GHS5850 Nursing Leadership And Management


Part One

A policy is a declaration of intent, or a course and principle of action.

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Australia’s national health policy is overseen and managed by the Australian Government. However, key elements such as the operation hospitals are managed by states (DHHS 2016).

In essence, Australia’s primary responsibility is for community and public healthcare.

The Department of Health and Human Services oversees this in Victoria.

Their slogan is “aspire for all Victorians be healthy, safe, and capable of leading a life they love.”

They “deliver policies programs and services that improve the health and wellness of all Victorians.” (DHHS 2016).

The Consultative Council on Obstetric and Paediatric Mortality and Morbidity, (CCOPMM) brought to the Department of Health and Human Services’ attention a series of perinatal fatalities that occurred in Djerriwarrh Health Services during 2013 and 2014.

After seven of these deaths could have been prevented, an independent review by the Australian Commission on Safety and Quality in Health Care was conducted. This review examined the department’s response to these deaths and the ability of the department to detect and respond quickly to new critical issues in the public healthcare system.

ACSQHC, after an evaluation, found significant issues. It discovered that Djerriwarrh had significant deficiencies in clinical management. The department’s processes were incapable of detecting these deficiencies.

Following these findings, Dr Stephen Duckett was asked to review the following:

The current systems in place for governance and quality control at hospitals are reviewed by the department.

We will offer advice on how systems can be improved in areas where they are not working.

Although the Djerriwarrh hospital was affected by these incidents, they are indicative of a wider problem.

The review is comprehensive, revealing, and enlightening. It will be a major issue for all hospitals and health services.

These recommendations are numerous and will lead to serious changes.Major deficiencies addressed

It was revealed that the department has inadequate oversight of hospitals.

It was also found out that the department lacks the information necessary to assure both the Minister and the general public that all hospitals provide safe, high-quality care (DHHS 2016, 2016).

The following are the main deficiencies in health care as identified and addressed by this review.

1.The failure to report adverse patient events or errors.

This was due to the fact that the department had “no functional incident management system” for hospital staff to report patient injury (DHHS 2016 p13).

The Victorian Health Incident Management System, (VHIMS), is described as difficult to use. It’s also poorly designed and overly complicated.

The current “incident classification component” of VHIMS has more than 1400 types. Users need to select the correct classification. It is time-consuming and complicated.

This means that users can incorrectly categorize incidents or select generic classifications like “other” to save their time” (DHHS (2016), p107).

All the reports on the Djerriwarrh tragedies weren’t made correctly or timely, it was discovered.

Nonetheless, it was found that the department wasn’t monitoring or analysing the incident data and would have missed them anyway (DHHS 2016).

“A dysfunctional system for incident reporting means that potentially useful information regarding recurrent safety breach is often not reported, misclassified and lost before it reaches departments” (DHHS 2016 p14).

It was also found out that the “departments performance monitor framework” wasn’t designed to detect catastrophic failures. (DHHS, 2016, p13).

This is the NSQHS standard number one – Governance for Safety and Quality in Health Service Organisations (NSQHS (2012)).

This particular standard requires that certain criteria be met to attain it.

One is about incident management and complaints management. It requires that adverse events be reported, analysed, and acknowledged.

Djerriwarrh, or any department, has clearly failed to meet this criteria.

2. The department’s expert boards are disorganized and are not equipped to identify problems promptly or follow-up to prevent them happening again (DHHS 2016).

DHHS, 2016, also identified cultural barriers to reporting.

For example, staff complaints were dismissed, ignored, and discouraged.

It was also revealed that both the regulatory oversight and internal management did not notice or address the issues (DHHS, 2016).

This NSQHS defect is related to standard number one – Governance for Safety and Quality in Health Service Organisations.

One criterion in this standard has been violated is incident and complaints management.

It is clear that patient safety, quality incidents, were not reported correctly and not analysed.

3.The department has over-relied upon accreditation when the evidence suggests it is not justified (DHHS 2016).

Djerriwarrh Health Services had been consistently recognized as a high performer at the end (2012)-13. It was also ranked at the top of the list at the end 2015 and the department was not concerned until 2015. At that point, seven potential deaths could have been prevented.

There were many factors that contributed to this failure, however poor clinical governance was ultimately to blame.

Disturbingly this clinical governance failure in Djerriwarrh was a problem that could easily occur in any hospital/health service (DHHS, 2016).

The NSQHS to which this defect is related is standard number 1. It’s called ‘Governance of Safety and Quality in Health Service Organisations’.

This specific standard has specific criteria that must be met to reach this standard.

One of those criteria requires that a governance structure be implemented that regularly conducts clinical audits (NSQHS (2012)).

This has been clearly ineffective as if regular and effective audits were conducted, then any failures in clinical governance would be identified.

4. The department is not using routine data that was collected to monitor hospitals’ complication rates. (DHHS 2016).

The department is unable to provide critical information to hospitals and doctors because the essential data is not being collected or not available in a convenient format.

A lot of routine data was collected, but the department doesn’t have enough access to it to monitor patient outcomes, or investigate red flags.

The department is not able to access detailed information about hospital-acquired conditions, so cases of underperformance were missed.

This defect refers to NSQHS Standard Number One – Governance for Safety and Quality in Health Service Organisations (NSQHS,2012).

One of the standards is about governance and quality improvements systems. This means that there must be integrated systems for governance to actively manage quality risks and patient safety.

The department clearly failed this aspect, as cases of underperformance and red flags have gone unnoticed, placing patients at high risk.

5.In public sector, the Department expects and depends too heavily (DHHS 2016, 2016) on hospital boards in order to ensure safe and continuous improvement of care.

The department also does not adequately equip all boards to effectively perform this function (DHHS 2016).

This is because the department’s governance of hospitals is poor.

The department wasn’t giving enough importance to patient safety.

The review focuses on the differences between small and big hospitals in terms of hospital boards, and the opinions of CEOs. However, that is not the purpose of this essay.

The bottom line is that the department didn’t do enough to be involved in, understand, or even pick up these disparities. It did so at the expense and risk of patient safety and continual improvement in health care.

The NSQHS to which this defect relates is standard number 1 ‘Governance of Safety and Quality in Health Service Organisations.’ (NSQHS (2012).

To meet this standard, there are two requirements that must be met.

The first is quality improvement and governance systems.

Integrated systems of governance that are designed to actively manage patient safety risks and quality risk have clearly been breached.

Furthermore, the criterion to manage complaints and incidents has been broken. In other words, patient safety incidents cannot be reported and analysed at every level of the healthcare system.

6. Similar to the sixth point, the private sector also has a greater dependence on local governance (i.e.

Hospital boards) to ensure care is safe, and continually improving (DHHS 2016).

It was also discovered in the private sector that no routine monitoring is done on patient outcomes or serious incidents. (DHHS, 2016, DHHS).

Private hospitals are not currently subject to the same reporting requirements that public hospitals. Furthermore, very little data about their safety performance is collected or monitored by private hospitals.

This is the NSQHS to which this defect relates. It is standard number one -Governance for Safety and Quality in Health Service Organisations (NSQHS, 2012).

The same as in point 6, two criteria required to meet the standard have been violated.

The first is that of governance, quality improvement systems, and the second is that incident and complaints management (NSQHS2012).

The department could and should be doing more in both areas to ensure hospitals don’t offer care when they aren’t able (DHHS 2016, 2016).

7. The department has not been supportive enough for hospitals and has provided inadequate leadership in safety and quality improvement (DHHS 2016).

The department has not provided the required support or sustained investment to help hospitals get the resources they require.

Hospitals are sometimes left to their own methods of safety and quality improvement. This can lead to duplication, inefficiency, and variation in quality and work (DHHS, 2016).

Also, it was found that hospitals do not have access to high-quality information. Hospitals cannot also learn from each others.

Overall, the department isn’t offering strong enough support and doesn’t provide the information, resources and incentives that are needed for hospitals to be able to provide the best possible care.

The department also lacks communication with external experts, particularly regarding sharing information and identifying unsafe practitioners (DHHS 2016, 2016).The NSQHS that this deficiency relates to is ‘Governance for Safety and Quality in Health Service Organisations'(NSQHS, 2012).

The standard has been broken on two levels.

The first is ‘clinical practices’.

This criterion stipulates that clinical staff must follow current best practice in providing care.

This is a clear indicator that clinicians may not be following current best practice if they are not sharing high-quality information among hospitals.

The second criterion, ‘governance & improvement systems’, has been violated (NSQHS (2012)).

This criterion stipulates that ‘there must exist integrated systems of governance to actively monitor patient safety and quality risk’.

Inefficiency has been observed in the department’s overall governance when it comes to providing resources for clinicians and hospitals.

In a broad sense it seems likely that the department’s deficiencies are related to all of the current NSQHS Standards.

These include preventing, controlling, and managing healthcare-associated infections, medication safe, clinical handover and blood and blood products, preventing, managing, and responding to severe acute medical conditions, and preventing falls.

These issues all result from a significant lack of clinical leadership.

The review defines clinical Governance as the “systems, processes, and procedures that health services should have in place for being accountable to the community to ensure that care that is safe, effective and patient-centred is continuously improving” (DHHS (2016), p3.

The review concluded that Djerriwarrh’s process, as well as all hospitals, was not capable of detecting clinical governance deficiencies.

These deficiencies and problems with clinical governance do not only affect Victoria.

There are many articles detailing similar issues within health care systems relating both to quality and safety and clinical governance (Atsalos, O’Brien, & Jackson, 2007.; Robinson, Travaglia & Braithwaite, 2008.; Tuan, 2015.)

Duckett (2008) suggested that Victoria’s health system doesn’t need major reform.

However, it is clear that there is need for change at the macro level of Commonwealth and State governments as well as at the micro level between health care providers (Duckett 2008).

Part two – Change management

Based on the review by Stephen Duckett it is obvious that major change is urgently required within the department.

Change is an integral part of healthcare.

External and internal factors both influence change. It is important to adapt and align an organisation with the constantly changing realities. (Kumar Kumar Deshmukh, Adhish, & Adhish. 2015).

Examples include technological advancements, demand for quality control, epidemiology and reemergence, erasing evidence-based policy, healthcare and medical care privatization and commercial interest, and health as an individual right (Kumar, Kumar, Deshmukh, 2015).

It is important that an organisation adapts to changing conditions in order to survive.

Change can be difficult to implement, or even carry out over time.

Organisational change “requires personal transformation in an organisational setting” Carlopio & Andrewartha (2008, p.496).

People resist personal change.

It takes work, perseverance, and time.

It can feel like you are losing something as the old ways of doing it become obsolete. However, change allows us to adapt, learn and grow.

According to research, healthcare sectors are often faced with challenges when implementing effective change (Allen (2016)).

These issues include difficulties in motivating employees, communicating the change need effectively, and maintaining improvements over time. Martin Weaver & Currie, 2012.

It is clear that the complexity and intricacy of the health system makes it difficult to make changes (Allen, 2016).

Both macro and micro changes can be considered change.

For health care, and the Victorian system of health care, macro can refer to changes at the organisational or system level.

Micro change can also refer to a specific department or work unit.

Concerning the Victorian Health Care System, macro change is needed at an overall level. This includes the department.

This will hopefully lead to a ripple effect that will reach down to the micro improvements in service delivery and patient care.

However, these changes will require proper change management (Currie & LoftusHills, 2002; Kumar (2015)).

Change Process

The ability to influence and implement organisational change is enhanced if nurses and health professionals are well-versed in theories and models of transformation (Mitchell, 2013, Price, 2008).

This is especially important for leaders, particularly in the healthcare sector, who are most likely to be initiating and implementing change.

There are many theories that can help you implement organizational change (Allen 2016; Freshwater 2014).

The two most relevant models for health care change are however, the following.

The majority of current theories and models are adaptations to Kurt Lewin (1947), and his three stage model for change.

John Kotter (1996) created an eight-step step change model, which is based on Lewin’s process of three steps. It was successful (Kumar. et. al. (2015)).

While both models can be summarized in the following, Kotter (1996) will show you how to improve reporting culture on a ward that is focused around safety.

Answer to Question: GHS5850 Nursing Leadership And Management