The Quality of Healthcare: Developing an Implementation Plan - Essay Example

Developing an Implementation Plan al Affiliation Healthcare is one field of stability that can never be neglected by any group of people. This is because any failure in the healthcare sector has far reaching consequences directly and indirectly to the economy, as well as the sociopolitical stability of any country. The quality of health care depends largely on the workforce available and how this workforce is suited, technically and personally to the job. As such, a big issue in the health sector all over the world has been the lack of enough staff to cater for the available workload in the hospitals and other related healthcare settings. The nurses, being one of the most crucial partakers in healthcare are one of the most affected by staffing issues and staff shortages. According to Institute of medicine (IOM 2010) the major tasks performed by nurses in the hospital setting are related to direct care of patients, drugs administration and documentation. With the increased shortage issues, there is little time spent on the most important task, direct patient care. Hinno et al., (2012) assert that the lack of enough nurses in the field leads to neglect of important duties and thus compromise the quality of care given (Hinno et al., 2012). The staffing issue is, therefore, an important consideration in healthcare. This paper is focused on developing a strategized implementation plan to address and improve the nurse-patient ratio in pediatric trauma center in Lehigh Valley Hospital in Pennsylvania. The preparation of an implementation plan will first have to collect data regarding the problem from the nurse managers for whom the plan is intended. First, it will be important to look into the issue of inadequate nurse-patient ratio in the hospital in depth. The number of nurses available in each shift in the department will be assessed to justify the need for change. In addition, the number of nurses allocated for each shift will be compared to the expected workload with a special focus on the incidences of trauma emergencies in the department. The proposed plan will be presented as a solution to these problems, supported by the evidence of inadequate staffing and failure of nurses to meet the most important needs of the patients in the unit. From the department in charge, the plan will be presented to the hospital administration for scrutiny and approval. It is from the administration that the exact communication to the rest of the staff will be done through the hospital informational system. The paediatric trauma centre is one place in the hospital that is always busy. The number of patients in the unit is always more that 95% of the unit capacity. This implies that the unit is literary full almost all the time. It also means that the number of nurses required to provide service in the unit is always high. Based on the acuity of the patients in the centre, team nursing has proven to be relatively ineffective in meeting all the needs of the patients. This is because of two main reasons. First, there are so many tasks that are supposed to be performed on the patients, and they are all done by the nurses. Secondly, the morning shifts have relatively less number of nurses in relation to the tasks that should be performed during these hours. This makes it difficult for the nurses to do more than the routine duties which are not enough for the patients. To solve these problems, the following solutions have been proposed. First, the hospital should revisit the staffing policy which does not allow for employment of Unlicensed Assistive Personnel in the hospital. This will be an important step in reducing the staffing issues. The personnel will be tasked with all the duties that do not require direct presence of the nurses. The qualified nurses will, therefore, be involved more on delivering quality nursing care to the patients. The second part of the proposed solution identifies specific shifts as having more direct workload than others. The morning shift will have to include more nurses and the support personnel than the rest of the shifts tom ensure that all the basic nursing procedures are performed. In addition, with more qualified nurses available, after the employment of the unlicensed personnel, primary nursing will be possible. This will involve one nurse being in charge of five patients in the unit to provide primary nursing care. This does not only improve the quality of care and outcomes but also increase accountability and responsibility. Finally, the proposal identifies the need to have a reserve group of nurses who will be readily available in cases of emergency in the unit. Nursing care quality is directly related to the number of nurses working in the unit as well as the organisation and staffing program of the unit (Boltz et al., 2013). Having low number of nurses in a unit such as a trauma centre, where acuity of the patient is at a high-level compromise quality. This is because besides the normal nursing care procedures such as medication, planning of care and implementing the nursing procedure, the patients also require assistance in most of their activities of daily living such as feeding, toileting and changing. The nurses are, therefore, faced with an increased workload and sometimes end up serving only the activities of daily living, which are by and large unavoidable. The implication of this is that the quality of care provided by the nurses is compromised. Including the unlicensed assistive personnel is highly likely to bridge this gap of quality. The personnel will be required to help in those duties such as feeding that do not require professional training while the nurses perform the nursing care. Further, with primary nursing care, each qualified nurse will perform his or her duties on a specified number of patients while still supervising the assistive personnel providing care to his or her group of patients. According to Boltz (2013), there is a perception among the nurse managers and care supervisors that besides having better problem solving skills, certified nurses are considerable higher performers in terms of quality delivery, interdisciplinary collaboration and general nursing care delivery (Boltz et al 2013). However, these benefits of having qualified and certified personnel are compromised by having them to perform duties that do not necessarily require their expertise. In addition, as observed by Flynn and McKeown (2009), having more personnel in the unit not only increase the hands available for the jobs but also ensures skill mix which benefits the patients directly (Flynn & McKeown, 2009). This mix of skills is only possible when the workload of the nurses is reduced enough to allow autonomy and accountability. When exploring the relationship between the nurse-patient ratio and burnout, patient outcomes and job dissatisfaction, Knudson (2013) made some observations. First, his study identified that increasing the number of patients under one nurse compromises care and increases the rate of mortality by 7% for each patient added. Secondly, the additional patient increases nurses’ burnout and job dissatisfaction by 23% and 15% respectively (Knudson, 2013). This implies that the negative effects of poor staffing are both short and long-term. In short-term, the patients who fail to receive adequate care are likely to have negative outcomes that are not the focus of the nursing profession (Hinno et al. 2012). On the other hand, the dissatisfied nurses suffering from burnout are more likely to leave the profession, frustrated and demotivated (Zhu et al., 2012). This prints a bad image for the profession as well as reducing even further the population of nurses available for patients care. Based on the urgency of the issue, there is a need for rapid change, and hence the implementation of the plan proposed. The solutions identified should lead to a comprehensive review of the staffing policy in the hospital with the aim of incorporating these proposals into the policy. The process should, therefore, take less than one month to implement. The implementation will involve all the stakeholders in the hospital management. The hospital administration should, after approving the proposal, give a direct communication to the human resource departments as well as other departments such as the finance department. All these people, including the managers in different units should be served with the proposal document and required to give feedback within one week. After one week, a meeting of all the stakeholders should be convened. Through a PowerPoint presentation, the proposal developer should provide a deeper insight on the plan, address the issues from stakeholders and possibly incorporate their suggestions. A survey should later be conducted among the nurses to identify their individual concerns regarding the plan. This survey will focus on minimizing resistance to change by identifying issues beforehand. The administration should then be ready to release funds to help in the implementation of the first phase of the plan, which should be a pilot project. Quality improvement funds can be used for this course. The outcomes of the implementation should be recorded through daily reflective questions answered by nurses after every shift as well as the patients manual and electronically collected and recorded information to the track progress. With healthcare gaining so much focus in the recent years, quality improvement is key to success of most of the programs and projects that the government initiates. The single most important aspect of quality in health care is the availability of enough, capable and motivated staff (Purcell et al., 2011). This can only be achieved with proper staffing to improve the quality of care delivered; reduce nurses’ burnout, dissatisfaction and turnover. References Boltz, M., Capezuti, E., Wagner, L., Rosenberg, M., & Secic, M. (2013). Patient Safety in Medical-Surgical Units: Can Nurse Certification Make a Difference?. MEDSURG Nursing, 22(1), 26-37. Flynn, M., & McKeown, M. (2009). Nurse staffing levels revisited: a consideration of key issues in nurse staffing levels and skill mix research. Journal of Nursing Management, 17(6), 759-766. doi:10.1111/j.1365-2834.2009.01023.x Hinno, S., Partanen, P., & Vehviläinen-Julkunen, K. (2012). Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses. Journal of Clinical Nursing, 21(11/12), 1584-1593. doi:10.1111/j.1365-2702.2011.03956.x Knudson, L. (2013). Nurse staffing levels linked to patient outcomes, nurse retention. AORN Journal, 97(1), C1. Purcell, S. R., Kutash, M., & Cobb, S. (2011). The relationship between nurses stress and nurse staffing factors in a hospital setting. Journal of Nursing Management, 19(6), 714-720. doi:10.1111/j.1365-2834.2011.01262. Zhu, X., You, L., Zheng, J., Liu, K., Fang, J., Hou, S., & … Zhang, L. (2012). Nurse Staffing Levels Make a Difference on Patient Outcomes: A Multisite Study in Chinese Hospitals. Journal of Nursing Scholarship, 44(3), 266-273. doi:10.1111/j.1547-5069.2012.01454.x Read More