Health Leadership & Management Innovation Essay Example
HEALTH LEADERSHIP AND MANAGEMENT INNOVATION 15
Health Leadership and Management Innovation
Health Leadership and Management Innovation
The patient journey has for long posed increased challenges in healthcare. Health care organizations are struggling to keep up with rising demand for admissions. The process or cycle of a patient’s journey is both critical for their health as well as established guidelines for effective health care delivery. Healthcare professional are faced with increased need to ensure effective patient journeys. This requires the need for safe clinical handover, preventable admissions, and development of clinical assessment units. The maternity environment is specifically faced with these challenges and therefore the need for an innovative change to ensure increased effectiveness and efficiency. The following paper aims at proposing a Criteria Led Discharge within a maternity environment. Criteria Led Discharge (CLD) involves the discharge of patients by midwife, nursing, junior medical and allied health staff who have the essential knowledge, competencies, and skills to examine patients and start inpatient discharge (Department of Health, 2014). This process is reinforced by standards or criteria, which are created with multi-disciplinary contracts or agreements and permitted by the Authorized Admitting Practitioner who has the final clinical responsibility for the admitted patient. CLD is an effective element if the overall treatment planning of patients (Queensland Health, 2015). The following paper will focus on identifying and substantiating the need and aim of CLD in the maternity environment. Additionally, the paper will also propose the change strategy to be used in relation to the best practice drawing of leadership and management literature. The paper will also focus on a business plan that will detail the tasks to be carried out in terms of implementing the CLD innovation. All factors of the implementation will also be considered including evaluation, risks, resources and costs. The CLD innovation is aimed at enhancing the overall healthcare delivery process as well as effectiveness.
Need and aim of CLD
Discharging patients plays a critical role in the overall performance of healthcare delivery. According to Lloyd (2013), the discharge process of some patient units is sometimes dysfunctional and leads to duplication, delay, and waste. Moreover, the rate of admission and demand for hospital bed has increased continuously in Australia for the past decade. According to Lloyd (2013), demand has increased by about 12% in a period of three years and is expected to rise in the future. This means that more people are in need of admission, but the patient management process has witnessed increased challenges resulting in inefficiencies as well as delays in healthcare delivery. One of the main challenges facing the maternity healthcare services in Australia is bed blocks. A report by Deloitte regarding the services offered at Women and Children Hospital revealed increased inefficiencies including greater lengths of stay for all manners of birth while comparing other similar services (Biddle, 2014). Hospitals have for long been faced with the challenge of discharging patients in an effective manner. This particularly faces the maternity unit where patient transfer occur unequally throughout the week, According to Henderson, J., Koehne et al., (2014) the rate of transfers from admission to transfer of care occur frequently during week days and rarely on weekends. Furthermore, there is a mismatch between admission times and transfer of care time that eventually impacts the needed number of inpatient beds in maternities. This ultimately leads to bed blocks that result in increased burdens of demand on critical health resources. The main challenge in these inefficiencies is the fact of staff or healthcare professional’s availability. Most hospitals and healthcare givers often face increased human resources creating a challenge for discharging patients given that only the medical individuals, who admitted patients have total responsibility of their health planning process, thus are the one to decide when to discharge the patients (Lloyd, 2013). Healthcare delivery is always focused on continued improvement as well as innovation. The main focus should be directed towards increasing the overall decision making capacity of healthcare teams to allow for effective and efficient admission as well as transfer of care planning. With the main challenge of bed blocks, inefficiencies, and strains on critical health resources a new innovation is needed to address this continuous challenge (Lloyd, 2013). The Criteria Led Discharge offers a solution to these challenges in numerous ways.
The proposed and identified solution to this challenge is CLD with the aim of enhancing the patient care planning process as well as transfer of care in maternities. CLD basically focuses on ensuring that patients can be discharged on the basis of established criteria instead of depending solely on individual staff criteria to discharge patients (Queensland Health, 2015). When an overall or general criterion is developed healthcare professional in charge of discharging patients can work as team by using the criteria to enable transfer of care effectively. According to Anderson et al. (2014) CLD has the ability to enable suitable healthcare professional including midwives, junior medical and allied staff transfer patients by developing and offering established criteria for the transfer development process. When relying on CLD, the decision made for discharging a patient are developed and criteria are recognized by the senior medical clinician or the healthcare professional responsible for admitting the patient (Biddle, 2014). From here, CLD competent staffs can the enable the discharge of patients based on the documented criteria. Staff members are also required to monitor or ensure that the CLD criteria are achieved. When patients do not meet the established criteria they cannot be eligible for CLD. However, it is important to note that CLD is not an alternative to clinical process of decision making, but rather a support or enhancement of the decision making process. In addition, the established criteria does not mean that anyone in the healthcare profession can discharge a patient, but only the CLD competent or trained personnel are equipped to discharge patients using CLD.
There are a number of benefits associated with CLD in terms of addressing the gaps as realized in the maternity environment. Research has illustrated that patients desire to be involved in their care planning process. Research has illustrated that CLD has the capacity to enhance patient experience (White, 2014). When using CLD, patients are allowed to make their own decision in terms of care planning. This offers patients a better understanding their discharge decision and can easily get home or back to their lives sooner than expected (Queensland Health, 2015). The whole experience of involving the patient offers a fresh and improved practice of healthcare delivery. CLD has also been shown to improve patient safety. Relying on individual decisions to transfer and discharge patients may pose increased risks in terms of compliance or even errors (Hickman & Ojo, 2014). However, CLD offers a checklist as well as results to ensure complete compliance with transfer and discharge instructions. In turn, this helps to enhance patient safety by ensuring that all criteria developed by the senior clinician are followed and used as the basis for discharge (The Royal Childrens Hospital, 2015). Moreover, the development of the criteria is based on multi-disciplinary decisions and participation, thus ensuring increased patient safety. CLD also has the ability to decrease the unnecessary length of stay. CLD basically enables patients to be discharged using a criteria rather than on a healthcare professionals recommendation (Biddle, 2014). Even when the responsible staff for discharging a patient is not available, CLD ensures the competent staff available at the moment can effectively discharge a patient. This helps to reduce the unnecessary stay at maternities. CLD is also capable for reducing waste. The overall costs of admitted patients are relatively high and place a burden on healthcare resources including staff and care costs. The ability to discharge patients effectively or at the right moment ensures that such waste is reduced effectively. Lastly, CLD has the potential to enhance healthcare professionals’ experience by reducing the pressure of transferring and discharging patients or in the last minute. Moreover, the staffs are able to experience reduced stress from lack or decreased bed blocks thus enabling them to work more effectively (The Royal Childrens Hospital, 2015). CLD also enables the staff to work as a team, thereby developing their overall experience in terms of enhancing best practices in healthcare delivery. Overall, CLD is a significant innovation in ensuring increased effectiveness as well as efficiency in healthcare delivery.
Change is an inevitable part of an organization as it is in for humans (Cameron & Green, 2015). For CLD to be established effectively there is increased need for change in the organization. There are numerous theories in relation to change management in an organization. In this case, this proposal develops its change strategy using Kotter’s 8 step model. The first step in creating or implementing change is creating urgency. Change can only occur effectively when the whole organization is in need of the change or have a mutual desire for the change. Kotter argues that for change to be effective approximately 75% of the organization’s management requires to buy into the desired change. This is the one of the critical steps in the change process as it can have long-terms impacts. The first step in this case is getting all senior healthcare professional into believing or acknowledging the need for CLD implementation. This can be achieved by highlighting the challenges faced in the current maternity environment and how CLD can offer a solution. The need to go direct to the point is based on illustrating need for change by showcasing the potential threats and opportunities available (Cummings & Worley, 2014). The first process will basically involve convincing and dynamic reasons to get patients, staff, and senior staff to support the change.
The second step in Kotter’s change management theory involves developing a strong coalition (Appelbaum, et al., 2012). This process involves the development of leadership agents to convince the whole organization of the new change (Hayes, 2014). People need to believe the need for change and support the proposed change. A strong need for leadership competencies is needed in this case to ensure that people can follow the leaders vision in terms of implementing the change. To develop a coalition on implementing CLD, there is need to identify potential leaders in the organization (Gray, Jackson, & Daly, 2012). This may include senior healthcare professionals especially in the maternity environment. These leaders should be tasked with developing an overall vision as well as values that people can identify with in terms of CLD. CLD should be marketed or promoted as an innovation to enhance healthcare delivery, thus benefiting the patients as well as staff (Loh, E. 2014). Additionally, there is need to ensure that the team or organization has the right kind of people implying that there may be need for additional staff or experts to ensure increased success (Langabeer et al., 2015).. The third step involves creating a vision for the CLD change. CLD implementation will be viewed as a means to enhance patient healthcare delivery as well as promote best practices in terms of effectiveness and efficiency when it comes to the maternity environment. Overall, this vision should be communicated frequently to the organization to enable all members of the organization to develop a mutual understanding and belief in the change (Klein, et al., 2013). The fourth step involves communicating about the vision (Webster, 2012). One of the main challenges is addressing people’s concerns in terms of new change. To enable an effective CLD implementation, there is need to communicate about the vision of the program while addressing patient or staff concerns in an honest and open manner. All operations of CLD and the change management should also apply the vision to ensure it makes clear sense for the organization.
The fifth step involves removing obstacles or challenges in the change process (Webster, 2012). Once the organization is convinced of the desired change, they develop the support and desire for achievement in relation to the new change (Huber, 2013). Nonetheless, there are numerous challenges that may hinder this desired change. Therefore, there is need to remove all the possible obstacles that may hinder the desired change. For CLD to be implemented effectively, it is important to hire or identify change leaders whose main role will focus on delivering CLD. Moreover, each of the healthcare professionals should get revised job descriptions as well as the structure of the organization. Another strategy involves appreciating, rewarding, and recognizing people’s efforts towards the implementation of the change (Akenroye & Kuenne, 2015). Therefore, the CLD innovation will also feature a rewarding and recognition system through issuance of certificates to all who put in effort to implement the change, the sixth step involves developing short-term wins. The main concept behind this step is that success tends to enhance motivation (Appelbaum, et al., 2012). Therefore, all measures will be taken to ensure that direct results and early results are documented for the organization can view their success in the short-term. Moreover, the CLD implementation plan will involve short-term targets such as ensuring that about 2 in 5 of discharged patients use the CLD innovation. The seventh step involves developing on the change implemented by reviewing challenges and implementing necessary changes as a continued process of change (Webster, 2012). This is an important step in ensuring that each step taken towards successful change is improved continuously. The last step embroils in developing the changes made in the organizational culture. This necessitates the role of a leader in terms of communicating the vision frequently and ensuring increased support of the changes made in the short and long-term periods (Rowitz, 2013). The CLD plan will undertake a process that will see senior staff and junior staff support its implementation over the long-term.
The first step of the implementation plan or the business plan will involve setting up of a multidisciplinary team to head the CLD development process. All the senior clinicians and experts of CLD will converge and analyze data to determine the issues of timely discharge. The executive team or the senior management healthcare professionals will be tasked with identifying the relevant criteria for discharging patients (Swayne et al., 2012). Moreover, the team will also determine and reach an agreement on the range of patient groups who are applicable for CLD. The next step will involve training of the interdisciplinary team who will include midwives, nurses, allied and junior staff members (Kerzner, 2013). In the maternity environment, this applies mostly to midwives and junior medical staff. All these members will receive training and specified roles and responsibilities in terms of CLD. Additionally, the executive team will also review the processes and systems to establish an agreed target. This is in line with ensuring that some amount change or improvement is realized with the implementation (Kongstvedt, 2012). Additionally, the executive team will also be tasked with identifying the required skills for CLD implementation and execution (West, Ramirez & Bernardo, 2012). The executive team will also develop a policy that will be improved on the basis of feedback from care givers, incident reports, and audits. The overall first phase will be completed within three months to ensure that all the above have been accomplished before CLD can be started officially.
The organization will also develop a dedicated help communication in line in terms of a CLD office where the senior clinician will be responsible answering all questions and concerns shared by the interdisciplinary team and senior executives concerning CLD (Huber, 2013). This office will act as a control mechanism in alerting any potential challenges related to the implementation of the change. The implementation will undergo a transitional process of pilot testing to ensure that all staff and the executive team have developed the suitable criteria for discharging patients.
The implementation will require different resources and costs, but the major resources include staff, time, and knowledge. The CLD initiative requires suitable staff to ensure that it’s effective (Wahlster, et al., 2015). All; these staff should CLD competent people meaning that only people with certain skills can discharge patient. Moreover, the CLD innovation will also require time dedicated to creating the criteria as well as monitoring if patients meet the criteria. Lastly, the CLD plan requires multidisciplinary knowledge that can be drawn from senior healthcare professional. The costs of implementation are not expected to be high since this is a sort of process change rather a new project requiring acquisition of new equipment of staff.
The need to consider risk management is of great importance to the CLD implementation plan. The plan will develop a risk probability and impact evaluation plan. This will identify the likelihood of risks based on project objectives including criteria, competent staff, and amount of bed available (Chance & Brooks, 2015). This will ensure that most of the possible risks are avoided before they occur. Additionally, the plan will also involve an evaluation plan that will be conducted on the basis of previous audits and patient/staff feedback before and after its implementation (Sebastianet et al., 2014).
In conclusion, the patient journey has for long posed increased challenges in healthcare. Health care organizations are struggling to keep up with rising demand for admissions. The process or cycle of a patient’s journey is both critical for their health as well as established guidelines for effective health care delivery. Healthcare professional are faced with increased need to ensure effective patient journeys. This requires the need for safe clinical handover, preventable admissions, and development of clinical assessment units. The maternity environment is specifically faced with these challenges and therefore the need for an innovative change to ensure increased effectiveness and efficiency. This proposal has focused on implementing Criteria Led Discharge as a way of enhancing the patient transfer of care process. Criteria Led Discharge (CLD) involves the discharge of patients by midwife, nursing, junior medical and allied health staff who have the essential knowledge, competencies, and skills to examine patients and start inpatient discharge. This process is reinforced by standards or criteria, which are created with multi-disciplinary contracts or agreements and permitted by the Authorized Admitting Practitioner who has the final clinical responsibility for the admitted patient. CLD is an effective element if the overall treatment planning of patients.
Akenroye, T. O., & Kuenne, C. W. (2015). Key Competencies for Promoting Service Innovation: What are Implications for the Health Sector?. Innovation Journal, 20(1), 1-21.
Anderson, C, Biddle, B, Cornwell, C, Davey, P, Lynch, S & Petersen, R., (2014). Criteria Led Discharge. Retrieved from http://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Clinical%20Senate/PDF/Assoc%20Prof%20Rod%20Petersen.March%2021%202014.CLD.ashx
Appelbaum, S. H., Habashy, S., Malo, J. L., & Shafiq, H. (2012). Back to the future: revisiting Kotter’s 1996 change model. Journal of Management Development, 31(8), 764-782.
Biddle, B., (2014). Postnatal Criteria Led Discharge. Retrieved from https://www.healthroundtable.org/Portals/0/PublicLibrary/2014/HRT1420/2c/2.2c-4-BelindaBiddle-WCNA-SA011112014-READY.pdf
Cameron, E., & Green, M. (2015). Making sense of change management: A complete guide to the models, tools and techniques of organizational change. Kogan Page Publishers.
Chance, D., & Brooks, R. (2015). Introduction to derivatives and risk management. Cengage Learning.
Cummings, T., & Worley, C. (2014). Organization development and change. Cengage learning.
Department of Health, (2014). Criteria Led Discharge Guideline. Retrieved from https://www.health.qld.gov.au/qhpolicy/docs/gdl/qh-gdl-416.pdf
Hayes, J. (2014). The theory and practice of change management. Palgrave Macmillan.
Henderson, J., Koehne, K., Verrall, C., Gebbie, K., & Fuller, J. (2014). How is primary health care conceptualised in nursing in Australia? A review of the literature. Health & social care in the community, 22(4), 337-351.
Hickman, S., & Ojo, O. (2014). Implementing Early supported discharge, Chronic Obstructive Pulmonary Disease, Community, Primary care, Multidisciplinary team, Change management, Kotter’s 8-step Model. Journal of Nursing and Health Care (JNHC), 1(1).
Huber, D. (2013). Leadership and nursing care management. Elsevier Health Sciences.
Huber, D. (2013). Leadership and nursing care management. Elsevier Health Sciences.
Kerzner, H. R. (2013). Project management: a systems approach to planning, scheduling, and controlling. John Wiley & Sons.
Klein, L., Kennedy, C., Young, W., Sutherland, K., Payne, S., Neumeier, M., … & Cockerill, R. (2013). Implementing an Advanced Computerized Provider Order Entry System to Neonatal Intensive Care Using Kotter’s Change Management Model. Navigation.
Kongstvedt, P. R. (2012). Essentials of managed health care. Jones & Bartlett Publishers.
Langabeer II, J. R., Nagtalon-Ramos, J., Msn, C., & Helton, J. (2015). Health care operations management. Jones & Bartlett Publishers.
Lloyd, K., (2013). AN ACI RESOURCE FOR IMPLEMENTING CRITERIA LED DISCHARGE — CONSULTATION DRAFT. Retrieved from http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0015/205503/2._ACI_-_Criteria_Led_Discharge_-_Consultation_DRAFT.pdf
Loh, E. (2014). LAMP: Leadership, Advocate, Management, Professional-a new simple and dynamic medical management competency model for doctors. Dignam, D., Duffield, C., Stasa, H., Gray, J., Jackson, D., & Daly, J. (2012). Management and leadership in nursing: an Australian educational perspective. Journal of nursing management, 20(1), 65-71.
Queensland Health, (2015). Criteria Led Discharge Service Delivery Model. Retrieved from https://www.health.qld.gov.au/caru/improving-services/sdm-cld.asp
Rowitz, L. (2013). Public health leadership. Jones & Bartlett Publishers.
Sebastian, A., Fulop, L., Dadich, A., Fitzgerald, A., Kippist, L., & Smyth, A. (2014). Health LEADS Australia and implications for medical leadership. Leadership in Health Services, 27(4), 355-370.
Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2012). Strategic management of health care organizations. John Wiley & Sons.
The Royal Childrens Hospital, (2015). Criteria-Led Discharge Background. Retrieved from http://www.rch.org.au/clinicalguide/guideline_index/CriteriaLed_Discharge_Background/
VanVactor, J. D. (2012). Collaborative leadership model in the management of health care. Journal of Business Research, 65(4), 555-561.
Wahlster, P., Goetghebeur, M., Kriza, C., Niederländer, C., & Kolominsky-Rabas, P. (2015). Balancing costs and benefits at different stages of medical innovation: a systematic review of Multi-criteria decision analysis (MCDA). BMC Health Services Research, 15(1), 1-12.
Webster, M. (2012). Successful change management—Kotter’s 8-step change model. Leadership Thoughts.
West, D. J., Ramirez, G., & Bernardo, F. (2012). Leadership and globalization: Research in health management education. World Hospitals and Health Services, 48(3), 14.
White, N. (2014). Criteria led discharge among patients who have undergone laparoscopic cholecystectomy, laparoscopic appendectomy or hernia repair in an emergency short stay ward: a best practice implementation project. The JBI Database of Systematic Reviews and Implementation Reports, 12(4), 548-567.
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