Leading Care Into the Home: An Organizational Leadership Plan for a Hospital-at-Home Program and Its Defense Before the Executive Committee
Student Name
Doctor of Nursing Practice Program, Aspen University
DNP855: Organizational Leadership and Systems-Based Practice
Instructor Name
Month Day, Year
Leading Care Into the Home: An Organizational Leadership Plan for a Hospital-at-Home Program and Its Defense Before the Executive Committee
This final paper brings together the course's work on systems, structure, culture, microsystems, collaboration, stakeholders, and change into one organizational leadership plan. It describes how I, as a DNP-prepared nurse director, would lead a hospital-at-home program at Riverside, the composite community hospital used throughout this course, and then defends the plan against five questions a mock executive committee posed. The defense is written as it would be answered in the room: directly, with evidence, and with honesty about uncertainty.
The Plan in Brief
The program will provide acute hospital-level care at home for up to ten patients a day with conditions such as heart failure, pneumonia, cellulitis, and chronic obstructive pulmonary disease. It will be staffed by registered nurses and paramedics making daily visits, a nurse practitioner or hospitalist for daily medical care, remote monitoring, and 24-hour escalation. It will launch in four phases with named owners and checkpoints defined by implementation outcomes, governed by a steering group that includes the stakeholders with power to block it.
Leadership Approach
My leadership approach is relational rather than task-focused. Across 129 studies synthesized in a systematic review, leaders who worked through relationships, transformational leaders among them, repeatedly showed up alongside more satisfied nurses and healthier work environments, while leaders focused mainly on tasks showed up alongside worse results in a number of studies (Cummings et al., 2018). Transformational leadership, as described by Bass and Riggio (2006), rests on four behaviors: acting as a credible role model, inspiring through a shared vision, encouraging people to question assumptions, and attending to each person's needs and growth. For a new program with a small, dispersed team working in patients' homes, those behaviors translate into practical commitments: spending time on home visits with staff, involving the team in designing protocols, inviting challenges to how the program works, and attending to each member's workload and safety. Staff who work alone in strangers' homes need a leader who knows what their day is like, not one who reads about it in a dashboard.
How I Will Spend My Time
A leadership plan should say what the leader will actually do. In the first six months, I will spend roughly a third of my time on home visits alongside the team, a third with the stakeholders whose referrals and approvals the program depends on, and a third on protocols, data, and the steering group. I will hold a brief daily huddle by video with the home team, review every escalation personally during the pilot, and meet monthly with the hospitalist lead and the emergency department medical director. As the program stabilizes, time in the field will fall and time on sustainment, payer contracts, and succession planning will rise. Making this allocation explicit lets the committee judge whether the plan's commitments are realistic.
Committee Question 1: The Chief Financial Officer
"This program costs money to start. What is the return, and what if we don't reach it?" The best evidence we have is a randomized trial, where the adjusted mean cost of the acute care episode was 38 percent lower for patients treated at home, with fewer laboratory tests, imaging studies, and consultations (Levine et al., 2020). Our financial model does not assume that size of saving; it assumes a smaller one and adds the value of inpatient beds freed for surgical admissions during winter peaks. The model breaks even at a census of six. If we do not reach it by the expansion checkpoint, the steering group can pause and correct before further spending, which limits the downside.
Committee Question 2: The Chief Medical Officer
"Is it safe? What happens when a patient deteriorates at 2 a.m.?" Every patient will have continuous or scheduled remote monitoring, a 24-hour nurse line, a paramedic response standard of 30 minutes, and a direct transfer pathway back to the hospital that bypasses the emergency department. An early multisite evaluation found that hospital-at-home care met quality standards at rates similar to acute hospital care, with a shorter length of stay and some evidence of fewer complications (Leff et al., 2005). The pilot will not expand unless fidelity to escalation protocols reaches 90 percent and no serious event is attributable to the home setting.
Committee Question 3: A Board Member
"Won't this serve only patients with nice homes and family at hand?" The concern is valid. Eligibility requires a safe home environment and a way to reach help, which could exclude patients living alone or in unstable housing. The program will track who is offered, who accepts, and who is excluded, by race, ethnicity, insurance, and neighborhood, and report it to the board. Where exclusion reflects a solvable barrier, such as the lack of a phone or a working heater, social work funds will address it. The program will not claim to serve everyone, but it will show honestly whom it serves.
Committee Question 4: The Nursing Union Representative
"Our members will be driving alone to homes at night. Who protects them?" Staff safety provisions were negotiated before hiring: paired visits for any home flagged as unsafe, a check-in and check-out system for every visit, mileage reimbursement and paid travel time, and the right to leave any visit that feels unsafe without penalty. Staffing ratios for home visits are set by travel time as well as acuity. These commitments are written into the program's policies, not left to individual goodwill.
Committee Question 5: The Chief Executive Officer
"What if it fails?" Then we will know why. Each checkpoint measures a specific implementation outcome, so a failure will point to a cause: low acceptance by patients, low referral by physicians, poor fidelity, or excess cost. Some of those causes can be corrected; if they cannot, the program will close its pilot with a report the organization can learn from. The worst outcome would be a program that continues without evidence that it works, and the checkpoint structure is designed to prevent that.
Conclusion
An organizational leadership plan is tested when people with power ask hard questions. This plan answers the finance, safety, equity, staff, and failure questions with evidence, specific safeguards, and a phased structure that allows correction. Leading a hospital-at-home program requires systems thinking, stakeholder engagement, and a relational style suited to a dispersed team. Those are the capacities this course has aimed to build, and the defense is where they must hold up.
References
Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nd ed.). Lawrence Erlbaum Associates.
Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016
Leff, B., Burton, L., Mader, S. L., Naughton, B., Burl, J., Inouye, S. K., Greenough, W. B., Guido, S., Langston, C., Frick, K. D., Steinwachs, D., & Burton, J. R. (2005). Hospital at home: Feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Annals of Internal Medicine, 143(11), 798-808. https://doi.org/10.7326/0003-4819-143-11-200512060-00008
Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600
How this DNP 855 Module 8 example is structured
DNP855 Module 8 typically closes with an organizational leadership plan defended before a mock committee. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example summarizes the plan, grounds the leadership approach in evidence and theory, and answers the hardest questions from each committee member directly and honestly.
DNP855 Module 8 questions, answered
What does DNP855 Module 8 usually ask for?
The final module typically asks for an organizational leadership plan that you defend before a mock committee, answering challenges from executives and stakeholders. Aspen does not publish module deliverables, so your classroom's instructions govern.
How should I prepare for a mock committee defense?
Anticipate the hardest question each member would ask, such as cost, safety, equity, staff impact and what happens if the plan fails, and prepare direct answers with evidence and the specific safeguards in your plan.
Which leadership styles are linked to better nursing outcomes?
A systematic review of 129 studies found that relational styles, including transformational leadership, were associated with better outcomes for nurses and work environments, such as higher job satisfaction, than task-focused styles.
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 Aspen University 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.