Implementation of Work-Based Learning and Improvement of Quality in Healthcare Facilities - Literature review Example

Asesiad Myfyrwyr Tudalen Gynnwys Student Assessment Title Page Grwp Group Cangen Branch Rhif Asesu NHS 4226 Assessment Number Rhif Banner Banner Id Côd Asesu Assessment Code Teitl yr Asesiad Implementation of Work Based Learning and Improvement of Quality in Health Care Facilities Assessment Title Modiwl Work Based Learning (MSc) Module Rhif yr Ymgais 1st Attempt Attempt Nifer y Geiriau 4000 Word Count Tiwtor Personol Personal Tutor Tiwtor Arolygol Supervising Tutor Dyddiad Cyflwyno Submission Date Imрlеmеntаtiоn оf Wоrk Bаsеd Lеаrning аnd Imрrоvеmеnt оf Quаlity in Неаlthсаrе Fасilitiеs Introduction The detrimental effects of burnout among healthcare professionals is well established in research (Boamah, Read & Laschinger, 2016), and has been identified as being responsible for compromised quality of healthcare services, patient dissatisfaction, and even high turnover rates among healthcare professionals, particularly nurses, who are the first responders in the emergency department (Alotaibi, Paliadelis & Valenzuela, 2015; Jennings, 2008). However, a work-based learning activity to explore different ways of working could reverse the onset of burnout among healthcare practitioners and even foster job satisfaction and improve the quality of healthcare, which would lead to improved patient safety and satisfaction as well (Elizabeth, Williams, Gakhal, Caley & Cooke, 2012). The ensuing reflective writing examines the implementation of work-based learning (WBL) in a healthcare establishment that could potentially lead to improvement in the quality of healthcare services provided therein. While the implementation of a work-based learning environment in the healthcare organization is an onerous task (Raelin, 2008) and may face numerous challenges, its success could reduce the occurrence of burnout (The Health Foundation, 2012) among the healthcare practitioners, and thus yielding long-term benefits to the workforce and the entire healthcare establishment ultimately. This reflective essay places the journey of implementation of the work-based learning project in the healthcare environment into perspective, while interrogating and validating the implementation process alongside. The essay begins by identifying the problem facing the healthcare institution, which facilitates the establishment of the aims of work-based learning project to the healthcare establishment. Thereafter, the causes of the problem are identified and expounded by providing a detailed background. After that, achievable quality improvement approaches that would be employed to address the issue in the healthcare facility and their justification are discussed. In this case, various quality improvement models will be compared and contrasted in order to develop the most suitable approach that would ensure success in implementation. Finally, the barriers that would be faced when implementing the work-based learning project in the healthcare facility are identified and explained in a reflective style , with recommendations of how these barriers would be managed being discussed as well. The essay will begin with a discussion about the possible reasons to why burnout is so evident in the healthcare system. Indeed, during the entire discussion, efforts have been made not to disclose the identity of individuals and healthcare establishments in addition to maintaining confidentiality of all information sourced from them. What is the problem? The environment being discussed has received numerous complaints from nurses and patients alike the incoherence of systems of working and breakdown of communication, an indication that they are not satisfied by the state of affairs at the facility (McHugh, Kutney-Lee, Cimiotti, Sloane & Aiken, 2011). On one hand, the nurses, in particular, are complaining about excessive workload, extended exposure to stressful events and conditions, and inability to cope with stress (Jennings, 2008). On the other hand, the patients are complaining about lack of adequate individualized attention from the healthcare professionals at the healthcare facility, and sometimes neglect and lack of a warm and friendly atmosphere (Jennings, 2008). Indeed, the emotional state of the nurses in the healthcare facility is characteristic of burnout although many of the nurses may not be aware of it as there is evidence of high sickness levels, demotivated staff and many job vacancies. Various studies have identified the symptoms of burnout and other conditions that are associated to burnout such as compassion fatigue and secondary traumatic stress (STS). For instance, Baydoun, Dumit and Daouk-Oyry (2015) found that sickness and absenteeism was rampant among nurses. In addition, Mudaly and Nkosi (2013) adds that the cadre of nurses complaining about increased workload and technology innovation and invention may have been experiencing the onset of burnout, which was manifested as absenteeism from the health workstations, a reason attributed to the ongoing staff shortage. Further, Sherrignton (2013) in survey of 800 Swedish workers found that 79% of private employees and 64% of public employees attended work with headache. The survey indicated that there was a 21% to 27% decrease in work effectiveness among these employees. Furthermore, Boamah, Read and Laschinger (2016) work-life interferences and short-staffing were primary contributors to nurse staff burnout, poor patient care quality and job dissatisfaction. Evidently, from these research findings, nursing practice is a stressful occupation, a situation I can relate with considering that nurses experience suffering of patients and their families on a daily basis and often feel helpless and overwhelming, particularly when they have to witness a patient in near death situations and sometimes loss of life. From these problems, interventions should be aimed at establishing the process associated with work-based learning implementation and its impacts on the quality improvement at the healthcare facility, the identification of the most appropriate methods and measures that can be put in place in order to implement work based learning and improve on the quality of healthcare services, and the identification of the aspects of quality and the contributions that work based learning concepts can make in improving on the situation. In addition, the aim of the intervention is to employ the most appropriate tools of implementation and justify its choice from a set of approaches that are available. Why is there a problem in the first instance (background information) Burnout among healthcare professionals is an undesirable situation considering that they are expected to deliver individualized high quality healthcare services in a timely manner and often in a short notice (Boamah, Read & Laschinger, 2016). Burnout is the state of being exhausted physically and mentally due to stress (Jennings, 2008). Burnout is manifested as many symptoms such as poor concentration, depression, lack of motivation, regular sickness, extended and extreme fatigue, absenteeism and even exit from the nursing career at the worst (van Mol, Kompanje, Benoit, Bakker & Nijkamp, 2015). Much evidence exists to validate these symptoms and their prevalence among healthcare workers. For instance, Bulman (2013) observed that the nurses facing the problem of burnout usually take too long to complete their activities due to lack of concentration. Other conditions closely associated with burnout are compassion fatigue and secondary traumatic stress (STS) and they can occur in isolation or in combination as well (Newell & MacNeil, 2010). Indeed, burnout compromises the delivery of high quality healthcare services by nurses and other healthcare workers (McHugh, Kutney-Lee, Cimiotti, Sloane & Aiken, 2011). In fact, the problems associated with poor handling of patients as well as some of the medical errors which have negative impacts on quality are associated with the burnout among the nurses (McHugh, Kutney-Lee, Cimiotti, Sloane & Aiken, 2011). However, providing for debriefing sessions, opening channels of communication and holding simple special events for the nurses may help motivate then and improve stress management (Happell, et al., 2013). According to Burnes (2014) public image of the healthcare facility is impacted negatively in the event of poor quality of service. A hospital or clinic that in which healthcare services are perceived as lacking in quality through events such as medical errors, unfriendly healthcare workers, lawsuits, extended hospital stays, and patient deaths among others, gain a poor reputation (Burnes, 2014). Once a healthcare facility is perceived negatively by the patients and the community, it experiences difficulty in convincing people that it can offer high quality healthcare services and also is unable to attract highly qualified healthcare personnel as well. Such poor perception is difficult to redeem and may even result in the closure of the healthcare facility if not remediated early and sustainably (Burnes, 2014). Indeed, I have noticed that many healthcare facilities experience difficulties in keeping abreast with the changing healthcare environment and new developments as well. In the healthcare setting, new challenges keep emerging from time to time due to various factors (Cottrell, 2013). For instance, new approaches to care, advanced technologies and discerning patients are some of the challenges that healthcare facilities face. Indeed, Cottrel (2013) observed that the hospital environment was also changing with the introduction of new technological machines and equipment. Unfortunately, nurses are expected to adapt to these changes seamlessly. Indeed, implementation of a work-based learning environment at the healthcare facility is a huge undertaking because it requires a transformation of the organizational culture of the healthcare establishment, total support from the management of the healthcare facility and participation of the entire nursing fraternity within the healthcare facility. However, for the proposed work-based learning project for the healthcare facility, an achievable intervention could be achieved within the confines and limitations I had. Specifically, I decided on come aspects at the workplace that could be implemented, which could still employ work-based learning principles, and thus end up improving the quality of service at the healthcare facility in addition to contributing to the prevention and management of burnout among nurses at the facility. Clearly, burnout among nurses and the quality of healthcare delivered in a healthcare facility are closely related (Duffy, 2013). Therefore, as ways to eliminate or at least reduce the occurrence of burnout at the facility were being considered, it is not possible to ignore the healthcare quality issues that are associated to compromised healthcare services. Different aspects of quality at a healthcare establishment can indicate what is working at the healthcare facility and what is not, and thus can be a pointer towards areas in the facility that need attention for remediation. For instance, long patient waiting lists are indicative of lack of equipment or breakdown of equipment needed to treat the patient problem, a deficiency of medical personnel, poor planning, lack of leadership, and poor communication with patients and a myriad of many other quality related issues (Batalden & Davidoff, 2007). Therefore, to identify which quality issues are compromised by a problem, it is pertinent that the associated quality of healthcare can be measured. In this case, burnout can present specific observable and measurable quality issues such as lack of sufficient nurses due to chronic absenteeism, misdiagnosis and erroneous medication due to lack of concentration, or increased nurse turnover due to job dissatisfaction (Mudaly & Nkosi, 2013). To this end, it is pertinent to first identify the quality issue caused by the problem, in this case, the problem of burnout. One way of identifying quality issues is by identifying the category to which the issues fall, which can be either in the underuse category, the misuse category or the overuse category (Teleki, Damberg & Reville, 2006). Indeed, the effectiveness and success of a healthcare facility is gauged by the quality of healthcare it provides. Therefore, considering quality issues in a healthcare environment is pertinent because people need the assurance that their taxes that are dedicate to health by their governments are being used prudently and that the services from the healthcare facilities reflect the value of the investment a made. In other words, there is need for assurance that the investments in healthcare produce acceptable returns in terms of the desired healthcare outcomes among patients and populations. From another perspective, quality issues justify any increase or reduction of investment make in a healthcare facility. For instance, such issues can be a pointer to where investments for improvement should be directed to raise the healthcare quality. Indeed, considering that resources allocated to healthcare are always never sufficient, and continue dwindling with time, the few resources available need to be used prudently. However, for maximum benefits of the used resources to be realized, such resources should be directed to the most critical issues that need to be addressed first or those that have a large spillover effect on the services provided at the healthcare facility (Batalden & Davidoff, 2007). The normative re-educative model for improvement provides a suitable avenue for addressing the quality issues emanating from burnout at the healthcare facility (Bordia, et al., 2004). The root cause analysis and the fishbone approach are two approaches by which the model for improvement can be implemented at the healthcare institution, although I would opt for the fishbone approach also known as the Ishikawa approach, for its ability to solve a complex problem such as burnout (Card, 2013). In using the fishbone approach, which is a cause and effect analysis approach, I would undertake four steps (Kruskal, et al., 2011). The first would be the identification of the problem, which in this case is burnout, which is presented with a myriad of other problems such as medical errors, absenteeism, and nurse turnover. The second step would be the working out of the major factors involved, which in this case would be issues that as fatigue, lack of motivation, and job dissatisfaction among others. The third step would be the identification of possible causes, which in this case would be limited knowledge of how to handle workplace stress, poor communication among staff and between the staff and the healthcare facility administrators and managers, poor scheduling of duties and shifts, inability to use technology at the healthcare facility, among others. Finally, I would perform an analysis of the fishbone diagram obtained. This would help present a wide variety of solutions that can be implemented depending with the capacity of the healthcare facility. What Quality Improvement approaches will be used and why to address the issue. Health care quality is ‘the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’ as defined by The Institute of Medicine (Pelletier & Beaudin, 2008). Therefore, to enhance quality, care need to be based on the most robust and up-to-date clinical evidence, should be delivered in a manner that exhibits cultural and technical competence, and should be accompanied by shared decision-making and effective communication (Pelletier & Beaudin, 2008). The desired goal of quality improvement is the attainment of total quality, which comprises of attitudes and orientations that permeate the whole healthcare organization and the manner in which business is performed both internally and externally. Therefore, people working in a total quality work environment strive for continuous quality improvement and excellence in all their undertakings. However, the object of this project was to improve the quality of healthcare in the facility through solving the problem of burnout among nurses. Due to the complexity of this problem, the healthcare facility should strive for continuous quality improvement that would eventually lead to an organizational change in the end. According to Batalden and Davidoff (2007, p 2), quality improvement is, ‘the combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development’. Therefore, quality improvement should be undertaken incrementally with the aim of attaining total quality. The proposed work-based learning project would facilitate the improvement of quality of service and thus address the problem of burnout in nurses at the healthcare facility in a comprehensive and sustainable manner (Pelletier & Beaudin, 2008). According to Hardacre and Schneider (2007) work-based learning can be termed as learning while working. Learning may be within or outside the work environment with an aim of improving performance in a given workplace. Within the healthcare environment, work-based learning has the potential of meeting the healthcare practitioner’s needs through promotion of practice driven learning. Such learning would enable nurses to pinpoint the positive aspects of their experiences, articulate learning with assessment needs and link learning to practice. Indeed, nurses need to update the knowledge and skills from time to time in order to improve on their ability to deal with emerging challenges (Burnes, 2014). Therefore, continuous training and learning is thus an important aspect that needs to be put in place to improve on the skills of the nurses, which would have a positive influence in the improvement of services at the healthcare facility. Service improvement is an important aspect of quality in the healthcare sector. However, service improvement is a continuous process, and it therefore requires a follow up and evaluation of the work based learning activities to ensure that it is successful (Fitzpatrick, 2013). In addition, the service improvement activities need to be supported by policies to ensure effectiveness and efficiency, thus requiring the total support of the management of the healthcare facility. From this perspective, the management have a role to play in improving on the working condition by embracing flexibility, which is vital in improving in promoting the work-based learning process and solving the quality problems. In addition, the management can offer nurses sufficient work based learning opportunities, which is vital in ensuring that they are able to carry out their duties effectively. Further, the management can put in place measures to ensure that resources are available and change management process is supported (Fitzpatrick, 2013). Indeed, working towards a quality based healthcare system through the implementation of a work-based learning environment has numerous benefits, which include enhanced stress management, motivation and job satisfaction, reduced medical errors and nurse turnover and increased patient’s safety and satisfaction (Jenning, 2008). For instance, Alotaibi, Paliadelis and Valenzuela (2015) found that educational opportunities among nurses and having equity policy drivers in the workplace would ensure more job satisfaction. In addition, Jenning (2008) observed that to embrace WBL and quality improvement in healthcare facilities, effective leadership had to be embraced. Moreover, nursing input can be both motivated and enriched via WBL skill mix provision whether formal or informal (The Health Foundation, 2011) . Various quality improvement approaches need to be considered in order to ensure that the intended work-based learning environment is created at the healthcare facility ultimately to eradicate the problem of burnout among nurses. However, the best approach can be determined by undertaking various analyses such as the cause and effect analysis. Duffy, (2013) points out that a better understanding of the cause as well as the effects can be obtained by using the cause and effect diagram. The cause and effect diagram enables the use of simple steps when analyzing the problem and hence leading to the most appropriate solution (Berends & Crinall, 2014). Luckily, the cause and effect diagram does not require much expertise to use and hence it is relevant in the present situation in which expertise and experience may be lacking. Ultimately, in order to improve on the quality of services in the healthcare facility, detailed information about the problems and processes is required. In this case, burnout among nurses at the facility is caused by work overload, poor scheduling of tasks and duties, and ineffective communication among nurses and facility administrators. The solutions identified include the provision of breaks within the shift, the availing of a suggestion box, and having regular debriefing sessions with the nurses. To this end, the Plan, Do, Study and Act (PDSA) approach is the most appropriate clinical practice improvement model as recommended by Hewitt-Taylor (2013). To ensure that this model works, the implementation of the practice change has to focus on various issues including training of the personnel. Therefore, at the onset, adequate information regarding the need for change has to be provided to the stakeholders in order to avoid any incidences of resistance to change. This would be done by having brainstorming sessions in which nurses, administrators, and other healthcare professionals share their experiences and cite the challenges they face that may be compromising the quality of service at the healthcare facility. These sessions would not only unearth the current position but also come up with possible solutions that can be implemented incrementally. Indeed, leadership that employs transformational, mentoring, coaching and participatory approaches is pertinent to ensure that the discussions are focused to the problem and the intended position after implementation of the quality improvement solutions. In addition, measurements of the changes among the nurses will be done to evaluate the effects of changes (The Health Foundation, 2012; Michael, Schaffer, Egan, Little & Pritchard, 2013). Such parameters of measurement will include patient satisfaction, absenteeism, presenteeism and mortality reduction among the patient (Jones, et al., 2012). These parameters will be evaluated versus the model for improvement (Aims, measurement & ideas, hunches, other people etc.). As such, an evaluation mechanism on a quarterly basis is also required to ensure that the process is successful. After a roadmap to the implementation of the solutions has been formulated, immediate implementation should ensure. This would be facilitated by having teams of nurses undertake the implementation of the solutions. I have noticed that working in teams enhances collaboration, focus and motivation. Indeed, the debriefing sessions would provide extra opportunity for nurses to learn from each other’s experiences and evaluation of the progress in a continuous manner. In addition, any challenges met during the implementation process would become unearthed thereby providing opportunity to modify the approaches used. What barriers may I face? The implementation of the quality improvement of nursing practice through provision of breaks, the availing of a suggestion box, and the implementation of regular debriefing sessions, in a manner that would facilitate the utilization of work-based learning may experience numerous barriers. Indeed, the change process is prone to various challenges that can be associated with various stakeholders as observed by Gopee and Galloway (2014). Specifically, the barriers are situated in the nurses themselves, the management and the healthcare facility as well. Indeed, I felt that many healthcare professionals are ill prepared for the stressful working conditions often found in healthcare facilities upon graduation from medical and nursing schools, a situation that suggests that these healthcare professionals have much more to learn about their workplace environment. Worse still, many healthcare facilities are poor at easing the stress experienced by the healthcare professionals operating therein with many claiming to be strained in resources required to foster experiential training that would ensure that these professionals are able to cope with their workplace stresses adequately enough to foster compassion satisfaction and elevate job satisfaction as well. In addition, other healthcare facilities lack capacity to mentor newly recruited nurses to help them cope with the stressful working conditions that they would encounter in the course of their nursing practice. One of the barriers that need to be overcome would be possible resistance from both the nurses and the healthcare facility management, who are the key stakeholders in the healthcare facility. This is supported by Duffy (2013) who observed that resistance to change by the major stakeholders is one of the main challenges that may affect the implementation process has emphasized this challenge. Specifically, nurses may resist taking time off their schedules to attend debriefing sessions for fear of victimization by the management of the healthcare facility and due to reluctance to leave their workstations and patients. In addition, the nurses may display reluctance in making suggestions through the suggestion box, particularly those that may be scathing to the management and critical of workplace processes and conditions, for fear of victimization as well. However, I would address the nurses concerns by employing effective communication, mentoring and coaching skills to emphasis the benefits the nurses would accrue from participating in the suggestions. I would also motivate the nurses by having regular feedback sessions in which positive outcomes reported by nurses who comply would be applauded and where experiences would be shared freely. Concerning the debriefing sessions, I would guide the nurses to develop their own stress coping mechanisms from the information shared from their experiences. Equally, the management may resist providing breaks and availing debriefing sessions citing them to be wastage of valuable time that would otherwise be used to attend to patients. In addition, they may make the suggestion box ineffective when they are reluctant to go through the information therein or they refuse to discuss and act on the issues raised by citing lack of time. Therefore, to encourage the management to undertake and encourage the practice changes, I would use my analytical skills to justify the cost effectiveness of the project and my negotiation skills to elicit support due to the benefits that would be accrued in the long term. In this aspect, the Lewin’s theory of change management in collaboration with the model for improvement, root cause analysis and fishbone approach offer valuable insights that would inform my approach. Specifically, main objective is identifying factors likely to impede change from taking place, including the static forces and driving forces that spur or promote change (Heward, Hutchins & Keleher, 2007). Indeed, I would need to have an elaborate comprehension of the workplace atmosphere and environment at the healthcare facility in order to come up with the most appropriate leadership approaches to help implement the proposed practice change (Mitchell, 2013). Conclusion This project set out to reflect on the implementation of healthcare service quality improvement through the provision of breaks, the availing of a suggestion box, and the implementation of regular debriefing sessions, which are meant to remedy the problem of burnout among nurses. The Plan, Do, Study and Act (PDSA) approach was the clinical practice improvement model employed because it leveraged the cause and effect analysis approach, which was pertinent for dealing with burnout, a complex problem. While resistance from the nurses and the administrators in the healthcare facility was projected to be the major barrier to the implementation of quality improvement, leadership approaches that employ coaching, mentoring, participation, collaboration and transformation were recommended as being most effective in guiding the practice change process. References Alotaibi, J., Paliadelis, P.S. & Valenzuela, F. (2015). Factors that affect the job satisfaction of Saudi Arabian nurses. 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