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  1. Quality Improvement in Health and Social Care


    Task one:
    Using an appropriate reflective model, provide a reflective account on the experience of producing your improvement plans for Liverpool Community Health Trust (70 marks).

    Task two:
    Design a Personal Development Plan to address any skills gap that you identified (during your reflection) in producing your improvement plans. (20 marks).

    Reading List/ Resources/ References
    1. Juran J. (1988). On Planning for Quality: Free Press: New York

    2. The Chartered Quality Institute (2017) What is Quality? available at

    3. www.nice.org.uk www.england.nhs.uk

    4. The Kings Fund (2015) Leadership and Leadership Development in Healthcare: The Evidence Base
    London: FMLM

    5. Moon, J (2004). A Handbook of Reflective and Experiential Learning London, Routledge Falmer
    6. Buchanan D & Huczniski A. (2017). Organizational Behaviour (9th edition)

    7. Mullins,L.(2016). Management and Organisational Behaviour (16th edition) Pearson: Edinburgh

    8. Bessant, J. & Tidd, J. (2015) Innovation and Entrepreneurship Sussex: Wiley

    9. Harrison, M. (2004). Implementing Change in Health System London: Sage


Subject Nursing Pages 10 Style APA




This is a reflective account of my experience on writingassignment for an improvement plan for Liverpool Community Health NHS Trust (LCH). I researched and read about LCH case study to understand the issue that should be addressed in my writing assignment. According to Kirkup (2018, p.5)LCH trouble began when the Trust set infeasible cost improvement measures and got fixated on attaining the Foundation Trust (FT) status. The cost improvement approach meant that LCH had to implement massive cost-savings, which included a reduction in staff numbers. The workers who raised concerns about poor service delivery were bullied and distraught and became afraid to voice their dissatisfaction. Likewise, the staff lacked training in medication management, record keeping, and patient management, resulting in drug administration errors, deaths of patients, and avoidable patient harm. Similarly, these failures were replicated in the HMP Liverpool health center, where LCH provide healthcare services to prisoners (Kirkup, 2018, p.7). This paper reflects onmy experience writing an improvement plan for LCH case study and a personal development plan to address my shortcomings during the experience and an action plan on how to improve my skills.

Gibbs’s Reflective Cycle Steps

Graham Gibbs in 1988 created the Gibbs Reflective Cycle to encourage individuals to think systematically regarding their experiences during a particular circumstance, event or activity. I am using the Gibbs reflective cycle to reflect on my writing experience developing an improvement plan for LCH case study. The Gibb’s model gives me the opportunity to learn what I can do to improve patient care in my practice as a community nurse after learning from the LCH case study the causes of patient harm.  Learning happens when a nurse undertakes reflection on the incidences experienced on duty or on academic work. The Gibbs’s reflective cycle has six phases: situation description, feelings, evaluation, analysis of what is learned, conclusion, and the action plan for the future. 


Step One: Description

I am reflecting on my experience on writing an improvement plan to address the patient harm safety concern for LCH. I started by mapping out my research ideas by writing down the factors as per the case study caused patient harm. I used a mind map tool to settle on the research topic of “Preventing Patient Harm at LCH” as a single map. Afterwards, I listed all the sources and created branches for each page I wanted to use that relates to this research topic. Next to the source title, I wrote down the topics covered in each source, its main question and significant passages that I thought I wanted to quote in my research. The incident at hand was providing an improvement plan for LCH after the CQC report highlighted that LCH caused unnecessary patient harm for several years and undue stress to employees who sometimes were bullied and harassed when they raised worries about the deterioration regarding patient services.

Developing the mind map took me a day. I had to be mindful with managing my time because the assignment had a deadline which was almost due and I have not started writing the assignment. After connecting ideas in the mind map, I narrowed down to the following as the possible improvement plan for preventing patient harm at LCH:

  • Reinforcing the usage of the electronic prescribing and alert framework. Use automated information systems like computerized provider order entry (CPOE) to decrease the alert burden by concentrating on clinical-related warnings. Drugs order will be processed via CPOE.
  • Education and training of the employees is a crucial element in improving safety in LCH. Education interventions to enhance the prescription and administration of drugs might influence clinical conduct about enhanced adherence to guidelines.
  • Fostering and supporting the usage of medication reconciliation by clinicians. Medication reconciliation is the formal procedure of creating and recording a reliable, definitive list of drugs across transitions of care and afterward fixing any inconsistencies. Increased drug inconsistencies at discharge are linked with an amplified number of prescribed medications, emphasizing the need to tackle poly-pharmacy as a multi-faceted risk to patient health.



Step Two: Feelings

I was afraid that I would not complete the assignment on time because the CQC report was so detailed with several pages to read from and make recommendations. I decided to use a diary to plan my tasks daily. Making a task plan made me feel I was making progress because I had a task goal of reading three pages of the CQC report daily and making suggestions from what I read. I was able to complete reading the CQC report in two days.

Step Three: Evaluation

The things that were good was that from writing this assignment, I learned as a community nurse, importanceof examining the medication chart meticulously while adhering to the five rights of drugs administration. I felt upset to learn that these patient harms happened and were never reported for several years. The fact that such mistakes happened and remained unreported emphasized shortcomings in the LCH system(Marquis and Huston 2009, p.30). I learned a lot from the LCH case study regarding procedures, factual insights, and prescribing abilities. I now acknowledge the significance of clinical cases reporting and guaranteeing that systems foster individual and team learning. What did not work well to my advantage was the time constraint that I had. The short time-span I had to submit the assignment made me forgo social meetings for four daysjust to finalize on my work.

Step Four: Analysis

This writing experience made me apprehend how easy it is for severe errors to happen and possibly cause patient harm when operating in a complex and bulldozed structure as LCH. The significance of a supportive environment, interpersonal communication, employee training, and personal responsibility were emphasized.  The World Health Organization (WHO) in 2016 highlighted that several patients suffer injury or death yearly because of preventable medical errors (WHO 2016, P.10). Drug administration is among the highest-risk areas of nursing practice, which should be given considerable attention by LCH stakeholders. Accordingly, meticulous ad comprehensive processes and standards exist to ensure secure, legal, and effective practice. Examples are the Medicines Act (1968) and the NMC’s Regulations for medicines administration. The QCQ report on LCH highlighted that factors such as overworked employees, lack of training, poor communication between healthcare providers and patients, inefficient drug knowledge and experience, insufficient patient knowledge, and inadequate perception of risk were responsible patient harm. The 1987 Consumer Protection Act and 1968 Medicines Act demand that to administer drugs, the practitioners must ensure that the correct medication is given, at the proper time, to the right patient, in suitable drug form, and at the right dose.

The NMC (2015) Code highlights that medication administration is an area of worry for public security and the principles outlined by the law should be followed. LCH patient harm as a safety concern underscored the need for vigilance as practitioners. Concerning the reporting of patient harm as a result of drug errors,Stein (2003, p.460) discovered that nurses indicated fear of disciplinary action if they report patient harm cases. The regulations for medicine administration by the NMC (2015) advises healthcare providers that an open culture should exist to foster the prompt reporting of errors or cases. To learn from mistakes, Hewitt-Taylor (2013, p.35) argue that practitioners first should admit that a mistake has happened. These mistakes should be used as a learning experience to deliberate on and avoid them from occurring again.

As stated by Stein (2003, p.462), medical errors can be partly linked to the failure of several health practitioners to deliberate on their professional practice. The ability to decisively reflect on one’s practice is vital to improving and maintaining proficiency. In 2008, the National Institute for Clinical Excellence (NICE) employed national standards in developing goals and measurable results for reflective practice groups to enhance mental awareness of employees, with the intent of producing beneficial transformations both to an individual’s practice and the hospital procedures and practice (NICE, 2009).

Step Five:Conclusion

In retrospect, the knowledge I have gained from this writing experience I would use it to do things differently as a community nurse working at Hertforshire NHS Community Trust.  As a community nurse, this writing experience made me learn the significance of putting the patients’ well-being at the forefront by providing quality care. Quality care can be provided when a nurse is competent and knowledgeable hence personal development as a practitioner is crucial(Harrison 2004, p.35). I could have advocated for increased staffing because employee’s burnout resulted in patient harm because of high workload and tiredness if I was a Nurse Director at LCH. Increasing the staffing ratios could have prevented the ensuing chain of events.

Step Six: Action Plan

In future, I intend to enroll in leadership training course because I aspire to become a nurse director. The leadership training will give me the knowledge of effective governance in a healthcare setting and creating a friendly and supportive environment that fosters a culture of excellence. Likewise, I intend to enroll in drug management training course to become more competent andknowledgeable in this field and also empower me in dealing with diverse patients. 

Learning Style

My preferred learning style was Peter Honey and Alan Mumford (1986). After filling the Honey and Mumford questionnaire, the score indicated that I am a pragmatist learner. For example,while researching on the LCH case, I discovered about the 1987 Consumer Protection Act and 1968 Medicines Act that as a community nurse I should follow when dispensing medication. Hence, after completing my BSN, I plan to pursue a course in medication management.

Critical Incident

Researching and writing this assignment made me realize as a future nurse leader, the significantof havingcompetent nursing staff in providing quality care. While reading the CQC report, I noticed that lack of training and work overload were the primary reason for medical errors. As a community nurse this incident made me realize the significance of employee training in improving productivity.

Skills Gap Analysis

I realized that I have great analysis and critical thinking skills because I analyzed the case study and suggested improvement plans suitable for LCH scenario. However, I realized that my time management skills required some improvement I did not complete the assignment as planned in my task diary. Also, I need to improve on my grammar and punctuation because when I reviewed my work, I realized some punctuation and grammatical errors.

How the Context Influenced My Experience (Covid-19)

The LCH case context as a community nurse enhanced my awareness on self-care more so during this COVID-19 period. Likewise, the case context highlighted the significance of due diligence as a nurse practioner in delivering patient care. During this COVID-19 I follow due diligence by washing my hands, keeping social distance and wearing a mask to prevent infection and following COVID-19 protocols at the hospital to keep patients safe. Likewise, I sensitize my neighborhood residents on these safety measures too.

Time Management Issues

I deliveredthe assignment before the deadline, but I did not operate within the timeframe as I wrote down in my task diary. The assignment completion delayed by one more day because I needed more time to review my work.

What I Learned and How it Will Impact My Future Career

From this writing experience, I learned that quality care can be provided when a nurse is competent and knowledgeable hence personal development as a practitioner is crucial. This has inspired me to complete my BSN. I plan to study and get an Adult Acute/Critical Care Nursing certification. Behavioral theory best supports my role as a team leader during this teamwork.

Personal Development Plan (PDP)

A PDP is a written explanation of self-reflection and development, which act as a detailed action plan utilized in fulfilling academic, career or personal centered goals. The purpose of a PDP is to assist workforce attain short and long-term career objectives and also improve present job performance (Greenan, 2016, p.330).

Part 1 – Personal Analysis


Ø  I have excellent analytical and critical thinking skills. 

Ø  I am pursing a BSN which gives me a leverage to aspire for a management role at Hertforshire NHS Community Trust.

Ø  Over four years’ experience in the nursing field.

Ø  Understanding dementia which is an online course with University of John Hopkins I am pursuing.

Ø  Fervent about nursing.

Ø  Strong interpersonal abilities developed via my job as a community nurse.

Ø  Strong written communication abilities developed via academic work.


Ø  I lack time management skills.

Ø  I suffer from procrastination

Ø  I suffer from delegation because I fear another person will not deliver work as per my expectations.

Ø  Recalling diseases pathophysiology.

Ø  I have challenges with my grammar and punctuation when writing.


Ø  Few persons want to work in dementia nursing.

Ø  The opportunities to study dementia education are not competitive.

Ø  I relish working with older adults (Moon, 2004, p.40).

Ø  Several career developments prospects available in nursing.

Ø  Future interest in pursuing post graduate course in drug management and critical care and become a preceptor for undergraduates. 


Ø  Balancing work and personal commitments.

Ø  Being discouraged if marks are below what I anticipated.

Ø  Dementia nursing might seem dull and uninteresting to others.



Setting Goals

What I want to learn

What I need to do

The resources and support I require

How I will measure success

Target date

Learning and development

Attend four workshops geared towards my present specialty, dementia nursing, drug management, and critical care.

Mentorship from senior colleagues





Attend workshops

Ensure that I contact these leaders and request for mentorship and attend their meetings.

December 30th, 2020

Patient Care

Follow patient hand-over notes protocols each time I end my shift.

A checklist to be signed by both the departing and arriving nurse to guarantee protocols are followed.


Daily feedback from the nurse director on signed checklists.




To use the ward policy rules to create an updated patient and staff safety and danger checklist.

The list should be checked by each staff nurse on a rotating premiseto achieve this goal.

Feedback from colleagues

July 30th, 2020.


Chart my patient notes regarding my interaction with the pateints while I can still remember them. This will aid me in streamlining the shift hand-over and guarantee I do not forget crucial notes before engaging in other tasks.

Accuracy is crucial in delivering the excellent patient care and reducing the danger of safety problems.


Feedback from the nurse director.

30th June


Part 3

Personal Objectives

Short term goals (next three months)

Ø  I plan to attendworkshops, education, conferences, and events hosted by NMC to help me interact with my peers in the nursing field, share knowledge, and advance my career through continuous education.

Medium-term goals (18months)

Ø  Be offered the role of guiding and managing a small team such as the ward staff nurses to implement my leadership abilities

Ø  Complete my online dementia education course

Long-term goals (5 years)

Ø  By 2025, I aspire to have completed my BSN. I plan to study and get an Adult Acute/Critical Care Nursing certification. By adhering to the NMC of critical care nurses’ rules for exam eligibility, I should complete this objective in two or three years.

Ø  Get promoted to middle management and get colleagues, senior management, and Board support.

Ø  Be assigned the task of managing a big team and work towards becoming the Trust CEO.


In conclusion, this writing assignment made me learnthat leaders with emotional intelligence allow their members to express their sentiments openly and honestly to avert patient safety issues. Likewise completing this assignment made me contemplate on my personal analysis as a nurse practitioner, andI devised a personal development plan as a blueprint on how to enhance my skills to improve in my career. Likewise, I used this personal reflection to learn more concerning myself. To handle my weaknesses as a transformative leader, I cautiously examined the abilities that I lacked or needed improvements and devised an action plan to attain my goals.







Greenan, P., 2016. Personal development plans: insights from a case-based approach. Journal of Workplace Learning.28(5), pp.322-334.

Harrison, M.I., 2004. Implementing change in health systems: market reforms in the United Kingdom, Sweden, and the Netherlands. Sage.

Hewitt-Taylor, J., 2013. Planning successful change incorporating processes and people. Nursing Standard (through 2013)27(38), p.35.

Marquis, B.L., and Huston, C.J., 2009. Leadership roles and management functions in nursing: Theory and application. Lippincott Williams & Wilkins.

Moon, J. A., 2004. A handbook of reflective and experiential learning: Theory and practice. Psychology Press.

National Institute for Clinical Excellence, 2009. Using national standards to develop aims, objectives, and measurable outcomes for reflective practice groups on older people’s mental health wards. Retrieved fromhttp://www.nice.org.uk/usingguidance.sharedlearningimplementingniceguidance/examplesofimplementation/eximpresults.jsp?o=344

 Nursing and Midwifery Council, 2015. The Code. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

Stein, H., 2003. From (non-)reflective practice to medical mistakes: a case within a story. Families, Systems & Health, 21(4), 459-463.

Kirkup, B., 2018. Report of the Liverpool Community Health independent review. NHS Improvement. retrieved from https://improvement.nhs.uk/documents/2403/LiverpoolCommunityHealth_IndependentReviewReport_V2.pdf

World Health Organization, 2016.  Medication Errors. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/252274/9789241511643-eng.pdf;jsessionid=814FF7B760E643D4ECFF4A9123AE05DA?sequence=1



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