QUALITY AND CARE GOVERNANCE
INTRODUCTION
The healthcare professions all involve life and
death situations. In these situations, quality is crucial and quantity is
irrelevant. In my place of employment, there are increasing medication errors
happening in my hospital which may due to many possible causes. But as we know
that patient safety and quality care is very important. The blame is placed on
aspects of manpower (labor), management, money (finances), and materials. It is
time to seriously rethink, redesign, redevelop and
reinvigorate the way
governance
is practiced in my
current place of employment. There is a need for better quality and care
governance.
Clinical
governance provides
a framework for a coherent, local program of
quality
improvement and an opportunity to share best practice. For healthcare
professionals,
clinical
governance
will be about building upon and linking together many of the activities that
they are already involved in, which help to promote and improve standards of
patient care.
Medication errors that occur in many
healthcare organizations mirror the increasing problem worldwide of
deterioration of health care. The deterioration of healthcare work and its
environment is a major problem of concern to the healthcare leaders or managers.
A healthy work environment is necessary to bring about quality healthcare
service to the population. An unhealthy work environment would create a
devastating impact not only to the healthcare professionals and the clients but
most importantly on the effectiveness of the entire healthcare system.
The possible root causes
for this apparent deterioration of healthcare work are outlined in the
succeeding sentences. (1) Healthcare professionals are placed in leadership
positions even if they are not adequately prepared and without adequate support
for their roles. (2) Healthcare professionals, especially in the case of nurses
are assigned to handle many clients than they can handle. (3) Decision-making
within the work environment is done only by one department, without consultation
of all the other parties that are involved.
Many medical-surgical nurses
experience difficulty when calculating drug dosages. One study revealed that 56%
of nurses could not calculate medication dosages to a 90% proficiency rate. In
addition, nurses made significantly more
errors
in calculating
intravenous drug dosages as compared to oral, intramuscular, or
subcutaneous drug dosages ( 2004).
The nurse should double-check the
six rights of safe medication administration and know the desired action and
side effects ( Perry, 2004). If the medication has an antidote, it must be
available during administration. When administering potent medications, the
nurse must assess vital signs before, during, and after infusion.
The resulting
environment
created by these situations brings about many negative results in the working
environment. When inadequate leaders are placed in positions, there will be
dissatisfaction and high turnover for
healthcare
leaders and the staff as well. For example, when each nurse is assigned to
handle many clients, this would result in confusion and the clients are placed
at risk for errors and injury. The nurses are also frustrated, angry and
stressed out. Decisions that are made without consulting all the parties
involved places everyone involved – doctors, clients, nurses, managers and other
staff - at risk. The overall quality of care offered by the healthcare service
would be diminished.
In the case of Brighton Hospital,
they needed drastic adaptations to changes presented by the changing times.
However, the system that they have is not as updated, therefore, they needed to
implement change quickly. In the following pages, discussion on the change and
adaptation shall be discussed.
CONTEXT
What were the forces of change that
caused the reorganization of Medical Records department?
Brighton Hospital was faced with an
enormous task: To be able to make room for bigger and more advanced medical
records department. This was due to the fact that they were getting much more
out-patients sue to the closing of other hospitals. They needed to adapt to the
changing workload and the demands for more efficient and more modern procedures
at the records department.
It seems that there is also an apparent poor
quality of management and leadership in this case resulting to the poor quality
of service. Management is necessary to make labor and
capital productive and requires converting economic principles into rules of
behavior that can be clearly communicated to employees, bosses, clients, and
other partners. Management in health care is not simple. In management it is
people, not things that have to be managed, and because decisions must be made
under uncertainty, based on expectations, without ever really knowing the entire
facts one would like to have, it makes it all the more complicated.
Applying the four key components of clinical
governance to the problem is helpful. The activities
involved in
clinical effectiveness will include finding out what is the best
known practice a specific medication administration, appraising the available
evidence, changing the practice by educating the health care staff, and
confirming through monitoring or
clinical
audit that actual practice is consistent with best practice.
The human resources component of the
clinical
governance
framework would aim to ensure that the health care staff has the right
education, adequate training and development, skills and competencies to provide
quality
care to patients
which include the proper medication administration.
The expected outcome of the recommendations
should be a decrease in the incidence of medication errors.
To address the areas that needed change, the
management seemed to have sought to apply 'Total Quality Management' (TQM) to
their organizations to help them plan their efforts. The promise of superior
performance through continuous quality improvement has attracted a wide spectrum
of business to TQM, with applications reported in many domains including
healthcare .
There are some
advantages that clinical healthcare services sector guided by
the principles of TQM. Basically,
the Total Quality Management philosophy of
management within
clinical healthcare services sector
is customer-oriented. All members of a total quality management (control)
organization strive to systematically manage the improvement of the organization
through the ongoing participation of all staff in problem solving efforts across
functional and hierarchical boundaries. TQM incorporates the concepts of
product quality, process control, quality assurance, and quality improvement.
Consequently, it is the control of all transformation processes of an
organization to better satisfy customer needs in the most economical way. Total
quality management is based on internal or self-control, which is embedded in
each unit of the work system (technology and people). Pushing problem solving
and decision-making down in the organization allows people who do the work to
both measure and take corrective action in order to deliver a service that meets
the needs of their patients.
Describe and contrast the culture of the Medical
Records Department before and after the reorganization.
Before the reorganization occurred,
the department was undoubtedly efficient, no matter how out-dated their
techniques were. They also maintained the good relationships they had with the
rest of the hospital staff. They had occasional meetings and greetings that
helped maintain these ties. However, as and the reorganization came, there were
significant changes in the department. There were a number of restrictions that
removed the “homey” feeling of the department. Furthermore, the efficiency of
the department was suffering, as well as the ties with the rest of the hospital
staff. It seemed that the reorganization and the new system were not able to
address the needs of the hospital, in contrast to the older system. The
un-updated system worked much more efficiently and did not alienate the staff
from the rest of the department. However, with the new system, the staff was
removed from their normal sunny disposition and was forced to be alienated from
the rest of the hospital staff. Furthermore, they were piled with more and more
tasks, and they were not able to efficiently work on these. They continued to
have back lags. When they used the old system, they did not have any lags, and
even had time for breaks.
Every
organization
has a formal power structure of supervisors, managers and executives. There is
also an informal power structure in the shadows of organizational culture (,
2002). These are the people others look to because they know how to work the
system to get things done around the office, the warehouse, the plant or the
shipping department. These are, simply stated, the ordinary workers and
employees. It is them, the so-called informal power players, who are most likely
to feel threatened by new ways of doing things and most likely to resist
change if
they are being ignored by management.
Describe and evaluate the role of in introducing
the new system.
role in the new system is very
vital in spelling the success or failure of the undertaking. As the lead
officer, he should, more or less, view the all the aspects of the undertaking,
not only the technical. This is because the answer to the problems lies not in
the obvious.
According to (2002), the most important
ingredient for successful change is employee involvement--their interest, active
participation, energy, creativity, good nature and support are essential. The
department should gain the support of all its employees by empowering them. And,
to maximize the return on employee effort, it is fundamental that the employees
of the company are vested in the end result.
Employees can contribute new ideas to increase
operational effectiveness, bond together to create an enhanced sense of
teamwork, instill a new feeling of purpose and energy during a time of possible
confusion and even chaos, and provide feedback on the change itself ( 2002).
With the employees support and new ideas, the
changes that the company planned may be enhanced to a more effective way for the
good of the whole organizations.
As the supervisor of the new
department, she carries the burden of bringing the new to the old. She was part
of the old team, and as such, she holds the key to the acceptance of the
employees to the change. She has the ability to let the employees see the
possibilities that the new system would bring to them.
What would you have done differently in this
situation in terms of bringing about changes to the culture and structure of the
Medical Records department?
If given the chance, I would, first
and foremost, attempt to incorporate some of the few cultural aspects of the old
system to the reorganization of the department. As was mentioned, they had
worked efficiently enough using their methods, why not continue to use that? But
of course, we should add slight modifications. According to (2002), the secret
to effective
change management is to reprogram the culture slowly but
steadily. The real key to successful
change
management is to be able to ensure that the business and culture are in sync
with each other. The culture must constantly support the business initiatives.
Left unattended, the two will get out of sync, and the culture will deteriorate
and bring down the business or make it less efficient (2002). By culture, it
includes the employees and how they do things in the organization. If
organizational culture does not support the change needed by the business, then
most likely the whole organization will suffer. There are some recommendations
that can help overcome employee resistance to change and get business and
culture in sync.
Studies of change management in organizations
suggest that employees are more likely to respond to an intervention when they
directly contribute to its development or when the content of the intervention
accurately reflects their personal concerns (2002; 2002). In order for an ethics
program to be accepted by employees, it is thus important that their perspective
be incorporated into the design by whatever means are most appropriate to the
particular cultural context (1994).
What would you do now if you were ?
If I were I would hold a
meeting with the staff. I would ask them to voice out their opinions so that I
would know which part of the new system is wrong. Then I would draw a new system
that would incorporate some good aspects of their old system. That way, they
would more comfortable and at ease working in the department. I would also give
them mandatory overtime every Friday of the week to take care of any lags.
According to (1997), generally, switching
of jobs of employees is because of their want for changes and usually these
people are expecting changes. However, many of these employees often negatively
react to these changes especially in the way they do their job. According to
(1997), “some resent having
change
being handed down from on high without being given the opportunity for input.”
Managers should be able to reduce employee resistance to be able to successfully
implement changes.
Change Management
For ABC company, there needs to have ways to
utilized within the research study will basically involve the process and the
related information regarding the social change theory and its aspects that may
result to a certain resistance to change such as in the field of social
communication and how to manage change and strategies to avoid resistance to
change in terms of social perspectives within a business and or a company’s
context as well as point of view. Thus, any theory that purports to explain how
these systems work and how oppressive social inequalities are maintained must
not be so framed as to imply that those who benefit from them are not free to
change
them. Otherwise they would not be morally culpable for their part in
perpetuating the system. The problem involved a kind of change-responsibility
and resistance level problems, to avoid this problem any explanation of how
process of social change are supported in a way that implies that both those who
benefit and those who are responsible for challenging and resisting such sources
of change. It might seem that social constructionist
theories
of male and white dominations could better handle this change dilemma but
‘social construction’ (1990 ) as a theoretical tendency is not a coherent whole.
Change is the process of going from one state to
another, be it a subtle or total difference like for example, when ABC company
brings in a systems analyst to model the existing structure they are more than
likely going to want a new system implemented, thus creating change in embracing
it, creating a giant change in companies across the globe. ( 1997 ) Moreover, it
could be a reality that companies resist to certain changes in the workforce as
for them change is negative in the sense that the company is changing its
system, and staff members might feel that their jobs are being threatened like
by the implementation of certain SCM systems and that a good change management
is crucial as it's not really that easy to make a loss from sudden, unplanned
changes.
The framework of the ABC ways is
based on competencies, which contribute to the timely and accurate
implementation of SAP software and technologies. The core components of the ABC
Methodology dramatically improve the SAP implementation timeline, while ensuring
that all the steps in a new project are concisely addressed. Application – This
is a team of successful developers’ average over 15 years of experience in SAP
and systems management methodologies. The deep industry-specific implementation
experience allows the company to quickly assess a company's needs, and deliver a
solution that is designed specifically to a company's industry. Best Practices -
The ABC methodology takes advantage of proven practices, utilizing best
practices keeps the implementation process in alignment with proven and trusted
practices, while delivering the desired company-specific SAP system. Configured
Solutions - GEMS configures SAP solutions in synchronization within IT and
business needs. Henceforth, change Management - It is essential that each new
project has a seamless transition from old systems to new. New processes and
systems demand change inside a company and managing the adoption and change of
new systems is essential to the success of a project. The combination of GEMS
expert training and the use of iTutor in the SAP Solution Manager, allows a
company to seamlessly manage the transition from the old to new. GEMS extensive
change management experience enables a company to accurately address the pain
points that are often present in a systems change.
ABC Methodology Change Management
In the implementation of a new system, the ABC Methodology facilitates a
fundamental change in the way in which applications work within an organization
through the following means: Dramatically transforming old manual paper-flows
and work tasks, or changing simple batch-based computer systems. Reducing costs,
improving product throughput eliminating duplication and redundancy, improving
supplier relationships, improving customer service levels, and improving product
and service quality.
Training staff to use new system, and ease any cultural change aversion
For ABC, supply chain management (SCM) is the combination of art and science
that goes into improving the way your company finds the raw components it needs
to make a product or service and deliver it to customers. Supply chain
management software is possibly the most fractured group of software
applications on the planet. Some vendors have assembled many of these different
chunks of software together under a single roof, but no one has a complete
package that is right for every company. For example, the company need to track
demand, supply, manufacturing status, logistics and distribution. They also need
to share data with supply chain partners at an ever increasing rate. Many SCM
applications are reliant upon the kind of information that is stored in the most
quantity inside ERP software.
Internal resistance to change
If selling supply chain systems is difficult on
the outside, it isn't much easier inside. Operations people are accustomed to
dealing with phone calls, faxes and hunches scrawled on paper and will most
likely want to keep it that way. If ABC can't convince people that using the
software will be worth their time, they will easily find ways to work around it.
The company cannot disconnect the telephones and fax machines just because you
have supply chain software in place. There is a diabolical twist to the quest
for supply chain software acceptance among the employees. New supply chain
systems process data as they are programmed to do, but the technology cannot
absorb a company's history and processes in the first few months after an
implementation. Forecasters and planners need to understand that the first bits
of information they get from a system might need some tweaking. If they are not
warned about the system's initial naiveté, they will think it is useless. In one
case, just before a large automotive industry supplier installed a new supply
chain forecasting application to predict demand for a product, an automaker put
in an order for an unusually large number of units.
Supply chain management is a paradigm driving
many businesses and in turn business relationships as of the present. Aside,
customers are dictating how their orders and shipments will be handled. They
want to drive out excess inventory and costs. They want their orders shipped
complete, accurate, on time and in the manner they require. Compliance means
continued business. Non-compliance means financial penalties and possible loss
of business. Furthermore, ABC should distinguish between basic needs, such as
delivery on time and advanced functions, the needs are attained and are
mandatory, whereas advanced needs give a competitive advantage. The issue is not
just to identify problems. It is to understand what the best practices are how
performance compares, why it may not be competitive, what must be done to
improve it and implementing changes.
The introduction of change at ABC resulted
to several effects on its personnel. Although the change project was intended to
improve the company’s operations, negative issues had also been observed. For
instance, the initiation of change in the company has been difficult at first
due to the resistance of some employees. The employees believe that change in
the company will only take valuable resources such as funds, time and energy.
They also believe that changing their work routines will only lead to work
disruption. This in turn affected the training programs conducted during the
change implementation phase as some employees would refrain to participate in
the said programs.
Internal change and external change may
highly affect the people involved in the company, co in order for them to be
prepared for the changes that would occur within the company, I proposed a
meeting that would at least, give them a brief insight on the goings-on within
the company. Though this meeting may not change the whole effect of the changes
implemented, at least, the people involved would not feel left out.
2. What risks did you identify and how
did you overcome them?
As mentioned in the previous question, reactions
on the specific changes differ, whether negative or positive. This effect of
change had been cited in (1951) theory of change. In this theory, noted
that managers should be aware of the two types of resistance forces that can
result from change. These forces are derived from customs or social habit and
the other is from inner change resistance. The root of change resistance is
brought about by the interplay between the group and its individual members. As
most group members would want to maintain behavioral norms of the group, the
individual resistance from each member would increase. This is the same in
organizational application. Some ABC staff would want to maintain their usual
work routines and practices; these employees’ resistance influences others,
thus, the issue worsens.
The company however, did not leave the
problem unaddressed. The management encouraged its staff to participate in its
training sessions, one-on-one sessions, team meetings, and follow-up sessions.
Once the one-on-one sessions got underway, positive word-of-mouth quickly began
to change employee attitudes. When people heard about the effectiveness of the
belief approach in solving various organizational problems - and how good their
co-workers felt after their one-on-one sessions - they became less apprehensive
about participating and even began to look forward to meeting with their
managers.
3. In what ways does
your project support the strategic business directions of your organization?
Significant developments were obtained by the
company through its introduction of change. Its ability to develop effective
developmental strategies for instance, had been developed. Through the
initiation of change, the company management was able to develop a change
project that directly addresses its main issues. By developing an appropriate
plan, PNS was able to gradually achieve its objectives. This development is
important as this allows the company to apply cost-effective projects. The value
of this development had been stressed by the contingency theory. Basically, the
contingency theory stresses that there is no single way on how one can manage
different organizations.
The change allowed the retail company to apply
the concepts indicated in the contingency theory. In turn, this enabled the
company to increase its competitiveness. Considering that the company is being
threatened by the presence of several competitors and new business entrants, the
change made it possible for PNS to maintain the business and integrate essential
improvements. These include the development of highly-skilled employees,
acquisition of better customer relations and enhancement overall store
operations. In addition to this, the modifications in the company made its
management sector more aware of the different pressures affecting the business.
Another important development in the company brought about by change is that it
made the company more adaptable, resourceful and creative. In terms of human
relations, designing a change project that is directed for the customers and
employees made the company more people-oriented, which is an important feature
in today’s business sector. As people serve as the main support of the company,
learning how to give them due value is an important factor for PNS’s progress in
the future.
Thus, activity based costing permits proper
identification of the present cost of SCM, a starting point for SCM
improvements. With this cost foundation, you can see the financial impact of
supply chain programs as to revenue growth, asset utilization and cost
reduction. ABC permits customer profitability and order profitability analysis.
It permits non-traditional analyses such as performance measurement, partnering
or outsourcing so important to competing. The supply chain management requires
that an organization be built from the outside in, from the customer inward to
what is required to meet his needs. SCM is not functional; it is a process that
horizontally crosses the company.
SUMMARY/CONCLUSION
A healthy organization is one that welcomes
change, supports learning and development of individual abilities. ( 2001 )
Furthermore, a successful organization development program should create an
organizational culture that solves its own problems and adapts readily to
changes in managerial wishes and the environment. In this sense the objective of
implementing change is to create a learning, dynamic organization with a higher
quality of working life for individuals (1993 ).
