Discuss about the Interventions to Improve Surgical Culture.
Workplace culture refers to the way things are done in an organization and includes shared structures, norms, routines, and rules that offer guidelines and constrain behavior in work communities (Eskola, et al 2016). Values and beliefs are significant as well as legitimate guiding principles of any organization and are considered to be the philosophies and ethical practice rules (Taplay, et al 2014). They signify an institution’s most significant aspects and what it is striving for. In most cases, values and beliefs are symbolized by public statements including the vision and mission statements. It is through the workplace culture that beliefs and values are learnt and through relationships with other professionals that a certain workplace culture is reinforced in practice. It is therefore important to get a clarification and comprehension of the underlying beliefs and values for one to understand workplace culture and consecutively develop practice (Eskola, et al 2016). As Taplay, et al (2014) states the values and beliefs in an institution are established over time, they are perceived to be valid, and are transferred to new individuals who enter into the culture. Additionally, the association between workers and work environment ascertains the workplace culture’s perception. With regard to health care, it is the workplace culture that qualifies the experts’ work and care for their clients by replicating a microsystem culture level in which delivery and experience of care occurs (Eskola, et al 2016).
A healthcare workplace culture influences the delivery of care that is clinically effective, person-centred, and improving continuously in response to a context that is changing as it influences the behaviors and attitudes of employees. Workplace culture also plays a crucial role in determining whether a certain organization is a healthy and happy place to work. Although in a workplace subcultures exist, overall culture determines the quality of care offered to patients in terms of cultural attitudes towards timeliness, respect, cleanliness, and dignity. As Davies and Nutrey (2008) suggest, some workplace cultures forges an environment where excellence can flourish and others cannot. If for instance employees have an attitude that is conducive to making errors and underperforming the organization itself and the patients will be impacted negatively. On the other hand, employees possessing good personal values about the components of a good healthcare will depict conducive working behaviors that are promote quality care. Leadership plays a significant role in determining the kind of culture in an organization. If a leader, for example, believes and practices the ethos of care that is person-centred and prioritizes the needs of individuals rather than those of the organization it is likely that they will instill the same concepts in other subordinate employees.
An efficient culture also offers other benefits. For instance, in the healthcare settings resources are scarce compared to other settings and a culture of waste reduction, efficiency, and financial planning helps to reduce costs . Additionally, a culture of an organization also affects the overall performance of the healthcare institution. As such, a culture of attention to detail, hard work, and efficiency can help improve measures such as survival rates and patient number that receives treatment. Where a toxic culture exists, serious implications for employee well-being and patient outcomes are observed. Such negative cultures may lead to poor retention of employees, high sick leave levels, many medical errors, and low employee psychological empowerment.
There are various factors that affect the culture of an organization, including in a health care setting. First is communication as suggested by Bhattacharje (2013). Communication is an important concept in ensuring patient safety. It binds team members together allowing them to act with shared objectives and with coordinated activity. A workplace with effective communication creates a culture of honest and open communication (Sacks, et al 2015). As Dingley, et al states, ineffective communication among care givers is one of the leading causes of patient harm and medical errors. Teamwork also influences the culture of an organization. A culture that supports teamwork between healthcare professionals is important. With regard to person-centered care, interprofessional teamwork required certain aspects to be effective, including cooperation, communication, work climate, respect, and coordination as stated by Korner, et al (2015). Interprofessional teamwork has been shown to improve outcomes on patients, health care professionals, and in the organization level (Korner, et al 2015). On the patient level, teamwork of high quality has been positively associated with higher satisfaction, adherence to treatment, improved safety of patient, improved treatment quality, and improved clinical outcomes. on the other hand, health care professionals outcomes contributed by teamwork include higher job satisfaction, enhanced well-being, increased team efficacy, improved mental health, and better team climate (Korner, et al 2015).with regard to organizational level, it results to reduced turnover, higher retention of workforce, and saving in costs (Korner, et al 2015). Therefore, a workplace that supports teamwork is bound to perform well.
Effective coordination as suggested by Cropley and Saandrs (2013) is also an essential aspect that can help improve quality of care and reduce cost in healthcare. With regard to provision of person-centred care, care coordination requires effective interaction of healthcare professionals to assume accountability, build relationships, provide patient support, and develop connectivity (Group Health Research Institute, n.d.). Care coordination has been shown to increase care compliance (Rizo, et al 2016). Therefore, a culture with care coordination can be beneficial in many aspects.
The person-centered nursing framework by McCormack and McCance (2006) sourced from a blend of two conceptual frameworks. A conceptual framework was developed by McCance to describe caring as perceived by patients and nurses. On the other hand, McCormack developed another conceptual framework that emphasized on person-centred practice from an autonomy study in older people (Manley, McCormarck, and Wilson 2008). The principles in which the two frameworks are based on are consistent with other human science approaches including the core of human choice, freedom, holism, relationships, responsibility, and the essence of space and time (Manley, McCormarck, and Wilson 2008). The resulting person-centred theoretical framework is comprised of four constructs,
Health care provision has evolved to patient-centred care (PCC) from utilization of the traditional paternalistic strategy of the ‘care giver/doctor knows best’. Under the latter approach health professionals made instructions and prescriptions of treatment with limited input from the patients and their families (Delaney 2017). On the contrary, studies suggest the importance of advocating and endorsing the patient’s needs where greater emphasis should be placed on individual patients through patient-centered care. Person-centered care is a strategy that emphasizes on development of therapeutic relationship and mutual respect between the healthcare personnel and the patient (Broderick and Coffey 2012). Person-centred nursing respects the beliefs and values of every individual, promotes a connectedness between the healthcare giver and the patient, and is important for quality person-centred care. In professional nurses’ guidelines person-centred care is a core value and its provision is founded on five areas, (a) the vital aspect of knowing the patient and meeting their needs using this information, (b) welcoming the patient’s family, (c) providing a personalized environment, (d) providing activities that are meaningful, and (e) ensuring flexibility and continuity (Broderick and Coffey 2012). Evidently, person-centred care is entrenched within the holism prototype that takes individuals as physiological and psychosocial whole.
Patient-centred care presents with many benefits. Since its emphasis is on communication it ensures shared decision making and collaboration processes as it views the patient as an active participant as opposed to a passive medical process component (Delaney 2017). Additionally, PCC adherence promotes concordance between adherence of patients to treatment and health care professional’s plans, increases satisfaction of patients with the offered care, and improves health outcomes. What is more, it allows patients to manage their health better due to the support and information they are provided with (Delaney 2017). As Delaney (2017) emphasizes, the PCC strategy has been shown to significantly reduce the need of patients to access hospitalizations, specialty care, and necessitates minimal pathological investigations. Studies have also shown that PCC adoption in patients’ health management of chronic conditions leads to an increase in adherence to medications (Delaney 2017). Other benefits of PCC include reducing stress, improving self perception, and increasing empowerment in patients.
In practice, the PCC is at the centre of culture change theories and is characterized by certain elements including personhood, nurturing relationships, creation of supportive organizational and physical environment, and maximization of autonomy, choice, and comfort (Jones 2011). When these organizations adopt this approach, the knowledge of the care givers regarding their patients is increased. Additionally, health care professionals discover the kind of activities the patients’ desires including choices regarding basic care. Further, the frontline care givers should develop the relationship with the parents by determining the patient’s past accomplishes family, hobbies, and career together with their current desires and current wishes.
SCARF is a brain based model that governs a reward or threat response in people and depicts the level of people’s engagement to their environment (Rock 2009). It is composed of five domains which include status, certainty, autonomy, relatedness, and fairness (Tillot, Moxham, and Malsh (2013). According to the model, the brain act in response to behaviors it recognizes as threats or rewards. When a perceived threat is recognized by the neurobiological pathways avoidance becomes the response. On the other hand, when reward pathway is simulated a pleasurable response is observed. In practice, scarf offers a framework for health care leaders to reflect on the characteristics of individuals that result from workplace culture. As such, it allows for identification of factors that may either engage or disengage employees for leaders to implement strategies that promote positive workplace culture.
Change of culture in the health care setting is a promising solution that will enable transformation from the traditional approach to the PCC as stated by Doll, et al (2017). However, it is not a one-time occurrence but a journey that progresses through time (Jones 2011). Person-centred principles of care include (a) empowerment of the health care staff, (b) resident care direction and activities, (c) encouragement of shared decision making, and (d) provision of a favorable environment that makes patient to feel at home (by Doll, et al 2017). For healthcare organizations to achieve change in their culture they have to enact a comprehensive change that will affect their mission and vision statements, leadership, culture, and strategy. However, implementation of change has been shown to be challenging with most changes being incremental, small, and planned as opposed to intentional, major, and organizational changes by (Doll, et al 2017). The former is referred to as evolutionary change and the latter revolutionary change. Evolutionally change involves reforming the culture by implementing a policy that involves capitalizing on the traditions, working practices, and lessons that have been fruitful to the organization over time (Scott, et al 2013). On the other hand, revolutionary change involves transformation of the existing culture and is appropriate as an intervention for a stagnating culture that necessitates complete overhauling. As Doll, et al (2017) outlines, revolutionary culture is important to the future of nursing.
Change management is a dynamic, complex and challenging process, and promoting it is fatiguing and demanding. It involves addressing the complexities accompanied by the process. As Al-Abri (2007) states, it involves assessment, planning, and implementation of operations, strategies, and tactics and ensuring that the change is relevant and worthwhile. With regard to workplace culture, an effective change involves unfreezing old behaviors, establishing the new, and re-freezing them (Al-Abri 2007). It is important for employees to understand the rationale behind a certain change and how they will be influenced to prevent reactions such as anger, insecurities,
Every culture change strategy should consider possible hindrances to the purposed change. The major sources of resistance in a health care organization include:
The culture of an organization is transmitted and entrenched through a wide range of channels such as established procedures and practices of working including written documentation, professional demarcations, physical spaces, and shift patterns. Therefore, it is impossible for a specific culture change strategy to be able to effectively transform simultaneously all the fronts, necessitating establishment of realistic implementation time frames (Scott, et al 2013).
External factors such as stakeholders may also work against internal reform efforts. Therefore, a culture changing strategy should heed the constraints presented by these entities in establishing the behavior, norms, and values of health care givers (Scott, et al 2013). For instance, to change the culture of National Health Service in the UK the influence of external entities that affect internalization of core values must be considered. Such stakeholders include the Royal Medical Colleges (Scott, et al 2013).
Since change evokes a sense of loss in most cases reactions to change is expected from professional bodies or individuals (Scott, et al 2013). Therefore, it is important for a change strategy to ensure that a large workforce advocate and work towards achieving the change to avoid failure of the initiatives.
In any transformation in culture leadership plays a significant role to ensure its success or failure. Inadequate leadership has been shown to be a key contributing factor to culture change failure (Scott, et al 2013). As such, integrating both transformational and transactional leadership styles during the change period is necessary. For example, a transactional approach may be employed where the employees who employ patient-centred care are rewarded. At the same time, this approach alone may not be sufficient for employees to embrace the change. Transformational strategies of leadership may be employed to help health care employees’ cognitive apprehension of what is involved in patient-centered care.
Conclusion
Therefore, workplace culture plays a crucial role in shaping the behaviors, attitudes, beliefs, and values of the employees and it guides their acts. It is through the workplace culture that beliefs and values are learnt and through relationships with other professionals that a certain workplace culture is reinforced in practice. Since these beliefs, values, and practices are strongly rooted, it is difficult to change them. Some of the hindrances to successful culture change include complexity of culture, lack of appropriate leadership, lack of ownership, and external influences. Changing the workplace culture is therefore a complex process that necessitates sustained support and input to overcome the hindrances. One of the important and advocated changes in culture in health care settings is the transformation from a traditional approach of care to a person-centred one. Person-centered care is a strategy that emphasizes on development of therapeutic relationship and mutual respect between the healthcare personnel and the patient. However, since changing an organizational culture is a long-term process, most health care institutions are yet to integrate the new approach fully.
References
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