Service Improvement Plan - Essay Example

?Service Improvement Plan Executive Summary District nurses face a lot of challenges in their work. One major challenge in this respect is heavy workloads that come with insufficient rest, stress and related problems. This problem can however be solved if the number of referrals that come their way is reduced. This can effectively be achieved by establishing a criteria for referring patients to district nurses such as through the application of a checklist or referral criteria. In order for the project to be successful, hospital staff and management support will involved in the implementation process. The project involving nurses at the district and ward levels will involve filling of the checklist before referrals are made to district nurses. A pilot study will be done to establish the effectiveness of the proposed criteria before necessary changes are made to improve the criteria and associated processes. Evaluation of the project will be based on the number and type of referrals to district nurses after the implementation of the criteria in comparison to data obtained before the institution of the project. Introduction Several changes have been witnessed in nursing practice at the district level over the last couple of decades. Some of the changes that are evident include the introduction of new technologies to help in nursing, the rise in morbidity rates, and the increase in mortality rates. Yet another major change in the same respect is the attendance to more complicated cases in the community. With this being the case, it is beyond doubt that the nursing fraternity in the district has become overloaded which has effectively increased the stress levels experienced by the nurses. In order to solve this problem it is proposed that a District Nurse Checklist be created and instituted for use in deciding whether or not a patient should be referred to a district nurse for care. The proposal will rely on a SWOT analysis of the proposal considering its effectives in predicting the internal and external forces that may affect the success of the project. During implementation, the PDSA cycle will be applied considering its effectiveness, limited resource requirements and limited risk association. Analysis of Change Needed According to the Royal College of Nursing (2003), a major problem facing district nurses is the huge number of referrals that they have to handle. More specifically, the problem is seen when such referrals are uncalled for. Clover (2010) notes that for every single inappropriate referral to a district nurse, close to five hours of precious time is lost. A study conducted in the past revealed that several patients were discharged from hospital with community nurses taking little or notice of the events (Clover 2010). The study further revealed that several cases of referrals were inappropriate and therefore had to be re-routed or altogether declined. It must be taken into account that there are several alternatives that can effectively be applied to ensure proper home are to patients who have been discharged. Some of these alternatives according to Vafeas (2000) include practice nursing, visiting clinics and making outpatient hospital visits. A report by the Audit Commission (1999) reveals that of all referrals to district nurses, 11% are unwarranted. Practical experience during clinical practice as a member of district nursing teams has shown that inappropriate referrals are associated with a lot of time and resource wastages. What this means is that without a proper referral criteria that assists clients and other health practitioners in deciding when and when not to effect a referral, the situation is bound to get worse. In effect, when a referral criteria is developed, various parties will better understand their responsibilities and roles, the district nursing service will enjoy greater credibility, and health practitioners will be encourage to work in unity. Health practitioners, patients and clients among other parties should appreciate the reason for the establishment of the district nursing criteria one it is instituted. The New NHS, Modern, Dependable’s developing primary care groups of 1998 is dedicated toward ensuring simplicity and effectiveness in service provision (Department of Health 1998). The mission of the policy is to encourage collaboration between members of multi-disciplinary teams in the provision of healthcare. The development of strategies and measures that will see different players in the healthcare sector engage in collaborations to a greater extent is surely in line with the policy. The development and implementation of referral criteria is in line with the policy as it will see nurses at the ward and district levels manage their work better. The NHS seeks to adopt methods that will achieve improved performance in its pursuit of world class standards (Department of Health, n.d.). The NHS therefore finds it important to focus on safety and quality without forgetting about efficiency and personalization of services. The proposed referral criteria is in line with NHS’ policy of continuous improvement as patients who are in need of specialised services will receive such services as provided by a less burdened workforce. Proposed Solution to the Problem In order to solve the problem currently facing the district nursing staff, a District Nurse Checklist should be generated for use by staff nurses stationed in the different wards that serve the district. Such a measure will ensure that referrals are correctly made. Furthermore, it will make patients understand that the care and service they are given at their level is appropriate. The checklist would be made of a flow chart that provides direction on the course to be taken in case of a yes or no answer to the guiding questions. With the help of the checklist, the nurse will be advised on whether a particular patient should be discharged, is fit for outpatient care, or their case should be escalated to another level for appropriate care. Essentially, the checklist will be helpful in developing a picture of the kind of services district nurses offer and which kind they offer not. Better said, various parties will be able to tell which kind of treatments the district nurses are supposed to give such as housebound and palliative care. It is important for health practitioners to keep records regarding their patients and their needs. In this respect, the referrals should include such details as the names of the patient, their date of birth, address, contacts of their general practitioner, personal contact details and specific nursing needs. The checklist should provide that district nurses should attend to patients who are house bound or in cases where home visits are absolutely necessary. This group will consist of patients who can only leave their places of residence by ambulance. SWOT Analysis Strengths The successful implementation of the checklist program will significantly cut costs currently being experienced by the NHS District Services Time saving for the district nurse Correct service delivery to patients Weaknesses Some staff stationed at the ward level may fill the checklist wrongly or may fail to rely on it altogether Increased amount of paperwork to nurses Opportunities The proposed criteria may be applied in other areas of referral such as occupational therapy and physiotherapy More efficient service use realised if the criteria is properly used. The proposal may be universally applicable in the country if it is successfully implemented. Threats Staff may fail to comply with the proposed solution While intended to ease workload on nurses, the proposed solution could do the opposite Time and resource constraints for the full implementation of the plan The implementation of the project requires capital which may not be availed by the government hence hampering progress. Some parties may go to court seeking to have access to district nursing care against the guidelines of the checklist thereby stopping its use. Action Plan and Evaluation Strategy During the implementation of the proposed project, PDCA will be applied. PDCA is appropriate considering that it enables the testing of changes before they are wholesomely implemented. Furthermore, it allows stakeholders evaluate the practicability of the proposal. Yet again, it is safer and more efficient when it comes to small sale testing of improvements before their full implementation (Basau, 2004). Testing before implementation involves the use of less resources and time and posses less risk and is bound to face less resistance. Yet again, the process is an effective learning tool that is safer and less disruptive in its application. The PDCA cycle involves four major stages: Plan, Do, Check and Act in sequential order (Basau, 2004). The fist stage involves establishing the aims and processes to be executed so as to get the anticipated results. The second stage involves the actual implementation of the plan and data collection. The check stage involves evaluation or analysis of the data before and after the change has been implemented so that a conclusion regarding the effectiveness of the proposal can be drawn (Basau, 2004). The last stage involves taking corrective actions with respect to the root causes of errors. The corrective actions are taken to improve the process or product. Plan Establish the Objective: To establish a checklist that will help in reducing the cases of unnecessary referrals to district nurses. Establish elements of the referral criteria Set up a multi disciplinary group that will present diverse views Identify a team leader Garner executive, management, and board support Do Create referral criteria draft Inform all stakeholders about the new criteria Perform a thorough audit of inappropriate referrals per month based on type and number Conduct pilot criteria for six months Check Analyse the difference between the number and types of referrals before and after the implementation of the checklist/criteria. Act Make necessary changes to ensure better service and higher efficiency Implement the new changes Leadership is a critical aspect in the success of any project (Lussier & Achua, 2009). There are several leadership styles that people apply each with its advantage and disadvantages. Some of the leadership styles commonly applied at the organizational level include democratic and autocratic (Lussier & Achua, 2009). A democratic leader involves followers in decision making while an autocratic leader makes all the decisions alone and expects followers to follow instructions. Autocratic leadership should be applied where staff members are well motivated, for short durations and in rare occasions (Lussier & Achua, 2009). A person to lead the implementation of the project will be hired. The person will have to be an employee of the hospital. The person will need to provide input for half a year to see the results of the pilot study. Link nurses will be trained on how to use the proposed criteria and they will be asked to train nursing staff in their wards on the same. In order to ensure that the tool is being put to appropriate use, weekly audits will be conducted during the first two months and thereafter such audits will be conducted monthly. At the ward level, efficient leaders will be appointed. A link nurse will be appointed from among the staff nurses. The staff nurses are chosen for this post considering that they involve more with the care of patient and will most probably be the ones in charge of filling out the referral forms. A nurse who mostly applies the autocratic leadership style and has good leadership qualities will be appointed leader to tell other staff members on how the tool should be used. A democratic leader would not be appropriate as the members of staff have no say in how the project will work. They will only be required to follow what has been established already. The leader will have to be confident and respectful of the other staff members and consistent in their style of leadership. Their followers will have to understand the tool before its enforcement, providing feedback regarding the effectiveness of the checklist once it is implemented during the pilot study. Conclusion The aim of the service improvement proposed is to reduce inappropriate district nurse referrals which by extension will result in cost cuts and reduced waste of resources. The proposal is also expected to bring a rise in clinical time for more efficient patient care and lower the rates of referral. References Audit Commission, 1999, First assessment: a review of district nursing services in England and Wales. London: Audit Commission. Basau R., 2004, Implementing Quality: A Practical Guide to Tools and Techniques : Enabling the Power of Operational Excellence. Cengage Learning EMEA, New York. Clover B., 2010, Botched referrals cost district nurses five hours each, Viewed from http://www.nursingtimes.net/whats-new-in-nursing/primary-care/botched-referrals-cost-district-nurses-five-hours-each/5020576.article [Accessed 5 October, 2012] Department of Health, 1998, Developing Primary Care Groups, HSC 1998/167, London, The Stationery Office. Department of Health, n.d., The NHS Improvement Plan, Department of Health, London. Lussier R. & Achua C., 2009, Leadership: Theory, Application, & Skill Development. Cengage Learning, New York. Royal College of Nursing, 2002, District Nursing: changing and challenging. A framework for the 21st century. London: RCN. Publication code: 001 786 Vafeas, C., 2000, Referral criteria, Nursing Standard, Vol. 14, No. 45, pp. 39–41 Appendix 1: Timetable Action Time in Months 1 2 3 4 5 6 7 8 9 10 Establish the Objectives and plan the project Set up a multi disciplinary group and Identify team leader Garner executive, management, and board support Create referral criteria draft Inform stakeholders of the criteria Audit of inappropriate referrals per month Pilot Study Data Analysis Make necessary changes the criteria Implement the new changes Read More