Management and Delegation - Essay Example

Part 1 Management and Delegation Introduction The Oxford University Press (2012) generally defines management as the “process of dealing with or controlling things or people”. In the field of medicine or health, management is about treating and controlling diseases or disorders, as well as caring for the patients suffering from these diseases (Oxford University Press, 2012). This paper shall discuss management and delegation in relation to the management of a patient with leg ulcer. Scenario In one scenario, a nurse assigned leg ulcer dressing to a new staff nurse without evaluating the new nurse’s capability in wound dressings and associated skills. What was good about the situation was that the staff nurse delegator was able to assign the task to a newly qualified nurse who had the rudimentary skill in dressing wounds. The wound was therefore properly cleaned and dressed without any errors and without any delays. The designation of the task eased the burden on the staff nurses who were already shorthanded and overworked. All in all, the risk of administration delays or even missed medications was reduced with the delegation of the task. In addition, delegation also allowed the new nurse to improve on her skills. There were several unfavourable aspects of the approach to delegation applied by the staff nurse. For one, the nurse-delegator did not ascertain first whether the delegatee had sufficient knowledge and skills in carrying out the task (Lynch, 2009). It is important for the delegator to first establish the skills of the delegatee before any task is assigned in order to prevent any medical errors and prevent any patient risks (Vincent, 2011). The staff nurse was just fortunate that the delegatee happened to be knowledgeable and to be relatively skilled in leg ulcers wound dressing. Nevertheless, the staff nurse took a major risk in assigning the task to a delegatee before doing a preliminary assessment of the delegatee’s skills and knowledge. The staff nurse also did not wait for the delegatee to agree to the task. She assigned the task and then left the delegatee on her own to carry out the assigned task. There is a need for acquiescence between the delegator and the delegatee because there is a greater degree of accountability for the task if the delegatee has agreed to carry out the task in the first place (Storey, 2002). Moreover, simply assigning the task without waiting for the delegatee’s agreement is tantamount to an authoritarian leadership, one which often results in unfair outcomes for the delegatee (Storey, 2002). The manner of delegation could have been improved by the delegator by first assessing the delegatee’s knowledge and skill in leg ulcer wound dressings, and then waiting for the latter’s agreement. The delegator could also have stayed to supervise the delegatee’s wound dressing in order to ensure that the delegatee knew what she was doing and to prevent errors during the procedure. The situation could definitely have been handled better. The delegator could have made the proper assessment of the delegatee first before any task was delegated and the delegatee’s permission could have been sought before the task was delegated. The delegator also could have supervised the procedure before leaving the delegatee to carry out the task. Management includes various processes and personnel within the healthcare profession as it helps achieve improved patient outcomes. Different styles of management may also be applied by the health professionals in order to ensure such outcomes (Walshe and Smith, 2011). These styles of management are based on specific skills and job descriptions for the health professionals and through the coordinated working of these professionals, efficient patient care can be ensured (Walshe and Smith, 2011). Management is important because it provides an orderly, systematic, and evidence-based process in ensuring the efficient intervention of any issue or problem (Gopee and Galloway, 2009). It is important because it provides a scholarly as well as skills-based administration of interventions and treatment for patients (Gopee and Galloway, 2009). In other words, management provides direction for health professionals and it eventually ensures favourable patient outcomes. In this case, management should have provided a correct direction for the nurse delegator. Delegation is a necessary part of management. Management is a huge undertaking and it involves various tasks and responsibilities which often need the assistance of other individuals (Wheeler and Grice, 2000). Delegation, in this case, prompted the new nurse to develop skills in actual practice, specifically in leg ulcer wound dressing. Management is often carried out by a leader or manager who is tasked with various responsibilities, including the task of delegation. In this case, the new nurse gained some leadership and management skills. Delegation also involves the “process of entrusting somebody else with the appropriate responsibility and authority for the accomplishment of a specific activity” (QFinance, 2009). In this case, the staff nurse’s task of dressing the wound was assigned to the new nurse. The NHS (2010) also discusses that delegation refers to the process with which registered practitioners can assign work to a support worker who is also considered competent in performing the task. In this case, the staff nurse was incidentally able to delegate the task to the new nurse. In order to ensure adequate patient care in the case of the patient with leg ulcer, delegation was carried out and it guaranteed that the patient received the care he needed and at the time he needed it. The delegation however did not consider the right fit for the task at hand (Lynch, 2009). Delegation is also a process which ensures quality care at the least possible cost. Where delegation is applied, it also involves the most appropriate utilization of resources, as well as the best application of the team (Williams, 2012). It is also applied in order to fulfil the higher demands and needs of patients and other health professionals. Health professionals are often considered fully accountable for their practice to the patients themselves, as well as to their employer, to the public, to their profession, and to themselves (Williams, 2012). The accountability involved in the delegation process refers to the requirement of responsibility for one’s actions or inactions and that of being able to defend or lend legitimacy to one’s decisions. The staff nurse was therefore accountable for her act of delegation and she is also responsible for securing sufficient supervision or support for the patient and for other health professionals (Royal College of Nursing, 2011). In instances where the wound dressing would not have been carried out properly, the patient’s wounds would have deteriorated, thereby causing unfavourable patient outcomes. Delegation involves other factors but primarily, it must be considered only if it is in the best interests of the patient; and the manner of implementing it must be in accordance with various standards, policies, protocols, as well as the National Service Framework and National Occupational Standards (Williams, 2012). In this case, since the staff was overworked, delegation was made in the best interests of the patient. However, measures to ensure competent delegation could have been applied by the delegator, especially in considering the delegatee’s skills and capability. There are various elements which should have been considered before the task was delegated to the new nurse. First, the task itself should have been considered first. The delegator should have assessed whether or not the task can suitably be delegated or if the task could only be carried out specifically by the delegator alone (Hopkins, 2007). The delegator should also have evaluated if information gathering or decision/making was involved in the task. It is also important to note if in the process of delegation: clinical reasoning is needed, a protocol has to be followed, various high level manual skills are needed, or if the task is complicated (Williams, 2012). In this case, the wound dressing required infection control measures; no high level manual skills were needed. In evaluating the delegatee, it should also be important to evaluate if the delegatee is actually competent in carrying out the task. This was not carried out by the delegator. Finally, the delegator should also have deduced if the delegatee actually understood what was being asked of her and whether or not she knew and understood the limits of her competence (Williams, 2012). As for the patient, delegation should have been carried out after evaluating if he could participate in his care and if his condition is actually stable (Williams, 2012). An evaluation of the patient’s condition is essential, including his level of anxiety, the complexity of his condition, as well the possible unpredictability of his condition. In evaluating the patient, he was somehow apprehensive about a new nurse undertaking the wound dressing. But after showing competence in the task, his anxiety was eliminated. As for the delegator, he should also have understood what the standards of the practice are and what the delegatee’s level of competence was. He also had to have the right tools to support his delegating decisions and designations with specific reasons attributed for each delegatee and patient pairing (Hopkins, 2007). He did not apply these considerations in his delegation and simply called the new nurse to carry out the task on a particular patient. In order to manage efficient delegation, the simple delegation rule – SMART (specific, measurable, agreed, realistic, and time bound) should have been applied by the nurse delegator. First, being specific means being clear about the task to be delegated and about the goals of the delegation (Vincent, 2011). Secondly, the task must be measurable, meaning the expected outcomes must be specified and indicated as the task is being delegated (Vincent, 2011). Thirdly, there must be agreement to the task. Parties involved cannot be held responsible for a task which they have not agreed to. Their commitment is significant if they have agreed to the task (Vincent, 2011). Fourth, the task must also be realistic, hence, the task, the person involved, the patient, and the situation in general must be assessed before any task is delegated. Finally, the task must be time-bound, meaning, an expected time frame for the job to be started and finished must be indicated and agreed upon by the parties involved (Vincent, 2011). The delegator however did not apply these elements to her delegation process, as a result, gaps in the delegation process were clearly apparent. Various management skills are needed in order to ensure effective delegation. One of the most important skills needed is that of communication (Nemeth, 2008). The delegator should have applied this concept in her delegation process. Effective communication between the delegator and the delegatee can make all the difference in the efficacy of the delegation process and the overall achievement of goals of the delegation. Primarily, it would have informed her that the delegatee did not have enough experience to carry out the wound dressing on her own. Through the good flow of communication, all questions would have been settled between the parties before the task was delegated (Nemeth, 2008). The task could also have been properly carried out by the competent parties through proper communication processes. Different leadership styles are also applied within the delegation process and various leaders adopt leadership styles based on their personal and professional choices (Oliver, 2006). The nurse delegator in this case was an authoritarian leader. The authoritarian leaders do not delegate as much, and if they do, they often direct and control behaviours of the delegatee. They however work well in crisis situations (Oliver, 2006). The hospital was short-staffed and this leader immediately started delegating tasks in order to ensure the smooth running of the ward. She did not however make appropriate judgments as she delegated the tasks. The democratic leaders are actually better delegators as they function by facilitating and sharing responsibility for decision-making (Oliver, 2006). Finally, the laissez-faire leaders are non-controlling and easy-going types. They allow delegation and they supervise their delegatees to a minimum extent, allowing their delegatees to carry out their functions in any way they choose (Zineldin and Hytter, 2012). Conclusion Management involves the process of coordinating and dealing with people; and in healthcare, it involves the process of treating diseases. Delegating is a part of the management process and it involves the process of designating particular tasks to a support worker. In healthcare, delegation usually involves the process of assigning health interventions to support staff workers and other delegatees. Management and communication skills are an essential part of effective delegation and various leadership styles apply delegation in a variety of ways. In a scenario where a staff nurse delegates leg ulcer wound dressing to a new nurse without ascertaining the skills and knowledge of the delegatee, there is an inherent risk of medical errors being committed by the delegatee. Effective delegation needs efficient communication between the delegator and the delegatee; moreover, the delegatee must also have the necessary skills to carry out the task delegated in order to avoid any medical errors from compromising the patient’s health. In the future, the staff nurse must first ascertain the delegatee’s skills and knowledge before delegating any task to the delegate; he must also gain the delegatee’s agreement before delegating the task. These aspects are part of efficient delegation and management and they help ensure that the patient’s outcome would improve and that the health professionals are functioning efficiently as a coordinated unit. References Gopee, N. and Galloway, J., 2009. Leadership and management in healthcare. London: Sage. Hopkins, S., 2007. Health care assistants in general practice: delegation and accountability. London : RCN Lynch, P., (2009). Chapter 13: Delegating and supervising [online] Available at: http://www.radcliffe-oxford.com/books/samplechapter/2234/Lynch_13-6bbdfc80rdz.pdf [Accessed 26 May 2012]. National Health Services, 2010. Delegation [online] Available at: http://www.hcswtoolkit.nes.scot.nhs.uk/roles/working-safely/delegation [Accessed 26 May 2012]. Nemeth, C., 2008. Improving healthcare team communication: Building on Lessons from Aviation and Aerospace. Ashgate Publishing [online] Available at: http://www.abdn.ac.uk/~wmm069/uploads/files/Communication%20Book%20Chapter.pdf [Accessed 26 May 2012] Oliver, S., 2006. Leadership in health care. Musculoskelet Care 4(1), 38–47. Oxford University Press, 2012. Management [online] Available at: http://oxforddictionaries.com/definition/management [Accessed 26 May 2012]. QFinance, 2009. Delegation [online] Available at: http://www.qfinance.com/dictionary/delegation [Accessed 26 May 2012]. Royal College of Nursing, 2011. The principles of accountability and delegation for nurses, students, health care assistants and assistant practitioners [online] Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0003/381720/003942.pdf [Accessed 26 May 2012]. Royal College of Nursing, 2008. Health care assistants and assistant practitioners: Delegation and accountability [online] Available at: http://www.ukaps.info/HCA_booklet.pdf [Accessed 26 May 2012]. Storey, L., 2002. The ‘crackerjack’ model of nursing and its relationship to accountability. Nurse Education in Practice, 2(2), 133-141. Vincent, A., 2011. Setting goals & delegating using smarter SMART: Improving accountability and the likelihood of completion. NHS Training [online] Available at: http://medicology.co.uk/resources/articles/7.pdf [Accessed 26 May 2012]. Walshe, K. and Smith, J., 2011. Healthcare management. UK: McGraw-Hill Companies. Wheeler, N. and Grice, D., 2000. Management in health care. London: Nelson Thornes. Williams, L., Exploring delegation: a workshop for registered staff. Powys Teaching Health Board [online] Available at: www.wales.nhs.uk/sitesplus/829/opendoc/163351 [Accessed 26 May 2012] Zineldin, M. and Hytter, A., 2012. Leaders' negative emotions and leadership styles influencing subordinates' well-being. International Journal of Human Resource Management, 23(4), 748-758. Read More