Assignment Task The following hypothetical case study has been developed in conjunction with senior healthcare executives and managers that have held and currently hold clinical, corporate, and academic roles.
Introduction to Healthy Hospital (HH)
Healing Haven Hospital (HHH) is an acute public hospital located in Australia. It provides emergency, medical, and surgical services, mental health, drug treatment, and community health. HHH is accredited against the National Accreditation Scheme. Comprising 950 beds, HHH is responsible for delivering surgical, diagnostic, and therapeutic procedures to a catchment area of a fast-growing population of approximately 1 million people. The original facility is over 30 years old, with several additions and upgrades over that period to accommodate the expanding demand.
The demographics include a high proportion of Aboriginal and/or Torres Strait Islander peoples and culturally and linguistically diverse communities (CALD), including refugees. Residents live in medium and high-density housing, where there is high rental demand. New housing estates are being developed and there is a growing network of infrastructure projects including major roads, public transport, and a regional airport. A university has recently opened a new campus within walking distance of HHH, with placements for medical, nursing, and allied health students being offered.
The facility is one of seven that belong to a local health area (Area) and is the major referral facility for the region. The facility’s general manager and leadership team report to a central administrative management system, operating within a matrix structure. Each facility is run by a General Manager (GM) who reports to a Chief Executive Officer (CEO). The Area operates under a governance scheme where there is a Board comprising a chairperson and 15 members from the local region that represent various organizations, communities, and interests.
Overview of General Ward (GW)
One of the largest departments in HHH is the General Ward (GW). Comprising 40 beds, the department is split into two sections with 20 beds per section. Each section has its own manager; however, the managers often work across both sections with staff expected to report to multiple managers. Patients present with a variety of conditions and typically stay in GW for 5 days. There are clinical placements of medical, nursing, and allied health staff in GW. The department’s built environment is currently undergoing a redevelopment, including new patient beds, updating of staff desks, new paint, and technology upgrades. The unit has a large kitchenette in one section and a smaller coffee/tea/water station in the other section. There are signs that these facilities are only for staff use; however, patients and their visitors regularly use them. A shared tearoom for both sections is close to the elevator, however, is yet to be redeveloped, is leaking in parts and is not regularly utilized. Most staff choose to eat lunch at their desk or the HHH staff cafeteria, located two levels up. There are two meeting rooms, however, the smaller room has an air-conditioning system that works sporadically, and the larger room is often booked by education convenors and other department meetings. There is a rollout of new desktop computers in the shared workspace between the two sections.
There are 120 staff that work in the GW. Of these, 65% are full-time and 35% are part-time or casual. The professional breakdown is as follows: 86 are nurses; 15 are allied health; 15 medical including registrars, interns, and specialists; and there are 4 admin staff. Across all disciplines, 45% of staff are from a CALD background whilst the area population is 60%. Only 1.5% of staff identify as Aboriginal and/or Torres Strait Islander peoples, whilst the area population is 4.5%. Operational staff across all disciplines typically work in the GW for approximately 18 months and move to positions in other departments within HHH or to other nearby facilities. Managers in GW typically stay in their positions for 10 years or more. The average age of operational clinical staff is 26 and the average age for management staff is 56. In addition to the mandatory training required for all clinical and corporate staff under the Health Services Act (HSA) of the Region, professional development opportunities are available. An in-house leadership institute for all HHH is available for training in management and leadership skills to be able to step up into more senior roles. Additionally, tertiary opportunities in clinical, management, and research training are available; however, few staff from GW enroll in any of the workshops and mentorship programs. If staff do enroll, they are not supported to utilize available study leave and are told by GW management that they must use their own annual leave entitlements. If staff choose to use their own annual leave and request sign-off to enroll in the Area-supported courses, they are usually unable to find a manager to provide the sign-off as during a shift, across all disciplines, the manager delegated changes with staff often expected to be reporting to two managers.
The increasing reports of incidences
Recently, HHH has been featured in the media with patients and anonymous staff reports about critical incidents, poor complaints handling, and general cleanliness concerns. A preliminary internal investigation by the Governance Unit (GU) has flagged GW as one of the departments that have received high levels of criticism. The criticism is directed towards incidences that have been poorly addressed. Upon review of 24 months of data from the Incident Reporting Management System (IRMS), there are red flags due to incomplete and inconsistent reporting of the incidences in the IRMS and complaints made to the GM of HHH about specific events. The GM has invited you to be a member of an independent Review Team (RT). Your expertise from a different organization, service, or sector provides a new perspective on the management challenges which are acknowledged as common problems across all healthcare organizations. The RT has been asked to spend some time at the GW to interview staff as well as observe how the department functions.
Observation and reporting
The RT spent one month at the GW, speaking with patients and their families, staff, and contractors. Observation of interactions also took place, as well as a review of department-level data including frequency and types of meetings, training sessions, logbooks, and paper/electronic patient record systems. Upon review of the data collated, several reoccurring themes emerged.
The majority of staff, including clinical and corporate, protest about the mandatory training that they need to attend. It is difficult to recruit part-time and shift workers as they are expected to complete the same amount of training as full-time workers. These part-time workers often work at several facilities in both public and private settings and are expected to complete the mandatory training at each facility. Medical staff, in particular, complain about the training, and the educators have shortened the sessions as a result of the feedback, however, attendance and participation are still lagging behind other departments.
Several prescribing incidents have arisen with medical and nursing staff debating who should be responsible for the entry into IRMS. Approximately 15% of the IRMS over the past 12 months are medication errors relating to prescribing. The Nursing Unit Manager (NUM) on duty eventually enters the incident into IRMS, however, these reports are incomplete as the NUM does not have the clinical expertise or details about specific incidents to document all the information. The NUM also cannot make any changes because the reporting and authority lines over medical staff only allow medical staff to make these changes. Food-related issues are often referred to dietitians and speech pathologists but are the responsibility of the food services. There is often tension between the dietitians and speech pathologists over scope of practice issues. The dietitians feel all dietary and nutrition referrals should be their domain, but the speech therapists feel that they can also address these concerns. The head of allied health has raised this as a concern at every weekly staff meeting for the past 14 months. Scheduled regular meetings between the Medical Head of Department (MHED), nursing unit managers, allied health, and corporate management have been sporadic for 18 months.
Collection of blood samples and other diagnostics is problematic as the porters on the ward are sent from temping agencies, with large numbers of new members of staff needing to be trained. Blood samples have been frequently misplaced, and blood needs to be redone. This increases the number of invasive procedures, the risk of infection, and costs associated. Patients then remain in the ward for longer periods than initially discussed with the patient and family. These increased lengths of stay are resulting in escalating anger from patients and carers and blame is being directed towards staff. Porters are regularly sent from the imaging department to collect patients; however, the patient is often in a medical consultation, having a shower, or at rehabilitation in another department.
Medical rounds occur every morning at 8 am and 7 pm at night, with doctors and nurses holding their own meetings. Allied health clinicians do not participate in or attend either of the rounds as they typically are scheduled to work between the hours of 9 am – 5 pm. There is a logbook where communication issues and other concerns can be written for staff to be aware of; however, this logbook was lost when the redevelopment of the tearoom began. When clinical issues do arise, staff tend to communicate with one another using medical notes rather than also communicating verbally with each other about the issues.
Porters have identified the staff in the GW as the most difficult department personnel to interact with, and as a result, it is given the lowest priority. Since the redevelopment of the department and the updating of the flooring, staff have had more workplace accidents such as there has been more frequently tripping. This is reflected in the IRMS reporting which has indicated in the increase of falls-related incidents. The reporting of workplace injuries, comprising predominantly of falls, back injuries, and stress leave, are increasing at a rate of 10% per year. There are 10 active workplace bullying claims that are being investigated with 8 of the cases amongst the nursing discipline. Staff across all disciplines warn new staff not to trust any of the management staff with confidential, personal issues as these
