Leadership for the Clinical Context NURS5041 Case Study Information - Assessment Three The Integrated Health Service 2021 (Acknowledgement Professor Phill Della) able of Contents Introduction 1 The Integrated Health Service (IHS) 1 Profile of the Integrated Health Service (IHS) 1 Vision: 2 Mission: 2 Value: 2 Clinical Governance 2 Clinical Services 2 The Organisational Structure 3 Clinical Activity 4 Clinical Indicator Data 5 Workforce Indicators 6 The Quality Department 7 Your role in this case study 7 The assessment task/s 8 Introduction You have recently been asked by your unit manager to review some of the clinical issues highlighted from a number of sources, that require attention to improve practice

You have recently been asked by your unit manager to review some of the clinical issues highlighted from a number of sources, that require attention to improve practice. As you read through the information below, refer to the highlighted rows in Table 2 and make notes related to the following points:

Issues related to clinical practice that requires attention.
Current clinical indicators compared to National / International Benchmarks.
Analyse the clinical indicators to identify areas for improvement.
Think about how you might lead change in practices.

The Integrated Health Service (IHS)

The Integrated Health Service (IHS) was established in 2015 and provides a comprehensive, integrated health service. The service commenced as a Government commitment to improving health services covering community assessment through to acute care and back to community care. The health service achieved accreditation in 2017, having met the National Accreditation Health Standards. Recently however, there have been a number of media news reports about overcrowding in the emergency department, patients not receiving the best care, and increased waiting times for elective surgery in orthopaedics and ophthalmology.

The media reports in brief include:

A report in daily newspaper that mental health patients had been waiting in the Emergency Department for 3 days before a bed was available in the Mental Health Unit.
In August 2019 a patient had surgery on the wrong limb which resulted in an amputation
The infection rate within the IHS was substantially higher that of other health services within the region. This has resulted in patients cancelling their surgery, as they fear getting a severe infection
In September 2020 the local newspaper reported that a patient had died following cataract surgery. The newspaper alleged that the patient was given a medication after surgery that they were allergic to, which resulted in death.

The Accreditation Agency has informed the Chief Executive Officer that the health service accreditation is now under review. The accreditation agency will require a report on the Clinical Indicators for the Hospital and may decide to include a site visit. If the health service loses its accreditation, funding from the Government and Private Health Providers will be decreased.

Profile of the Integrated Health Service (IHS)

The IHS was established in 2015 and has the following services:

Acute Hospital inpatients: a 650-bed hospital offering general surgery, general medicine, paediatrics, mental health, maternity services and urgent care services. The hospital has six operating rooms, a radiology and pathology department, and a speciality outpatient department.
Ambulatory home service which provides care for patients who have been discharged from the acute service sector

The hospital has the following strategic statements:

Vision:

To provide excellent health service to all we care for in our community.

Mission:

To provide an integrated health care service that has highly skilled clinical professional staff who provide personalised care that will allow patients to remain in their community.

Value:

Patient centred care
Excellence in clinical care
Individualised care
Open communication

Clinical Governance

The IHS has a comprehensive clinical governance framework with four main pillars:

Clinical Risk Management
Clinical Effectiveness
Workforce Development
Consumer Participation and Engagement

Clinical Services

The IHS has the following service profile:

Acute Hospital - provides general surgery, general medicine, paediatrics, mental health, maternity services and urgent care services. The hospital has six operating rooms, a radiology and pathology department, and a speciality outpatient department. The hospital provides a community-based general health service and refers critical, complex patients to a teaching hospital for speciality services such as cardiac surgery

Ambulatory Home Service - established to provide a hospital in the home services. This includes nursing and allied health services. Patients who are transferred to the service have been discharged from IHS. The IHS does not accept patients from other health services

The Organisational Structure

Board of

Management

CEO

Director of Clinical

Services

Staff Development

Manager

Staff Development

Nurse

Ambulatry Home

Services

Clinical Nursing

Staff

Acute Hospital

Services

Clinical Nursing

Staff

Nurse Manager

Ambulatory Health

Services

Clinical Nursing

Staff

Departments

Corporate Services

Quality

Department

Cleaning and

Catering

The CEO and Director of Clinical Services are both medical doctors. There are nurse managers in charge of the ambulatory health service, the acute hospital service and the ambulatory home service. There is also a nurse manager overseeing staff development. There are three support services for the clinical areas (corporate services, quality department, and cleaning and catering), with these managers reporting directly to the CEO.

The Quality Department reports directly to the CEO and has no management authority for the clinical areas.

You are one of the clinical nursing staff working in a medical/surgical ward within the acute hospital services, and report to the nurse unit manager.

Clinical Activity

The following table indicates the clinical activity for the last three years.

Table 1: Summary of Clinical Services and status 2018 -2020 (note the impact of COVID-19*)

	Activity	2018	2019	2020*	Status*
1	General Surgery: number of procedures performed	17,900	13,700	9,200	There is a decrease in patients being referred to IHS for surgery from General Practice
2	General Medicine: number of inpatients	19,000	16,000	10,100	Demand has decreased; patients arriving at other hospitals and not willing to be transferred IHS.
3	Paediatrics: number of inpatients	500	270	210	A decrease in demand for paediatric services due to parents not wishing to use IHS.
4	Mental Health – the number of inpatients	1,660 inpatients	2,400 inpatients	3,500 inpatients	Increasing demand for inpatient services
5	Maternity: number of births	960	2,600	3,100	Demand is on target

*Data impacted by COVID-19

The IHS service demands have increased in the areas of urgent care services, maternity and mental health. However there have been decreases in the areas of general surgery, general medical patients and paediatric hospital admissions.

The Chief Executive is concerned about the number of the Clinical Services which are not meeting their performance requirements including:

General Medicine has seen a decrease in the number of inpatients and this is despite a full range of general medicine being provided by IHS. The concern is why has there been this decrease, and patients from the community not wanting to be admitted to the IHS.

A decrease in paediatric admissions despite an increase in the number of births for the area and increase in the number of births at IHS.

Clinical Indicator Data

The clinical indicator data for the hospital is provided in Table 2.

Table 2: Clinical Indicator Data for IHS 2018 - 2020

Clinical Indicator	2018	2019	2020
Medication Safety – Medication Errors	4%	9%	12%
Preventing and Controlling Healthcare- Associated Infections	Staphylococcus Aureus Infection Cases per 10,000 days of patient care
	0.23	0.57	0.65
	Hand Hygien e Compliance
	83%	64%	59%
Preventing Falls and Harm from Falls	Falls as a percent age of patient days
Preventing Falls and Harm from Falls	0.31%	0.46%	0.52%
Surgical site infection rate	17%	23%	31%
Total Number of Consumer Complaints	120	370	410
Percentage of Complaints managed within 30 days	95%	58%	42%

Workforce Indicators

The following are details of workforce indicators for the IHS.

Table 3: Workforce Indicators

Indicator	2018	2019	2020
Staff Establishment Percentage of part-time staff	20%	46%	59%
Staff Lost Days Absenteeism Worker Injury
	8%	19%	30%
	4%	9%	15%
Staff Turnover	8%	29%	38%
Staff Vacancy Rate	9%	22%	34%

The Quality Department

The Quality Department (QD) was established in 2015 to prepare for accreditation and to monitor clinical activities. The QD has a Manager and two Clinical Quality Offers. The manager reports directly to the Chief Executive Officer and has no management or authority for the clinical units.

The QD has the organisational responsibility for clinical goverance which includes:

Consumer Engagement
Clinical Risk Management
Complaints Management and Resolution
System-wide Quality Management
Accreditation

The activity within the QD has rapidly increased and has now focused on complaints management. The number of complaints has increased dramatically and the time to manage individual complaints has doubled making this outside the required Health Departments Policy of 30 days. During this busy time the Quality Department has also not convened a Consumer Engagement Committee, the Clinical Risk Management Committee or the Accreditation Committee. The next Accreditation Survey is due in six months.

The Quality Department provides administrative support to a number of quality improvement projects, for example falls management. It was noted in a Newspaper report that the IHS has not adopted a system-wide falls assessment and management approach. Individual clinical areas have varying degrees of falls identification check lists, and limited prevention programs.

Your role in this case study

In the interim, and as preparation for the next clinical audit, your Nurse Manager has asked you to help with leading change in ONE of the two areas highlighted in Table 2.

The assessment task/s

Choose:

Using the case study data as a starting point, choose ONE of the issues (highlighted rows) from Table

2.

Analyse:

Include a process or framework you could use in analysing your chosen issue, using other data from the case study that are likely connected to the issue of choice. Think about ways in which you could gather accurate information (from your own area) to understand the factors impacting on the chosen clinical issue.

Recommend changes for practice:

Formulate recommendations for leading change (improvements) in clinical practices based on relevant literature, and where applicable, health policies and/or guidelines from: your own hospital or work setting, State, National or International health authorities.

In essence, this assessment draws together the content covered in this unit and knowledge gained from your broader reading.

Refer to the assessment rubric for further detail about the criteria.

ASSIGNMENT COVERSHEET Please complete all fields below		DATE STAMP
PART A – to be completed by Student (please write clearly)		30^th May 2021
Student ID: 20033581
Surname: Tan
Given Name: Boon Theng
Assignment Number: 3		Unit Code: NURS5041
Assignment Title: Case Study		Unit Name: Leadership for the Clinical Context

Lecturer’s Name: Associate Professor Michelle Kelly		Class Day and Time: Monday 1900hours
Due Date: 30^th May 2021 at 2345hours
Student comments to lecturer (if any):


Please read the following and sign where indicated DECLARATION: I declare the attached assignment is my own work and has not previously been submitted for assessment. This work complies with Curtin University and Curtin College rules concerning plagiarism and copyright. I have retained a copy of this assignment for my own records. [Refer to http://policies.curtin.edu.au/policies/viewpolicy.cfm?id=82de4fc5-f631-11dc-9515-45785751f674 for Curtin University plagiarism and copyright information.] [Refer to the Policy library on www.cic.wa.edu.au for full details on Curtin College Plagiarism and Student Misconduct policies.] Student’s Signature: ______________________ Tan Boon Theng_______________________________Date: _____ 30^th May 2021______ NOTE: Assignment will NOT be accepted unless the above has been fully completed, signed and dated.
PART B – to be completed by Lecturer: Comments to Student











Recorded Mark:	Lecturer:		Date:

Case Study

Tan Boon Theng

School of Nursing, Midwifery and Paramedic, Curtin University

NURS5041: Leadership for the Clinical Context

Associate Professor Michelle Kelly

30^th May 2021

Word Count:

Table of Contents

Introduction………………………………………………………………………………..

Background…………………………………………………………………………………

Analysis of Issue……………………………………………………………………………

Strengths……………………………………………………………………………….

Weaknesses……………………………………………………………………………..

Opportunities……………………………………………………………………………

Threats…………………………………………………………………………………..

Development of Plan to Change Practice…………………………………………………….

Plan………………………………………………………………………………………

Do………………………………………………………………………………………..

Study…………………………………………………………………………………….

Act………………………………………………………………………………………

Recommendation…………………………………………………………………………….

Conclusion……………………………………………………………………………….......

References……………………………………………………………………………………

Introduction

Effective and timely hand hygiene is the cornerstone of safe and successful health care. According to Centers for Disease Control and Prevention (2020), healthcare providers clean their hands less than half of the times they should. In this paper, the issues faced by Integrated Health Service will be analysed using SWOT analysis and The Plan Do Study Act (PDSA) cycle will be used to lead the change needed in the facility.

Background

The Integrated Health Service (IHS), established in 2015, aims to provide excellent health service by highly skilled clinical professionals who will provide personalized care to ensure patients remain in the community.

Analysis of Issue

SWOT is one of the oldest and best-known organizing frameworks in management

Strengths

One of the strengths Pearl Izumi upholds is that

they have a wide variety

One of the strengths Pearl Izumi upholds is that

they have a wide variety

One of the strengths that Integrated Health Service upholds is that it offers a wide range of services, including general surgery, general medicine, paediatrics, mental health, maternity services and urgent care services.

Holistic services

Comprehensive clinical governance framework

Highly skilled clinical professional staff

Provide personalized care

Weaknesses

When it comes to weaknesses, every hospital will at some point in time have weaknesses that they will have to overcome. For Integrated Health Service, the main weakness involves having high staff turnover rate and high staff lost days. Another weakness would be the

When it comes to weaknesses, every company will at some point in time have weaknesses

that they will have to overcome.

When it comes to weaknesses, every company will at some point in time have weaknesses

that they will have to overcome.

High staff turnover rate

High staff lost days

Longer patient wait times

Opportunities

In order to improve Pearl Izumi as a company, some opportunities that will help improve

overall includes advancing the technology that is used with the products

In order to improve HIS as a company, some opportunities that will help to improve overall includes advancing the technology that is used with the products. Another opportunities includes…..To show more awareness, IHS could….

Threats

IHS faces several challenges such as

Competition from other hospitals

Overdramatization of media

Strategy misalignment between organization

When strategy is misaligned, company divisions can drift into a self-directed mode that stray further from corporate goals.

Development of Plan to Change Practice

Plan

Do

Study

Act

Conclusion

The hospital faces a threat of losing its accreditation due to the numerous complaints that have been raised by patients. However, through a detailed plan, the facility will be able to boost its confidence among consumers and improve patient outcomes.