Clinical Scenarios
1. Describe Berwicks theory of continuous improvement and how it applies to this scenario. Which of Deming’s obstacles agrees with this theory?
2. Comment about the organizational culture in this scenario.
The Organizational culture of the said clinical scenario is that of the Academy culture wherein, one can highly practice and develop their skills of expertise. However, in the given scenario there had been various incidents that one can question the competence of every members of the health care professional team. Although, they are highly skilled individuals they have not provide a stable and safe environment for the patients which was shown when her indwelling catheter was kinked that resulted in an inability to discharge urine continuously. One could say it’s a question of their competence because once you insert a catheter, urine would immediately pass through and if not, it would mean that something cause the obstruction, by that immediate action can be done knowing that the patient is on surgery the next day, it is possible that patient is on emotional stress and that incident could aggravate stress. In addition, it is a nurse responsibility to check the urine output from time to time, 50 ml for 4 hours one could assume that there must be a problem due to the fact that urine output for an hour is 30 ml. I could also comment that the staff is not properly organized especially, when the chart of the patient had been misplaced – patient’s charts are important documents noting the progression of the patient’s condition. There are some points that the nurse manager failed to coordinate with the staff, it is her role to supervise every action of the staff, and the failure of her staff is her liability due to the fact that she is superior in rank. Presence of communication barrier between them can also affect how they treat their patients because communication is an integral aspect in a work environment it is through communication that one can actively integrate procedures effectively and this can also, ensure that the staff as been working together effectively – teamwork can lead to safe and effective care or the maintenance of the operational management that could lead to smooth flow of the activities of the ward, as evidenced by no negative feedbacks or complaints coming from the patients.
3. Identify three unintended outcomes from this scenario that could impact on patient satisfaction/perception of the services delivered.
In regards with the above scenario, I could say that the staff won’t be able to deliver safe and effective care, the physical, emotional, occupational welfare of the staff won’t be maintained and there would be lack of work ethics in the clinical area.
4. Describe how the key principles of quality could be used to prevent these outcomes.
Quality is one characteristic that one needs in a health care system not just for the reason that the patients paid for the service but it is the sole responsibility of the health care team to provide the quality standard care for the patients. it is a fact that the main character of the health care system is the patient, that is why, nursing care plan is to be made for patient – care management depending on what the patient has been complaining or what the patient needs, it is the nurse discretion on how to prioritize his interventions to meet the goals or objectives with regards to patient care. Lets say that quality care is given, this would result to smooth flow of the activities in the ward with no medication errors and accidents is likely to be prevented as evidenced by absence of any negative feedback or complaints from the patients thus, promoting better treatment outcomes. When we speak of work ethos this would refer to the attitudes and relationship between the staff on how they relate to each other if this has been effectively implemented the ward would exhibit a free and harmonious environment, efficiency and competence of the staff. To exhibit an example of the impact of quality care, a journal article entitled, “Journal of Ambulatory Care Management Special Issue: Technology for Patient – Centered Collaborative Care,” wherein it was stated that health care in the United States is “neither patient – centered nor collaborative ( 2006)”. Furthermore, he noted that to make care a more patient – centered, must be more proactive, inclusive, and customized to individual patients. To make it more collaborative, it must utilize teams of practitioners that share information among members and patients alike. A related article to support what has been previously mentioned, a survey that was printed in the article entitled, “Patients Report Positive Impacts of Collaborative Care,” ’s , M. D., surveyed approximately 25,000 adults with chronic diseases or dysfunction about the collaborative nature of the care they receive. The survey resulted to only 21 percent participated in good collaborative care, 26 percent fair collaborative care and 43percent experienced poor collaborative care. Those experienced good collaborative care, say the researchers, are more likely to enjoy higher levels of provider continuity, easier access to care, and greater efficiency of care.
5. Describe three processes in this scenario that were patient safety issues.
First scenario would be the intended CT scan after the surgery that is to be done prior to the transfer yet, it was done a week later. The standard operating procedure must be followed because there is a reason why it has to be done right there and then, the failure to do so is a question of adequacy. The second scenario concerning with her unfamiliar medications though it was explained to the patient the action of the drug; with regards to the medicine tablets that relieves constipation, it would be proper to assess first if the client is constipated knowing that the nurse can access freely the patient’s chart and the fact it is a new medicine, she could question immediately the reason for the prescription of the drug when patient can pass stool. The third scenario would be the incident when the patient broke her hip. Upon observation, one could say that it is a product of the recklessness of the staff they have failed to provide a safe and effective care to the patient. It is known that the patient had been improving from her surgery since she can manage to walk without any supervision; the said accident only crippled her chance to be back to the pre – illness stage.
6. Describe a process improvement method/model that could be used to improve one of these processes, and how it could be used. Include data required and how it could be analyzed.
, Inc, (“”), an alliance of 11 freestanding nursing homes in eastern Wisconsin, it seek to change the clinical quality of care and the organizational culture in its member facilities. The model includes a shared program of staff trainings; clinical consultation and education from a geriatric nurse practitioner, comparative data on resident outcomes, and a structure of multidisciplinary care resource teams who are empowered to develop and implement interventions that they believe will improve the quality of care for residents. The integration of clinical and cultural efforts allows staff to develop new skills, provides them with more input and respect, which in turn leads to better problem – solving and more effective decisions. It also provides a structure that supports career advancement and higher levels of job satisfaction and commitment, measured through lower turnover and greater retention, and it leads to improved facility outcomes ( 2002).
Figure 1: Importance of Role of Elements in Phases of Wellspring Implementation
Source: 2002
During phase I efforts are focused of the Wellspring Elements: the Alliance, Modules and the Geriatric Nursing Practitioner. The purpose of the alliance creates a forum for management staff in each of the facilities to collaborate on Wellspring implementation, to share resources, to create a friendly competition among network facilities regarding the achievement of resident outcomes, and to hold each other accountable for enhancing quality of care and the quality of work. The role of the Geriatric Practitioner maintains the enthusiasm and commitment for Wellspring among administrative staff who participate in the alliance. The learning training modules were developed to enhance the knowledge and skills of all staff members and to facilitate the culture change needed to use their newly acquired skills.
The phase II: planning implementation in facilities and Units, it centers on the role of the Care Resource Team (CRT), the Wellspring coordinator, data collected from the Wellspring database, and the administration at each individual facility are the central. In this phase the role of the modules, the GNP and the Alliance become ancillary and supportive (, 2002). For example, the CRT needs to implement something; she must refer to the modules in order to educate itself or take necessary precautions to implement it effectively. In the alliance partnership can be use on the second phase through networking and sharing of problems / solutions at modules. The coordinator will serve as the link between the team and the administration; the coordinator either assists the team members to ask administrators for necessary resources or goes on their behalf. The role of the administration is to support to assist the CRTs to obtain the resources and to sponsor training. The Wellspring database is use for planning especially in care areas that needs attention as new strategies are to be implemented to improve care practices. The effect of the previous phases will lead to clinical and cultural change in adherence to plan.
The phase III: implementing Wellspring, this is the phase wherein the coordinator, the CRT and the administration plays the vital role of implementing strategies that have been thoroughly planned. In this phase they will try to gain the commitment effort of the charge nurse and front line staff for the success of any plan by explaining the plan while maintaining the link between the administration and the team. Dissemination of the plan throughout the facility is primarily accomplishes through the work of the CRT members. Another role of the CRT in the implementation process is the integration of the plan at the level of the charge nurse. All of the process involve must be given support from the administration.
The phase IV: sustaining Wellspring Implementation; in here the modules and the date will the supporting elements while the coordinator, CRT and the administration will function on the same manner as possible. The challenging part here is the organization of effective continuing education to disseminate wide knowledge to understand the implementation plan.
7. Describe the role of clinical governance in the prevention of the problems that occurred in this scenario?
Clinical Governance is the term used in the United Kingdom National Heath Services (NHS) to describe a systematic approach to maintaining and improving the quality of patient care. The most widely cited formal definition describes clinical governance as cited in (2006) “A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.” (, 1998). The role of the clinical governance in the said situation is to correct whatever mistakes or flaws that the health care unit has failed to detect. In lie with the definition of the clinical governance, it will provide measures that will improve the inaccurate and inadequate system that has been endangering the lives of the patients in the said health care unit through the elements of clinical governance such as: education and training, clinical audit, clinical effectiveness, research and development, openness and risk management.
8. Provide information about tools, resources and other Quality Improvement (QI) strategies that could be used to improve services monitoring and evaluation in this organization.
There are several Quality Improvement tools mentioned in the Quality Assurance Project for healthcare and workforce improvement, such as the: (1) the four – step approach to quality improvement, (2) the spectrum of quality improvement approaches, (3) performance improvement and the (4) benchmarking. Let’s take benchmarking as an example to emphasize how quality improvement tools will increase the adequacy of the health care system. What I know of benchmarking is that it is a process use by many organizations to implement strategies in which, it evaluates various aspects of their courses of action in relation to the best practice within their segment of the organization. In allows the organization to think as a group to create new strategic plans or integrate strategic plans in order to improve the previous plan. Plainly said, it is one of the important ideas to keep in mind is that benchmarking does not mean replicating someone else’s process exactly, but rather seeking out aspects of a successful process that could improve your own work (, no date). For example, in the mentioned clinical scenario, there are few instances wherein, the competency and adequacy of the staff can be questioned in particular when the patient slipped on a wet floor. The nurse manager can call her staff in a benchmarking activity where they can discuss the flaws and possible interventions that can be applied to improve the situation. This also, at the same time enhances the group thinking process that will allow them to initiate actions into their own discretion by learning from other organizations that are efficient enough in delivering efficient and effective care to the patient. They can compare their won performance from other health care teams that they may seek approaches to bring about improvements in their performance. The said plans must be implemented in order for each of them can evaluate the results by monitoring the development and reviewing the benefits.
Reference:
Credit:ivythesis.typepad.com
0 comments:
Post a Comment