Health leadership and management - Essay Example

The management concepts of leadership and identification and establishment of a risk management process are to be applied for the ultimate design of a health care process. Such processes are more required at the Intensive Care Unit (ICU)/facilities of any hospital as ICU is one of the most critical services of any hospital and the quality of patients' response is important in determining the success of the entire hospital itself. In the following paragraphs we examine the application of the leadership concepts and risk management processes to the ICU facilities so as to lead to identification and reporting of incidents that are potentially harmful to patients.

Nearly half all ICU patients suffer from potentially life-threatening adverse event, including infection.Nosocomial infections in ICU are 3-5 times higher than non ICU; 50% of all nosocomial epidemics occur among the 10% of ICU patients; more than 30% of US hospital costs are allocated for ICU care alone. Several evidence based practices have been identified in case of ICUs which help prevent infections. Low evidence based practices are cleaning insertion site, use of heparin,tunneling,routine catheter change, routine Ab prophylaxis, hand washing compliance and use of Sucralfate; medium level evidence based practices are peri-operative normothermia, continuous oscillation,suprapubic catheters, barrier Precautions and Ab restrictions; high evidence based practices include supplemental perioperative oxygen, semi-recumbent position ,selective decontam- GI tract and silver alloy-coated catheters, to quote a few.

While these best practices are indicative of the desirable course of actions in ICU situations ;they perhaps indicate more to the risk perceptions and associated risk bearing events within the ICU environment.. Thus best practices are to be documented and diligently implemented and perhaps linked to performance evaluation. However there are noticeable gaps in prescription of these best practices and their actual practices which leads to occurrence of adverse events in ICU care. A careful identification and documentation of deviations which have resulted in adverse incidents is the much needed innovation for ICU management.

However it must be remembered as Kaplan says," An appreciation of the power, productive and seductive, of stories of best practice, may provide some "heedfulness" to work in the strategy field(Kaplan,2003). In some evidence seeking research studies, nurses with higher patient load were linked to higher 30-day risk-adjusted mortality. Similarly studies observed a 7% increase risk of dying within 30 days for each additional patient added to nurse load. One study on adverse drug events showed that 78 percent of adverse drug events were due to system failures (Leape et al, 1995).

Any design of an ICU health care system would require establishment of a system which would adherence to such practices by ICU staff at all levels with adequate motivation. Some authors have emphasized the need for organizational change in health care, calling it "the key to quality improvement". In discussing how such change can be managed, Davies and Nutley assert that cultural change needs to be