation of change management strategies, customized to meet the organization's unique needs. The team communicated the rationale behind the changes effectively, emphasized their long-term benefits, and provided comprehensive support and training to employees throughout the implementation process. This approach led to a smoother transition, minimizing resistance and promoting positive attitudes towards the new initiatives [50]. A notable application of this study was the Deprescribing Program for the Primary Health Care Corporation, targeted at reducing unnecessary medication use among the elderly population. As individuals age, the likelihood of being prescribed multiple medications for various health conditions increases. The program addressed these concerns by identifying and discontinuing unnecessary medications for elderly patients [51]. Assuming we have data from the Primary Health Care Corporation on the number of medications prescribed to elderly patients before and after the Deprescribing Program, the reduction in unnecessary medication use can be calculated with the following formula:

Percentage Reduction in Medication Use = ((Baseline Medication Use - Post-Program Medication Use) / Baseline Medication Use) x 100%

For example, if the average number of medications prescribed to elderly patients was 10 before the program and dropped to 7 after the program's initiation, the percentage reduction is calculated as follows:

Percentage Reduction in Medication Use = ((10 - 7) / 10) x 100% = (3 / 10) x 100% = 30%

In this case, the Deprescribing Program led to a 30% reduction in unnecessary medication use among elderly patients. For a comprehensive assessment of the program's effectiveness, improvements in patients' health outcomes and quality of life, as well as potential cost savings for the healthcare system, should also be considered.

Limitations

While the OD process proved to be a valuable experience, it is necessary to highlight the limitations encountered during the study's execution. Among the most prominent limitations were the scarcity of resources, such as time and budget. This lack of adequate resources posed significant difficulties in achieving the desired outcomes, constricting the overall scope of the study. Despite the team's best efforts, these constraints presented formidable challenges. Another considerable limitation was resistance to change from some employees, which notably slowed the implementation process. This resistance underscored the necessity for careful planning and communication with all stakeholders to ensure their active participation and support in implementing changes. However, through stakeholder engagement and consistent communication about the study's objectives, these obstacles were surmounted, reflecting the crucial role of thorough planning, communication, and stakeholder involvement in successful organizational change management. The shortage of resources and resistance to change were pivotal obstacles the team needed to overcome during the implementation of the OD process. The limited resources made it challenging to execute all planned activities, forcing the team to prioritize tasks and omit some facets of the OD process, which could have contributed additional value to the study's final outcomes. Furthermore, resistance from certain employees complicated the process. Some were skeptical or unaware of the study's goals, leading to delays and even refusal to participate in some instances. Overcoming this resistance required a well-communicated and collaborative approach that involved all stakeholders in the study's planning and implementation. Despite these hurdles, the study was successfully completed due to proactive stakeholder involvement and continuous communication about the study's objectives. Given the limitations of the study, several measures were taken to address them effectively. Firstly, careful planning and judicious use of resources were prioritized. With scarce resources at their disposal, the team was compelled to adopt a creative and innovative approach. Even with these constraints, the team found solutions that allowed them to maintain high-quality results. Secondly, proactive engagement with stakeholders was used to tackle resistance faced during the implementation process. Regular communication ensured that stakeholders were informed and updated about the study's goals and potential benefits, motivating employees towards active participation and reducing resistance to change.

The limitations experienced during the study underscore the importance of meticulous planning and effective communication in organizational change implementation. Stakeholder involvement, especially from employees who might be directly or indirectly impacted by the changes, is crucial. To alleviate resistance to change, it's vital to communicate study goals, objectives, and expected outcomes clearly. This can help stakeholders understand the study's purpose, allowing them to align their actions and attitudes accordingly. By doing so, the study was able to overcome the constraints of limited resources and resistance from some employees. The positive outcome achieved testifies to the effectiveness of careful planning and communication strategies that kept all stakeholders informed, engaged, and motivated throughout the study. Thus, the limitations faced reinforce the significance of careful planning and communication when implementing changes in an organization and their positive impact on study success.

Conclusion

The OD process was successful in fulfilling its objectives of enhancing overall efficiency and productivity within the organization. Changes made to the structure, culture, and systems led to increased employee satisfaction, improved productivity, and enhanced customer satisfaction. The study's alignment with its rational and specific aims was clear throughout the process, with a thorough evaluation methodology ensuring that all objectives were systematically addressed. The study's limitations underscored the importance of meticulous planning and effective communication when initiating changes within an organization. These limitations were surmounted by involving stakeholders and ensuring everyone was well-informed of the study's goals. In conclusion, the OD process was an insightful experience, shedding light on the challenges of instigating change within an organization. Employing the PDSA cycle and an extensive evaluation methodology, the study team was able to pinpoint areas for improvement, showcasing the study's value in both financial and non-financial terms, while gaining a thorough understanding of the study's impact on people and organizational systems. Interpreting the experience and outcomes of the study suggests that the effort had a positive influence on the organization. The study achieved its objectives in terms of cost savings and quality improvement, along with enhanced employee and customer satisfaction. Nevertheless, the study faced certain limitations, such as maintaining the implemented changes over time and the necessity for continual support and engagement from the senior leadership. Lessons gleaned from the study include the importance of setting clear objectives, involving stakeholders throughout the process, and employing an extensive evaluation methodology to measure the study's impact. The study team also learned the importance of tackling potential obstacles to change, such as resistance from employees or a lack of resources. Looking ahead, it is crucial to ensure the sustainability of the changes put in place by the study. This will demand ongoing support from the senior leadership, sustained stakeholder engagement, and regular evaluations to verify the intended impact of the changes. The study's results could potentially be applied to other contexts within the organization, and could serve as a model for future OD studies. Concerning implications for practice and further study in the field, this study underscores the significance of using a structured and systematic approach when implementing organizational changes. The PDSA cycle and thorough evaluation methodology employed can serve as models for other organizations aiming to enact similar changes. Future studies could examine the effectiveness of these methods in diverse organizational contexts or with different types of interventions.

References

1. Nasr T, Mollazehi M. Deprescribing Program for Primary Health Care Corporation: Reducing Unnecessary Medication Use in the Elderly. (2023).
2. Robinson L, Dickinson C, Bamford C, et al. A qualitative study: professionals’ experiences of advance care planning in dementia and palliative care,‘a good idea in theory but…’. Palliative medicine 27 (2013): 401-408.‏
3. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine 175 (2015): 827-834.‏
4. Abiiro GA, De Allegri M. Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates. BMC international health and human rights 15 (2015): 1-7.‏
5. Prince MJ, Wu F, Guo Y, et al. The burden of disease in older people and implications for health policy and practice. The lancet 385 (2015): 549-562.‏
6. Zia A, Kamaruzzaman SB, Tan MP. Polypharmacy and falls in older people: balancing evidence-based medicine against falls risk. Postgraduate medicine 127 (2015): 330-337.
7. Molokhia M, Majeed A. Current and future perspectives on the management of polypharmacy. BMC Family Practice 18 (2017): 1-9.‏
8. Mazhar F, Akram S, Al-Osaimi YA, et al. Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors. Pharmacy Practice (Granada) 15 (2017).‏
9. Wu H, Kouladjian O’Donnell L, Fujita K, et al. Deprescribing in the older patient: a narrative review of challenges and solutions. International journal of general medicine (2021): 3793-3807.‏
10. Lavan AH, Gallagher P. Predicting risk of adverse drug reactions in older adults. Therapeutic advances in drug safety 7 (2016): 11-22.‏
11. Reeve E. Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice. Journal of pharmacy practice and research 50 (2020): 98-107.‏
12. Farrell B, Tsang C, Raman-Wilms L, et al. What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: a modified delphi process. PloS one 10 (2015): e0122246.‏
13. Dills H, Shah K, Messinger-Rapport B, et al. Deprescribing medications for chronic diseases management in primary care settings: a systematic review of randomized controlled trials. Journal of the American Medical Directors Association 19 (2018): 923-935.‏
14. Johnson RL, Saha S, Arbelaez JJ, et al. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. Journal of general internal medicine 19 (2004): 101-110.‏
15. Tannenbaum C, Farrell B, Shaw J, et al. An ecological approach to reducing potentially inappropriate medication use: Canadian deprescribing network. Canadian Journal on Aging/La Revue canadienne du vieillissement 36 (2017): 97-107.‏
16. Senior B, Swailes S. Organizational change. (2010).
17. Gill PS, Beavan J, Calvert M, et al. The unmet need for interpreting provision in UK primary care. PLoS one 6 (2011): e20837.‏
18. Odukoya OK, Chui MA. E-prescribing: a focused review and new approach to addressing safety in pharmacies and primary care. Research in Social and Administrative Pharmacy 9 (2013): 996-1003.‏
19. Luxton DD. Recommendations for the ethical use and design of artificial intelligent care providers. Artificial intelligence in medicine 62 (2014): 1-10.‏
20. Starfield B. Is patient-centered care the same as person-focused care?. The Permanente Journal, 15 (2011): 63.‏
21. Taft T, Weir C, Kramer H, et al. 2444 Development of an instrument to identify factors influencing point of care recruitment in primary care settings: A pilot study at University of Utah Health. Journal of Clinical and Translational Science 2 (2018): 40-41.‏
22. Stacey D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane database of systematic reviews 4 (2017).‏
23. Krishnan S, Subbiah K, Chandra P, et al. Minimizing risks and monitoring safety of an antenatal care intervention to mitigate domestic violence among young Indian women: The Dil Mil trial. BMC Public Health 12 (2012): 1-13.‏
24. National Institute for Health and Care Excellence. Dementia: A NICE-SCIE guideline on supporting people with dementia and their careers in health and social care (Revised) (2011).‏
25. Dieleman M, Gerretsen B, van der Wilt GJ. Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review. Health Research Policy and Systems 7 (2009): 1-13.‏
26. Reddy KS, Patel V, Jha P, et al. Towards achievement of universal health care in India by 2020: a call to action. The Lancet 377 (2011): 760-768.‏
27. Conrad DA, Perry L. Quality-based financial incentives in health care: can we improve quality by paying for it?. Annual review of public health 30 (2009): 357-371.‏
28. O'Reilly D, Linden R, Fedorko L, et al. A prospective, double-blind, randomized, controlled clinical trial comparing standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care only for the treatment of chronic, non-healing ulcers of the lower limb in patients with diabetes mellitus: a study protocol. Trials 12 (2011): 1-10.‏
29. Capehorn MS, Haslam DW, Welbourn R. Obesity treatment in the UK health system. Current obesity reports 5 (2016): 320-326.‏
30. World Health Organization. Interprofessional collaborative practice in primary health care: Nursing and midwifery perspectives (2013).‏
31. Hegarty KL, O’Doherty LJ, Chondros P, et al. Effect of type and severity of intimate partner violence on women’s health and service use: findings from a primary care trial of women afraid of their partners. Journal of Interpersonal Violence 28 (2013): 273-294.‏
32. Blythe SL, Wilkes L, Halcomb EJ. The foster carer's experience: An integrative review. Collegian 21 (2014): 21-32.‏
33. Verheij RA, Curcin V, Delaney BC, et al. Possible sources of bias in primary care electronic health record data use and reuse. Journal of medical Internet research 20 (2018): e185.‏
34. Foster M, Whitehead L, Maybee P. The parents’, hospitalized child’s, and health care providers’ perceptions and experiences of family-centered care within a pediatric critical care setting: A synthesis of quantitative research. Journal of Family Nursing 22 (2016): 6-73.‏
35. Street Jr RL, Liu L, Farber NJ, et al. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. Patient education and counseling 96 (2014): 315-319.‏
36. Kleczka B, Musiega A, Rabut G, et al. Rubber stamp templates for improving clinical documentation: a paper-based, m-Health approach for quality improvement in low-resource settings. International journal of medical informatics 114 (2018): 121-129.‏
37. Nakku JE, Okello ES, Kizza D, et al. Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs. BMC health services research 16 (2016): 1-12.‏
38. Ramsay J, Rutterford C, Gregory A, et al. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. British journal of general practice 62 (2012): e647-e655.
39. Knowles SE, Chew-Graham C, Adeyemi I, et al. Managing depression in people with multimorbidity: a qualitative evaluation of an integrated collaborative care model. BMC Family Practice 16 (2015): 1-10.‏
40. Kirmayer LJ, Narasiah L, Munoz M, et al. Common mental health problems in immigrants and refugees: general approach in primary care. Cmaj 183 (2011): E959-E967.‏
41. Flinter M. From new nurse practitioner to primary care provider: bridging the transition through FQHC-based residency training. Online Journal of Issues in Nursing 17 (2011): 6-6.‏
42. Van Rijn B, Wild C, Moran P. Evaluating the outcomes of transactional analysis and integrative counselling psychology within UK primary care settings. International Journal of Transactional Analysis Research 2 (2011): 34-44.‏
43. Brugués B, Asensio C, Mateo F. Implementation of nurse demand managment in primary health care service providers in Catalonia. Atencion Primaria 49 (2017): 518-524.‏
44. Saxon D, Ashley K, Bishop-Edwards L, et al. A pragmatic randomised controlled trial assessing the non-inferiority of counselling for depression versus cognitive-behaviour therapy for patients in primary care meeting a diagnosis of moderate or severe depression (PRaCTICED): study protocol for a randomised controlled trial. Trials 18 (2017): 1-14.‏
45. Thomas M, Murray-Thomas T, Fan T, et al. Prescribing patterns of asthma controller therapy for children in UK primary care: a cross-sectional observational study. BMC pulmonary medicine 10 (2010): 1-9.‏
46. Jakab M, Krishnan C. Community involvement in health care financing: Impact, strengths and weaknesses. A synthesis of the literature. World Bank. 2001 (2015).‏
47. Milne A, Brigden C, Palmer A, et al. The intersection of employment and care: evidence from a UK case study. European Journal of Social Work 16 (2013): 651-670.‏
48. Curtis JB, Aten JD, Smith W, et al. Collaboration between clergy and mental health professionals in postdisaster contexts: Lessons from the Upper Big Branch Mine disaster. Spirituality in clinical practice 4 (2017): 193.‏
49. Helmer DA, Beaulieu GR, Houlette C, et al. Assessment and documentation of sexual health issues of recent combat veterans seeking VHA care. The Journal of Sexual Medicine 10 (2013): 1065-1073.‏
50. Davy C, Bleasel J, Liu H, et al. Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review. BMC health services research 15 (2015): 1-11.‏
51. Joshi C, Russell G, Cheng IH, et al. A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination. International Journal for Equity in Health 12 (2013): 1-14.‏