Reflective Diary - Health Management - Essay Example

? Reflective Diary Table of Contents Reflective Diary 3 References 7 Reflective Diary There are differences and conflicts among the various stakeholders in the change project, all needing to be evaluated, addressed and resolved for all the parties to cooperate and for the change project in general to succeed. For one, the introduction of the new protocol, even if it only covers ankle and foot injuries in the emergency department, is a big change from what the stakeholders are used to. Any change in general, as we have seen in the literature, is unsettling. Human nature fears and is wary of the unknown. The familiar is comfortable, even if it is not the best arrangement for all parties involved. In the field, for instance, the nurses were initially hesitant about being part of the training, and had many questions and private qualms that they shared with me. This was the reality, even as they allowed me to explain the protocol in broad strokes. The doctors, meanwhile, while generally quiet, had a stance of wait and see, and leaned on the skeptical side. The administration of the hospital too, even when they agreed to the change project, also obviously wanted to make sure that the change would result in positive changes in the unit in general, and liked that the scope of the change was limited and very specific to ankle injuries. There had to be interventions and explanations prepared for the patients as well. Underneath some of these concerns is a need to take charge and be control of the situation. The change was to unsettle them from their cozy and safe positions. The conflicts that are to come from the change in the balance of power between nurses and doctors when it comes to decision making are profound, even if they are limited to just ankle and foot injuries in the emergency setting. The adoption of the Ottawa ankle rules in the emergency department implied that triage nurses are to be empowered with making key treatment decisions for patients with ankle injuries, without the doctor’s prior and express approval. For doctors this meant trusting the nurses to be competent and correct in their diagnoses. For the hospital and the patients what is at stake is patient welfare, and who takes ultimate responsibility for the well-being of the patients for those cases that fall within the ambit of the Ottawa ankle rules. These are seemingly benign issues, but from the perspective of who takes responsibility for patient well-being these are profound conflicts that the change project needed to properly evaluate, negotiate and resolve (Institute of Medicine, 2006). In the above evaluation conflicts it is clear too that there are dependencies in the actions and the outcomes of the actions of the various stakeholders to the change project. For instance, nurses can become empowered only with the trust and confidence given to them by the doctors, with whom the triage nurses have to work in tandem in taking care of patients with ankle injuries, making use of the Ottawa ankle rules. If doctors fail at trusting the competence of the nurses’ decisions tied to these rules, then the whole process and change project falters. Doctors will make their own decisions regardless of the nurse recommendations. On the other hand, if the nurses persist with making use of the protocol even without the cooperation of the doctors, the dependencies also break down and nurses and doctors can duplicate each others’ work. Taking a step back, the decision of the hospital administration to allow the change project to push through also cascades down the line into making all of the involved parties cooperate and see to it that their actions at least give the project a chance to make it to completion. This is so they can see whether the protocol improves their work and the patient outcomes. In the change project even the nurses were hesitant at first to make use of their new power to make recommendations on x-rays, because they knew too that the patients and the doctors depended on the accuracy of their diagnoses. On the other hand, the dependencies work both ways too. Nurses depended, and will continue to depend on the trust of the doctors for them to be able to continue to make use of their new powers under the protocol. This tight dynamic hinges on nurses continuing to make accurate and reliable diagnoses making use of the Ottawa ankle rules, and on doctors in particular building on the recommendations of the nurses to be able to make the best overall decisions for the well-being of patients with ankle injuries (Jimmerson, Weber and Sobek, 2005). From the point of view of the patients, on the other hand, it is clear too that there are many factors at play relating to their overall well-being. One is that they have to trust that the nurses are competent and have their best interests in mind. Two is that with the greater efficiency that the Ottawa ankle rules provides, care will be more efficient, so that those who are further down the line will be able to get speedy and reliable treatment as well. This works for the benefit of all patients. A third set of factors relating to patient considerations, meanwhile, has to do with the optimized steps in the diagnostic process resulting in fewer steps potentially, fewer x-rays, more timely and cost-effective care, and overall better patient outcomes. Then again, as has been discussed above, all these hinge on a complex set of dependencies. At the end of this nurses have to be reliable, technically competent, and accurate in their diagnoses, or the whole arrangement topples down (Eitel, Rudkin and Malvehy, 2008). From the point of view of the entire unit, and a step back the entire hospital, the success of the change project has large implications for the quality of care, cost of providing care, and the reputation of the hospital in all. Where the Ottawa ankle rules succeed, more timely and efficient care is provided to more patients, improving costs and patient well-being. These translate to a better overall reputation for the hospital. Moreover, organizationally, the hospital benefits from the success of the Ottawa ankle rules by priming the hospital to be ready to accommodate more changes, involving the use of other triage protocols that can further improve and build on the success of this change project (Institute of Medicine, 2006). References Eitel DR, Rudkin SE, Malvehy MA, et al, 2008, Improving service by understanding emergency department flow: A white paper and position statement prepared for the American Academy of Emergency Medicine. Institute of Medicine, 2006.  The future of emergency care in the United States health system. Ann Emerg Med. 2006; 48:115–120. Jimmerson C, Weber D, Sobek DK., 2005, II Reducing waste and errors: piloting Lean principles at Intermountain Healthcare. Jt Comm J Qual Patient Saf. 31:249–257. Read More