Week 1 Objectives: Clinical Governance in Healthcare PDF

**Week 1 objectives** **Identify why clinical governance is key in healthcare and organizational performance** Clinical governance is key in healthcare and organizational performance as good pt outcomes are dependent on doing an affective job; which we can manage through performance orientation an...

**Week 1 objectives** **Identify why clinical governance is key in healthcare and organizational performance** Clinical governance is key in healthcare and organizational performance as good pt outcomes are dependent on doing an affective job; which we can manage through performance orientation and be accountable. [Clinical governance is important for: ] - Safeguarding high standards of healthcare - Continuous improvement of services - Environments where clinical excellence can flourish [Clinical governance:] A systematic, integrated approach to assurance and review of clinical responsibility and accountability that improves quality and safety, resulting in optimal patients outcomes. **Understand role of national safety and quality health service (NSQHS) Standards** [Clinical governance from NSQHS: ] 1. Governance, leadership and culture 2. Pt safety and quality systems 3. Clinical performance and effectiveness 4. Safe environment [1:] governing bodies establish policy frameworks, managers lead and coordinate the workforce, clinicians work in clinical teams and improve safe care and patients in the center of this are the partners in the delivery of care. [2:] policies and procedures, healthcare records, diverse and high risk groups: these are what we base our care on, ways to collect data: feedback and complaints, incident management and open disclosure, risk management. [3:] safety and quality training, performance management, EB care, variation in clinical practice and health outcomes. [4:] reduce hazards, ensure pt safety, use of furnishings, artwork, light, engagement in mental health pts, simply environment to reduce unnecessary stimulation for the cognitively impaired **Discuss risk management** [Risk management:] identifying areas of concern and making sure changes are introduced to make improvement. Identify the risk -- assess the risk -- control the risk- review controls. [Drivers for implanting sound risk assessment:] world event that affect care, regulatory influence, DOH reporting, Standards. [Tools to identify contributing factors to risk:] root cause analysis, Ishikawa diagram, 5 whys, FMEA [To ensure risk is linked to quality]: good management systems, finance management, right decisions are being made, recognize and manage risks, encourage and reward good performance **Key terms:** [Governance:] to ensure an organization does what it should through leadership, delegation, oversight of quality management, monitoring, reporting and risk management. [Good governance:] 1. openness, transparency and integrity 2. effective collaboration 3. performance orientation A diagram of a diagram of a diagram Description automatically generated with medium confidence[Healthcare corporate governance]: clinical governance, financial governance, risk governance, other (human resources, legal) [ACSQHC strategic intent]: 1: safe delivery of health care 2: partnering with consumers 3: partnering with healthcare professionals 4: quality, value and outcomes [4 principle of Wa health clinical governance, safety and quality:] care is consumer and carer centered, care id driven by information, led for high performance and organized for safety. [Care is consumer and carer centered:] open disclosure, pt/community representation, facilitating pt autonomy [Care is driven by information]: EBP, QI in practice, professional development, research activities [Led for high performance]: staff forums, feedback opportunities, satisfaction surveys, transparent leadership [Organized for safety]: incident/near miss reporting, no blame culture, culture of safety, RCA process [Patient safety surveillance unit (WA elective services target)]: focuses on the percentage of pts on the waiting list [Patient safety surveillance unit (WA emergency access targets)]: requires that 90% of pts presenting to a public ED will be seen and admitted, transferred or discharged in 4 hrs. [Root cause analysis:] retrospective approach, systematic and comprehensive methodology to identify system vulnerabilities, aim of preventing adverse events happening, a method to learn why it occurred, identify vulnerabilities that may not be immediately apparent, important to identify and act on system failure **Week 2 objectives** **Analyse definitions of leadership theories** [Trait theory leadership:] Idea that leaders are born and not made. Includes the knowledge of the business, initiative, flexibility, creativity, charisma, emotional intelligence, drive and motivation. [Behavioral theory:] Idea that good leaders can be taught and learned. inherent traits of a person don't matter, promotes value of leadership styles, good leadership is an acquired trait. [Transactional theory:] SMART goals and incentives, actionable measures and monitoring, passive management and setting performance benchmarks [Fielders contingency model:] leadership styles change based on situational variable, based on relationship between styles and situation. +-----------------------------------+-----------------------------------+ | [Transformational ] | - inspire followers | | | | | | - walk the talk | | | | | | - people driven | | | | | | - genuine concern for needs of | | | followers | | | | | | - innovating | | | | | | relationship oriented | +===================================+===================================+ | [Authoritarian ] | - maintains strong control | | | | | | - motivates by coercion | | | | | | - directions given like | | | commands | | | | | | - communicates in a downward | | | pattern | | | | | | - decision making doesn't | | | involve others | | | | | | - controlling | | | | | | - produces high productivity | | | | | | task oriented | +-----------------------------------+-----------------------------------+ | [Democratic ] | - Less control is maintained | | | | | | - Directed through suggested | | | and guidance | | | | | | - Communication flows up and | | | down | | | | | | - Emphasis on "we" not "I" | | | | | | - Criticism is constructive | | | | | | - Promotes autonomy | | | | | | Relationship oriented | +-----------------------------------+-----------------------------------+ | [Laissez-faire ] | - Little or no | | | control/direction | | | | | | - Delegating approach | | | | | | - Support when requested | | | | | | - Looks like a lack of | | | leadership | | | | | | - Can cause frustration | | | | | | - Works well in an environment | | | with team members who are | | | highly skilled and motivated | | | | | | Task oriented | +-----------------------------------+-----------------------------------+ | [Transactional ] | - Based on rewards and | | | sanctions | | | | | | Task oriented | +-----------------------------------+-----------------------------------+ | [Situational ] | - Leadership style changes | | | based on the situation | |  | | +-----------------------------------+-----------------------------------+ | [Servant ] | - Encourage diversity of | | | thought | | | | | | - Create a culture of trust | | | | | | - Have an unselfish mindset | | | | | | - Foster leadership in others | | | | | | - Empathetic, caring, puts | | | employees first | | | | | | Relationship oriented | +-----------------------------------+-----------------------------------+ [Two main types of leaders: ] - Task oriented: focused on the task, facilitating work to get the task done, focused on results - Relationship oriented: focused on relationships, focused on communication, focused on wellbeing of team members, facilitating interactions **Discuss the differences between leadership and management** A group of people holding a rope Description automatically generated [Manager:] - Assigned position - Legitimate power - Control day to day operations - Manage resources to achieve organizational goals - Accountable an responsible [Management process:] planning -- organizing- staffing- directing- controlling- planning [Nurse manager:] appointed management position with responsibilities to perform administrative tasks including plan staffing requirement, control use of resources, budget and productivity goals [Leader:] comforting, approachable, recognizes strengths and weaknesses, knowledgeable. **Discuss the relationship of leadership and management to nursing** **Explore how to develop a leadership style** [Developing your leadership ability]: emotional intelligence, integrity in decision making, decisiveness, flexibility, self-confidence, followership, alliances [Emotional intelligence]: social skills, self-awareness, empathy, motivation, self-regulation. [Decision making]: complex, cognitive process, choose particular course of action, more than one possible course, must choose between alternatives, usually triggered by a problem [Followership:] interpersonal process, leaders cannot exists without followers, most leaders are also followers [Clinical leader:] the concept of clinical healthcare staff undertaking the roles of leadership; setting, inspiring and promoting values and vision, and using their clinical experience and skills to ensure the needs of the pt are central focus. **Week 3 objectives** **Quality improvement:** **Discuss the meaning of quality healthcare** - Quality goods - Quality performance - Informal 'quality' as an adjective [Quality: ] - the standard of something as measured against other things of a similar kind - the degree of excellence of something - distinctive attribute or characteristic [quality in health care]: the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge\ [Quality care:] Quality of care is the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people centered +-----------------------------------+-----------------------------------+ | [Patient focused ] | - providing care responsive to | | | individual preferences, needs | | | and values | +===================================+===================================+ | [Safe ] | - avoiding injuries to patients | | | from care that is intended to | | | help them | +-----------------------------------+-----------------------------------+ | [Effective ] | - providing services based on | | | scientific knowledge | +-----------------------------------+-----------------------------------+ | [Efficient ] | - avoiding waste --- of | | | equipment, supplies, ideas | | | and energy | +-----------------------------------+-----------------------------------+ | [Equitable ] | - care that does Kot vary in | | | quality due to persona | | | characteristics such as | | | gender, ethnicity, | | | geographical location, | | | socio-economic status | +-----------------------------------+-----------------------------------+ | [Timely ] | - reducing waits and delays for | | | those-who receive and give | | | care | +-----------------------------------+-----------------------------------+ **List the dimensions of quality that define and underpin quality care\ ** **Describe the Quality Improvement (QI) Process and its importance in embedding change for improvement** - Quality improvement refers to the use of systematic tools and methods to continuously improve the quality of care and outcomes for patients. [Effective quality control programs have: ] - Support from top level administration - Commitment by the organization in terms of financial and human resources - Excellence - Process is continuous **Quality care model:** [Structure]: physical and organizational characteristics where healthcare occurs. - Includes building staff and equipment [Process:] focus on the care delivered to patients. - Includes how the organization operates: nursing, catering, cleaning, accounts [Outcome:] effect of healthcare on the status of patients and populations - Includes: mortality, morbidity, length of stay - [Nursing outcome measures:] 'nursing sensitive' outcome measures: pt fall rates, nosocomial infection rates, pressure injury, pt satisfaction [Quality cycle]: assists us to ensure the best results can be achieved toward our desired outcome. The underlying principle of the cycle is that the activity is not complete until evaluation shows goal is achieved. **Explain the Plan, Do, study, Act (PDSA) QI cycle** [Plan: ] - set a SMART goal, make sure you have a timeline, align plan with the change theory lewin (unfreeze ). what is going to set you up for success. What you are doing to prepare your staff for the change [do: ] - During this phase the stragey will be implemented over... time. - Carrying out the plan. - Document potential problems, do audits, look at data. - Link do with change on Lewin cycle. Show your not just implementing something without a plan. Implementing change management theory [Study: ] - analyzing data, Incidence reports. - During study incidence reports will be analysed (don't give results). Audit it to see if staff are filling it out properly. Proposing getting data from patients. (bedside handover includes the consumer) - based on the data analysed in study it will be decided whether or not too adopt, adjust or abandon the strategy - aligned with refreeze in the Lewin **Change management:** **reflect on the meaning of change and quality improvement in healthcare** - make or become different - move from one to another [change rules: ] - should only be implemented for a good reason - be gradual - should be planned, not sudden - all individuals affected should be involved in planning +-----------------------------------+-----------------------------------+ | [Internal driving forces FOR | - new equipment | | change ] | | | | - employee attitudes and | | | behaviors | | | | | | - resource allocation | | | | | | - internal competition | | | | | | - education | | | | | | - results of audits | | | | | | - increase in trends | +===================================+===================================+ | [External driving forces FOR | - global event | | change ] | | | | - government acts | | | | | | - standards | | | | | | - pt demographics | | | | | | - rising cost | | | | | | - competition | | | | | | - workforce shortage | | | | | | - research evidence | +-----------------------------------+-----------------------------------+ **critically analyse the management of change at the organisational level\ **[Planning change: ] - who, how, where, when and why - potential solutions - barriers, strategies - timeline - communication - tools - use a team approach - right people from the right area on the right team [Force field analysis:] for change to be successful, driving forces need to outweigh the restraining forces [Driving forces:] economic gain, improve situation, challenge, future impact, growth [Restraining forces:] need for security, lack of time or energy, failure to see big picture, perceived loss, negative past experience [Who facilitates change: ] [Change agent]: the expert in the field and will educate the team, put the team together. - [Function of change agent:] articulate vision clearly and map timeline, mention ideas, select change project team, give constant updates [Champion:] Part of the immediate team that the change agent will educate. Always available for support In your small area. from within the area of work, nominated as the support person for the particular change **explore the principles of change** [principles in leading change:] - A change in one part affects other parts and other systems - Concrete and specific feedback about the process of change will enhance its acceptance - People affected by the change should participate in making the change - People need assistance in dealing with the effects of the change - People should be informed of the reasons for the change - Suggestions and contributions re. implementation of change should be sought & incorporated - identify theories, strategies and tools of change management [Leadership role in change: ] - Identify and manage the resistance - Motivate - Guide - Educate [Management role in change: ] - Control the change\ Forecasting with strategies such as SOAR or SWOT(legal, political & economic) - Resourcing - Strategies needed **Identify theories, strategies and tools of change management** [Change agent strategies: ] [Rational empirical:] Assumes that people are rational and receptive to change when given adequate facts\ [Normative - re-educative]: Change will only occur when attitudes and relationships are altered [Power -- coercive:] Result of an individual\'s need to please another, or fear of the outcome\ Lewis change model: Unfreeze: - Determines what needs to change - Ensure there is strong support from management - Create the need for change - Manage and understand the doubts and concerns Change: - Communicate often - Dispel rumors - Empower action - Involve people in the process Refreeze: - Anchor the changes into the culture - Develop ways to sustain the change - Provide support and training - Celebrate successes [Transtheoritical/stages of change model ] 1. Precontemplation 2. Contemplation 3. Preparation/determination 4. Action/willpower 5. Maintenance ' [Kotterrs 9 step model ] 1. Establish a sense of urgency 2. Form a powerful guiding coalition 3. Create a vision 4. Communication vision 5. Empower others to act on vision 6. Plan for and create short term wins 7. Consolidate improvements and produce more change 8. Institutionalize new approaches  [ADKAR model ] - Awareness - Desire - Knowledge - Action - Reinforcement [Six Sigma/DMAIC] - Define - Measure - Analyse - Improve - Control  [DMAIC ] - Define - Measure - Analyse - Improve - Control [Resistance to change: ] - Should be expected - May be rooted in anxiety or fear - Not all resistance is bad; may be a warning - Viewing the resister as the solution can help reframe issue - May be due to a lack of trust - Can be individual or collective resistance [Techniques to reduce resistance:] education, communication, negotiation, co-opting, coercion, leadership skills [Things to avoid when applying change:] simply announce a change without laying foundation, communicate ineffectively, ignore peoples fears, fail to be open to criticism **Week 4 objectives** **factors that influence contemporary nursing practice, including:** **Identify the development and change in nursing** [challenges in nursing in Australia: ] - Rising health care costs - ageing population - Technological change - need to improve equity, accessibility - Drive for efficiency - need to maintain & improve safety and quality - Economic uncertainty +-----------------------------------+-----------------------------------+ | [Nursing in1980's ] | [Nursing in 2024] | +===================================+===================================+ | - Transitioning from Apprentice | - Focus on outcomes | | style education to Uni based | | | -education | - Heavily regulated | | | | | - Team Nursing | - Licensing and accreditation | | | | | - Hierarchical structure | - National Standards | | | | | - Technology was being | - Financially and evidence | | introduced | Driven | | | | | - Accreditation was new | - Technology focused | | | | | | - Highly skilled workforce | | | | | | - Specialisation | | | | | | - Consumer focused | | | | | | - Employee engagement | +-----------------------------------+-----------------------------------+ [ What has changed in nursing: ] - Expanded nursing roles - Models of practice delivery used in specialist areas - Practice change which support MDT approach - Use of caregivers - Promotion of EBP - Development of continuity of care [Teletriage:] The nurse is in a dedicated call centre with computerised decision support or algorithms. [Telenursing:] Nurses who deliver, manage and coordinate care and services using telecommunication technology [Online video consultation:] Nurse is located with a person in their own home and contacts a medical practitioner/specialist or other healthcare professionals to discuss required care. [What is health informatics:] - Using computing, networking and communications to support the health- related fields - Intersection of information technologies, computer science, social science - powered by various forms of information technologies, Internet enabled technologies, communication technologies [Impact on nursing of health informatics:] - Communication - Efficiency - Clinical practice - Education - Research - Patient participation - Improved outcomes [In summary: ] - Nursing is changing - Care is influenced by the consumer - Nurse leaders need t be adaptive and innovative - Nurse leaders need to constantly look at how we deliver care - An opportunity to rethink what is being done **Identify social, cultural and environmental influences** [Social cultural and environmental influences: ] - Consumer participation/partner ship - Increasing rates of chronic illness - Ageing population - Environmental (natural disasters, climate change) - Conflict (war, terrorism) - Lifestyle (reduced physical activity, obesity) - Political policy initiatives - Technology (procedures, pharmacology, gene therapies) - Financial (wages, employment, and the financing of healthcare) - Infectious diseases [Rural and remote challenges]: People living in rural and remote areas tend to have shorter lives and higher levels of illness and disease risk factors than those in major cities **Discuss key challenges for nursing leaders** [Key challenges for nurse leaders: ] - Focus no longer just on process of how care is delivered, but on outcomes - Care according to specific standards associated with better outcomes - Patient satisfaction and perception of care - Technology - Workforce shortages - Safety and quality issues linked to financial pressure - Accountability for managing and leading staff responsible for providing pt care\ Analyse and discuss contemporary nursing issues [Pt centered approach:] dignity and respect, shared decision making, open communication, collaboration [Manging and leading the staff accountability: ] - Drive accountability - Accountable leaders - Share the vision - Prioritise - Identify & develop - Influence other [How to develop a culture of pt safety and quality care: ] - Reporting culture - Learning culture - Flexible culture - Just culture **Analyse and discuss contemporary nursing issues** [Safety and quality issues are directly linked to financial pressure: ] - Length of stay as an important measure - Activity based funding - Increase focus on \"never events\" - A culture of safety and quality [Workforce issues: ] - Shortage of over 100,000 nurses by 2025 - Shortage worldwide - Increase in part time workforce - Ageing workforce - 88% women - Spike in retirement [Social media guidelines: ] - Remember the National Law - Advertising guidelines - Comply with professional obligations - Comply with privacy and confidentiality obligations - Present information in an unbiased, unsubstantiated evidenced-based claims context **Week 5 objectives** **Identify key elements of consumer-centred care** [Partnering with consumers: health leaders must] - develop - implement and - Maintain -- systems to partner with consumers. [Levels of partnership ] 1\. At the level of the individual 2\. At the level of a service, department or program of care 3\. At the level of the health service [Consumers expect:] clinical effectiveness, pt experience, safety [Pt centred care: ] Collaborative and respectful partnership - Consider the patient's opinions - Respect their values - Maintain their dignity Right to receive information in a manner they can understand - so they can make the right choices [Pt centred care relevant frameworks:] DOH clinical governance, safety and quality, ACSQHC strategic intent, NSQHS partnering with consumers, clinical governance framework [Consumers values:] involve pt carers and communities, Effective consumer participation requires leadership to ensure involvement and deliver equitable, consumer and carer focused health care [What is the right to health:] Health services, goods and facilities must be provided to all without any discrimination, All services, goods and facilities must be available, accessible, acceptable and of good quality. [Australian Charter of Healthcare Rights:] Describes the rights of all people using the Australian health system, Essential to make sure that, wherever and whenever care is provided, it is of high quality, safe and meets consumer needs and expectations. [7 rights as per the Australian charter of healthcare rights ] 1. access 2. safety 3. respect 4. partnership 5. information 6. privacy 7. give feedback **Discuss why consumer engagement is essential in healthcare** [Why engage consumers: ] - active partners - values in planning, service delivery and evaluation, meaningful opportunities to actively engage and ensure they are listened to [ ] [Types of consumer involvement: ] A blue and white text on a blue background Description automatically generated [Areas pts can be involved in: ] - Service redesign - Sharing decisions on care - Reporting adverse events - Complaints - Research - Policy Development - Planning - new hospitals - Audits - Committees -- NSQHS Standards committees - Hospital Executive Committee [Community advisory committee:] Assisting the health service to appropriately integrate consumer and community views at all levels of its operations, planning and evaluation, and Advocating to the organisation on behalf of the community. **Discuss the responsibilities of healthcare professionals in maintaining consumer healthcare rights** [People who complain have basic expectations:.\ ] - be heard and understood - be respected - be taken seriously - be given support or assistance if required - have their concerns dealt with effectively and efficiently - be informed of the process, progress, findings and outcome - have appropriate action taken as a result of their complaint. [Common themes in complaints: ] - Treatment issues - Communication - Access issues - Professional conduct - Discharge process [Process of complaints: ]  [Responsibilities of health care professional in dealing with complaints ] - Show respect and consider patient\'s wishes - Speak in words that can be understood - Listen attentively - Answer questions honestly - Address fears by providing appropriate information - Inform and educate about patient\'s illness [Complaint outcome] - Factual --- evidence to support, explanation - Work within boundaries - Attention to detail - Meaningful and appropriate apology as required - No blame culture - Outcome should match issues --- answer/respond to questions asked by complainant [Open disclosure:] open discussion of adverse events that result in harm to a pt while receiving health care with the pt, their family and carers A close-up of a list of words Description automatically generated [Traffic light approach to deal with complaints: ] - Stop before you speak (allow the person to vent and do not react defensively) - Listen for understanding (actively listen to the complaints, empathize and acknowledge their point) - Look for solutions (express regret that they have had a poor experience and consider options for action to resolve the issue) [Glad, sure sorry approach to deal with complains] - Glad \"I\'m glad you brought this to my attention\" - Sure \"I\'m sure there is something we can do to help you\" - Sorry \"I\'m sorry our service has not been what you would have expected. \" **Explore options for patient involvement in their care and in the organisational processes** [Consent responsibilities: ] - Inform patient about what to expect from treatment - Gain consent to treatment - Gain consent to any research to be performed - Provide appropriate information and time - Assess and inform patient of any level of clinical need [Advocacy]: pleading a case for a patient or supporting patients and families in exercising autonomy and free choice [Who needs advocacy] - Lack of knowledge - Little power - Need to make a decision - Receive inadequate care - Cannot communicate - Essentially, anyone who accesses the healthcare services **Week 6 objectives** **Reflect on the meaning of organisational culture within health care** [Organisational culture]: is a system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common [Positive organisational culture:] the vision, values and behaviours of an organisation and the people within it, where staff are provided with the direction and resources that enable them to thrive [Characteristics of organisational culture: ] - Multi disciplinary team work well together - Communication and coordination - Consumer first - Consumers don\'t feel like projects or numbers - New initiatives are embraced not ignored - Organisation meets its mission **Critically analyse definitions of organisational culture** [Styles of organisational culture ] - Caring workplaces - Purpose-driven cultures. - Learning cultures - Playful (enjoyment) environment - Results-oriented cultures - Authority cultures - Safety and risk-conscious cultures - Structured and methodical work environments. [Assessing the organisational culture] - What is the Organisation's Physical Environment? - What is the Organisation's Social Environment? - How Supportive is the Organisation? - What is the Organisational Power Structure? - How Safe is the Organisation? - What is the Communication Environment? - What are Organisational Taboos? **Discuss how we can influence and change culture** [Factors in healthcare culture that could act as a barrier to pt safety: ] - Unclear unit/ward values - Fear of punishment for errors - The lack of systematic analysis of mistakes - The complexity of the work - Inadequate teamwork. - Lack of leadership - 'The way it has always been' [Influencing change in organisational culture - managers and leaders] - Cultural change cannot occur because of an educative, counseling approach. - For an organisational culture to be effective, a whole-system approach is required where individuals are encouraged to work collectively and collaboratively to develop, implement and fulfil the aspirations of the organisation [Transformational leader: ]  [How can YOU influence the culture?] - Patient safety - Patient perception - Communication with patients - Supporting innovation in practice - Governance - Putting your hand up [Working in committees] - Provide novice nurse--leader opportunities and responsibilities - Networking - Create environment to lead to shared decision making - Encourage interaction free of status and power [Positive safety culture: ] - Strong leadership\ to drive safety culture - Strong management commitment with safety culture a key organisational priority - Staff who are always aware that things can go wrong - Acknowledgement at all levels that mistakes occur - Non-blame, non- punitive response to error [What are the principles of risk management? ] - Avoid risk - Identify risk - Analyse risk - Evaluate risk - Treat risk [Clinical risk management] - Identification and reduction of potential risks - Examination of clinical incidents/adverse events for causative and contributing factors and trends within and across health services. [Reporting \'no blame\' culture ] - Incident and adverse event reporting, monitoring and trend analysis - Sentinel event reporting, monitoring and clinical investigation - Risk profile analyses, risk register [Sentinel events ] - Surgery or other invasive procedure performed on the wrong site resulting in serious harm or death - Surgery or other invasive procedure performed on the wrong patient resulting in serious harm or death - Wrong surgical or other invasive procedure performed on a patient resulting in serious harm or death - Unintended retention of a foreign object in a patient after surgery or other invasive procedure resulting in serious harm or death - Haemolytic blood transfusion reaction resulting from ABO blood type incompatibility resulting in serious harm or death - Suspected suicide of a patient in an acute psychiatric unit or acute psychiatric ward - Medication error resulting in serious harm or death - Use of physical or mechanical restraint resulting in serious harm or death - Discharge or release of an infant or child to an unauthorised person - Use of an incorrectly positioned oro- or naso-gastric tube resulting in serious harm or death. **Identify appropriate techniques to maintain a culture of safety as an individual** [Benefits of open disclosure :] For patients, their families and carers - can allay feelings of anxiety and abandonment after harm - shown to have a cooling effect on desires to litigate - most commonly motivated by patients simply wishing to find out exactly what happened (esp. when faced with evasion and lack of communication). [The 'three bucket' model] A buckets of liquid Description automatically generated with medium confidence [Self Bucket -- internal & personal factors]  [Context bucket: environmental factors ] A table with text on it Description automatically generated [Task Bucket -- inherent factors to the task]  [Non-Technical Skills] - Human Factors on an individual level - Non-technical skills (NTS) are defined as the social (teamwork, leadership, communication),cognitive (situation awareness, decision-making, cognitive readiness, task management) and personal management (stress and fatigue management) skills necessary for safe and effective performance [Closed loop communication] Communication to a specific person and then reaffirmed; - Telephone orders - Medication - Theatre - Consent - Delegation of task [Situational Awareness (SA):] the perception of elements in the environment, the comprehension of their meaning in terms of task goals, and the projection of their status in the near future [Three Levels of Situational Awareness] Level 1 : Perception The ability to perceive the immediate local environment Level 2: Comprehension The understanding and interpretation of these facts Level 3: Projection The ability to project the picture and plan the immediate future +-----------------------------------+-----------------------------------+ | [Level 1: perception] | - The patient is not breathing, | | | looks blue... | | | | | | - What is the make up of the | | | environment around you during | | | a typical emergency? e.g | | | furniture, light, people | | | | | | - What elements can make it | | | difficult to assess the | | | situation? | +===================================+===================================+ | [Level 2: | - Once you have appraised the | | comprehension] | situation, spend a moment | | | drawing a conclusion: | | | | | | - 'The team are going to be 30 | | | minutes...' | | | | | | - 'The HR is rising still; what | | | does that mean?' | | | | | | - 'Is the blood pressure under | | | control?' | +-----------------------------------+-----------------------------------+ | [Level 3: projection] | - What does the current | | | situation mean for the | | | immediate future? | | | | | | - 'Are there other cases that | | | are a priority?' | | | | | | - 'Do I need to allocate our | | | resources elsewhere?' | | | | | | - Do we need additional help?' | +-----------------------------------+-----------------------------------+ [Common SA Errors: Measure Fixation] - Measure fixation implies behaviour and activities in order to achieve specific performance indicators which may not be effective. - Measure fixation occurs when the pursuit of success as measured, rather than as intended, becomes the main focus. - Three members of a team trying to fix the infusion pump - Focus on the four-hour rule, where the \'measure\' becomes the goal rather than what the measure is intended to achieve.   [Common SA Errors -- Tunnel Vision ] - Tunnel vision... undue focus on performance measures to the detriment of other areas. - Only focussing on what appears to be the immediate problem - The chest pain that has also had a bleed - Trying to get IV access while the airway obstructs...   [Other Common SA Errors ] - Distraction -- The irate relative, noise, darkness - Over confidence -- I don't need any assistance with this - Denial -- Constantly dabbing the oozing wound -- Allowing a PPH to get out of hand   [Ways of Avoiding SA Errors ] - Higher level training -- USA Airline industry, NASA, Air Force -- MET training and ward drills - Aviation - Rotation of attention through -- Plane -- Pathway -- People - Plan - Consider: -- Patient -- Progress -- People -- Plan -- A B C D E [Six Simple rules for Redesigning Care ] - See things through the patient's eyes - Find a better way to do things - Look at the whole picture- strategic - Respect the idea and work of others - Give frontline caregivers the time and tools to tackle the problem - Take small steps as well as big leaps **Objectives** **Identify the relationship between human resources (HR) management and organisation management** [Human Resource Management ] - Is about the acquisition, optimisation and development of the workforce. - Helps shape the relationship between employer and employee and the culture of the organisation. - Balances organisational needs with employee needs in pursuit of business success. [Clinical performance and effectiveness:] safety and quality training, performance management, credentialing and scope, safety and quality roles and responsibilities, evidence based care, variation in clinical practice and health outcomes [Introduction to HRM] - Staffing: important phase of management process - Labour intensive: require many employees to accomplish goals - Workforce should reflect gender, culture, ethnicity, age, language and diversity of local community - Health disparities: due to lack of diversity - Staff needs to be sensitive and responsive to local community they serve **Explore the HR activities performed in organisations** [HR Activities ] - Job analysis - Human resource planning or employment planning - Recruitment, selection, retention - Performance appraisal - Career planning and development - Employee motivation - Remuneration / Benefits - Industrial relations - Health and safety programs - Manage diversity - Training and development [Human Resource Management (Workforce Services) ] - Issues related to people such as compensation, hiring, performance management, organisation development, safety - is also a strategic and a comprehensive approach to managing people, the workplace culture and environment. [Strategic involvement:] the manager being involved in all strategic matters pertaining to the management of the organisation including planning, financial and human resources. [Human Resource Planning ] - Right number of qualified people in the right jobs at the right time - Planning to meet projected demand - Current nursing workforce is ageing [Management Ideas Influencing HRM ] - Missions and objectives. - Long-term thinking and planning. - Resource management. - Proactive. [The Unit Managers Responsibilities for Staffing ] - Rostering continues to be an important function of first- and middle-level managers. - Need to feel they have some control over rostering, shift options, staffing policies. - Some organizations now use staffing clerks and computer programs. [Developing Staffing and Rostering Policies ] - Should be thoughtfully developed, fairly applied, and clearly communicated to all employees - Written policies - Scheduling and staffing policies [Sequential steps in staffing: ] 1. Determine requirements 2. Recruitment, interview, select and assign 3. Induction and orientation [Determine Staffing Needs ] - Number and types of personnel needed to fulfil philosophy - Fiscal planning, where is the money coming from? - Chosen patient care delivery system; based on needs of patients and the availability of competent staff in the different skill levels [Nursing Hours per Patient Day] the NHpPD model: - Ensures flexibility in the supply of nursing and/or midwifery hours to meet the variable demands of patient care, with the recommendation of minimum safe staffing levels. - Measures and reports on the direct clinical care hours require and provided by nurses and midwives. [Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act:] to enshrine in law minimum numbers of nurses and midwives to care for patients. [Queensland Government (2016) endorsed minimum nurse-to-patient ratios: ] - one nurse to every four patients for a morning and afternoon shift (1:4) and - one nurse for every seven patients for a night shift (1:7) - in acute medical and surgical wards in prescribed wards and facilities in the State's public health services [Impact on good nurse to pt ratios ] - decreased lengths of stay in hospital - reduced inpatient mortality - fewer adverse events. [Appropriate staffing numbers benefits the nursing workforce by reducing ] - work-related injuries, - absenteeism and turnover, and - by increasing job satisfaction. [The aim of the recruitment and selection process is to appoint:] - the most suitable and available people - to create a high quality workforce - to achieve the strategic objectives and business outcomes of the organisation [Job Descriptions:] Defines a job in terms of specific tasks and responsibilities and identifies the abilities, skills and qualifications needed to perform it successfully [Purposes or goals of an interview: ] - The interviewer seeks to obtain enough information to determine the applicant's suitability. - The applicant seeks to obtain enough information to determine possible acceptance of position. - Regardless of end results, the applicant will continue to have goodwill toward the organization. [Indoctrination:] The planned, guided adjustment of an employee to the organization and work environment [Three phases: ] - Induction: Activities that educate new employees about the organisation - Orientation: More specific to the position - Socialisation: Internalising values & culture of the workplace [Performance Appraisal Cycle] - A formal process of defining employee performance expectations. - Measuring, evaluating and recording performance relative to those expectations and providing feedback - Also, opportunity for recognition of achievement and identification of career goals [Indications of substandard performance]: lack of skills, slow pace, does not finish tasks in time, absenteeism, evidence of alcohol or drug abuse, disruptive or unco-operative behaviour [Retention:] High turnover of staff is costly to the organisation in terms of time and money [Retention strategies such as:] Flexible rostering, Flexible hours, Work life balance policy, Access to leave, On-site childcare, Training & development, Career progression, Parking [Action 1.20 states:] The health service organisation uses its training systems to: - Assess the competency and training needs of its workforce - Implement a mandatory training program to meet its requirements arising from these standards - Provide access to training to meet its safety and quality training needs - Monitor the workforce\'s participation in training [The main object of the Work Health and Safety Act 2020:] provide for a balanced and nationally consistent framework to secure the health and safety of workers and workplaces [The Equal Opportunity, Discrimination and Harassment Policy:] to ensure the creation and maintenance of an environment in which Staff Members are treated with respect, dignity, fairness and which is free from all forms of discrimination and harassment. [Workplace grievances:] Any real or perceived problem, or any significant question, dispute, difficulty, claim, complaint, concern raised by one or more employees in relation to work or the work environment [Career Stages ] Promise - Early career (first 10 years) - Reality overload common as a result of inexperience - Focus is on role socialisation, expertise building, and defining career goals Momentum - Mid career (11 to 29 years) - Experience, mastery, and accomplishment - Challenge is avoiding stagnation **Discuss the importance of Employee Engagement** [Employee engagement ] The extent to which employees are: - satisfied, loyal, committed, - keen to stay in their role, - confident that they are valued, - feel that the work they do is meaningful, - see a future with the organisation, - prepared to apply discretionary effort because they feel they make a difference. [A Model of Employee Engagement] Freedom: losing the reins of control Community: increasing the sense of belonging Purpose: working to make a different [Factors Affecting Engagement] - Job design - Management style - Rewards and recognition [Intellectual capital: ] - Competence: skills, knowledge, attributes, skill utilisation - Commitment: loyalty, practical benefits of staying - Control: work autonomy [Psychological job needs: Meaningful work:] The extent to which people feel that their work is significant and worthwhile to themselves, the organisation and the community. [Psychological job needs: Responsibility:] The extent to which people feel personally responsible and accountable for the outcomes of their work. [Psychological job needs:] Knowledge of results: The extent to which people know how effective their work has been and what impact it has had. [Measuring Engagement ] - typically qualitative research instruments (i.e. questionnaires) using summative rating scales. - The dimensions used in these instruments vary [Reward systems are designed to: ] - Recognise the value of the work - Promote distributional justice (fairness in distribution of rewards) - Recognise individual expertise and achievement - Engage and motivate employees [Extrinsic and intrinsic rewards ] - Extrinsic: tangible rewards, pay, benefits - Intrinsic: making a difference in the community, contributing to social outcomes, social interaction, fun, recognition [Managers must demonstrate behaviours that motivate their staff: ] - Clearly communicate expectations - Assign work duties commensurate with abilities - Identify achievements - Listen in order to identify unmet needs that can cause dissatisfaction - Promote self-growth - Develop unit goals that integrate organisational and individual goals - Encourage mentoring, coaching **Week 8: SUMMARY** Week 1 -- Clinical Governance Week 2 -- Leadership & Management Week 3 -- Quality Improvement & Change Management Week 4 -- Contemporary Nursing Issues Week 5 -- Consumer Expectations Week 6 -- Organisational Culture Week 7 -- Human Resource Management A blue and white text on a blue background Description automatically generated [Clinical Governance ] - Clinical governance is a shared responsibility to ensure that all patients receive the best care. Nurses, midwives and managers therefore share the common goal of optimising patient care. We share accountability for the care we deliver, the equitable use of resources and building a positive workplace culture. - It is a systematic, integrated approach to assurance and review of clinical responsibility and accountability that improves quality and safety resulting in optimal patient outcomes.  [National drivers\... ] National Model Clinical Governance Framework 2017 Australian Safety and Quality Framework for Healthcare 2010 National Safety and Quality Health Service (NSQHS) Standards 2018 Australian Health Service Safety and Quality Accreditation Scheme (AHSSQA) Australian Commission for Safety and Quality in Health Care (ACSQHC) Australian Institute of Health and Welfare [ACSQHC Strategic Intent]  [State drivers.] A document with text on it Description automatically generated [Clinical Governance Framework] Care is consumer and carer centred [Consumer partnership is evident at all levels of the organisation ] Open disclosure patient/community representation facilitating patient autonomy [ ] [Care is driven by information ] Relevant, accurate information is available and used at all levels of the organisation to guide quality improvement activities. evidence based practice QI in practice professional development research activities   [Led for high performance ] Executive and clinical staff have the right qualifications and skills to provide safe, high quality health care; and to foster a culture of openness, collaboration and continuous improvement. staff forums feedback opportunities satisfaction surveys transparent leadership   [Organised for safety ] Minimisation of clinical risks and incidents and a systems approach to harm minimisation incident/near miss reporting no blame culture culture of safety RCA process   [How could a newly qualified RN engage in Clinical Governance?] Take part in policy development Advocating for patients Reporting errors and near misses Use of evidence-based care Support and participate in QI projects A dhere to the Codes and Standards when working Follow hospital policies and guidelines Reporting breaches of unethical behaviour or negligence Participate in performance development Keep up with mandatory learning and training Participate in performance management [ ] [Partnering with Consumers] the value of the consumer voice the need for consumer experience and expertise to help shape decisions about health care at every level [The Partnering with Consumers Standard was developed as there is good evidence that delivering care that incorporates consumers' needs and preferences can lead to: ] better health outcomes better experiences greater efficiency of care   [Australian Charter of Healthcare Rights] [7 rights: ] - Access - Safety - Respect - Partnership - Information - Privacy - Give feedback  [Open Disclosure] - the open discussion of adverse events that result in harm to a patient while receiving health care with the patient, their family and carers. - an apology or expression of regret, which should include the words 'I am sorry' or 'we are sorry' - a factual explanation of what happened - an opportunity for the patient, their family and carers to relate their experience - a discussion of the potential consequences of the adverse event - an explanation of the steps being taken to manage the adverse event and prevent recurrence.    [What is Quality Care? ] "Quality of care is the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people centered"   [Six dimensions of quality ] Safety Effectiveness Patient centeredness Timeliness Efficiency equity [Reason's Three Bucket Model ] A list of words on a white background Description automatically generated   [Structure + Process = Outcome]  [Incidents and near misses ] [ Tools to identify contributing factors ] -- Root Cause Analysis -- Ishikawa diagram (Fishbone diagram) to investigate the cause and effect -- 5 Whys -- FMEA (Failure, Mode, Effect, Analysis) All aimed at identifying contributing factors and causes, to avoid 'bandaiding' and missing the 'real' issue [Root cause analysis (RCA)] A close-up of a diagram Description automatically generated [Quality Improvement Cycle]  [Change] Is inevitable Can be driven by many forces Seldom easy Communication - can make or break a change Leadership and planning change is critical Can be re-energizing and empowering for a workforce Timing is important Top-down vs workforce involvement [Lewin's Force Field Analysis] A blue and red figures pulling a blue ball Description automatically generated [Internal Driving Forces] New equipment Employee attitudes and behavior Resource allocation Internal competition Education Results of internal audits Increase in trends of reportable events   [External Driving Forces ] Global events Government Acts Standards Patient demographics Rising costs Competition Workforce shortages Research evidence Customer satisfaction   [Driving / Restraining Forces ] [ Driving Forces ] -- Economic gain -- Improve situation -- Challenge -- Future impact -- Growth, recognition, achievement, and / or improved relationships [ Restraining Forces ] -- Need for security, emotional -- Lack of time or energy -- Failure to see the big picture -- Perceived loss of freedom -- Negative past experience -- There may be something wrong with the plan   [Change Strategies]  [Lewin's Three Stage Change Model/Theory] A diagram of a change process Description automatically generated   [Leadership Styles ] Kurt Lewin's (Autocratic, Democratic, Laissez-Faire, Situational, Transactional and Transformational) A red figure surrounded by people Description automatically generatedA close-up of a person Description automatically generated  A person standing next to a ladder Description automatically generated [Leadership vs Management ] [Leadership: guiding, teaching, motivating ] Create the vision/people orientated Align people and inspire them Crate change proactively Keep the values visible Collaborate Motivate and inspire Continue to challenge the status quo Empowerment of self and others Get position due to abilities, skills attributes [Management: Co-ordination and integration of resources through controlling, organising and directing ] Implement the vision Plan, budget and organise the team/ Seek step-by-step improvement Maintain order and system Manage the impact of change Control and problem- solve Contribute to teams Appointed to task then may hire Resource Management Budgeting CEO, department head  [Ageing Population] Patients living longer, requiring care for longer -- but also sicker and more costly to care for (financially and needing human resources). increase of comorbidities which leads to an increase of patient acuity. Increase in financial cost of healthcare because of the comorbidities. Nursing shortage and bed capacity shortage because of the sheer volume of patients to care for. Mass exodus of experienced nurses who are ageing out of the profession. Ratio of population contributing to tax funding public health vs the population requiring that funding.  [How is the ageing populating changing healthcare?] Leading to reduction in patient safety Lack of support leading to burnout Leading to higher rates of junior nurses leaving the profession perpetuating the problem Increased use of technology to care for more acutely unwell patients. Leading to increased need for education and training for staff Contributing to the increased cost of having an ageing population   [Violence & Aggression] Healthcare is more accountable and consumer focused, which is good overall but leaves not much accountability for patient behaviour towards healthcare professionals. Patients more likely to question and second guess healthcare professionals -- don't just believe what they are told. This is also good as it can contribute to their health literacy, but in some instances, patients lash out to the healthcare professionals caring for them. The kinds of recreational drugs used in contemporary times are more likely to result in violence and aggression compared to recreational drugs used 60 years ago -- think heroin vs meth.   [How is this violence and agression changing healthcare? ] Staff receive training on dealing with violence and aggression (WAVE) De-escalation training Physical ways to keep yourself safe Use of behavioral charts to try to hold patients accountable WorkSafe Campaigns and signage around healthcare centers reminding patients to treat staff with respect Security teams in hospitals to attend Code Black's to help with physical restraining Nurses leaving the profession because of physical violence   [COVID-19] Highly contagious, quickly spreading to all over the world because of contemporary transportation (planes and ships). High death toll in ageing and vulnerable populations. Increase in number of patients requiring hospitalization and nursing care during acute periods of pandemic. Sicker patients requiring more nursing care and more therapies driven by technology (Ventilator support, ECMO, Dialysis\...) World shutdown. Flights cease. Vaccine hesitancy   [How is covid changing healthcare? ] Mandatory mask wearing Lockdown tracking spread of disease by checking into public venues and events. Fear and mistrust develop Some people being secretive not following mandates and putting others at risk Increased vigilance of PPE wearing and hand hygiene in hospitals Environmental impact of increased resources used. Vaccination developed have to force some people to get vaccinated Broader implementation and use of telehealth Nurses burning out during this period. Mass early retirement of experienced nurses who had a few more years left before retiring. Nurses leaving the profession Nursing shortage Uneven skill mix with mostly junior nurses leading to decrease in patient safety   [Organisational culture] "...is a system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common." (Marquis & Huston, 2021) The summation of how people within an organization interact with each other and work together.   [What are the factors in organisational culture that affect patient safety? ] Unclear unit/ward values Fear of punishment for errors The lack of systematic analysis of mistakes Inadequate teamwork Lack of leadership 'The way it has always been'   [How do we develop a culture of patient safety and quality care?] A few words on a paper Description automatically generated with medium confidence [Human Resource Activities ]  [Determine Requirements ] Consider numbers and type of staff required - Workload model, Nursing Hours per Patient Day calculation Consider constraints: financial, availability   [Recruitment / Selection ] The aim of the recruitment and selection process is to appoint: -- the most suitable and available people -- to create a high-quality workforce -- to achieve the strategic objectives outcomes and goals of the organisation Recruit applicant pool Interview process Selection checks Assign / Notify   [Process of Indoctrination ] Induction - educate new employees about the organization as a whole Orientation - specific orientation to the new high acuity ward area, upskilling/training Socialisation - internalizing and adopting the values and culture of the workplace, fit into 'norms'   [Employee Engagement] The extent to which employees are: satisfied, loyal, committed, keen to stay in their role, confident that they are valued, feel that the work they do is meaningful, see a future with the organisation, prepared to apply discretionary effort because they feel they make a difference.   [Retention strategies that could be used to reduce staff turnover ] Flexible rostering Flexible hours Reward and recognition Work life balance policy Access to leave Professional development Career progression On-site childcare Parking