Service Improvement in Nursing - Essay Example

Due Nursing, as many people may fail to realize is a hectic job much as it is very helpful and productive. Nurses usually have to put in long working hours every day and this can be very tiresome and therefore draining. Most nursing systems operate using shifts whereby a bunch of nurses work for a certain number of hours and their spots are later filled in by a second bunch of nurses who report after their hours are up. If the system is favorable, there may even be a third shift of nurses coming in. In most cases however, two shifts is considered to work just fine. It barely comes as a shock that the working conditions in most nursing systems are wanting. My work area is no different. I work as a National Health Service nurse in a Short Stay Ward. We keep patients at the ward for a maximum of seventy two hours before we discharge them or transfer them elsewhere if need be. Of late we have adopted a QCC drive to carry out the function of patient observations for the first twenty four hours of their admission at intervals of four hours each. Thereafter the nurses are required to apply their professional intellect and decide how often the patients need observation. My unit of fellow nurses and I decided that eight-hour-intervals would be quite appropriate for patient observations for the next forty eight hours of their admission. All our patient observations go into the database to enable the Trust note when we complete them on time and when we fail to as well. Failure of which, a fine is charged on all the nurses by the QCC. The system perceives itself to be foolproof and top-notch, needless to mention. The reality is quite the contrary. Despite our commitment to the working of this system, it has proven to be problematic. Here is why. After a much-needed debate for a reasonable amount of time, my unit and I decided that our first patient observations during the initial twenty four hours which are to be done at eight-hour intervals would be at 6:00 hours and 14:00 hours respectively. As for the latter patient observations at four-hour intervals, we agreed upon 6:00 hours, 10:00 hours, 14:00 hours, 18:00 hours, 22:00 hours and 2:00 hours in that order. The rest of the hours are appropriate but for 6:00 hours, which is undoubtedly a challenge. First off, the patients do need their rest. Waking them up at 6:00 hours in the morning for their routine observations certainly does not help this aspect of their recovery. It is deemed problematic and causes a disturbance to the patients a lot more than it helps. As if that’s not all, the daily routine at the National Health Service commences at 7:00 hours. You realize one hour is a very short time to make rounds of observations on fifteen patients. That is, before the morning shift of nurses show up for a handover and interrupts the patient observations. Indeed we have considered the possibility of waking the patients up earlier than 6:00 hours but this would be too unkind and inconsiderate to their needs as well. Of course, our failure to complete these rounds on time leads to a fine by the QCC as mentioned earlier. My idea of the improvement of services revolves around patient observations as this is our major challenge at the moment. I have a suggestion that nurses should start the rounds but once time is up they should make way for the healthcare assistance. My master plan is mainly focused on the leadership problems we have at the facility. The best way to organize depends on the nature of the environment to which the organization must relate (Burke, 205). It is my belief that most of the shortcomings we experience at the work area are as a result of poor leadership, which in turn leads to poor formation of plans and hence failure. Therefore I intend to address this issue and offer a better approach to the leadership and management of the ward. I have borrowed certain intelligence from the father of psychology himself, Kurt Lewin, particularly his theory on change. Also the leadership styles based on the Goleman model as noted in the book by Goleman proved to be very helpful. I have indeed applied each and every step in creating a project plan, with all the details required to make my plan comprehensible. Other theories such as the contingency theory and the trait theory could be applicable as well. It is important that a leader first have that position, but if you want to become a real leader, you have to qualify for that position before your followers will really look up to you as their leader (Bacher, 272). Leadership is something that must be earned. 1) Explain my project plan to all the affected parties and address the major components of my plans I intend to address all the parties that are going to be affected should my project push through. That is, the nurses, the healthcare assistance, the managers of the ward and the trust. My plan is dependent on the cooperation of each of the above mentioned. I will address the nurses and seek their opinion on the matter since they are directly affected by what my plan entails. They should be okay with the new setup I am proposing to the authority. The same goes for the healthcare assistance. They are the ones required to take over part of the work set apart for the nurses n the morning. Management of course needs to approve my plan before I can even present it to the external parties like the Trust. This is a necessity as I will need to convince the mentioned stakeholders to buy into my idea. Moreover, I will explain the main components of my project, rather what my project would require to be met. The cost The management and the Trust will have to work hand in hand to ensure that the healthcare assistance is compensated for the extra hours that they put into work. Also, if need be the nurses might have to forego a little bit of their money owing to the fact that some of their work will be taken care of by another party. Time The healthcare assistance will need to spare more time in the morning in order to handle the patient observations from where the nurses step off. The Trust will also be required to spare some time to look into the above matter and make necessary financial arrangements. 2) State roles and responsibilities I need to identify the roles and responsibilities that each person might have to do with my project plan, particularly those who have to sign off on various parts and issues. The project sponsor The one who provides capital for the project to kick off will need a full update on the entire plan. This is most probably the management of the ward. The business expert advisors Their advice is crucial before the undertaking of the project as they know better regarding certain matters as this. They should be able to foresee the success or failure of the project before it starts. Project manager I as the project manager already approves of it so there is not much need for me to review the plan. End users These those will be affected directly by the project. That is, the nurses. They should review the project though usually they do not sign off on anything. 3) Organize a kickoff meeting The kickoff meeting is one that assembles together all the stakeholders of the project plan. Discussions about the project are held and each member both the nurses and the healthcare assistance) gets to chip in their idea of what they would like included or excluded from the plan. This meeting would also serve as a show of the management’s willingness and commitment to the project plan should he/she show up. The kickoff meeting is also an opportunity to build team spirit and make necessary ground rules about the project. Roles and responsibilities of each participant are clearly defined should the project push through. The project sponsor, also the management, will give his vision regarding the project plan. 4) Come up with a scope statement This is most probably the most important element of my project plan. Here I will state the problem the nurses have been having and how I intend t solve it. I will write in detail my solution plans and what I expect to achieve at the end of my project. The results must be positive in order to trigger the management’s faith in the project thereby funding it. The scope statement is more of a contract between me, as the project manager, and the management, as the sponsors, and cannot be altered minus the approval of either party. 5) Create a scope baseline The scope baseline has a lot to do with the deliverable of the project. In other words it is the breakdown of the work to be done into smaller and smaller levels or units. Here I will list all the tasks to be carried out as a result of the project. The nurses will be required to carry out their usual patient observations as before save for the last one. Here they are expected to work more diligently than before to cover as much work as possible so that the healthcare assistance won’t have too much work in their hands which was not even meant for them to begin with. Just to be clear, this is the 6:00 hours shift. The healthcare assistance on the other hand also has its work cut out. They should report to work earlier than usual to avoid as much interference with the usual daily routine as possible. This is because early arrival will ensure early commencement of work. Therefore it will all end very fast and the day nurses who start work at 7:00 hours can encounter minimal disruptions from them. I will have to submit a work page to each of the involved parties so that each can know their tasks as to what they are to do and when to do it. 6) Create a schedule along with a cost baseline There are certain steps to follow in the coming up with a schedule and also a cost baseline:- I should create a work breakdown structure by listing down the operations that need to be undertaken in coming up with a work page. Come up with the resources of undertaking each single task. Estimate the time it would take to finish each task in the work page. Identify how much it would cost to fund a certain task. Take under consideration the resource constraints. Observe which tasks depend on the performance of other tasks to create a critical path. Eventually come up with a schedule and finally the cost baseline. I should keep in mind that this is one-step that includes a procedure that is not constant but can change from time to time. 7) Come up with baseline management project plans. After completion of the above steps I will come up with the steps that my project team will require to manage the variances of my plan. In the life of the project plan, there will be suggestions of changes coming from the affected parties. Some of these changes will be put into effect and this might result in a change of the entire baselines. However, not all claims for changes will be put into practice due to various reasons. All the same, there should be a process to take into consideration all the request from external parties and identify how much they will affect the project should they be put into effect. This is what the baseline management project plans are for. 8) Create a staffing plan Though the whole ward is aware of the changes regarding the shift plans, I should come up with an official staffing plan. In this I indicate that the nurses’ schedule does not change entirely but for one tiny adjustment. The nurses will make their usual patient observations as before. However the part that changes is the 6:00 hours patient observation. Due to lack of enough time for the nurses to conclude their last round of this observation, they will be required to stop duty at 7:00 hours sharp as the new shift of nurses commences duty. The last part of the patient observation will be complete by healthcare assistance that will be required to report a bit earlier than usual. 9) Make an analysis of the project quality along with the risks Project quality involves ensuring that what I hope to achieve at the end of my project is up to standard with the expectations of every participant in the project. I should ensure that every party gets satisfied, even the healthcare assistance that is being added a small load of work. Despite all the good plans I have for my project, there is always a may risk that something negative may occur. In my project plan, I face the risk that the time still not be appropriate to complete the work in time not to interfere with the daily routine at the ward. The impact that this might have is that it might slow down the processes of the rest of the day. Therefore to counter this, my suggestion is that we could add a small number of healthcare assistance, maybe one or two to ensure that the disruption to the daily nurses if minimized to the fullest. 10) The communications plan This is one of the most crucial parts of my project plan. I should ensure constant flow of communication surrounding my project. Or this, a communication matrix could come in handy as it acts a store for all the critical elements of my project. For instance, management may want a constant report on the progress of my project and in a specific format an date. In addition, information as to who is allowed access to certain information and who is not. The communication matrix documents certain elements of the project like decisions, daily routine schedule, and methods of problem resolutions. Communication consists of the review and approval process of the project, the various changes that may occur to the project and the specific roles that each stakeholder has in the project. The above summarizes my project plan for the improvement of the nursing services at the National Health Service where I work. However, for the project to push through, leadership is key. As mentioned earlier, the ward I work at has massive leadership issues that need urgent handling. For ensuring the success of my project I plan on seeing to it that the leadership requirements are met. For this, I will include in my project plan the various leadership styles that I feel would be appropriate to run the ward and hope that my suggestions are received positively. Different types of organizations or species are needed in different types of environments (Farmer, 256). Since this project is based on change and how to incorporate it into the current system, the best theory to use is the Lewin theory of change. Goleman leadership style is the most appropriate to apply in our ward’s management. Leadership is often influenced by the behavior of people at the place of work. Their reaction towards the change I want brought about is what matters as it will determine the success of my project. Behavior is a state of dynamic balance of forces working in opposing directions (Lewin, 62). Application of the Lewin concepts i. Driving force According to Lewin people need a drive. That is, a force that nudges them in the direction that leads to the occurrence of change. In my work area, the driving force for the nurses would be that they would not be fined by the QCC anymore because of incomplete patients’ observations. As for the healthcare assistance, the fact that they would earn slightly more money should be motivation enough to get them to accept the change. Management on the other hand would be pleased to know that all the patient observations would be completed efficiently and not in such a rush. After all, the popularity of the ward depends on the satisfaction the patients get out of their treatment. ii. Restraining forces These forces go against the driving forces. They intend to counter the enhancement of change. The nurses might not be willing to forego a chuck of their salary that should be used to compensate the healthcare assistance. Management too might not be willing to encounter the side-effects that come along with change. Generally, change is costly and disorients the balance of the current state. Despite all this, I am driven to make this work. Stages of change 1. Unfreezing. This is where I am expected to find something that will make it easier for the stakeholders of my project to let go of the previous system and make way for the new one. Most people do not like change but with the right motivation, anything can be achieved. I will hold a meeting where I will list all the advantages of the new proposed system as opposed to the old system. In the new system, there is not much confusion. Everybody knows what they are expected to do and at what time. The nurses will not have to be worried of an uncertain fine by the QCC therefore thy will be at ease. 2. Movement In this stage people are more open to the suggested idea and are willing to take a chance on it. Their state of mind changes and this affects their thoughts, how they feel and behavior too. 3. Refreezing Here I am required to get all the stakeholders adapted to this new system. There should be complete transformation from the old system to the new system as if the old never existed. Refreezing is a necessary step to ensure the success of the proposed project. Minus this stage, people could easily find themselves going back to the old routine as it is what they are used to. I believe that by applying the Lewin’s theory of change, people might be more accepting of my project as it makes the changing process sound so simple. To further boost my chances, I will use the Goleman’s leadership styles as they could prove to be very useful in this process of transition. On top of this our leadership at the ward is wanting. Goleman leadership styles Goleman pushed for an emotional approach to leadership. He claimed that a fine leader had to be in tune with the emotions of the people he served. This would enable him understand them better and how they feel about his leadership among other things affecting them. He came up with six ways in which resonance can be created. Thus the evolution of the six leadership styles. Management must be concerned above all else with achieving alignment and goof fits (Lewis, 199). A leader can apply any of the six styles depending on what the situation call for. a) Visionary The leader has a vision in which he believes. He should also make the people feel that they inspire his vision and dream. As the project manager I do have a vision and that is to see that the nurses are not pressed for time that they actually do not have. In addition the patients get their observations without worrying about the commotion that comes along with it at the end. It is the nurses and patients who inspire this vision of mine as my project is all in their service. b) Coaching This involves assisting people in the identification of their various strengths and weakness alike. Then the leader can help the people focus on the betterment of their strengths. The nurses should do their work as efficiently as possible without worrying about the time lapse. c) Affiliative The leader creates a peaceful and harmonious working environment. He is in charge of boosting morale among the workers. This is what I intend to do with the nurses and also the healthcare assistance. I will see to it that they are all okay with the new arrangements and that they can work together without any conflicts arising. d) Democratic As a leader one is required to listen to the input of other concerned parties and take into consideration their thoughts and opinions. I plan to do the same with my project. I will welcome suggestions on whatever changes the stakeholders might want made and decide if it is worth implementing or not. e) Pacesetting As a leader one should be influential, that is, set the pace for those who follow you. I should first of all show the rest that the new system is capable of working in order for them to believe that it will work too. f) Commanding As a leader command is necessary. This is usually mostly in urgent situations when there is no time to explain, just command and the people obey. If need arises when I have to express some kind of authority on my fellow colleagues, I will. All in all, my project plan is a good one. If everything is followed to the latter I really do believe it could work out for the benefit of all. The nurses need a break as they have been under a lot of pressure to perform with very little time available. References BACHER, C. (2007). Contingency theory What are the strengths and weaknesses of the systems approach as used by contingency writers in analysing organisations? München, GRIN BURKE, W. W., LAKE, D. G., & PAINE, J. W. (2009). Organization change: a comprehensive reader. San Francisco, Jossey-Bass. CAMERON, E., & GREEN, M. 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