OrganizationalSystems and Quality Leadership
Inthe study of the cases, one of the main causes that came out clearlywas the issue of understaffing. From the case study, the hospital hassixty beds in the emergency room department yet the number ofhealthcare practitioners that were present on this day was four i.e.one secretary, two nurses and an emergency department physician.Also, from the case study, it is evident that the condition of thepatient worsened at the time when all these staff members wereengaged elsewhere. To prevent this from happening, there is a needfor the addition of staff in the facility. The ratio of the nurse`spopulation to the number of beds should be increased so that at anytime there is a nurse that is constantly attending to the patient.However, since employing new employees may be costly to thehealthcare facility, the management should consider adoptingtechnologies that can support the current employees.
Inthe case study, it is explained that the Mr. B was placed on anautomatic blood pressure machine that was to monitor his bloodpressure and saturation of oxygen after every five minutes. However,these machines would only alert the nurses of the changes in thesituation but does nothing to correct these changes. As such, fromthe case study, it is observed that Mr. B stayed awhile withoutsupplemental oxygen. Therefore, since the facility is understaffed,it can consider developing or adopting a new technology that not onlychecks for changes but also executes processes that could addressthese issues. Had such a machine been in use, it would have providedMr. B with the supplemental oxygen after determining the need to doso.
Thehospital, in this case study, had a moderate sedation system that wasin a good working condition. However, it is clear that the emergencydepartment physician had a problem in performing this procedure tosedate the patient successfully. Additionally, the emergencyphysician only realized the problem later on after reviewing thepatient’s medical history, something that should have been thefirst step. Even though the facility had state of the art sedationsystem, the physician lacked enough skills in handling the machine.It should not have been a problem sedating the patient. As such, theimprovement plan will be to employ technologies that are not onlyrevolutionary but are also easier to use. In Mr. B’s case study,the physician would be able to sedate patients easily, regardless ofthe difficulties presented by the patients.
Insummary, since the major cases for the even in the scenario areunderstaffing, lack of adequate skills and lack of appropriatetechnology, the improvement plan suggested is increasing theproductivity of the staff members through the implementation of newtechnologies that can automate processes. With these technologies,there won’t be any possible occurrence of the event in future.
Thebest change theory to implement in this case study is the KurtLewin’s change theory, which is a three-phase classical of changethat requires previous learning to be rejected and replaced (Burnes,& Cooke, 2013). The theory defines behavior as a dynamic balancebetween forces that work in opposing directions. The theory can beapplied in this case so as to improve the staff’s attitude towardsthe new proposed technologies so that they can embrace them. Thetheory can also change the attitude of the staff towards learning anew skill so that they can improve their skills (Burnes, & Cooke,2013).
Thetheory states that the behaviors of influenced by opposing forces,those that drive an individual to accept change and those thatmotivate someone to behave in a certain manner (Burnes, & Cooke,2013). Therefore, there are three concepts of this theory drivingforces, equilibrium and refraining forces. The driving forces wouldfacilitate the process of change and cause a shifting of equilibriumtowards change. The driving forces in this case study may include themanagement being champions of change by leading the process ofchange. Another driving force is the provision of an enablingenvironment. An enabling environment may be the provision of trainingsessions as well as funding these training so that the staff does notdig deeper into their pockets so as to get the needed advancedtraining.
Therefraining forces, on the other hand, are the negative issues thatchallenge the change process (Burnes, & Cooke, 2013). Forinstance, limited resources may be a refraining force in this casestudy such that it would be difficult to implement the proposed newtechnologies. Another refraining force is the staff’s lack of goodwill providing a non-desirable environment for change.
Tohelp execute the process of change in this case study, the process ofchange would go through three phases/stages. The first stage is theunfreezing where the management will determine a method to help thestaff abolish their old behavior and the facility to adopt oldprocesses (Burnes, & Cooke, 2013). To employ additionaltechnology, the management can assess and evaluate the resourcesavailable and ensure that they are effectively used. Throughevaluation, the health care facility can save for employing additiontechnology. The facility can also initiate the process ofimplementing the new technologies.
Thesecond stage is the movement stage where the behaviors and thoughtsof the practitioners are shifted (Cummings, Bridgman, & Brown,2016). In this case study, the management can promote the trainingsessions before the actual training. Through the promotion, the staffmembers would be told the various importance and benefits of the newtechnologies. This way, the staff members will be ready toaccommodate the new technologies.
Thethird stage is the refreezing stage. This is the last stage where theactual change happens (Cummings, Bridgman, & Brown, 2016). Forthe case study, the staff member would be taken through the actualtraining on how to use the technologies. The training would improvethe knowledge of the employees. It is also at this stage that theactual implementation of the actual technologies, like new automatedsystems including the check-in systems, would be implemented. Afterthe finalization of this stage, the health facility will have newtechnologies in use as well as a highly trained workforce.
Thehealth sector is a sensitive sector that needs continuousoptimization. The optimization is done by improving the conditions.To improve the conditions it is necessary first to analyze thefailures of the current situations. Additionally, it is important toevaluate the ability of the improvement plan not to fail. There arevarious techniques that can be employed for the evaluation. In thiscase study, the technique that will be employed is the Failure ModeEffects Analysis (FMEA) technique. This technique is a step by stepmethod of determining all the possible failures of ideology (Issar &Navon, 2016). The technique entails identification of ways in which aconcept may change and how these failures will impact on the overallprocess. The purpose of this analysis is to do away with all thepossible failures starting with the most prioritized one. Thetechnique entails close analysis of by a team of qualified members.The team would not only identify the possible failures into theproposed plan but will also rate these failures on a scale usingtheir possible impact. The team will also identify the causes ofthese failures, as well as the occurrence level rating of each cause.The next stage entails identification of controls and the detectionratings. Once all these procedures are done, the risk priority numberis then calculated as well as the severity. These values will help inlisting the potential failures. After rating these failures, theywill then arrange them accordingly starting with the failure with themost severe impact at the top and the one with the least severeimpact at the bottom. All these steps can be summarized in threephases known as occurrence, detection and severity. After arrangingthese failures, the team will come up with recommendations and waysof addressing these possible failures so that the improvement planbecomes successful once implemented. After conducting the FMEA, theteam will test the improvement plan using the PSDA cycle.
C1.Member of the Interdisciplinary team
TheFMEA technique is conducted by a team of interdisciplinary members.In this case study the interdisciplinary team will be composed of:
Thehealthcare management: Every process requires a leader to take peoplethrough it. Similarly, the analysis would require the facilitymanagement to come in as the leader of the process. It will be themanagement that will be in charge of championing the process,scheduling the process as well as making crucial decisions in thecourse of the process. The management will specifically help todetect whether the employment of new employees will result in failureor success. The management would chair the FMEA team.
Thenurses/healthcare staff it is these nurses and the otherpractitioners in the health facility who will be interacting withthese changes. For instance, it is these individuals who would takepart in the training sessions. Also, it is the same people who willbe using the new systems. Therefore, their input is crucial in theanalysis of the possible flaws of the improvement plan.
Trainingspecialists: The facility may lack individuals who will beundertaking the process of training it employees on how to use thenew technologies. In this case, the facility will employ the servicesof outside specialists in the various topics so as to take theemployees through the entire training process. The trainingspecialists may be renowned specialists in the field of advancednursing. The training specialists may be providers with thosecompanies that have outsourced their technologies to the healthcarefacility. The input of these specialists is necessary as they woulddetermine the possible ways through the technology can be employed.
Technologyservice providers: Since the firm may not be conversant with the newproposed technologies, the healthcare facility can seek theassistance of the technology providers in accessing thesetechnologies ability to succeed. The service providers would beuseful in analyzing the current conditions in the facility todetermine the capability of the facility to handle the technology.The technology service providers are also better placed anddetermining the various flaws and limitations that these technologiespresent to the users. As such, their input is also crucial.
Thepatients: the improvement plan directly affects the patients. Assuch, the patients are better placed at observing the various changesthat have occurred as a result of the improvement plan. The patientwill tell whether the changes will tell whether the improvement planaddresses the past challenges they were facing so as to determinewhether the plan will succeed or have flaws.
Beforeactual execution of FMEA technique, there are four pre-steps thatwill be executed. First, there would be a selection of the processthat requires evaluation. In this case study, the FMEA will be donein the process of patient care. The second step will be the formationof the FMEA. The team members to be selected will be individuals whowould positively influence the analysis process. The team secretary,facilitator, and the organizer will be identified at this step. Theseindividuals would constitute the executive members, and would havethe greatest responsibility. The team will be a multidisciplinaryone.
Thethird pre-step is the explanation of the methodology of analysis tothe team member. The analysis of failures can be conducted indifferent ways. The team will have to select a single technique toemploy in conducting the analysis. The importance of this is to makesure that all the team members be on the same page during theanalysis. The team members who may not understand the technique mayget additional information about the FMEA technique in this stage.Also, the scope of the analysis would be communicated at this stageas well as the timeline of the analysis. This will be necessary fordeveloping a flowchart and a schedule for the analysis. Since themethodology and the timeline of the analysis have been communicated,it will be necessary to draw a flowchart of the various activities aswell as the schedule of these activities. The flow chart will showhow the numerous steps will be executed one after the other.Additionally, the scheduling will ensure that the team members willstick to the plan. The scheduling will also help in the appropriateallocation of time such that the process is completed within the settime.
Thefourth pre-step will be to list failure modes and causes (Rienzi etal., 2015). In this pre-step, the team members will come up with alist of all possible problems. In listing these failure modes, theteam will include all the rare and minor problems. The possibleproblems in the case of Mr. B’s case include system breakdown andcorruption of the system among others. Once the team has listed thepossible failure modes, the team will identify the causes of each offailure mode. For instance, in this case study the system breakdownmay be caused by lack of updating or poor maintenance. Corruption ofthe system may result from unauthorized access and hacking. Suchfailures and causes will be listed in this phase.
Occurrence:In this step, the team will determine the occurrence rating for eachcause of the failure modes (Rienzi et al, 2015). The occurrenceratings will determine how the likelihood of the failure occurringfor the reason during the entire lifecycle of your scope. For thiscourse, a rating scale from 1 to 10 will be used where 1 denotesextremely unlikely, and 10 is inevitable. The scale will be used tolist the occurrence ratings of each cause on the FMEA table. In thecase study, the occurrence, for instance, of system failure will bedetermined and rated on the scale of 1 to 10. Similarly, theoccurrence of system hacking will also be rated. These ratings willbe based on how like they are able to occur. With the new technology,the occurrence of system breakdown is less likely to occur.
Detection:After determination of occurrence ratings, the team will determinethe process controls. The process controls will keep the failuresfrom reaching the patients. The controls would prevent the cause fromhappening. Additionally, these controls would also detect thefailures when they happen. In this step, there would be theconfirmation of detection rating used in each control. A scale of n1to 10 will also be used to determine the control with the highestdetection rating and that with the lowest detection rating. In thecase of Mr. B, the rate of detection of system hacking and systembreakdown will be rated at this phase. The rating will be based onhow easy or difficult it is to detect system hacking and systembreakdown. With the new technology, system breakdown is more likelyto be detected when it occurs.
Severity:At this stage, the team will determine the effect of each failure.The team will determine how severe these failures will impact on thepatient’s care when they result (Rienzi et al, 2015). The severitylevel of each failure will be assigned a score between 1 and 10, with1 denoting the least severe and 10 denoting the most severe effect onthe patient’s care process. In the case of Mr. B, the severity ofsystem breakdown or system hacking will be rated. In other words, howsevere will the impact be on the patients incase system failure orhacking happens. When these two failures occurs, they are effects aremore likely to be severe.
Itwould be necessary to test the interventions that were proposed. Tocheck these interventions, the PDSA cycle technique will be used. ThePDSA cycle has four stages. The plan is the change to be tested(Donnelly & Kirk, 2015). In this case study, the improvement ofpatient’s care would be tested. For instance, the ability of thenurses to use the pieces of equipment and the time taken to attendfully to a client. Concerning improved technology such as anautomated system for checking and correcting saturation of oxygen,the technology’s ability to handle patients would be tested.
Nextin the cycle is “Do” where the selected change will be studied.In the case study, the test will be conducted on a small number ofpatients (Tai, et al., 2015). For instance, some patients will becared for by the nurses using the old technology and another set ofpatients will be cared for using the technology. Also, data beforeimplementation of the improvement plan, and those afterimplementation of the plan will be recorded.
Nextis the “Study” where the data collected will be used to analyzewhether the improvement plan is effective or not (Donnelly &Kirk, 2015). In the case study, the results of the use of thetechnology will be compared with those collected in the absence ofthe technology. The comparison will lead to making of conclusions asto whether the technology proposed is effective or not.
Last,is the “Act”, where the team will decide to drop the improvementplan or not to. If it is obtained that the improvement plan iseffective, then the healthcare facility will adopt the plan (Tai, etal., 2015). However, when it is obtained that the proposedimprovement plan is not effective, then it will be dropped. For thecase study, if it is found that the new technologies can prevent thescenario in the case study from happening, then the technologieswould be employed.
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