NHS - Its Influence and Future Projects - Essay Example

NHS An Essay of their Influence and Future Projects Presented to ‘Insert In Partial Fulfillment for the Insert of Course Presented by Insert your name Spring 2011 Introduction The lack of communication in NHS has caused serious problems for patient care. Also, the cuts in NHS are disturbing and it is obvious that a complete new leadership and teamwork within the NHS is essential and can help with patient care and also resolve other problems. The consultation report identified the key role that healthcare professionals can play in safeguarding adults: first, in the identification of abuse, harm and neglect, and second, in developing appropriate responses to it. Although much progress has been made, NHS clinical governance systems do not yet formally recognize the need to work in collaboration with local authorities when adult safeguarding concerns arise during healthcare delivery. There was also a clear request from NHS respondents for guidance to clarify the relationship between adverse incident reporting, complaints, and safeguarding in order to encourage reporting in a way that supports the investigation and empowers staff in the process. The aim of this guidance is to encourage organizations to develop local robust arrangements to ensure that adult safeguarding becomes fully integrated into NHS systems. This will result in greater openness and transparency about clinical incidents, learning from safeguarding concerns that occur within the NHS, clarity on reporting and more improved positive partnership working (Department of Health, 2008). NHS Lack of Communication The lack of communication with NHS has caused problems for patient care (Borrill, 2002). In The NHS Plan2 shows the need to break down barriers between staff. This was emphasized so as to tackle the inefficiencies in working practices identified: ‘Old-fashioned demarcations between staff mean some patients see a procession of health professionals... Information is not shared and investigations are repeated ... Unnecessary boundaries exist between the professions which hold back staff from achieving their true potential.’(Borrill, p.27) ‘Throughout the NHS, the old hierarchical ways of working are giving way to more flexible team working between different clinical professionals’( p82). The importance of teamwork in health care has been emphasized in numerous reports and policy documents on the National Health Service. One particularly emphasized the importance of teamwork if health and social care for people are to be of the highest quality and efficiency: ‘The best and most cost-effective outcomes for patients and clients are achieved when professionals work together, learn together, engage in clinical audit of outcomes together, and generate innovation to ensure progress in practice and service.’ Over the last thirty years this has proved very difficult because of the barriers between Professional groupings - such as doctors and nurses (Borrill, 2002). Influence and Future Practice The response of the government has been to promise a huge increase in spending on the NHS. A key challenge is how this better funded delivery of healthcare can be managed to achieve good, fair and cost effective services for the whole population. A primary prescription that policy makers and practitioners have offered for meeting such a challenge facing the NHS is the development of multidisciplinary teamwork. This report details the findings of a major national study of teamwork in the NHS on the factors associated with effective team working, and the effects on quality of care and well-being of staff (Borrill, 2002). Planning, implementing and managing change in a fast-changing environment is increasingly the situation in which most organizations now work (Chapman, 2007). However the many complaints against NHS mannerism show their influence and practices needs improvement. Dr Janet McCray presents a grounded theory model of how inter-professional workings can be facilitated. Arising from a learning disabilities perspective, Dr McCray suggests that recent policy changes have resulted in a ‘role shift for community-based RNLDs [Registered Nurses for People with Learning Disabilities], where leadership skills and teamwork facilitation roles are increasingly at the forefront of their practice across the boundaries of health and social care. That responsibility for change and development is indeed filtering down through the hierarchical ranks of the NHS, as more and more people are being charged with leading developments within their own services. New roles and new responsibilities are located within those charged with providing the services rather than those managing them. Leadership is no longer the purview of the few, a fact that recognizes the increasing levels of academic preparation for those working within the NHS, and seeks to utilize the knowledge and skills developed as a result (Jasper , 2005) Leadership: The Four Layers in the Team Leadership Model 1. Top layer: Effective team performance begins with leader’s mental model of the situation and then determining if the situation requires Action or just Monitoring? 2. Second Layer: Is it at an Internal or External leadership level? 3. Third layer: Is it Task, Relational, or an Environmental intervention? Select a function depending on the type of intervention. See the next section for explanation of Function Interventions. 4. Bottom layer: Correctly performing the above three steps create high Performance through Development and Maintenance functions. (Northouse, 2007) Three key areas in which every manager needs to be competent: managing people, managing activities and processes, and managing and developing oneself on how to learn, achieve continuous improvement, foster engagement, make a business case, and prepare a business plan,. How to be an Even Better Manager provides sound guidelines that will help NHS develop a broad base of managerial skills and knowledge and build on existing skills. Even the most experienced manager needs to keep abreast of new developments and brush up on essential skills (Armstrong, 2004). “A team is a group of individuals who work together to produce products or deliver services for which they are mutually accountable. Team members share goals and are mutually held accountable for meeting them, they are interdependent in their accomplishment, and they affect the results through their interactions with one another. Because the team is held collectively accountable, the work of integrating with one another is included among the responsibilities of each member” (Avery, 2004). Clinical Findings in Working in partnership with staff The team worked initially with Boards of Acute NHS Trusts and later with Primary Care, Ambulance and Mental Health Trusts. Among the lessons learned from their own work and the increasing body of research-based evidence is the importance of the leadership role of the board in fostering a positive culture of change, enthusing and empowering staff. Other factors are the effectiveness of communication with external organizations, scrutiny of all points of contact with users of the services and involvement of users – patients and careers – at all stages. The Team evolved during the program, strengthening its clinical base and introducing patients and careers as associates. In order to meet demand and increase capacity of the Team, learning materials have been developed and these and their experiences widely disseminated This review summarizes the aims, objectives and progress of the work of the Board Development Program (Stanton 2006). Evidence-based practice that can be applied will have a significant impact on whether it is effectively utilized by health care professionals. This article describes how members of the Evidence-Based Council within Sheffield Teaching Hospitals NHS Foundation Trust resolved this issue by developing a user-friendly toolkit which systematically introduces the key elements that need to be considered and applied in order to enhance evidence-based practice at ward level (Ryton, 2007). However, overall it did not change the outcome of the damage done by NHS. NHS Work as a Team The goal is to see if NHS produces three of the NHS Evidence Specialist Collections: Commissioning, Health Management, and Innovation & Improvement. It is claimed that clinical supervision contributes to clinical governance of healthcare services, but many claims for its positive effects are unsubstantiated. AIM: To test relationships between supervision, quality of nursing care and patient outcomes. METHOD: A randomized controlled trial was conducted across Queensland, Australia, supplemented by qualitative data collection. RESULTS: Supervision had sustainable beneficial effects for supervisors and supervisees. The individual performance of clinical supervisors was affected by the culture of the organization. A positive relationship between supervision, quality of care and patient outcomes could not be established statistically, except in one location. DISCUSSION AND CONCLUSION: Proposals are made for future supervision implementation and further research is required (Badham, International Journal 2006). Purpose – Aims to provide a brief discussion of discourses of HRD, then a brief review of HRD within the NHS, including stakeholders in HRD, and particularly management development. To explore some of the different discourses used by different managers, particularly those with a nursing background and those without, and the possible reasons for the use of these different discourses. Design/methodology/approach – A qualitative case study approach was adopted, including semi-structured interviews. Primary research data were collected from tape-recorded interviews with seven Directorate General Managers from two Welsh NHS Trusts. Discourse analysis was used to explore connections between the participants, the discursive resources they employed and their professional identities. Findings – Provides evidence of some of the tensions associated with management development in the NHS, between professional and managerial development, between central and local HR activities, and between competition and cooperation. A particularly interesting dimension is the transition from being a nurse to becoming a manager and the ways in which different individuals cope, as articulated in their language use. Highlights some of the discursive struggles to maintain ones professional (nursing) identify when promoted to managerial positions. It provides examples of some nurses who have adopted the new managerial discourse without such apparent difficulty of changed identity. It also presents material from NHS managers who have no nursing background to enable further comparative analysis of the relationships between identity and discourse (Dowding, 2002). Research limitations/implications – The findings are limited by small sample size, although feedback suggests the findings can be generalized to other NHS Trusts across the United Kingdom, and possibly globally. Not one senior manager used the term HRD – it was always “training and development” or “professional development” or “managerial and organizational development” and sometimes “learning”. Nor was there much use of the governments preferred term “workforce development”. This has implications for HRD research within this context, suggesting the need for shared understanding amongst researchers and participants (Dowding, 2002). The question NHS should focus as a statement is: Why integrated primary health care is important; Developing your leadership skills; Theories of integration and Techniques that integrate linear and systems thinking (Thomas, 2006). Also: Discuss the implications of change in the health care delivery system on nurse leadership. Describe key modern leadership theories. Compare and contrast leaders and managers. Discuss the importance of nurse leadership and its relationship to modern leadership theories. Explain the role of the clinical nurse as a leader and why it is important( Finkelman,2006) Although creating a series of integrative exercises that are effective is not easy, instructors seeking to apply such pedagogy are likely to find the effort worthwhile. The simulations appear to heighten student interest, awareness, development, and retention of core skills. The process of conceiving, incorporating, positioning, delivering, and assessing them appears to heighten instructor ability to present core skills in ways that students can and want to grasp. Instructors seeking to adapt similar pedagogy may want to consider an unexpected ripple effect, though. Several students who have taken my Organizational Behavior course have enrolled in my other courses, seeking additional integrative exercises. Those needs deserved responsive action. Integrative exercises have since become a feature of many of those courses (Robbins, 2003) Financial budget cuts First, we will ensure that the funding is there to deliver the changes. The Department of Health will later this year (2008) make financial allocations to every PCT for the next two years. This will give PCTs clarity about the money they have to invest in improving the health of their populations. Second, publish an NHS Operating Framework to set out the enabling system that will deliver. Ensure best delivery of strategic plans. And third, we will ensure that, as the Department of Health develops the policy proposals (via legislation, where necessary), it does so in partnership with the NHS and stakeholders to ensure that the benefits identified are fully realized. We have seen a further increase this year in the number of fitness to practice cases notified to us by the regulators: from 915 in 2006/07 and 1,231 in 2007/08 to 1,370 in 2008/09. There has been a significant increase in the number of cases since 1 January 2009, as from that date we started to consider cases regarding the health of professionals, as well as, performance and conduct cases. This followed a change to the legislation brought about by the Health and Social Care Act 2008 (Council for healthcare regulatory excellence, 2008). Conclusion It is very important to have the finances in order in any business, home or office. NHS need to revisit this lesson. When you overcome that challenge, then you can start comparing whats happening with what the organization sets out to do (mission, values, goals, priorities, targets, key performance indicators, processes, measures); how the people feel about things (staff turnover, retention, morale, attitudes); and how customers and suppliers feel about things too (actually go out and visit customers, and ex-customers particularly). You must observe protocols very diligently - introduce yourself properly to people and explain who you are and what you are doing (Chapman, 2007). Efforts to promote primary and behavioral health care integration are taking hold across the country and will hopefully become a vital part of the behavioral health care system. Recent legislation at the federal level supports this idea, and NHS is working hard to partner with providers so that people can, for the first time, be treated as a whole person in a comprehensive and coordinated manner. In previous reviews of the NHS, frontline staff has been on the fringes or bystanders. For the NHS to be sustainable in the 21st century, it needs to focus on improving health, as well as, treating sickness. This is not about the ‘nanny state’. As a clinician, I believe that the NHS has a responsibility to promote good health as well as tackle illness. This Review has been different. We and our colleagues in the NHS have been at its core. (The Darzi Report). References Leadership & Management of Change References Armstrong, M (2004). How to Be an Even Better Manager; A Complete A-Z of Proven Techniques & Essential Skills. London: Logan Page. Avery, G. (2004). Understanding Leadership. London: Sage. Borrill, C. (2002). Developing Team Working Health: A Guide For Managers Birmingham: Aston Centre. Chapman, A. (2007). Change Management: Organizational and Personal Change Management, Process, Plans, Change Management and Business Development Tips. Retrived September 16, 2008, From http://www.businessballs,com/changemanagement. htm Dowding, L.& Barr, J. (2002). Managing In Health Care. London: Prentice Hall. Finkelman, A.W. (2006). Leadership and Management In Nursing. London: Prentice Hall. Jasper, M., & Jumma, M. (Eds). 2005). Effective Healthcare Leadership. Oxford. Blackwell Publishing Northouse, P.G. (2007). Leadership Theory and Practice. London: Sage. Robbins, S.P., Hunsaker, P.L. (2003). Training in Interpersonal Skills: TIPS For Managing People. (2nd Ed). London: Prentice Hall. Thomas, P. (2006). Integrating Primary Health Care, Leading, Managing, Facilitating. Oxford: Radcliffe Publishing Ltd. Clinical Governance References Badham, John., Wall, D., Sinfield, M., Lancaster, J. (2006). The Essence Of Care In Clinical Governance. Clinical Governance: An International Journal 11 (1) 22-29 Boogaerts, M., Grealish, L., Ranse, K. (2008) Policy And Practice; Exploring Tensions To Develop Practice Practice Development In Healthcare 7 (1) 49 - 57 Department Of Health (2008) High Quality Care For All: NHS Next Stage Review Final Report (The Darzi Report) London: DH Department Of Health, Retrieved September 18th, 2008 http://www.Dh.Gov.Uk/Policyandguidance/Healthandsocialcaretopics/Clinicalgovernance/Fs/En Degeling, P. J. (2004). Making Clinical Governance Work. British Medical Journal 328 (7467) 679- 682 Gask, L., And Cambell, S. (2005). Governing Mental Health: A View From Primary Care. Mental Health Review 10 (1): 30-32 Healthcare Commission, Retrieved September 18th, 2008 Http://Www.Healthcarecommission.Org.Uk/ Peak, M., Burke, R., Ryan, S., Wratton, K., Turnock, R., Vellanoweth, C. (2005). Clinical Governance: The Turn Of Continuous Improvement? Clinical Governance: An International Journal 10 (2): 98-105 Rogers, P.G. (2006). RAID Methodology: The NHS Clinical Governance Teams Approach To Service Improvement. Clinical Governance: An International Journal 11 (1): 69-80 Ryton, B., Grant, V., Little, A., Gilsenan, I. (2007) Step To It: A Toolkit For Evidence Based Practice Development In Healthcare 6 (4) 213-220 Stanton, P. (2006). The Role Of An NHS Board In Assuring The Quality Of Clinically Governed Care and The Duty Of Trust To Patients. Clinical Governance: An International Journal 11 (1): 39-49 New Ways Of Working References Those marked with * may be particularly useful in preparation for the debate. Care Services Improvement Partnership (2008) High Impact Changes For Health And Social Care. Http://Www.Csip.Org.Uk/Silo/Files/Hics-Doc-11th-March.Pdf Council For Healthcare Regulatory Excellence (2008) Special Report To The Minister Of State For Health Services On The Nursing And Midwifery Council, Retrieved September 16th, 2008 Http://Www.Chre.Org.Uk/_Img/Pics/NMC_Report.Pdf Department Of Health (2007) Facing The Future. A Review Of The Role Of Health Visitors. Http://Www.Dh.Gov.Uk/En/Publicationsandstatistics/Publications/Publicationspolicyandguidance/DH_075642 Department Of Health (2008) Modernising Allied Health Professions Careers – A Competence Based Framework, Retrieved September 16th, 2008 Http://Www.Dh.Gov.Uk/En/Publicationsandstatistics/Publications/Publicationspolicyandguidance/DH_086264 Department Of Health (2008) A High Quality Workforce. NHS Next Stage Review, Corrected Version July 17th 2008, Retrieved September 16th, 2008 Http://Www.Dh.Gov.Uk/En/Publicationsandstatistics/Publications/Publicationspolicyandguidance/DH_085840 Department Of Health (2007) Mental Health: New Ways Of Working For Everyone Http://Www.Nimhe.Csip.Org.Uk/Our-Work/Workforce/New-Ways-Of-Working-In-Mental- Health.Html *Department Of Health (2007) Trust, Assurance And Safety- The Regulation Of Health Professions In The 21st Century Http://Www.Dh.Gov.Uk/En/Publicationsandstatistics/Publications/Publicationspolicyandguidance/DH_065946 *Department Of Health, July 2006, The Regulation Of The Non Medical Health Care Professions Http://Www.Dh.Gov.Uk/Assetroot/04/13/72/95/04137295.Pdf Department Of Health, September 2006, The Competency And Curriculum Framework For The Physician Assistant. Http://Www.Dh.Gov.Uk/Publicationsandstatistics/Publications/Publicationspolicyandguidance/Publicationspolicyandguidancearticle/Fs/En?CONTENT_ID=4139317&Chk=Hhdsen *Developing Key Roles For Nurses And Midwives Http://Www.Dh.Gov.Uk/Assetroot/04/10/17/39/04101739.Pdf NHS Institute For Innovation And Improvement Http://Www.Institute.Nhs.Uk/ NHS Service Delivery And Organisation (March 2006) Www.Sdo.Lshtm.Ac.Uk/Files/Adhoc/31-Briefing-Paper.Pdf Skills For Health Http://Www.Skillsforhealth.Org.Uk/Page/Career-Frameworks *Ten Key Roles For Allied Health Professionals Http://Www.Dh.Gov.Uk/Prod_Consum_Dh/Groups/Dh_Digitalassets/@Dh/@En/Documents/Digitalasset/Dh_4061612.Pdf Ethical Legal References Bergland C. (2004). Ethics For Health Care. (2nd Ed). Oxford: Oxford University Press. Burkhart M A. & Nathaniel A K. (2002). Ethics & Issues In Contemporary Nursing. (2nd Ed). London : Delamar /Thompson Learning. Fletcher N. & Holt J (2001). Ethics , Law And Nursing. Manchester: Manchester University Press. Hendrick J. (2204). Law & Ethics. Cheltenham: Nelson Thomas Nursing And Midwifery Council (2004). The NMC Code Of Professional Conduct: Standards For Conduct, Performance And Ethics. London: NMC. Perry A. & Potter P. (2001). Fundamentals Of Nursing. (5th Ed). London: Mosby. Rumbold G. (2004). Ethics In Nursing Practice. (3rd Ed). Edinburgh: Balliere Tindall. Seedhouse D. (1998). Ethics: The Heart Of Health Care. (2nd Ed). Chichester: John Wiley & Sons. Tadd W. (1998) Ethical Issues In Nursing And Midwifery Practice – Perspectives From Europe. London: Mcmillan Press. Thompson I., Melia K. & Boyd K. (2005) Nursing Ethics. (4th Ed). Edinburgh: Churchill Livingstone. Yeo M. & Moorhouse A. (2002). Concepts And Cases In Nursing Ethics. (2nd Ed). Ontario: Broadview Press. Team Working References • British Journal Of Social Psychology • Group Dynamics Journal • Group Dynamics: Theory, Research, And Practice Journal • Journal Of Personality And Social Psychology • Small Group Research Journal • Team Performance Management Journal Read More