Report dealing with investigation of negative Perinatal outcomes at Djerriwarrh Health Services by Professor Euan M Wallace, showed that there lies certain problems in the quality and safety of the health care services of Djerriwarrh Health Services. The following report highlights the quality & safety and leadership management, two most vital domains responsible for system failure.
According to the review report published by the Australian Commission on Safety and Quality in Health Care (2015), the Djerriwarrh Health Services encountered a cluster of perinatal deaths at Djerriwarrh Health Services (2013 and 2014) (Picone & Pehm, 2015). The main reason highlighted against this issue is deficiencies in clinical care and lack of high quality education. According to The Sydney Morning Herald, six practitioners had conditions on their diagnostic ability, six were cautioned and 11 practitioners lack medical registration (Spooner, 2017).
In order to manage this risk, Bacchus Marsh Healthcare Service might have undertaken credentialing strategy. It is a process of verifying the qualification of the registered health practitioners while properly assessing their education background and legitimacy (Pradarelli, Campbell & Dimick, 2015).
According to the Credentialing and Defining the Scope of Clinical Practice for Medical Practitioners in Victorian Health Services (2011), the department requires to keep proper policies and processes of credentialing in place in regard to all the medical practitioners who have independent responsibility for patient care. This process must occur before giving appointment to the medical practitioners. The review of the process must take place once every five years. This review must be at times sudden or unplanned when significant underperformance is being suspected (Victoria Government of Health, 2011). As Djerriwarrh Health Services, both regional and rural staffs are responsible for performance monitoring and these include both quality and safety (Picone & Pehm, 2015). Proper consideration must be taken into consideration in order to ensure that they have capability along with management reporting lines, which is consistent with their responsibility.
Figure: Rule for proper credentialing Plan
(Source: Pradarelli, Campbell & Dimick, 2015)
Apart from the tier one and tier two of the credentialing strategy, Djerriwarrh Health Service in Bacchus Marsh must also incorporate period training of the nurses and the midwifery team who are operating in the perinatal unit in hospitals. The hospital must also abide by two principal lessons provided by the Organizational Accident Theory (OAT), error are mainly unavoidable side-effects of how the human process the information and think about it and proper analysis of error under any given accidental circumstances. Such analysis will mainly focus on the underlying problems that might have generated individual errors and violations (Lyndon & Kennedy, 2010).
Proper implementation of the credentialing strategy will help in increasing the patient protection and thereby improving the risk management and consideration in relation to liability. Such change management strategy will help in controlling perinatal mortality rate. It will also help in the reduction of the misinterpretation of fetal surveillance used in the cardiotocography. It will also help to ascertain skill o the task force of fetal surveillance during both the low patient population and when the patient number doubles as during 2006-2013 in the Djerriwarrh Health Service. Such credentialing strategy also promotes proper education among the supporting midwifery and with help in the recruitment of the formal expert in the multidisciplinary perinatal morbidity and mortality review.
Open Leadership: One main characteristic of open leadership is, it is optimistic in nature. Here the leaders mostly highlight the opportunities of any significant rule or decision. Another important trait of open leadership is establishment of enduring relationships among the teammates and this help in the generation of flexible professional relationship. However, open leadership style works best with the experienced worker where the system demands only few changes (Crowe, 2013).
According to the Economic times, the mode of leadership is changing and the modern companies are now highlighting that leadership trait, prevalent during the last century like command-control leader, is now inefficient in the present day scenario. In order to retain previous employees and to make them work in an organized manner, the work environment must focus on inspiring the capabilities of the employees in an open manner in comparison to the closed leadership model, which is majorly centered around the capabilities of a single leader (Varghese, 2017).
Djerriwarrh Health Service suffers from lack of innovation, creativity and accountability. The lack of innovation is being reflected with the increase in the number of the perinatal mortality rate. Gaps in the innovation and creativity are the driving causes behind the miss-interpretation of the fetal surveillance by the cardiotocography (CTG) which was occurring as a recurrent feature as reflected in the perinatal deaths review. Lack of creativity thus defines the lack of inadequate skills as highlighted by the investigation report by Professor Euan M Wallace on Djerriwarrh Health Service. Lack of accountability is generated due the lack of out-of-hours or emergency pediatric cover for neonatal resuscitation. This further justifies that there was a significant gap in care and accountability, leading to poorer than expected prenatal outcomes in Djerriwarrh Health Service.
Accountability, innovation and creativity are important domains in healthcare. All the debates centering on the paths to uplift the safety, quality of care, restriction in cost or health of the mass, highlight the issue of the accountability (Denis, 2014). Behind this concept, there is thought which echoes that healthcare system have an unexplored margin for the upliftment if they are able to align the proper utilization of the resources with effectiveness and appropriateness of care giving (Maynard, 2013). The main concept of accountability is, the administrative authority or the governing body is in a position to mandate organizations or providers to satisfy health objectives or goals (Denis, 2014).
Accountability regime is based on three pillars; a proper definition of desirable objectives or goals (here object is accountability) and the credibility to properly measure and carefully monitors the goals of achievement and other set of consequences for the organizations of the goals centering the achievements, which are unsatisfactory. Djerriwarrh Health Service is devoid three dominant models of accountability, first of the professional model where the individual healthcare professional and patient needs to join in the process of shared decision-making and the healthcare professionals are held responsible to colleagues and to the concerned patients (Wachter, 2013). The second model is economic model under which the market is brought to bear in quality of the health care and the said accountability is mediated via the consumers’ choice of the organization. The third and the last model is political model, where physicians are held accountable to a governing body (Das, Holla, Mohpal, & Muralidharan, 2016). Djerriwarrh Health Service lacks model one and model two and thus having a negative consequences in delivery of safe patient care and proper open leadership style will help in the re-establishment of an organized structure.
References
Credentialling and defi ning the scope of clinical practice for medical practitioners. (2017). Victoria. Retrieved from https://credentialling-and-defining-scope-of-clinical-practice-2011-update%20-%20PDF.pdf
Crowe, A. (2013). Open and social leadership/A new paradigm in emergency management. Journal of business continuity & emergency planning, 6(3), 253-267. Retrieved from: https://www.ingentaconnect.com/content/hsp/jbcep/2013/00000006/00000003/art00007
Das, J., Holla, A., Mohpal, A., & Muralidharan, K. (2016). Quality and Accountability in Health Care delivery: audit-study evidence from primary care in India. American Economic Review, 106(12), 3765-99. Retrived from: https://www.aeaweb.org/articles?id=10.1257/aer.20151138
Denis, J. L. (2014). Accountability in healthcare organizations and systems. Healthcare Policy, 10(SP), 8. Retrived from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255571/
Lyndon, A., & Kennedy, H. P. (2010). Perinatal safety: from concept to nursing practice. The Journal of perinatal & neonatal nursing, 24(1), 22. doi: 10.1097/JPN.0b013e3181cb9351
Maynard, A. (2013). Health care rationing: doing it better in public and private health care systems. Journal of health politics, policy and law, 38(6), 1103-1127. DOI: https://doi.org/10.1215/03616878-2373157
Picone, D., & Pehm, K. (2015). Review of the Department of Health and Human Services’ management of a critical issue at Djerriwarrh Health Services (pp. 3-4). Australian Commission on Safety and Quality in Health Care. Retrieved from https://www.google.co.in/url?sa=t&rct=j&q=&edata-src=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiOgM3ZotLYAhVpKsAKHWcEA9UQFggvMAA&url=https%3A%2F%2Fwww2.health.vic.gov.au%2FApi%2Fdownloadmedia%2F%257BC3F8FB6C-23CD-4B17-ABEA-876C7599DF4F%257D&usg=AOvVaw0XQE651gH1KOrddBZexze7
Pradarelli, J. C., Campbell, D. A., & Dimick, J. B. (2015). Hospital credentialing and privileging of surgeons: a potential safety blind spot. Jama, 313(13), 1313-1314. doi:10.1001/jama.2015.1943
Spooner, R. (2017). Forty workers investigated over Bacchus Marsh Hospital baby deaths. The Sydney Morning Herald. Retrieved 12 January 2018, from https://www.smh.com.au/national/health/forty-workers-investigated-over-bacchus-marsh-hospital-baby-deaths-20170309-guv0rc.html
Varghese, S. (2017). Embracing an open leadership style. The Economic Times. Retrieved 14 January 2018, from https://economictimes.indiatimes.com/corporate-dossier/embracing-an-open-leadership-style/articleshow/3084589.cms
Wachter, R. M. (2013). Personal accountability in healthcare: searching for the right balance. BMJ Qual Saf, 22(2), 176-180. https://dx.doi.org/10.1136/bmjqs-2012-001227
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