Stafford Acute Hospital - Assignment Example

? The inquiry into the Mid-Staffordshire NHS Foundation Trust xxxxx School: xxxxx xxxxx xxxxx Due xxxxxx Introduction In Mid Staffordshire, the NHS Foundation Trust operates and manages two hospitals, Cannock Chase Hospital and Stafford Hospital. Stafford hospital is an acute hospital; it offers a range of surgical and non-specialist medical services. It includes 24-hours accident & emergency department and some speciality wards. Cannock Hospital offers orthopaedic services for planned surgery, elderly care services, a nurse-led minor injuries unit and rehabilitation facilities (Mid Staffordshire NHS Foundation Trust Annual Report, 2008). Goals: According to the annual report of 2008, the basic goals of the trust were as follow. They wanted to develop and maintain the position as the first preference of a broad range of acute services. They wanted to achieve this by increasing the diagnostic direct access. In this way, the patients can make direct bookings for the diagnostic tests such as scans. Moreover, they wanted to decrease the waiting time of the patient in the hospital and to improve their experiences. By expanding the range and nature of services, they declare their ultimate goal was to increase their market share. They were trying to achieve this particular goal by developing the interventional cardiology services and implementing the marketing strategy. Further, they wanted to develop specific services into the Centres of Clinical Excellence. They were trying to expand the services of the hospital by developing the Dermatology Centre of Excellence, Orthopaedic and Rheumatology clinical expertise and scope of practice. They wanted to develop a seamless service provision across acute and community service. To bring the services closer to the patient’s home, the trust wanted to develop outreach consultant clinics. Other than this, they wanted to provide services like chemotherapy, in the homes of the patients. It was also part of their goals to develop services on the Cannock Chase Hospital site so that they can better meet the needs of the community. This was done by maximising the use of Cannock Chase Hospital, by relocating the trust services into two floors. With the help of partner organisations, they wanted to develop new health related services in vacant accommodation. Their last goal was to be the cleanest place in the town. This can be done by further investing in the recruitment of cleaning staff. This goal can also be achieved by providing high quality services with modern facilities. Likewise, they would be able to have strict hygiene standards (Mid Staffordshire NHS Foundation Trust Annual Report, 2008). In the coming years, these goals were not given the due importance by the management and thus, were ignored by them. Since the management did not stick to its goal, the trust collapsed when it was reported that around 1200 patients died due to the negligence of the staff between the years of 2005 and 2009 (Ellicott, 2010). As a result, on 9th June 2010, the secretary of State announced a full public inquiry in the form of commissioning, regulatory bodies, and supervisory (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2010). Literature review on healthcare system Heath care has emerged as a complex and dynamic organization. As the environment is ever changing and competition is becoming intense, the healthcare has also become technology oriented. This is done because in a small span of time they are expected to please their patients, keep good relationship with the staff, accommodate the shareholders, and meet the requirements of other stakeholders such as government, financial institutions, consumer forums, professional bodies and others. To maintain all the desires, management of the healthcare has to stay in touch with latest developments and the recent trends in patient care. Other than this, the management should improve their skills for better use of the existing resources and powerful technology. The management has to assess the performance of the hospital against the norms. Healthcare is a business and like all other businesses, it needs effective and appropriate management to let the business run smoothly. Managing Quality in Healthcare: Improvement in quality is an important goal in all clinical practices. The basic ingredients of quality are the commitment of the clinicians, outcomes of care, systematically monitoring of data on the processes and most importantly the active support of management. The basic steps that should be kept in mind for the quality assurance within the healthcare are to ask essential questions from the patients. Besides this, they should recommend the diagnostic test, if required. The important step is to consider different diagnosis for a patient if they are suffering from such conditions that can lead to multiple health problems. The doctors should not do the diagnosis in hurry. If they find confusion, they should consult either with the senior doctor or with their colleague (Weinberg & Stason, 1998). In the healthcare, at every hierarchy, lack of management skills in the employees or employers can result in devastating effects. It can lead to lack of improvement, low profits, poor performance, lower productivity, disheartening of employees, and jeopardize the organization. Consequently, it is necessary for the healthcares to manage all the departments appropriately. Managing Medicines in Healthcare: When the patient is in healthcare, they do receive medicine as a part of their treatment. For such reason, medicines should be used safely and appropriately so that they can maximise their benefits. In hospitals, the expenditure on the medicines is increasing as the number of patients is increasing. This rise can be reduced if the use of the medicine is managed and monitored in a better way. To have a better management of the medicine in the healthcare, it is necessary to use new technological developments in the hospitals. The higher authorities should manage the finances of the medicine in an effective way. The education on prescribing medicines for medical students and junior doctors can make them learn the effective use of the medicine (Audit Scotland, 2009). Managing Emergency Demand in Healthcare: Healthcare emergency departments are considered as a key part of the healthcare system. These departments provide early diagnosis, stabilisation, and initial management for patients with urgent and acute illnesses and injuries. Management of emergency department occurs at 2 levels; day to day management as they arrive and strategic planning that is done to meet the future demands. According to Cameron (2004), healthcares must have robust systems for providing real-time information on the number of beds that are available for emergency admissions. The beds are available for elective patients so that the waiting lists are kept down. The available beds should be used efficiently. The information should also deal with the planned admissions and planned discharges. Clear admission and discharge policies must be applied at the times of bed shortages. The quality of care provided by the hospital in emergency must be high. After being discharged by the hospital, patient should get the desired care (Account Commission of Scotland, 1998). In order to manage the emergency department in an appropriate way, new constructions can help to manage the growing patient load in the emergency. For the regular availability of the doctors, the management has to do Auditing of the staff members. In case of confusion, if the doctors concern with their colleagues there is a possibility that they might do the diagnosis quickly and properly. The regular checking of the emergency equipments is essential; in order to make sure that they are working properly. Humans learn at every stage of life, therefore the proper training of the nurse about the equipments can help them to perform their duties more efficiently (Karandawala, 2008). Leadership in Healthcare Leadership is a capability to discover personal and team beliefs in order to accomplish a change or to perceive vision of success. Leadership requires the aptitude that can critically appraise the team process and the outcomes on the path to achieve goals (Adair 1997). Leadership in the healthcare is considered as an essential role within new nursing and allied healthcare professional consultant posts. It is not reasonable for the clinicians not to recognize the importance of effective leadership in the existing healthcare settings (Ewens, 2002). Recently it is recognized that the wide range changes in the healthcare department cannot be implemented in the settings by using dictatorial management. It is also not necessary that leadership should be seen only in a management role, the leader could be chosen from within the team for a specific task. In the healthcare environment, the clinicians must have leadership expertise, so that they can implement changes in all the settings. These changes are based upon good clinical decision-making and around a patient-centred approach to care (Cooper, 2003). Improving the leadership qualities within the health organization will enable effective implementation and ownership of changes. Nonetheless, it will also keep hold of the staff, reduce their stress at the time of critical situations, and develop career advancement and job satisfaction in them (Department of Health, 2005). The Royal College of Nursing (2003) says that the leaders in the healthcare department are expected to improve the quality of patient care. This can be done by keeping a keen eye on the activities of the staff and on the equipments. Other than this, leaders can influence the improvements in the health of the population. It can be achieved by conducting small seminars on the health at different places. Additionally, the leaders have to use certain strategies that can promote and develop enthusiasm in the regular staff. These strategies can be in terms of incentives or bonuses. The clinical leaders should have the leadership qualities and style that requires for completing the specific task efficiently. Other than this, the leaders should know how to satisfy their own believes and believes of others as well. They must also bring the aptitude in the team that they all are working to achieve a common goal (Dale et al., 2002). Hence, this feeling can change the ambiance and motives of the healthcare. These processes can be done by the help of the potential change agents who can become an effective leader and change the environment of the healthcare (Oliver, 2006). In regard of the NHS foundation trust, much leadership has been changed but none of them was able to bring the positive change in the trust. Most of them were interested in becoming financially strong and thus they made it a foundation trust. However, due to wrong leadership it was seen that the trust did not flourish and ultimately has seen its end by having negative popularity. Now to develop a positive image of the trust, there must be some strong leadership that can work independently without the support of the management hierarchy. Problems with the Mid-Staffordshire NHS Foundation Trust The need to manage hospital beds and other resources effectively is very important. In recent years the admissions in hospitals are rising, thus the increasing numbers of emergency admission have built pressure on the hospitals that leads longer waiting lists, cancellation of the operations and endless waits in A&E. At the same time, as new ways of the treatment are developed in different settings, the number of beds is falling and the length of stay is getting shorter (Account Commission of Scotland, 1998). As per the view of healthcare commission, it is seen that in Mid Staffordshire NHS foundation Trust, virtually there were deficiencies at every stage of the pathway of emergency care. It can be concluded from the following points. At the time when the patients were arrived in A & E, mostly at the initial stage they were checked by the reception staffs that have no clinical training. Other than this, it was seen that the patients who were in the waiting room, were not regularly attended by the nursing staff. Moreover, it was seen that some important equipments such as cardiac monitors were either missing or not in a working position therefore treatments and assessments were often delayed (Healthcare Commission, 2009). Other than the equipment issue, it was also seen that there were very few nurses and doctors available in the hospital for the treatment of the patients. Those who were available on the duty had poor training. In addition to this, without consulting the senior doctors, the junior doctors were often put under pressure to make decisions. Since the area of clinical decision unit was not properly staffed, the patients who were moved there were not monitored in an appropriate way. Due to these reasons, the patients had to wait for the medications, wound dressings, pain relief, and antibiotics (Healthcare Commission, 2009). As the availability of the senior doctors was an issue, therefore after 9 pm only junior doctors were available to give advice to the surgical patients. The specialist trauma team was also not available. These reasons lead to the care and assessment of patients fell way below the acceptable standards (Healthcare Commission, 2009). It was also seen that at times, the patients had to run to the emergency assessment unit without required assessment; this also excludes the appropriate specialist care. For this reason, the emergency assessment unit had turned out to be noisy, chaotic, and busy with few nurses to handle the patients. Moreover, it was also seen that due to poor training of the nurses, many of the nurses were unable to understand the cardiac monitors and hence, did not carry out the observations sufficiently. As a result, it was impossible to identify the exact condition of the patient. In many cases, patients were not receiving the required medication. The availability of the beds were another concern, there were relatively few beds available for the patients who were suffering from stroke. Not all patients with heart attacks went to acute coronary unit. Moreover, there was no availability of non-invasive ventilation on the respiratory ward. It was also seen that the critical care beds were also not vacant (Healthcare Commission, 2009). On weekends, there was few theatre sessions available in the hospital. As a result, there was constant delay in getting to the theatre for the trauma patients and few of the patients were not getting the desired medication. Even if the operation was held, mostly post-operative complications were not always recognised. Furthermore, surgical practice was personal, relationships were poor thus little teamwork was seen. The level of recovery of the medical staff at night and on the weekends was little (Healthcare Commission, 2009). Across the trust, there was inadequacy in the arrangement to avoid fatal blood clots. The critical care beds were less in numbers and to access the medical advice from the critical care specialist was of a great concern. These factors have contributed as the problems for the trust (Healthcare Commission, 2009). In a private report, it was found that the patients were left humiliated and were not given the basic elements of the care. They were left in the sheets that were soiled with faeces and urine for a considerable period. Therefore, the relatives of the patients were forced to take the sheets to their home for washing. There was evidence that many patients suffered from falling and encountered serious injuries. However, their incidents were unobserved by the staff members. Moreover, the attitude of the nursing staff was rude and offensive. The trust’s staff not very concern about the dignity of the patients, left them in degrading conditions, or dressed them in the view of the passersby. The families were also forced to remove the used bandages and dressings from the public areas. The relatives of the patients were also seen cleaning the toilets themselves, as they feared to catch the infections (Boseley, 2010). Due to these conditions, it was seen that the mortality rate in the trust has rose to a striking level (Thompson, 2009). Ways to overcome the problems Action by the Board: The board of the trust must ensure that there is a systematic means of monitoring the outcomes of patients and rate of mortality. To achieve this, the board of the trust needs to discuss the quality of services provided at the trust. They need to reflect its arrangements for controlling the safety and quality of clinical care in the trust. The board of directors should see that the trust develop a learning culture. They should also arrange for the accurate and on time collection of the reports, internally and externally. Through workshops and seminars, the board of directors should teach the staff about the recent advancements in the technologies and their use. Responsibility of A&E Department: This department should provide safe services and must meet the requirements of the patients. The department must be properly staffed all the time and the equipments should be available and in order. Staff and the Capacity in Emergency Department: To avoid the negligence on the behalf of the trust due to less staffing, the trust must hire additional nurses and medical staff. This activity can ensure that the patients are provided with care throughout the trust, even at weekend and at nights. As a result, of this hiring, the trust can maintain the expected standards of the healthcare. Additionally, the trust needs to supervise and train the junior doctors and the nursing staff so that they can undertake an appropriate role and when they are placed in an exception, they remain confident and clear about the decision. In the critical care service, the trust must ensure that the number of clinical staff to advice the medical staff has adequate access. It is also to ensure that this is not dependent on the availability of the beds in the critical care unit. Ways to Improve the Standards of Care: It is the responsibility of the trust to ensure that the nursing and medical staffs deliver all the basic aspects of care. These aspects of care includes reviewing the patients on the regular basis and monitoring their condition after regular interval of time. In the check up, if they notice any complications they should not ignore it but manage it on time. It is also the duty of trust to make sure that the patients are timely reviewed by the senior doctors. The trust needs to do auditing for its arrangements and equipments used in medication such as non-invasive ventilation and cardiac monitoring, where necessary. Every board of director must have the comparative data that includes rate of mortality. These figures must be complete, accurate, and up to date. The trust has to give emphasis to the views of the people using services. The system should work effectively with others and share information to solve the problems they are facing (Care Quality Commission 2009). Conclusion Initially it was a small trust that was trying to support a range of specialities. After becoming a foundation trust, it has improved its finances. Nevertheless, it has lost its grip on the organizational and operational issues. It had no effective system for the management and admission of patients admitted as emergences. Furthermore, it did not have a system to monitor the outcomes for the patients. As a result, the trust failed to identify the high mortality rates among the patients who were admitted as emergencies. This was considered as one of the major failings of the hospital (Monitor, 2010). The trust has not looked at the problems provided by the care unit. The higher officials did not make any effort to develop an open, learning culture within the trust, and have not considered the quality of care as an important issue, thus has suffered grave results. Many patients who were admitted as emergencies did not receive an acceptable standard and there was shortfall in at least one aspect of the basic care. At the time of admission, those patients who had the possibility to recover from their condition were also mishandled. Their disease was either not diagnosed on time or they were not treated properly (Healthcare Commission, 2009). It is seen that due to the trust’s drive to become a foundation trust, it has lost its sight for the real priorities. The trust has saved its money by reducing the staff; however, the management has not considered the effect it can leave on the working efficiency of the trust. The prime concern of the trust was business and financial matters and thus, the quality of care of the patients who were admitted as emergencies fell way below the acceptable standard (Healthcare Commission, 2009). References Cooper SJ (2003). An evaluation of the leading an Empowered Organisation Programme. Nursing Standard 17(24): 33–9. Department of Health (2005). Supporting People with Long-Term Conditions London: Department of Health. Ewens A (2002). The nature and purpose of leadership. In E Hawkins, C Thornton (Eds). Six Steps to Effective Management: Managing and Leading Innovation in Health Care (Ch. 4). London: Balliere Tindall. Royal College of Nursing (2003). Clinical Governance: An RCN Resource Guide. London: Royal College of Nursing. Weinberg.S.N & Stason.B.W, 1998. Managing Quality in hospital practice. accessed on 12th march 2011 from http://intqhc.oxfordjournals.org/content/10/4/295.full.pdf Mid Staffordshire NHS Foundation Trust Annual Report (2008) http://www.midstaffs.nhs.uk/aboutUs/corporate/publications/ar/AR200708FT.pdf Karandawala, (2008). Future Health. Accessed on 12th march 2011 from http://www.akca.co.uk/files/managing-in-a-recession.pdf Account Commission of Scotland (1998). Managing hospital admissions and discharges. Accessed on 12th march 2011 from http://www.audit-scotland.gov.uk/docs/health/pre1999/nr_9812_hospital_admission_discharges.pdf Adair J (1997). Effective Leadership Masterclass London: MacMillan. Audit Scotland, 2009. Managing the use of medicines in hospitals. Accessed on 12th march 2011 from http://www.tsh.scot.nhs.uk/About_Us/docs/NHS%20QIS/Audit%20Scotland%20Reports/Medicines%20management%20-%20Apr%2009.pdf Boseley.S (2010). Mid Staffordshire NHS trust left patients humiliated and in pain. Accessed on 12th march 2011 from http://www.guardian.co.uk/society/2010/feb/24/mid-staffordshire-hospital-inquiry Care Quality Commission (2009). CQC reaction to Alberti and Colin-Thome reviews on Mid Staffordshire NHS foundation trust. Accessed on 12th march 2011 from http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=34865&FAArea1=customWidgets.content_view_1&usecache=false Cameron (2004). Managing emergency demand in public hospitals. Accessed on 12th march 2011 from http://www.health.vic.gov.au/emergency/auditor_general_report.pdf Dale C, Gardner J, Philogene S (2002). Overcoming barriers to change: case of Ashworth Hospital. In E Howkins, C Thornton (Eds). Six Steps to Effective Management; Managingand Leading Innovation in Health Care. London: Balliere Tindall. Ellicott.C (2010). NHS hospital scandal which left 1,200 dead could happen again, warn campaigners. Mailonline. Accessed on 12th march 2011 from http://www.dailymail.co.uk/news/article-1327766/Mid-Staffordshire-NHS-hospital-scandal-left-1-200-dead-happen-again.html Healthcare Commission (2009). Investigation into Mid Staffordshire NHS Foundation Trust. Accessed on 12th march 2011 from http://www.cqc.org.uk/_db/_documents/The_Care_Quality_Commission_plan_to_assess_progress_at_Mid_Staffordshire_NHS_Foundation_Trust.pdf Oliver.S (2006). Leadership in Health care. 4 (1): 38-47. Accessed on 12th march 2011 from http://www.susanoliver.com/pdf/my%20leadership.full%20text.pdf%2006.pdf The Mid Staffordshire NHS Foundation Trust Public Inquiry (2010). Accessed on 12th march 2011 from http://www.midstaffspublicinquiry.com/ Thompson.A (2009). Mortality rates at Mid-Staffordshire NHS Foundation Trust. Accessed on 12th march 2011 from http://www.parliament.uk/briefingpapers/commons/lib/research/briefings/snsg-05030.pdf Monitor (2010). Regulatory action. Accessed on 12th march 2011 from http://www.monitor-nhsft.gov.uk/home/about-nhs-foundation-trusts/regulatory-action Read More