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1. Memorandum

   From: Thomas Green

   To: All New Nurse Managers

   Cc: Allen Poe – Chief Nursing Officer

   Date: 12 October 2020

    

   Subject: Leadership Attributes

   My attention has been drawn to the recent death of a patient for which it is suspected that we should as a facility entirely take blame. That a nurse can stray from the call to duty owing that the things at stake are human lives is a frightening possibility. However, suspecting the same nurse of an error that may have cost a life calls for an exhaustive investigation. The primary focus of our care duty is the patient (Fix et al. 2018), and to sit by and do nothing while our members willingly cause harm to the same patients would be the height of irresponsible leadership.

   As Nurse Leaders, you are called upon to demonstrate a number of leadership attributes. First among these is the attribute of integrity (Sfantou et al. 2017). With integrity, it would be certain that you make the right decisions at critical moments in the care of the patient at all times and encourage those under you to do the same. Having integrity means making use of, and teaching others about the ethically viable practices that ensure that all choices taken would contribute to the overall well-being of the patient without being influenced by any outside force to do otherwise. Secondly, you have to possess the quality of emotional intelligence. As is the nature of nursing practice, there are several stressors that demand that the nursing practitioner and their leaders develop coping mechanisms that effectively respond to such stressors. As leaders, you are obligated to help nurses manage such challenges that can take emotional toll and undermine team collaboration. As leaders, you also have to show the feature of mentorship. Nursing practitioners and trainees have individual personalities that demand for varied motivational strategies. By empowering and guiding these nurses, you create an environment of continual learning helping them develop autonomy and feel less micromanaged.

   You also have to show effective communication skills. The multidisciplinary nature of nursing practice demand that collaboration is at the core of practice (Sfantou et al. 2017). You then ought to promote active engagement between the nurses and support staff, physicians, primary care providers and even senior executives. Effective communication is also seen in how the nurse informs the patient and family of the care plan and respecting their opinions too. Finally, you need to demonstrate professionalism. As leaders, you must be the ones to first actively promote competence and confidence. While representing the field in the boardrooms or at various points of professional contact, you have to understand the changing dynamics of nursing practice. As you guide those under you, always strive to ensure that you have the training that will enable you to exercise the full extent of your training.

   The incident in question will serve as an example on how to handle such cases in terms of data collection. Before any nurse is accused of having willingly caused a patient’s death, enough evidence has to be gathered. This will start at the point of admission. We have to establish how and when the patient was admitted and whether or not enough background information was collected. It then has to be established whether the right evidence-based decisions in terms of care were made by the nurse. The nature of care has to be established and given the nurse history, we will have to find out whether there was any element of abuse. The nursing interventions have to be interrogated so that it is seen that they were made from the patient’s point of need. Having collected all these data, a conclusion on culpability will then be made with regards to the nurse’s responsibility.

   The investigation of this nurse will be guided by elements of transformational leadership. Because this leadership system encourages nurses to be critical thinkers, it will have to be established some of the critical decisions that the nurse made or failed to make that may have directly or indirectly caused the death. There will be active attempts to break down the notion of bureaucracy and get the nurse to take responsibility of the decisions made for the patient. This is because in this leadership style, there are clear goals set with high expectations, provision of support and recognition, stirring emotions and inspiring people (Ree and Wiig, 2019). We will have to get the nurse to recognize her role as an integral member of the care process so that she can appreciate that maybe a little more commitment would have led to potentially better outcomes for the patient. The goal is to enhance more personal responsibility in the autonomy that transformational leadership provides.

   References

   Fix, G. M., VanDeusen Lukas, C., Bolton, R. E., Hill, J. N., Mueller, N., LaVela, S. L., & Bokhour, B. G. (2018). Patient-centred care is a way of doing things: How healthcare employees conceptualize patient-centred care. Health expectations: an international journal of public participation in health care and health policy, 21(1), 300–307. https://doi.org/10.1111/hex.12615

   Ree, E., & Wiig, S. (2019). Linking transformational leadership, patient safety culture and work engagement in home care services. Nursing open, 7(1), 256–264. https://doi.org/10.1002/nop2.386

   Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare (Basel, Switzerland), 5(4), 73. https://doi.org/10.3390/healthcare5040073

   Organizational Systems in Healthcare

   Mayo Clinic Health System

   Mission: To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.

   Vision: Mayo Clinic will provide an unparalleled experience as the most trusted partner for health care.

   Philosophy: The needs of the patient come first. In addition, the values of respect, compassion, integrity, healing, teamwork, excellence, innovation and stewardship are critical to care.

    

   The mission, vision and philosophy of Mayo Health System influence the nursing leader’s expectations in various ways. At the Micro level, the nursing leaders expect that both the nurses and the patients together with their families will work in collaboration to make patient-centred decisions and apply the values of evidence-based practice. The leaders expect that stressors and other relating factors will not bar the organization from exercising integrity, respect, compassion, teamwork and innovation in the provision of care (Barasa et al. 2015). At the meso level, the various departments independently work for the sole purpose of improving patient outcomes. When the patient is admitted to a certain department, that department exhaustively does healthcare background checks, protecting their privacy and acknowledging their right to the contribution towards their care plan. The leaders expect that at this departmental level, the people would come together to ensure that the patient is handled professionally and offered the best possible care. The nursing leaders at the Macro level expect that different departments will collaborate for the benefit of quality healthcare delivery. Whether it is the physiotherapy, counselling, documentation or laboratory departments, they would communicate consistently and clearly, with each expressing their role and responsibility in providing the patient with the best care available.

   The nursing leaders at the three levels address healthcare delivery goals in various ways. At the Micro level, the leaders ensure that the patient is received and attended to immediately, that there is sufficient contact and communication between the patient, their family and the health practitioners. The patient expresses their condition, the family presents their expectations and the organization begins the process of care delivery. At the Meso level, the leadership ensures that the various units within a department in which the patient is admitted coordinate to provide the best care backed by clinical evidence and experience (Krawczyk et al. 2018). The patient is diagnosed and individual care plans that respond to their specific needs are designed and implemented. At the Macro level, the nursing leaders implement the value of collaboration in the delivery of healthcare goals for the patient. The various department work as a team to complement the healthcare needs of the patient. Reliable communication and the clear statement of what must be done for the patient to achieve positive outcomes is key in achieving the desired goals.

   Ensuring that there is total integration and coordination at the three levels is essential for the nursing leaders. Even though the levels can be described in isolation, nursing goals can only be achieved when their functioning is viewed as a continuum and not a series of isolated events. Leadership at the Micro level ensures that the basic elements of care that includes making the patient and their family trust that the organization cares and will deliver are taken into consideration. They enhance effective communication and help with the preliminary documentation. When they hand the patient over to the next (Meso) level, it is expected that the communication started will continue within this level, with a care plan and clinical decisions made to suit the patient’s individual needs. When at this level it is decided that the patient needs services of other departments to optimise the outcomes, the leaders facilitate this collaboration, ensuring that the collaboration happens in strict adherence to ethical and moral standards. The three levels then work together to ensure that the delivery of healthcare goals for the patient is the priority at all times.

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

   References

   Barasa, E. W., Molyneux, S., English, M., & Cleary, S. (2015). Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation. International journal of health policy and management, 4(11), 719–732. https://doi.org/10.15171/ijhpm.2015.167

   Krawczyk, M., Sawatzky, R., Schick-Makaroff, K., Stajduhar, K., Öhlen, J., Reimer-Kirkham, S., Mercedes Laforest, E. and Cohen, R. (2018) Micro-meso-macro practice tensions in using patient-reported outcome and experience measures in hospital palliative care. Qualitative Health Research, (doi:10.1177/1049732318761366).

   Quality Improvement in Nursing

   Quality improvement in nursing practice is one of the essential elements of the practice in general. As a quality assurance manager, understanding the quality improvement process is an inevitable undertaking. The example provided in this quality management process involves Medication Error reporting as a process and how it may have implications in the provision of quality care. Health care organizations can make use of the established approaches to quality improvement which is well-known by various providers who are involved in clinical quality improvement (QI).

   As a nurse, I often encountered medication errors that needed action to be taken for remedy. One of the instances I came across was a medication error that one of the nurses in my team had made on a diabetic patient. The first thing I did was to complete the medication error notification form and forwarded it to the QI department. The QI department then sent the form, attached to the medication error sheet to the nurse who was responsible for the error. This nurse then completed the error sheet in which among other things, she indicated the patient name, hospital number, time of incident, date incident was discovered and the person who was affected. The type of error, description of incident, in what way the patient was affected by the error, the physician notified and the signature, date and time of the nurse involved were filled in. I discovered the error and so helped in filling in this sheet. The sheet was forwarded to the QI department where the record was filed and a copy forwarded to the Nurse Manager who then proceeded to fill in the follow up section of the medication error sheet and returned the sheet to the QI department.  The department then commenced the process of tracking, follow up and completion of the sheet.

   There are different ways of identifying a potential quality of service delivery problem. One of the ways is through periodic quality service assessments of various departments. When this is done, potential errors that may often lead to undesirable outcomes are discovered and corrected. Secondly, the clients and their families can be interviewed through questionnaires to discover potential errors in practice. Giving such questionnaires provides honest assessments that the management and QI departments can analyse and discover service delivery problems. In addition, service delivery problems can be discovered by encouraging communication between the nurses and the management and having an open communication channel for airing such concerns (White et al. 2017). Putting in place such measures ensures that nurses are free to report service delivery problems whenever they occur.

   Collection of data for illustrating the scope of a problem can be done in various ways. First, the use questionnaires given to clients and their families can be analysed to discover how deep a certain problem is within an institution. Secondly, the organization can analyse the electronic data used to diagnose and offer care plans for patients. In case a certain problem is found extensively distributed, the it can be concluded that the problem is wide in scope. A review of the filing done on nurses’ past errors can help determine the scope of the problem. In the case discussed above, the investigation was prompted by past errors done by the nurse and a review of her error files. 

   The handling of this service delivery problem requires the following of a systematic structure and process. It starts from the point of identification by a nurse, followed by the filing of an error notification form. The QI department then receives this form, releasing a sheet that has to be filled by the nurse in question and later by the Nurse Manager. The QI department then initiates investigation into the nature of the error with the intention of correcting and preventing possible similar future errors.

   To determine the effectiveness of the quality improvement effort, certain standards have to be used. First, it has to be seen that the problem or error does not recur after the improvement measures are implemented. As already suggested, this can be done through a quality assessment exercise periodically to know how effective the measure is. The effectiveness can also be gauged by looking at how much the nursing staff has embraced the recommendations of the QI department and committed to implementing the resolutions (White et a. 2017). These measures would inform the QI department’s possible review of the measures to make them more adaptive.

   To avoid the issue of Medication Error in the future, the healthcare organization has to put certain measures in place. First, there should be a clear system of reporting and responding to the medication errors. The nurses must be confident that the process is not meant to victimise but rather to improve the overall quality of service for the patients. Time taken to respond to these errors must therefore be minimised so that each case is handled with the seriousness it deserves. Secondly, communication channels have to be made more effective so that bureaucracy is minimised. This will make the errors to be handled faster and more professionally. This would prevent these errors from happening in future. Finally, enhancing collaboration can help minimise Medication Errors. Collaboration ensures that decisions are taken only after full consultations with the stakeholders. This would help minimise errors.

    

    

    

    

   References

   White, M., Butterworth, T., & Wells, J. S. (2017). Healthcare Quality Improvement and ‘work engagement’; conclude results from a national, longitudinal, cross-sectional study of the ‘Productive Ward-Releasing Time to Care’ Programme. BMC health services research, 17(1), 510. https://doi.org/10.1186/s12913-017-2446-2

   White M, Butterworth T, Wells JSG. (2017). Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective. J Nurs Manag. 25(7):519-530. doi: 10.1111/jonm.12489. Epub 2017 Aug 10. PMID: 28799269.

    

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Answer

Assessing Risk and Reward

The Nissan Motor Company is one of the leading automobile makers in the world. The Japanese carmaker has primarily enjoyed a successful run, allowing it to enter various regional and international markets such as the United States. However, the changing business environment was not favorable to the company in 2019. Notably, the cooperation recorded losses amounting to 7.8%. The experience pushed the management into making tough decisions, requiring almost all of its North American workforce to go for unpaid leaves.

In late 2019, the company announced that the decline in sales necessitated a two-day unpaid leave for the North American workers. The stated days for the vacation were January 2 and 3^rd    (Chicago Tribune, 2019).  Notably, this move was a crucial decision for the company because of its conflicting impacts. Whereas on the positive side, it could help the firm minimize expenses, it threatened to affect the public perception of the company regarding employee welfare.

The rewards for the decision involved cutting expenses by not paying the workers on leave, which eventually would translate into reduced expenses. Another reward was that the decision could allow the company to optimize performance by evaluating employee performances then developing new milestones. However, on the low side, the company risked affecting its public image and brand name, especially in the North American market. As per Chakravorti (2010), the way an organization treats its employees influences the firm’s public perception. Thus, Nissan risked eliciting a negative public perception. With a distorted public image, the company could fail to revive its declining sales.

I would have advised the management of Nissan to utilize the Predictive Analytic perspective in determining the right decision to take. Ideally, the approach tries to predict what might happen in the future if particular decisions or actions are undertaken at the moment (Traymbak & Aggarwal, 2019). Looking at the situation at Nissan, the company needed to develop a goal such as increasing sales. After that, they would have made decisions aimed at realizing the set goal. In this regard, the predicted outcome could give the management an overview of whether more risks existed or significant rewards could be realized.

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