Business Process Management of the United Kingdom National Health Service - Essay Example

?Introduction In the UK National Health Service (NHS) published the March 2009 Francis report on the failures of the Mid-Staffordshire NHS Foundation Trust as stated by Francis (2010a). This report was released by an inquiry chaired by Robert Francis which focused on the standards of care at the Trust. The findings of this investigation were published in March 2009 by the THC. The evidence was based on the views of patients, staff and their relatives as explained by Francis (2010b). This report entailed eighteen recommendations for improvement of care at the Trust. These recommendations were fully accepted by the Trust Board and the Department of Health. There were shortcomings in different aspects in the Trust that are explained below. Failures in Operations management The hospitals lacked well established protocols and pathways for the management of patients admitted in A&E (Accident and emergency) as expressed by (Francis 2010a). This department was understaffed and lacked proper equipment such as defibrillators for resuscitation trolleys. This left very few nurses to conduct urgent assessment of patients and receptionists who had no medical training were forced to take up this job. Nurses in the A&E did not have enough training and the hospital had weak leadership. The number of consultants to provide daily on call cover was insufficient and there were only few middle level doctors. The middle level doctors and junior medical practitioners were not adequately supervised. They were frequently under pressure to make prompt decisions in order to meet the set target of attending all patients in four hours and go through the A&E. This had resulted to a situation whereby patients are taken to the EAU (Emergency Assessment Unit) without necessary diagnosis and assessment. The situation of the EAU was not any different from that of the A&E. The EAU was outsized and had a poor layout and this made it difficult for nurses to tend to patients. This was aggravated by poor communication between patients and the medical staff as well as inadequate staff (Francis 2010b). The situation in this department can be simply described as hectic and chaotic. There was poor compliance with the accepted standards of practice in infection control. There was poor handover from the A&E to the EAU. This notwithstanding the care for patients from heart related conditions was reported to be excellent. The management had failed to attend to serious issues and monitor performance in the hospital. This had led to poor treatment of patients in the emergency department. There is poor recording and documentation of the patients’ activity and outcomes and the hospital does not have any reliable historical account of their past patients. The medical team generally lacked proper training to handle different complications. Most of the doctors and nurses admitted that the staff in the EAU lacked the skills to take care of surgical patients (Francis 2010b). There were poor procedures in surgery and the surgeons did not work as a team. Measurements to be taken by the hospital and stake holders There have been improvements on various areas in the trust after the shocking revelation by the investigation (Care Quality Commission 2009). The hospital has hired a greater number of qualified staff to improve the quality of care in the hospital. Training programmes have been set up for different staff to ensure their competence in handling equipment such as monitors and equip them with skills to handle patients. The trust deserves recognition for the measures it has undertaken to improve the quality of care in the hospital. There has been increased funding to the trust to hire more staff, purchase equipment and the necessary medication. The regulatory bodies have increased the number of inspections in the hospital to ensure strict adherence to quality standards. Stakeholder groups The DHS (Department of Health Services) works in collaboration with a wide range of stakeholders including community sector, government, voluntary sector, regional and local NHS organizations, patients and the general public. The stakeholders must work in cohesion to ensure improved health care in Trusts. Failures in Customer/patient handling Patient/customer handling at the Stafford NHS Trust hospital can be described as poor. This can be drawn from the numerous complaints and horrible ordeals of patients admitted for emergency treatment in the hospital. This is evident from the medical checks that were conducted by untrained receptionists and the frequent cases of heart monitors being switched off. Patients need constant care and strict adherence to meal times. However, at Stafford NHS Trust hospital patients were regularly left without food and drinks. In adverse cases patients were routinely left without medication (CQC, N. and Care Quality Commission 2010). To make the matters worse, operations were cancelled on many occasions regardless of the severity of the condition. These were the major contributing factors to high patient mortality in the hospital. The investigation led to the discovery that the hospital had inadequate members of staff that had adequate training. This explains why the untrained receptionists were involved in medical check ups and that they were expected to assess patients going through A&E. This resulted to high mortality rate in the patients admitted in A&E. Patients who were in critical condition and could not manage to go to the bathroom on their own were left in soiled beds for hours and without their medication. This led to increased chances of infections and bed and pressure sores. Patients waited for long to get medication, pain killers and wounds dressings. There were delays in scanning patients and the senior doctor usually left the hospital at 9 pm. The number of junior officers left in charge during night shifts was inadequate and they lacked the necessary skills to take care of some patients (Francis 2010b). Most of the patients interviewed said that they had a bad experience at the hospital. The care for patients was intolerable and this is clear as patients and relatives said that the patients rang the call bell when they needed to go to the toilet or were in pain but they were not responded to (CQC, N. and Care Quality Commission 2010). They further claim that patients were not given their nutritional supplements in good time. The condition of the bathrooms and commodes were not hygienic. The nurses did not conduct observations as required to identify the condition of the patients and if they found out the condition was worsening they rarely took remedial actions in time. Additionally, the observations were not done accordingly and poor records were maintained on the intake of medication, food and fluids. Bodies responsible for poor standards of care provided by the hospital Various organizations responsible for the regulation of quality of health care are to blame for the poor standards in the hospital (Care Quality Commission 2009). These include the NHS, National Institute for Clinical Excellence (NICE) Commission for Health Improvement (CHI), General Medical Council (GMC) and Care Quality Commission (CQC). These bodies should ensure that quality care is provided in hospitals and consistently conduct investigations to ensure that rules are followed. They should work more closely to set up an articulate approach of standard setting, monitoring and inspection of the health care sector. Failures in Business processes Management’s key performance indicators (KPI’s) The management has come up with a clear vision for achieving change in all the problematic areas (Care Quality Commission 2009). The management has established measures to ensure that patients get better quality of care in the hospital. The hospital has come up with strategies to curb the high mortality rates in patients admitted as emergencies. The required medical and surgical equipment are provided to improve health care provision in the hospital. The management has established a proper leadership mechanism to ensure operations run smoothly. There have been measures to improve communication between the staff and the patients. How do you think management might have better organised their many performance measurements The management should establish a team responsible for measuring performance. The committee should be responsible for decision making and managing liaison with major stakeholders. The team should set up objectives in performance management which should include quality improvement, accountability, monitoring change, planning and taking the patients’ needs into account (Slack, Chambers and Johnson 2009). The team should manage all performance measurements in the hospital as explained by Smith (2009). Lessons learnt by NHS managers and the government There are important lessons that can be learnt by the NHS and relevant bodies. Trusts should have access to reliable and timely information concerning various outcomes including comparative mortality (CQC, N. and Care Quality Commission 2010). PCTs (Primary Care Trusts) should ensure that they have efficient means of establishing patients’ experience and quality care. Effective handover should be maintained when mergers and reorganizations take place. Trusts should establish and resolve the loopholes in the quality of nursing care related to communication, nutrition and hygiene. Senior staffs that have the required training should be involved in the management of vulnerable patients. The system of governance in trusts should be persuasive on paper and in practice. Trusts should ensure that preoccupation with finances and strategic objective do not compromise the quality of care offered. Conclusion The trend in Mid-Staffordshire NHS Foundation Trust hospital was worrying and immediate action was taken to rectify this. The Francis report was an eye opener to the problems faced by patients in the hospital and recommendations were suggested to improve on the weak areas. The current condition in the hospital can be attributed to poor management and inadequate participation by the relevant organizations. The hospital took immediate action to correct the shortcomings that were stated in the report. It will take the combined effort of all the stakeholders in the health care sector to improve the state of the Mid-Staffordshire NHS Foundation Trust. References Care Quality Commission 2009, Care Quality Commission publishes progress report on Mid Staffordshire NHS Foundation Trust, viewed 17 June 2011, . CQC, N. & Care Quality Commission 2010, Care Quality Commission Publishes Progress Report on Mid Staffordshire NHS Foundation Trust, viewed 17 June 2011, . Francis, R 2010a, The House of Commons Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust: January 2005 - March 2009 (HC), 1st edn, vol.1, HMSO: Her Majesty's Stationery Office. Francis, R 2010b, The House of Commons Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust: January 2005 - March 2009 (HC), 1st edn, vol.1, HMSO: Her Majesty's Stationery Office. Greasley, A 2009, Operations Management, 2nd edn, Chichester: Wiley. Slack, N, Chambers, S & Johnson, R 2009, Operations management, 6th edn, Harlow: Financial Times/Prentice Hall. Smith, JM 2011, Performance Management and the WIKID Pearl. Read More