Clinical Governance in Adelaide State Hospital - Case Study Example

Clinical Governance in Adelaide State Hospital Name Institution Introduction and Unit Description: The Adelaide Nursing Unit (ANU) is a significant nursing unit within the Adelaide State Hospital (ASH), in which I have started working as the new nursing unit manager. The hospital is located Adelaide state town in Southern Australia. The nursing unit was started in 2003 and is big enough to accommodate a total of 60 nurses, who are regularly deployed to various departments within the hospital to offer their nursing services. The nurses share offices in pairs with the exemption of the unit manager and his assistant, who have got individual offices assigned to them. Some of these nursing offices are located in various medical departments within the hospital, mainly, to avoid congestion within the nursing unit and also to accommodate the nurses on duty. This also ensures quick responses by nurses especially during emergencies in different units. The larger part of the nursing family often work in the accidents and emergency unit because of the nature of services offered in that unit. Other core departments that require a lot of attention from the nursing unit includes paediatrics, wards, theatre, physiotherapy among others. These units and others keep our nursing unit open and busy 24 hours a day. Because of the fatigue associated with our nature of duty, we have strategized so as to ensure our nurses remain active and effective throughout the day by creating shifts among them. This means that some nurses (majority) work during the day while others work at night. The reason for more nurses during the day is because most of the times, the hospital experiences higher patient inflow during daytimes than at night. Other offices and personnel are incorporated in the Adelaide nursing unit to aid in service provision of by the nurses. These includes security officers, kitchen attendants and cleaners among others. The major roles played by our nurses include attending to emergency services such as accidents, looking after the patients and their welfare and reporting to the doctors the patient progress among others. As the new elect unit manager, I have chosen to employ clinical governance and its framework to analyse and evaluate some models in the unit such as workforce systems, clinical care and risk and quality systems. This is to help me in devising the proper plan and strategies for the upcoming year. Clinical Governance Systems in the Adelaide State Hospital: Accountability: This specifies whom is responsible for what and to whom they are answerable. This is not easily attainable in the health care world as much as it may seem simple from the outer perspective. For instance, the clinical professionals are accountable to the executive groups, registration boards and even to their patients. These boards and executive groups tend to hold the accountability of managers and clinicians on human resource and financial management, professional conduct among others [McS07]. However, during times of shortage in clinical professionals, these boards tend to withhold their exercises on accountability with the fear that some professionals may leave the public sector to start their own private clinics. Despite this fact, the clinicians are still held accountable for the quality and standards of services they deliver. Patients on the other side demand high quality and standards of services from their clinicians[Bra08]. In Adelaide, the aspect of accountability especially to the registration and executive boards is upheld, with almost all health care professionals being registered to the national bodies that oversee their performance. This includes all the nurses in my unit, who are registered by the nurses’ registration board of Australia. Ethics: This entails timely delivery of services to patients in an appropriate manner so as not to harm them in any ethical manner. This also covers service delivery within budget demands, thus executives and registration boards ought to ethical values in their places of responsibility by acting fiscally responsible. Governing bodies are also urged to keep up in vigilance and insist on promoting proper values and standards [Bra08]. According to the daily customer responses in our clinical reports, most of them are regularly satisfied with ethical conducts of their health care practitioners within the Adelaide State Hospital. This implies that the practitioners employ proper ethical values as much as the patients are concerned. Frequent visitation from various governing bodies responsible for various departments are done every month by different bodies’ officials so as to ensure proper ethics and code of conduct among the staff. The nursing unit is never side-lined during these exercises since our nurses are also vetted accordingly. Managing Performance: For a good management practice, both individual and group performance needs thorough reviews on regular basis according to the overall mission of the organization. Generally, performance management tend to harmonize the individual and group goals with the overall organizational goal [swa04]. It also shows the output with respect to the input of the personnel. A good system of performance management covers all performance details including what and how it is attained, and the extent to which it is achieved. It should be rather encouraging and developmental than a disciplinary and retributive tool [Bra08]. In Adelaide state Hospital, this tool has been out in place to ensure achievement of better results. This is mainly exercised through frequent departmental meeting, in which individual staffs are allowed to interact and give their views on various aspects of the hospital including the probable causes of failures and the possible ways out. Questionnaires are also formulated occasionally to collect the staff and patient ideas and reactions to certain critical issues, which are then put integrated to come up with a good plan for the future. The nurses are also allowed to participate in this practice and executives and boards ensure that things take the right course through proper supervision and participatory performance management. Risk management: According to the Victorian Managed Insurance Authority, risk management entails sequential and logical identification of risks, quantification of their impacts and addressing them in line with the stipulated acceptable limits. Health risks may range from financial, organisational, plant and equipment, patient safety and occupational health safety among others. Therefore, it is highly recommended that executives and boards responsible should ensure the establishment of proper plan and strategy for effective risk management [Bra08]. In Adelaide State Hospital, a number of measures have been put in place to cater for risks that may occur in the course of work. Firefighting equipment and extinguishers have been installed at various stations and departments within the hospital to ensure a quick and effective response during fire outbreaks. Numerous emergency exits, fire alarms, smoke detectors and fire assembly points have also been devised for the same purpose. Most of the wards especially the critical ones have been installed with alarm systems and CCTV cameras beside the patient beds for communication and monitoring of patients at all times. Two wards have also been set aside for responding to emergency cases. Our nurses have also been integrated into this system and are being trained on risk and disaster response and management. Despite the commendable efforts input by the Adelaide hospital management and its staff, a number of loopholes can still be perceived from various angles. Such need to be filled with immediate attention for the better result attainment. As the new nursing unit manager, I have come up with a number of ideas relating to clinical governance that I will put into practise, and with the help of my able nursing team and other willing personnel, I hope more satisfactory results await. Continuous education: This entails lifelong learning characteristics among individuals to ensure continuous improvement in the quality of services and care within the serene hospital environment. It is quite obvious that new knowledge and inventions keep emerging in all fields including the health sector. Therefore, it is rather proper for both individuals and organizations to get access to continuous learning practices to enable them upgrade their skills, ideas and technologies [swa04]. This includes various health practitioners who need to remain in the educational field so as to improve their service delivery to patients [Bra08]. I will do all that it takes to ensure that all the nurses under my watch get a chance to further their studies through allowing them to attend part-time classes. I will establish campaigns and programmes to amplify the need for continuous learning among the nurses and even other hospital staffs. Public forums, posters and flyers will be availed to this effect. I will ensure that I always present this issue before the board of hospital directors to convince them to organize for regular training of the staff on various ways to improve their service delivery, and if possible, to organise for academic scholarships as a way of motivation to the staff. Occasionally, I will give offs to those nurses who prove to be serious in academics. In order to demonstrate leadership by example, I will take part in the programs as the first continuous learner. Qualified Privilege: This mainly constitutes benefits given to clinical professionals when they occasionally meet to share their experiences about patient issues and information that could help to improve their performance [Wri03]. Such information is then expected to be kept a secret by the concerned parties although a lot of considerations are normally made to make things better. However, some professionals tend to be reluctant due to fear that such shared information might be exposable in later legislatures. It is globally accepted that all committees in charge of quality improvement have the right to qualified privilege, hence information acquired by the committee during its review process cannot be disclosed [Bra08]. With effect to this, I will launch the ‘Nursing Book of Improvement (NBI)’, which will be filled on at the end of every month with reports on challenges of the previous month. I will appoint a panel of 5 nurses who will undergo an oath to see to it that the book is safely kept and appropriately filled by end month, and that its content is not let out to any person. I will also withdraw some of their duties so as to give them enough time to go round all the hospital departments to gather information on both staff and patient challenges relating to the nursing unit. In order to come up with proper recommendations, I will organise for monthly meetings at the beginning of every month just to discuss the previous months’ challenges and then suggesting the possible ways out. All the nurses will participate in these meetings and they will be forewarned against disclosing any crucial details to unrelated persons. Credentialing medical practitioners: All the health clinicians should be credentialed according to the Australian Commission on Safety and Quality in Health Care. This board seeks to improve the staff credentialing process and to stipulate the clinical practice scope [McS07]. Reports show that it aims at ensuring health care provision only by well qualified and acceptable personnel so as to avoid any unnecessary misfortunes due to gambling with human life [Bra08]. In my reign as the head nurse, I will start by directing all the nurses and other officers in my department to submit copies of their credentials to my office for confirmation of their legibility. Any unqualified individuals will be kicked out of the nursing department with immediate effect. Those officers who might not have registered with the appropriate registration boards will be given time limit to do so, failure to which they will be replaced with more appropriate people. Promotion of nurses and other staffs in my department will strictly be done on merit and no favouritism will be tolerated. Improving information sharing: Information is said to be power. A lot of health care institution contain a great deal of information sources but it is quite clear that very few of them make use of these sources so as to improve their services. Some sources such as inpatient and outpatient units, client profiles and health status, finance, human resource and accounting offices among others provide very vital data that can be turned into useful information to help in the hospital’s strategic planning [Bra08]. I will be on the forefront to make sure that the hospital management make use of such information by the end of every year to avoid repetitive mistakes. I will also help to ensure installation of computer sets, reliable internet and desk telephones to aid in communicating with other departments. I will also request for all the information related to the nursing department to be availed to my office by all the other complementary departments for analysis, manipulation and integration into a good plan and strategy for the future. This will be a lot of work and hence will call for a hand from other nurses. Using audit: This generally refers to regular assessments aimed at improving the quality of service delivered by the system in question [Wri03]. In the health care field, auditing is done to alleviate care for patients and generate better results through a series of reviews in terms of patient care against mode of administration of such care, and then adopting the positive changes in the system. Boards and executives ought to ensure a widespread of clinical audit at regular intervals despite the fact that they are performed by clinicians [Bra08]. As the nursing manager in Adelaide State Hospital, I will put it as a reminder that clinical auditing be performed several times every year to ensure thorough assessment of every department. I will personal audit my nursing department thoroughly, at least thrice a year, during which all the nurses will give account of every duty, time and equipment assigned to them. I will reward the nurses according to their performance through off increment and longer working hours for the culprits. This I believe will send a message to all nurses and even members of other departments hence they will be up on toes to work for a better hospital. Conclusion: From the discussion, it is vivid that Adelaide State Hospital is a great health institution with a lot of health management principles already in operation. However, a lot more needs to be done in order to achieve better results in the future including auditing of the departments, improving information sharing among departments, credentialing medical practitioners, presenting them with qualified privileges and allowing them room for continuous education. I will ensure all these are put in place during my reign as the hospital’s head nurse. (Word count = 2441) References: McS07: , (McSherry & Pearce, 2007), Bra08: , (Braithwaite & Travaglia, 2008), Bra08: , (Braithwaite & Travaglia, 2008), swa04: , (swage, 2004), Wri03: , (Wright & Hill, 2003), Read More