Clinical Operational Management – Facts And Terms

Key issues identified

Describe about the Facts and terms for Clinical Operational Management .

Operation management by virtue of its characteristics has become indispensable for an organization in modern generation health care service providing industry across the world. This also holds relevance in field of clinical practices required in health care sector (Yoder-Wise, 2014). This report is based on case study of St Angels Integrated Healthcare and therefore has followed a logical pattern with focus on identification of issues as per the given case study of the health care unit. Clinical operations depend on effective operation management and this report has highlighted some measures as form of recommendation for the health care unit so that prevalent situations can be controlled by the Clinical operational manager of the case study organisation (Langabeer & Helton, 2015).

One of the significant issues within any industry is the high rate of employee turnover. Within the sector of health care high staff turnover is a bane and cripples the efficiency significantly. Instances of high staff turnover have been observed in St Angels Integrated Healthcare. One of the main reasons for such high rate of turnover was inter-professional conflict. Again, communication and lack of scope of practice have been identified as other significant catalysts for such high rate of turnover. Surveys carried out for ascertaining this issue revealed certain bottlenecks and pertinent strategies for arresting such abysmal rate will also be discussed in the paper.

As per the Press Ganey Satisfaction Surveys three key areas have been identified that require immediate attention. These are Professional Communication, Patient Information and Satisfaction with Service. Reports received from the patients indicated that different staffs and medical officers showed little concern and exhibited lackadaisical attitude while discharging medial duties. This has also caused negative media attention and holds the potential to blight the organisational image. Apart from such practices budget report and quality surveys have illustrated deviance from industry standards including highly sensitive areas of hand hygiene and patient injury. The report will also dwell on these factors and suggest effective recourses for overcoming such lacuna while delivering services to the intended audiences.    

The analysis of the case study sheds light on some important factors which are essential for the identification of issues the St Angels Integrated Healthcare confronts with. High rate of employee turnover is a significant issue for St Angels Integrated Healthcare because of constant change practices and high working load on staffs. This is a major concern for the case study organisation as the organisational vision could not be supported with higher employee turnover which could remarkably increase the overall business expenditure and could also reduce the profitability of the organisation as well. It could be observed from the provided statistical data that employee turnover in St Angels Integrated Healthcare has increased by thirty percent (Abdelhak et al 2014). Variance for employees is high and the unit is also over budget. The reputation of the health care unit has dipped and therefore recruitment of required number of international staffs is affected. Many nurses have unwillingness to workwith the St Angels Hospital and the Surgical Same Day Unit as they think that their scope of nursing practice is very limited in the organisation and this though prompts them to leave their jobs and to seek for knowledge development by undertaking advanced roles in nursing (Bronzino, 2014). 

High rate of employee turnover

High discontentment among staff is noticeable from the case study of St Angels integrated health care and the rising dissatisfaction among staffs are due to high work pressure and frequent change initiated by the organization leaving the employees in confusion. Decrease in quality of the services could be improved with increase in scope of practices for the nurse staffs and more effective motivational strategies for the entire workforce (Reeves et al 2013). Some remarkable achievement by the health care unit is being awarded with Equal Opportunity in the Workplace Agency (EOWA) Award, decrease in water consumption across the facilities by five percent and many others. The organisation is affiliated With Australian Council on Healthcare Standards Organisation.  However some areas of improvement are highly significant for the organisation to implement changes especially service delivery as well as pre services and post services quality require improvements (Bronzino, 2014). Thus some of the most significant improvement areas for the case study organisation are staffs and patient communications, better working scope for nurses and operational performance management for ensuring better quality in the daily service related functions for satisfaction of service users and so on. Service delivery cannot be complete without staff engagement and their elevated level of motivation (Abdelhak et al 2014). 

In the given case scenario, it is observed that there are some negative variances which are not indicators of effective operational management practice by the St Angel- surgical same day unit (Steed et al, 2011). Negative variances were in respect of management expenditure, medical and nursing expenditure, travel, staff education and pathology assessment as well as pharmaceutical expenses. Thus total negative variance is -340,400 due to difference in actual and budget expenses 1,548,400 and 1,208,000 respectively and this situation implies poor operational efficiency by the organisation (Reeves et al 2013). Lack of cost control initiative and cost control measures have generated this situation that have increased expenditures related to management, pharmaceutical, nursing and medical along with travel and training of staffs. The variance could be reduced with focus on implementing proper operation management and review of cost involvement and requirement of expenditures in the areas that increased the actual cost (Yoder-Wise, 2014).

Again, one of the key issues as has been revealed by inspections and surveys was hand hygiene. Lack of compliance to this basic practice further complicated the issues within this particular entity. Reports of non adherence and disobedience have resulted in infection. Specific indicators of hand hygiene compliance were 82% for St Angels and 68% for Surgical Same Day unit. Such deviation from the established standard was in stark contrast to 6C’s of nursing. In Australia, almost 10% of people admitted to hospital contracted Health Care Associated Infection (HCAI) costing the exchequer significant amount of money. Several barriers to hand hygiene are lack of awareness about hand hygiene, reluctance to frequently wash hands with soap due to concerns about dermatitis and even workloads. The Nursing and Midwifery Board of Australia stresses on the importance of hand hygiene and states that hand hygiene for nurses should be a daily practice. Alcohol based hand rub (AHR) has also been suggested as a viable alternative for individuals who have a tendency to develop dermatitis. Role of effective hand hygiene has also been eulogised by WHO and it was opined that such practices helped in preventing HCAI.        

High discontentment among staff

One of the alarming trends as deciphered by quality report was the declining quality of treatment observed across a wide range of areas. Some of these areas include referral rates, cases of relapse post the surgery period, medication errors and patient injury rate. With the inception of the Surgical Same Day Unit the reputation of St. Angels was also bolstered. However the KPIs have been inconsistent of late with anomalies reported from areas like medication safety, falls and injuries and cases related to pressure injuries.  Most of these issues can be tackled by adhering to the basic tenets of nursing and medication. Role of mentors have assumed a great role in providing quality care to patients and to demonstrate care, compassion and commitment while discharging duties. The six main areas include Hospital Acquired Complications, core, hospital-based outcome indicators, and patient safety reporting for hospitals, patient experience surveys in hospital and practice level indictors

Dissatisfaction among patients has multiplied due to the factors like staffs’ dissatisfaction and lack of practice scopes for nurses as well.  Lack of professional communication and consequent service deterioration has led to increasing patient complaints and discontentment. The poor operational performance of the organisation has resulted into over budget expenditures of the company which makes the situation even worse (Yoder-Wise, 2014). In terms of overall medication quality the picture is not by any means satisfactory. Units Acquired Infection Rate is above the national standards and also there is rise in number of patients returning to after surgery procedure and this pinpoints that medication and care practices by the organisation are erroneous (Gallan et al 2013).

In the table given below the identified issues are presented with possible opportunities for improvement corresponding to each type of issues

NUMBER	ISSUES	IMPROVEMENT OPPORTUNITIES
1	High employee turnover	Encouragement of work among staffs by high level of motivation, reorganisation of work for reducing high work load, proper change management.
2	Lack of satisfaction among patients	Collection of their feedbacks for reinforcing the weak areas of service and practices.
3	Over budget expenditures by the health care unit.	Effective operational governance and cost control not at the cost of quality and services for patients or service users.
4	Lack of professional communication with patients	Possibilities of improvement in current scenario by encouraging patient participation as well increase in communication with patients by providing them with timely feedbacks and answers to their queries, development of organisational communicational system depending latest technological facilities like ICT software.
5	Lack of scope of practices	Assessment of current practices and focus on some domains for expansion of scope. The areas of practice could be medication management and associated process, ordering of investigations when deemed to be required as well as discharge management.
6	Improper quality controls by the organisation and quality variance compared to national norms.	Quality to be focused on much adequately so that national benchmark could be complied with properly resulting into higher level of satisfaction among patients and profitability improvement. Improvement in medication and safety in medication could ensure reduction in errors in clinical practices.

The given case scenario has originated the need of implementation of an appropriate development plan that would encompass several improvements in the aspects that required maximum focus by the management of the organisation. The implementation plan for development includes several strategies that could bring about overall improvement in the operational gamut in the St Angels Integrate health care.

Low motivation among the staffs could be improved by planning for better motivational strategies for employees including better training, career growth opportunities, performance appraisal systems, good work environment, supportive leadership practices and many other strategic approaches. These will elevate the motivation among staffs (Steed et al, 2011). It is also vital to have nurse leadership in the organisation in this care setting. Work load can be properly allocated among the staffs by maintaining proper roster by considering some aspects like type of patients and acuity, staffs’ experience and number of patients, variation in shifting and available support to staffs. Implementation of digital database systems for managing daily work responsibility allocation operations for the staffs could be a greater help in that case (Yoder-Wise, 2014). Through nurse leadership, the care services and the medication could be much better as nurses can facilitate better care governance within the scope of policies and health care legislations. Nurse leadership can be effective for measuring risks for patients and also advocacy for patients and coordination at the time of care can be substantially enhanced (Hall, 2013). St Angels Hospital and the Surgical Same Day Unit need to implement clinical governance as a operational approach for ensuring higher level of service quality and care for patients. This needs to be worked as an integrated system for managing patient safety as well as to manage risks of decrease in quality (Nuti et al, 2010). At the same time the clinical workforce needs proper guidance in support of best available care options and technologies for improving care quality. It is has also become vital to review the skills of the managers, senior nurses and clinical professionals so that their abilities for providing better quality services to the patients and providing better guidance to the follower employees could be realised . Identification of care incidents are required to be reported to the proper authority of the hospital and analysis of the incidents can be effective for improving safety systems by identifying the causes of the incidents.

Negative variances due to poor operational efficiency

Budget variances need to be understood by finding out the causes of the variances (Abdelhak et al 2014). Special attention for cost reduction can be helpful for the hospital to control costs and decrease in variances between actual and budgeted. The hospital need to initiate talk with its suppliers if it is seen that cost is higher due to price increased by suppliers. Unrealistic and ambitious budget could increase negative variances and the hospital must ensure proper care while deciding projected expenditure (Reeves et al 2013).

Acquired infection rate in the hospital has increased beyond national standards and this requires the hospital staffs to follow hand hygiene and the standard in this respect is that eighty percent of the workers in the care setting need to follow 5 steps in hand hygiene. They must ensure that they cleanse their hands before they touch a patient, before cleaning or aseptic process, after body fluid exposure or risks, after touching a patient and surroundings of patients (Yoder-Wise, 2014). Current hand hygiene compliance is 82% by the St Angels hospital and 68 percent by Surgical Same Day Unit and this need to be improved more. Data as has been collected by an audit for Data Period One, 2016 contained reports gathered from 906 hospitals spread across the territory of Australia covering both the public and the private sector. The compliance rate was found to be 84 % with total moments being 647,349 and correct moments being 543,544. Thus it may be seen that St. Angels Hospital together with Surgical Same Day Unit are below the compliance level. The audit also revealed that compliance rate was highest after a procedure or Body Fluid Exposure Risk. When this rate is considered as a benchmark it may be observed that scope for improvement exists for St. Angels Hospital to develop hang hygiene compliance. Specific attenuation has to be given both before and after a procedure with greater care on Body Fluid Exposure Risk.     

(CQI) or Continuous quality improvement is effective benchmarking aspects that could be beneficial for the hospital to monitor and check quality issues (Lewis et al, 2014). For the hospital, local quality-collaborative acts as benchmark where in some performances encompass performance related data or knowledge and therefore the hospital could measure its performances and can try for ensuring improvement (Steed et al, 2011).

Another basis of benchmarking is health related information technology vendor that allow evaluation in support their systems. Prevention and management of pressure injuries are also to be ensured by the hospital (Langabeer & Helton, 2015). Standards for preventing falls and reduction in harm need to be complied with the hospital as the performance of the hospital is not satisfactory.  National benchmarks are meant for making it obligatory for a health care unit to follow care practices for health benefits of patients. Also depending on the benchmarks, performance of the hospital can be evaluated by its management and large differences among actual performance and the standards could be minimized.   This could be turned into significant level of improvement in the health care sector and the performance of the clinical operations as well as satisfaction among patients can be improved (Reeves et al 2013).

Lack of compliance to basic practices like hand hygiene

Conclusion

If the available scope of practices could increase level of contentment among staffs then, then as per the willingness of the nurses, medication management and process, discharge management and ordering of evaluation could be implemented but at the same time, the hospital need to have cost control mechanism for reducing costs for the purpose of reducing variance among actual and budget (Cardo et al, 2010). While implementing change the existing level of discontentment among staffs and low level of motivation could dissuade the change initiative by the hospital.  Increase in motivation among the staffs could support the change initiative and change can be better managed (Reeves et al 2013).

The case scenario given in the assignment reflects that St Angels Integrated health care has confronted several problems such as higher staff turnover, negative variances, drop in quality aspects, poor level of patient-staff coordination, and inadequate scope of practices for nurses leading to high attrition, lack of cost control mechanisms which are largely prevalent (Hall, 2013). Many nurses in the hospital were dissatisfied due to limited scope of practices and this has caused the hospital to suffer immensely in form of low level of care services for the patients or service users (Bronzino, 2014).

The case scenario reflects some requirement of improvement by implementation plan including motivation strategies for staffs, consideration on enhancement of scope of practices for nurses, cost control mechanisms for controlling variances among actual and budget cost. Quality of medication and care for patients can be improved by comparing performance with benchmark performance in quality and service attribute for helping patients (Garland et al, 2010). This will improve the reputation of the hospital and the problem like difficulty in recruitment of skilled and talented staffs can be solved and the workforce can ensure better care in form of effective care services along with better medication and support to patients (Langabeer & Helton, 2015).

References:

Bronzino, J. D. (Ed.). (2014). Management of medical technology: a primer for clinical engineers. Butterworth-Heinemann.    

Link https://www.abebooks.com/book-search/author/J-D-BRONZINO

Cardo, D., Dennehy, P. H., Halverson, P., Fishman, N., Kohn, M., Murphy, C. L., & Whitley, R. J. (2010).Moving toward elimination of healthcare-associated infections: a call to action. Infection Control & Hospital Epidemiology, 31(11), 1101-1105.

Garland, A. F., Bickman, L., &Chorpita, B. F. (2010). Change what? Identifying quality improvement targets by investigating usual mental health care. Administration and Policy in Mental Health and Mental Health Services Research, 37(1-2), 15-26.

Link https://www.people.vcu.edu/~masouthamger/mcleod-et-al-cpsp-special.pdf

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014).Medical-surgical nursing: assessment and management of clinical problems, single volume.Elsevier Health Sciences.

Link https://www.ctcpjournal.com/article/S1744-3881(15)30026-8/references

Nuti, S., Vainieri, M., &Bonini, A. (2010). Disinvestment for re-allocation: a process to identify priorities in healthcare. Health Policy, 95(2), 137-143.

Link https://onlinelibrary.wiley.com/doi/10.1002/hpm.2201/full

Steed, C., Kelly, J. W., Blackhurst, D., Boeker, S., Diller, T., Alper, P., & Larson, E. (2011). Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 Benchmark Study. American journal of infection control, 39(1), 19-26.

 Link https://textlab.io/doc/570814/validation-of-the-how2-benchmark-study

Langabeer II, J. R., & Helton, J. (2015). Health care operations management. Jones & Bartlett Publishers.

Yoder-Wise, P. S. (2014). Leading and managing in nursing. Elsevier Health Sciences.

Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev, 3(3).

Abdelhak, M., Grostick, S., & Hanken, M. A. (2014). Health information: management of a strategic resource. Elsevier Health Sciences.

Hall, R. (Ed.). (2013). Patient flow: reducing delay in healthcare delivery (Vol. 206). Springer Science & Business Media.

Gallan, A. S., Jarvis, C. B., Brown, S. W., & Bitner, M. J. (2013). Customer positivity and participation in services: an empirical test in a health care context. Journal of the Academy of Marketing Science, 41(3), 338-356.