The Effective Communications Systems at Metamorphosis Hospital - Research Proposal Example

 PROPOSAL: IMPLEMENTATION OF NEW PROCEDURAL GUIDELINE TO INCLUDE 'DRY WIPE BOARDS' TO FACILITATE EFFICIENT STAFF COMMUNICATION SYSTEMS AND IMPROVE PATIENT CARE Contents Page Executive Summary 1 Rationale for Proposal 2 Critical Discussion 3 Conclusion 6 References 7 Executive Summary 1.1 This proposal was instigated in order to highlight the need to establish more effective communications systems within the Rehabilitation Unit at Metamorphosis Hospital. 1.2 This proposed change was reviewed in light of current staff operating and procedural methodology for patient care as an improvement technique to enhance staff communication and reduce excessive spending at Metamorphosis 1.3 This research has identified several key members of staff within the Rehabilitation Unit that are instrumental to providing patient care which would be affected by the proposed policy change. As stakeholders, physiotherapists, nurses, patients, and physiotherapist assistants represent this group. 1.4 This research has identified the impact of the proposed changes on the health and emotional well-being of patients who will be invited to take a more active role in their service care, thus improving the public image of the Rehabilitation Unit at Metamorphosis and satisfy stakeholder expectations. 1.5 Shortened response time to changes in patient care to improve overall Unit service. 1.6 Increased perceptions of nursing autonomy; enhancing staff motivation among continuous care providers. 1.7 Innovation in communication procedures and patient handling, minimizing risk for negative patient care consequences and potential mistakes. Rationale for the Proposal The results of the 2nd quarter 2006 internal procedural audit indicated that the primary concerns of staff at Metamorphosis lie in: 1) The breakdown of communication between staff members regarding distribution of changes to patient care. 2) Low perceptions of teamwork methodology, decreasing motivation to perform to established standards of career excellence. Assumptions are often made that because groups of health professionals work together in delivering care then they are working together as a team (Crofts, 2005). However, in light of the somewhat sobering data from the recent audit, the necessity for improving communications within the Rehabilitation Unit is quite substantial if Metamorphosis is to provide exceptional patient care and promote a healthy team environment. Marla Johnson, Internal Auditing Coordinator, remarked in the 2006 audit, "The Rehabilitation Unit at Metamorphosis Hospital requires a somewhat dramatic and drastic change in procedure to increase patient perceptions of quality care and to promote teamwork amongst its staff; who are substantially overwhelmed by the abundance of patient care communication breakdowns". The strategic mission of Metamorphosis is to surpass public expectations for providing quality patient care and to elevate the hospital to become the foremost leader in rehabilitation. The key to accomplishing this mission relies on a multitude of factors, not least of which is in restructuring internal operations to ensure that the entire staff functions as a unified team and engages in effective communication; both amongst the hospital professionals and the patient as well. This proposal offers the functional purpose of implementing 'dry wipe boards' to be installed above patients' beds as a forum for rapid communication of patient changes in the Rehabilitation Unit and to provide a tool with which patients will remain continuously aware of how their needs are being communicated across the unit. Engaging the patient to become more actively involved in their therapies (and generic nursing care) will serve to put Metamorphosis in a category of enhanced public relations while allowing the professional staff to respond to changes without delay; or risk of patient error. Further, the proposed dry wipe boards can function as a tool with which to drive nurses' perceptions of self-managed autonomy by eliminating the continuous need to locate physicians in order to receive authorisation to alter minor patient care procedures. The result: A more competent, motivated team built on enhanced overall functionality as well as a staff that is equipped with the communication tools necessary to further Metamorphosis' mission for quality care. Critical Discussion In the UK healthcare sector structural changes have become surprisingly frequent and there are few professionals within the health care system who have not experienced this in some fashion. Oddly enough, many of those affected report negative consequences that have potentially adverse effects on service delivery (Bamford & Daniel, 2005). It is important to illustrate this important statistic as it might be argued that in order to improve communication processes within Metamorphosis, a structural change would be necessary to facilitate enhanced communication. The dry wipe boards are a somewhat proactive approach to fulfilling the audit recommendations by providing a method to enhance team effectiveness within the Rehabilitation Unit which involves a subtle change of operations; rather than a more radical (or costly) method to streamline staff functions (e.g. staff restructure, costly communication technologies). Existing executive literature at Metamorphosis indicates that cost-reduction is a sizeable factor in determining the direction for internal operations, thus the dry wipe boards can serve to satisfy continuous improvement initiatives at the hospital and avoid high-risk methods to establish superior communication channels. The stakeholders most largely impacted by the implementation of dry wipe boards are the staff physicians, nurses, and physiotherapy assistants. As has been indicated by the 2006 audit results, the breakdown of communication and teamwork within the unit primarily involves these professionals involved in discussing changes to patient handling. The Commonwealth Fund (2004) suggests that name recognition is important to effective teamwork, and that physicians are often embarrassed to admit they cannot remember a team member's name. From a physician's standpoint, the dry wipe board will ease this process by clearly indicating the identification of team members currently responsible for monitoring patient handling updates. This may appear to be a minor issue in establishing team methodology, however, to ignore the more emotional aspects of how team members interact is to deny interpersonal relationships among the staff. Avoiding team face-to-face contact due to simple embarrassment over name recognition issues most assuredly adds to the communication breakdown between physician and staff. Swansburg & Swansburg (1998) offer that nursing literature abounds with evidence of nurses' desire for autonomy and knowledge they may use to communicate their support of autonomy. As a significant step toward satisfying the goals of the audit report, increasing motivation among the nursing staff at Metamorphosis is crucial to driving excellence in nursing care. In terms of alterations to patient handling instructions, the dry wipe boards will afford continuous caregivers the opportunity to stretch the limits of their autonomy by eliminating the need to excessively notify physicians of minor changes to specific patient needs. Thus, allowing nursing professionals a forum to instantly update these changes promotes perceptions of a more self-managed environment; and allowing both nurse and physician the opportunity to engage in more productive aspects of patient care rather than "hunting down" one another to communicate these changes. As cited by Lingard et al (2004) and Gawande et al (2003), the authors point out that growing evidence indicates poor team communication as a major cause of medical mistakes that jeopardise patient safety. Further, Fiesta (1994), offers that the most frequent allegations against nurses concerning medical malpractice are the failure to monitor the patient appropriately and the failure to communicate significant findings to the physician. With these statements in mind, the dry wipe boards are not only a significant tool for rapid communication, but a risk management tool to minimise potential mistakes leading to allegations of poor patient care. Having a forum with which to express both significant and somewhat minute changes to patient handling procedures will ensure that both Metamorphosis and the patient are protected from potential harms. Complaints from patients often arise from poor communication and people in hospitals often feel vulnerable and ill at ease or simply find it difficult to understand the "system" or clinical processes involved in their treatment (Vincent, 2004). In light of the mission of Metamorphosis to improve patient perceptions of quality care, the dry wipe boards and the visible components of the patients' handling procedures will allow the patient to become more actively involved in their overall care; while having a visual medium to witness how their discomforts or concerns are being expressed across the staff of the Rehabilitation Unit. Allowing the patient to feel less anxious about the systems involved in the rehabilitation process can minimise difficult behaviours which put significant stress on the entire staff involved in patient handling. The Chartered Society of Physiotherapy (2002) suggests that physiotherapy assistants need to be aware that some patients who exhibit difficult behaviour may be anxious, and that it is the duty of the assistant to take this behavioural issue into account. Under the current system, difficult patients who resist therapeutic care might simply be unable to communicate their anxiety based on confusion of their care processes. The dry wipe boards, once implemented and utilised, will likely make the process of patient handling more effective as these resistance behaviours borne of anxiety over expressing patient needs are reduced. Creating a positive team environment, according to Bower et al (2003), requires support for innovation and the support of attempts to introduce new ways of working. The 2006 audit indicated that Metamorphosis' staff were "substantially overwhelmed" by recurring communication breakdowns. The dry wipe boards maintain the potential to radically change the current methods with which staff members interact to express patient needs, and interview data compiled within the audit shows that staff is ready to support any changes that lighten the burdens of a difficult patient care system. For this reason, after conducting a comprehensive SWOT analysis to analyze both the strengths of this proposal and the opportunities that the wipe boards will provide, it is proposed that a change agent be assigned from each department involved in patient care so as to facilitate this process of implementation. Saka (2003) describes a change agent as a manager who seeks to reconfigure an organisation's roles, responsibilities, processes and systems. In the role of the change agent, traditionally the agent identifies the problem, prepares a tentative plan, analyses staff reactions to the plan, establishes a timeframe for realistic completion, finally implementing and directing the change. The interruption to normal operations at Metamorphosis will be minimised in this scenario as recognising the problem has been satisfied through this research analysis; as have the proposed reaction of staff; considering the audit data supplied indicating a willingness to implement productive changes to procedure. Thus, the role of each change facilitator will be to assess the capabilities of each stakeholder group to understand the new process and will introduce a timeframe for completion to which each unit must adhere. Prior to implementation of the wipe boards, the primary change facilitator from the physician group will take a collaborative approach toward creating a learning environment in which each units' change agent will gain experience in how to best utilise the wipe boards and will take complete ownership of the process to align all of Metamorphosis' stakeholders to the new process. After successful implementation of the new procedure, each change agent will also take total ownership of monitoring quality within their assigned team by routine audits to streamline the overall process. At first determination, a competent assessment for a twelve-week launch period is proposed. Conclusion The executive-approved establishment of improvement methods designed to satisfy both the physical and emotional hardships of a staff member in the health care industry can only serve to increase motivation and enhance a teamwork philosophy amongst health professionals. The proposed implementation of dry wipe boards which would be designed to serve each individual patient within the unit will dramatically impact the functionality of the entire staff and guarantee a more balanced system for guiding quality patient care. Under the current system, response times are significantly lower than to meet the expectations of the mission of Metamorphosis; this statement supported by the 2006 internal audit and in the experiences of the staff plagued by patient communication breakdowns. The wipe boards will not only service the patient, but protect the overall security of the hospital in guaranteeing fewer patient errors and protect the common interests of stakeholders who require a more effective method of implementing communication systems changes. There is ultimately no down-side or individual who stands to lose from the proposed initiative and these dry wipe boards open the potential to build stronger partnerships between the patient and the individuals assigned to engage quality care systems. As is the mission of Metamorphosis hospital, the proposed implementation will serve to move the hospital forward in establishing internal operational procedures with a focus on quality management and continuous improvements. References Bamford, David & Daniel, Stephen. (Dec 2005). 'A Case Study of Change Management Effectiveness Within the NHS'. Journal of Change Management. London: Vol. 5, Iss. 4, p.391. Bower, P., Campbell, S., Bojke, C. & Sibbald, B. (Mar 18 2003). Team Structure, Team Climate, and the Quality of Care in Primary Care: An Observational Study. National Primary Care Research and Development Centre, University Of Manchester, University of York. The Chartered Society of Physiotherapy. (2002). 'Physiotherapy Assistants Code of Conduct'. http://www.csp.org.uk/uploads/documents/csp_assistants_code_conduct.htm. The Commonwealth Fund. (Nov 2004). 'Case Study: Promoting High Reliability Surgery at Kaiser Permanente'. CMWF Website. http://www.cmwf.org/tools/tools_show.htm?doc_id=257029. Crofts, Linda. (Aug 2005). 'A leadership programme for critical care'. Intensive and Critical Care Nursing. Department of Health and Human Services, Wivenhoe Park Colchester UK: Vol. 22, Iss. 4, p.222. Fiesta, Janine. (Jan 1994). 'Duty to Communicate – "Doctor Notified"'. Nursing Management. Vol. 25, Iss. 1, p.24. Gawande, et al. (2003). 'Analysis of Errors Reported by Surgeons at Three Teaching Hospitals'. Surgery. #133, p.614-621. Lingard, L., et al. (2004). 'Communication failures in the operating room'. Quality and Safety in Health Care. #13, p.330-334. Saka, Ayse. (2003). 'Internal change agents' view of the management of change problem'. Journal of Organizational Change Management. Bradford: Vol. 16, Iss. 5, p.481. Swansburg, Russell C. & Swansburg, Richard J. (1998). Introductory Management and Leadership for Nurses: An Interactive Text. Jones and Bartlett Publishers, Inc: p.506. Vincent, Nicky. (Jun 2004). 'Policy and Procedure for Dealing with Complaints'. Complaints Manager, Belfast City Hospital Trust. http://www.bch.n-i.nhs.uk/visitors/Complaints_Policy_PDF_65kb.pdf. Read More