With the changing world of health care rules and reimbursement,
reengineering of the system was bound to happen eventually.
“Reengineering is defined as the process of fundamental rethinking and
radical redesign of process to achieve dramatic improvements in
critical, contemporary measures of performance, such as cost, quality,
service, and speed. Reengineering is the design of a completely new
process, whereas variations on reengineering can deliver enhancement or
improvement in an existing process or a response to an external
stressor” (Edens, 2005
The nurse managers and leaders in the
organization have important role in this reengineering, they are
responsible for staff compliance, any conflicts that may be caused, and
aid in the transition with good communication. Change can be a
frightening thing for some people, and the nurse manager/leaders should
be there to help with this process. Allowing for open communication, and
honesty can put staffs minds at ease. Manager must also maintain a
positive attitude toward the reengineering process, and any negativity
can cause wide spread changes in morale. “Leaderships role is to tame
the change, control the conflict, and manage the communication” (Grand
Canyon University, 2011).
Edens, P. (2005). Workplace
reengineering, reorganization, and redesign for nursing
management:Principles, and practice. Retrieved from
www.medscape.com/viewarticle/511808 2
Grand
Canyon University. (2011). Reengineering healthcare. [Lecture notes].
Retrieved from
https://lc-ugrad1.gcu.edu/learningPlatform/user/users.html
POST 2
Nurse
managers and leaders need to not only be a major part of the changes in
health care but they also need to be the one who involves others in the
change process. “Leadership's role is to tame the change, control the
conflict, and manage the communication” (GCU, 2011). Nurse managers
need to be the role model for accepting change and also need to ensure
the process that facilitates these changes. Staff generally look to the
managers to guide them as children do to parents. As we once looked up
to our parents to see if their facial expression translated into
comfort, we look to our nurse managers to see if they have accepted the
change and will support the bedside nurse in the process. Change is not
easily accepted by the bedside nurse as we have our own way of doing
things that has been tweaked over the years to become the perfect
process that is efficient, safe and effective in ensuring our patients
get the best care and that our day goes well. When change is suggested
it concerns us that our process will be disrupted and we will lose
control of our day. If change is to be accepted, the nurse leader needs
to ensure that those whom the changes effect are present for the
formation of the change. For instance, if the change is in relation to
VAP prevention then not only should RT being involved but also infection
control and the bedside nurse. The bedside nurse can provide a great
insight into the process for the change in that they can see aspects of
the process that may not be effective or may cause other problems during
the change. The nurse leaders and managers need to ensure the voice of
the bedside nurse is heard and taken into consideration.
References
GCU. (2011).
Reengineering Health Care. Retrieved from Grand Canyon Loud Cloud: www.lc.gcu.edu
POST 3
Definition of reengineering;
“Systematic
starting over and reinventing the way a firm, or a business process,
gets its work done,” (Hammer, M., &Champy, J., 1993).
“Senior
nurses must acknowledge the importance of their role, recognising that
junior staff rely on their leadership in developing their own
professional skills. These nurses must use their leadership behaviour to
positively influence organisational outcomes and need to appreciate the
inter-relationship between developing nursing practice, improving
quality of care and optimising patient outcomes. Healthcare
organisations need nurse leaders who can develop nursing care, are an
advocate for the nursing profession and have a positive effect on
healthcare through leadership,”(Frankel, A.,).
There are always
times within a work environment that things have to change, not everyone
will be happy or on board with change, but ultimately it has to occur,
because it is the only way that industry can stay on top and competing.
The same goes for the health care field. Administrators have to be on
top of the game to keep up with the new innovations that make the
patient care outcomes the best. If we fail to keep up with new
technology example, “Robotic surgery which is less invasive, and the
patients spend less time in hospital, sometimes may even be in and out
as a day patient, which is much better for the patient, and also higher
income for hospitals.” We will lose to other facilities that provide
these new innovations, and ultimately could go out of business.
Healthcare like any other industry has to pay it’s way or it does not
survive with the completion that is out there today.
It is
therefore up to the leaders to provide the necessary education, staff,
resources At the forefront of this is a leader that is capable of
motivating her staff to accomplish this change, while possibly having to
achieve ways of cutting costs, but not taking away from patient care,
and staff satisfaction.
“Better outcomes for Patient care
ultimately, a goal of any healthcare organisation should be to influence
the quality of patient care through good nursing leadership. Good
leaders should encourage junior staff to gain a better understanding of
patients and their needs and values. Overall, these strategies will lead
to increased patient satisfaction, more effective nurse-patient
relationships and quicker recovery times. Empowered nurses are eager to
implement evidence-based practice. They are highly motivated, well
informed and committed to organisational goals, and thus deliver patient
care with greater effectiveness (Kuokkanen and Leino-Kilpi, 2000). Good
leadership could produce better patient outcomes by promoting greater
nursing expertise through increased staff ability and competence. Aiken
et al (2001) argued the hospital practice environment has a significant
effect on patient outcomes. Junior nurses should be encouraged to seek
maximum rather than minimum standards, and be expected to achieve and
maintain high-quality benchmarks” (Frankel, A.,).
References
Frankel, Andrew. What leadership styles should senior nurses develop? Nursing Times; 104: 35, 23-24.
(Hammer, M., &Champy, J., 1993 Retrieved from
www.buisnessdictionary.com
POST 4
Reengineering
in health care is a potentially powerful approach to improving health
care functions. Reengineering means to engineer again, to go back to
square one and start over as though there was nothing already in place.
The ultimate goal is to reduce cost, improve quality of care, greater
patient satisfaction and employee satisfaction. Reengineering include
abandoning obsolete systems, involving departments in cross functional
teams, amalgamating jobs, introducing new technologies and creating new
principles that suit the needs of the time.
Successful reengineering
requires a leadership style that features participative management,
delegations, employee empowerment and self directed teams. The nurse
leaders and managers have a great role in reengineering health care. It
is the leaders or managers who should establish an integrated vision,
mission and values, management philosophy, and strategic direction
upfront. Integrating operational accountability into the work-redesign
effort is important responsibility of leaders. When introducing new
techniques and principles, it is necessary to get the support and
approval of other members of the organisation otherwise the programs
cannot be implemented successfully. So the members should be informed
and their opinions are to be sought from time to time. It will help to
get more new and effective ideas.
Reference
Decter, M, B.,
Norris, J., & Kramer, S. (1997). Reengineering and integrating
healthcare delivery: What have we learned in the 1990s.Healthcare
Quarterly.Vol.1 (1).Retrieved from
http://www.longwoods.com/content/16600 Wood, D. (2012).Providers re-engineering healthcare for greater efficiency. Retrieved from
http://www.amnhealthcare.com/providers-re-engineering-healthcare-for-greater-efficiency/
POST 5
Continues
quality improvement is the process that employs rapid cycles of
improvement to ensure programs systematically and intentionally improve
services while increasing positive outcomes for patients, families and
the communities they serve. CQI collects data used to make positive
changes, even when things are going well, it focus its attention to
improve a situation rather than waiting to fix it when something goes
wrong (Huber 2010).
As nurse leader one important area that
requires CQI and education is the simple act of hand washing. Hand
washing is the single most important step in the fight against
infectious pathogens such as MRSA; hand washing only takes thirty
seconds to a minute in most instances (CDC) (2012).
In January
2013, at my place of work (VA) we receive an e-mail from the Chief of
Nursing congratulating the nursing staff for the decrease in new MRSA
cases, this can be attribute to the constant teaching and monitoring not
only of nurses but also medical and residents, sadly doctors are the
worst enemies when it comes to either using gloves when examining
patients or washing their hands right after performing this task.
We
also teach our patients to wash their hands before leaving their room
and using the hand sanitizers placed throughout the hospital at any
time. I have to add up that up to the present time the number of MRSA
cases continues at its lowest rate in part again to the continues
education of all involved.
References
Centers for Disease
and Control and Prevention (CDC) (2012) Protocol for Hand Hygiene and
Glove Use Observations. Retrieve from
http://www.cdc.gov/dialysis/prevention-tools/Protocol-hand-hygiene-glove-observations.html
Huber, D. (2010).
Leadership and Nursing Care Management. Retrieved from https://pageburstls.elsevier.com/
POST 6
Continuous
quality improvement is defined by as “philosophy and attitude for
analyzing capabilities and processes and improving them repeatedly to
achieve customer satisfaction’ (ASQ, 2007) Today’s health care industry
is facing many challenges and continuous quality improvement is the only
way, organizations can survive by maintaining patients’ safety and
also customers’ satisfaction. There are certain models of standards to
measure quality and it can be grouped into structure, process and
outcome. Donabedian’s structure, process and outcome model has been
widely by the professional nurses to develop quality management
programs.
Continuous quality improvement is process involving all
levels of organization to ensure customer’s safety and satisfaction with
the participation of everyone in the organization. The staff nurse is
accountable to assess the patient’s status health care services provided
and nurse manager must develop the work setting to facilitate the
primary nurse’s ability to undertake constructive action for improving
care. There will be quality improvement coordinators to assist the
department with other tools such as documentation and also demonstrate
how the requirements of external regulatory agencies (AHRQ, IHI, and
JCAHO) and professional standards are met. The nurse executives provide
vision and secure the necessary resources to ensure the quality. Some
organizations have risk managers in their multidisciplinary team.
I
work in labor and delivery. For the last three years we have noticed
that, infant fall rate is higher in our department on nights, when the
father of the baby drops the baby accidentally. So our manager created a
special committee to investigate the problem with the involvement of
risk manager and a social worker. We used Plan, do, check and act model
to manage this issue. The plan phase explained in different steps with
the help of flow chart when the fall was occurred. Then the members of
the team listed all the problems associated with the fall. Then the team
categorized all these factors. After categorization the team used cause
and effect diagram, and the potential factors are identified and
considered as the root of the problem. It was very interesting to know
about this mystery baby falls. The root causes were, extreme tiredness
because of prolonged labor, in-adequate safety check on babies, the
couches in the patient’s rooms were way too comfortable for a visitor so
they were falling asleep. Lack of listening ability due to extreme
tiredness, when the nurses were teaching the parents about safe sleep
practice. First time parents if they are very young are high risk for
the incidents. The involvement social worker helped tremendously to
resolve this problem. We removed those couches from the room. The
primary nurse did a detailed screening and teaching about the baby
safety, while parents were awake. Actually the prenatal clinic even gave
written instructions about patient safety. So we are making progress.
Reference: Huber, D.(2010).
Leadership and Nursing Care Management, 4th Edition. Maryland Heights, MO: Saunders Elsevier
Moran,M&Johnson,J.(1992) Quality improvement :The nurses role. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/1621942
Continuous Quality Improvement strategies to optimize your practice (2013): Retrieved from
http://www.healthit.gov/sites/default/files/tools/nlc_continuousqualityimprovementprimer.pdf
an offer to help you as well, you never know what new opportunities could result from that next conversation.
References:
Benton, D. (1999). Networking.
Nursing Standard,
13 (31), 21-27. Retrieved from ovidsp.tx.ovid.com.library.gcu.edu:2048
Nichol, H., & Tracey, C. (2007).Networking for nurses.
Nursing Management,
13 (9), 26-29. Retrieved from http://ehis.ebscohost.com.library.gcu.edu:2048/ehost/pdfviewer/pdfviewer?sid=ddff02ce-099d-4943-81
Peterson, D. (2012). What is networking? Retrieved from http://slisweb.sjsu.edu/career-development/
POST 7
CQI
is essential to patient care. It is based on and works hand in hand
with evidenced based practices at the bedside. If it were not for EBP
and CQI then protocols to prevent infections such as VAPs and CAUTIs
would not exist and thus there would be an increase in patient deaths in
the ICU. CQI requires the bedside nurse to stay up to date on their
skills and knowledge of recent EBP. CAUTI prevention is the product of
EBP prevention methods that are always under CQI assessments for further
prevention methods. The bedside nurse needs to not only stay abreast
of new information but also needs to be committed to putting this EBP
into work at the bedside.
In my practice, EBP is the difference
between life and death. The standard trauma patient does not present
with any infections. Therefore, the infections that they form are
usually a side effect of our treatment such as use of the mechanical
ventilator or a urinary catheter. Trauma patients carry a high
mortality already, when an infection is added to the mix of issues that
mortality rate increases dramatically. It is my responsibility as the
bedside nurse to stay update on the most recent evidenced based
practices that prevent these infections. “Because so much information
is available, no one could ever have sufficient capacity to acquire all
the knowledge he or she will need. Thus, the focus has shifted from
possession to access” (GCU, 2011). It is also my responsibility to
utilize those practices to ensure the process is working. If all staff
are using the protocols for infection prevention and infections from
ventilators or urinary catheters continue to occur then it is likely
that the process needs CQI to determine what other processes need to be
put into place to prevent the infection.
References
GCU. (2011).
Reengineering Health Care. Retrieved from Grand Canyon Loud Cloud: www.lc.gcu.edu
POST 8
Continuous
quality improvement (CQI) is a quality management process that
encourages all health care team members to continuously ask, “How are we
doing?” and “can we do better?” (Edwards, 2008). In establishing an
effective strategy for CQI one must book at the structure, process, and
outcome of the current situation and determine the changes necessary for
improvement.
The
lean process was implemented at a facility I previously worked at. The
purpose of the lean committee was to assess the workflow of the units
and determine areas the needed restructuring. The goal was to maximize
quality patient care while minimizing areas of waste. The committee
gathered input from staff on the current workflow process. They
determined that the nurses were spending a lot of time searching for
supplies needed to perform patient care. They also found that nurses
were unable to complete their charting in a timely manner. This was
hurting the facility financially due to the amount of overtime incurred
and creating nurse dissatisfaction. Once the committee identified the
issues they gathered input from the staff on how to improve the
process. With approval from upper management, they were able to place
locked supply cabinets in each patient room and install bedside
computers. The committee also organized the supply areas on the unit,
giving each item a “home”. This made it easier to find supplies when
needed. They did a follow up survey six months after the changes had
been made, to determine if they were helpful. They found increased
patient and staff satisfaction and a decrease in the amount of overtime
used.
Reference:
Edwards PJ, Maximizing your investment in EHR: Utilizing EHRs to inform continuous quality improvement. JHIM 2008; 22(1): 32-7.
