System Considering In Healthcare Nursing Essay.
The healthcare system can be defined as a couple of interrelated parts or agencies, which include caregivers and patients, bound by a common purpose and functioning on their knowledge. This large number of interconnections within and among makes the health care organisation organic (IOM, 2009). Such complexity brings problems and opportunities and requires organisations to adjust to the changes. The capability to understand and react to both the exterior and internal conditions may need a alternative thinking methodology of the system (Lebcir, 2006).System Considering In Healthcare Nursing Essay.
Systems consist of interrelated, interacting and interdependent parts configured in a manner that produces a unified full. System pondering studies these components parts, their interrelationship and just how they work as a whole. Matching to Senge (1993), system thinking is a conceptual framework, a body of knowledge and tools that is developed to make the full patterns of systems clearer, also to help see how they could be altered effectively.
There are various system thinking methods and the article will review some methodologies which were used in managing the research study of Ashford clinic.System Considering In Healthcare Nursing Essay.
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- 1 Circumstance Research- Ashford Hospital
Earlier in the year, Ashford medical center which acts quite a huge population experienced severe pressure on service. A healthcare facility got 67 ward mattresses. Patients had to wait for long in seats or trolleys at automobile accident and emergency product (A & E) before they could be admitted into the wards. This led to overcrowding of A&E device. Patients were asked to stay away from the hospital’s A&E unless essential. The professional medical providers were put under pressure and led to trading of blames amidst them. Patients were no more satisfied with the quality of attention. The management of a healthcare facility was disturbed and desired a way out of the messy situation.
2 Soft Systems Methodology (SSM)
SSM is an action oriented procedure for tackling identified real world problematic (cultural) situations ( Checkland and Poulter, 2006). Appendix A shows the SSM process steps which were followed throughout investigation.System Considering In Healthcare Nursing Essay.
- 1 Finding out
An exploration team was invited by Chief Executive (CE) and released for some health workers. While using the SSM the first stage was to recognize and provide a short description of the problem. Because of the workload the clinicians were encountering, getting them round a discussion table wasn’t easy. However, the investigation team shifted around requesting questions and observing proceedings. A rich picture was developed to help catch the main entities, structures and view points in the challenge situation of Ashton hospital (Shape1, Appendix B).System Considering In Healthcare Nursing Essay.
As part of the learning, the team got to identify key roles which were affected in this situation (Examination 1). The team already knew who your client was since it was the CE who wanted for intervention. The nurses and doctors (some with specialisation) in A& E provided treatment to patients with various health issues and injuries. . Where necessary, patients were changed to the ward. The foundation manger allocated beds to patient, as the ward manager supervised the ward. Stand1 shows the outcome of Examination 1 while table 2 shows the worldviews of the problem owners.System Considering In Healthcare Nursing Essay.
Having known the key issue owners, the cultural texture (Research 2) of the problem owners in term of their role in a healthcare facility, the norms (expected behaviour associated with such role) and the values (standard by which behaviours are judged) were discovered. That is illustrated in table 1 of Appendix B.
A political analysis (analysis 3) which enriched the social appreciation previously obtained through Analyses 1and II was done. The fact was to discover the disposition of electricity from the roles within a healthcare facility in so doing buttressing our ethnical understanding of the situation. The CE, being the top of a healthcare facility, had positioned electric power over other functions while the doctors appreciated expert power across the hospital. The facts of the evaluation 3 are shown in shape 2 of Appendix B. The culture examination provided a basic for determining the relevant issues, stars and conflict in the hospital.System Considering In Healthcare Nursing Essay.
The Client- person(s) who
caused the intervention to
The LEADER of Ashford hospital
The Practitioner- people performing
The Inspection team (Us)
The concern owners-people who are
concerned about or
affected by the
Doctors, Bed managers, nurses, patients, ward professionals, Chief Executive
Table 1: Evaluation 1 (the Treatment Itself) in Ashford clinic case study
”Targets must be satisfied with the available
”Patients have to be given effective
treatment before they are really discharged”
”Doctors do not release patients on
time and are always foundation blocking”
”We need better medical care service”; “we
Need to get prior to we are
”High benchmarks must be looked after in
”To many patients to deal with”
Table 2: Worldviews of the issue owners in Ashford clinic research study.
- 2 Making Purposeful Activity Models.
According to Checkland and Poulter (2006), every real human situation uncovers people trying to do something purposefully. The types of purposeful activity system viewed through the entire world view of the doctors and the bed manager were considered very relevant. This is because the doctors made decisions on patients that needed entrance while the bed manager was involved with allocation of bedrooms.
In order to model the purposeful activities, root definitions describing the primary activity operations and functions were developed utilizing a mnemonic ‘CATWOE’ research. Appropriate root definitions for the primary functions performed by doctors and foundation manager were formulated as follows:
A doctor system to provide quality and effective treatment attention, through the use of appropriate bought knowledge and clinic resources in, order to boost patient’s condition.
A bed administrator system that provides timely placement of patients in wards, by optimizing the use of available medical center beds, in order to donate to quality and effective patient health care.
Tables 3 and 4 show the purposeful activity models for the Bed Manager and Doctor respectively. The conceptual purposeful activity models are illustrated in figure 2 and 3 of Appendix B.System Considering In Healthcare Nursing Essay.
Purposeful Activity model 1
A bed supervisor system that provides timely keeping patients in wards, by optimizing the utilization of available hospital beds, to be able to donate to quality and effective of patient attention.
Admission of patients
Patients are admitted in medical center ward beds
Doctors do not release patients on time and they contribute to bed blocking
Bed professionals, doctors, ward professionals, nurses
Number of bedrooms, bed management and ward policies
Are beds available for patients? Are bedrooms data perfect?
How long do patient put it off before being accepted? Do patients over stick to ward bed? Optimum bed usage, longing time
Have all patients been admitted on time?
Table 3: Purposeful Activity model of Bed Supervisor.
Purposeful Activity Model 2
A doctor system to provide quality and effective treatment health care, through the use of appropriate purchased knowledge and hospital resources in order to boost patient’s condition.System Considering In Healthcare Nursing Essay.
Treatment and admission of patients
Patients are accepted and treated in the hospital
Patients have to be given effective treatment before these are discharged
Nurses, doctors, bed managers, ward managers
Bed management and ward insurance policies, option of beds
Have patients been treated and admitted
Are patients getting better?, cost of drugs, time
Have all patients been treated and admitted promptly?
Table 4: Purposeful Activity style of Doctors
- 3 Dialogue and Results.
Activities in conceptual models developed were used for the discourse. The most significant discovering that resulted from the analysis was in the area of discharge. Some of the problem that was assumed to be limited by the A&E was actually consequently of failure to adequately plan release in the wards. If the rate of patients requiring admission increased, there was a need to improve discharge programs.System Considering In Healthcare Nursing Essay.
However, it was realised that the doctors did not change discharge behaviour and created ready lists for patients that needed entrance. Facilitated brainstorming sessions resulted in discovering number of contributing causes of postponed discharge. Release was done after ward round which occurred in morning during week days and nights alone. Insignificant numbers of discharge were done over the weekend because there is no major ward circular. This meant that most patients needing entrance inside a & E over weekend got to hold back till pursuing week before bedrooms could be set up for the coffee lover. This also compounded the foundation crises.System Considering In Healthcare Nursing Essay.
A discharge task team was immediately setup. The primary function of the release team was to carry out additional ward rounds in the evenings and on weekends so as to discharge patients and free up more beds. They were in a position to indentify other causes of delayed discharge and fixed them. This made certain timely release fashion which then freed up mattresses for patients in A&E.
- 4 Power and weakness of SSM
The technique provided guidelines that were flexible to use. The use of models provoked issue and learning among the problem owners. Through dialogue and debates, a healthcare facility could realise that there was a need to amend patient release policy.
However, this technique could not satisfy everybody. A number of the discharge decisions were not favourable to the ward patients. Also customers of the discharge team acquired extra work to do and means of compensating them were not discussed. This may be seen from Jackson (2000) quarrels that SSM will favour the more powerful people in the system while genuine participative issue could be severely constrained.System Considering In Healthcare Nursing Essay.
- 0 Thinking Differently
Most of the inventions in our contemporary society today, such as electricity, mobile phone, programmed teller machine and many more, are the results of some people who decided to think differently. Thinking differently will involve using impressive and creative approaches to enhance healthcare delivery service (NHS, 2007)
The first level was to avoid and think of the complete situation and identify areas where creative thinking could improve things. It was witnessed that there was poor co-ordination of patients and bedrooms management while poor communication existed between the bed supervisor and other clinicians, in the wards and A & E, about bed availability.
A tool called Others’ Point of View (OPV) was then picked to describe the issue from others peoples’ perspective. The aim was to create some alternative means of framing the challenge and to consider what other people might say about foundation management of a healthcare facility.
Hotel supervisor – “Despite their poor hospitality, they still have more
clients. . . . poor service in hotel industry can make someone to be
out of business”
Service Specialist – “While customer service in a healthcare facility. . . no relation for
patients. . . customers are kings. . so can be the patients”
Journalist – “Taking the ill to a ill medical center”.
Patient -”This is disgusting. . . where else do they want us to go
The second period allowed clinicians to brainstorm and come up with ideas. At this stage no idea was good or bad. It allowed for individuals to speaking out their imaginations. The Fresh eye tool was chosen to see how similar issues were monitored in other business and the probability of implementing the solutions in to the hospital.System Considering In Healthcare Nursing Essay.
Hotels- Hotels manage rooms, bank checks customers in and out using software
systems designed to help administrator to trail all rooms availableness.
University- students can reserve their accommodation online while a system
assists in organising and allocating rooms to students
Airline – Airline Reservations Systems that handles air travel schedules, fare
tariffs, passenger reservations and ticket records.
This gave us insight to how clients and resources were being handled in other market sectors. The stake holders then agreed to try out a bed management information system.
The hospital applied foundation management information system on a small scale plus some of the huge benefits were highlighted (Table 5).
Real time online monitoring of bed position, bed supervisor did not have to go around wards again
It advanced communication between devices for patient admissions
Saved time searching for available bedrooms in the hospital
It provided a synopsis of bed occupancy rate in hospital
It was user friendly and easy to use.
Enabled more exact allocation of bedrooms for crisis patients
Table 5: Realised benefits associated with Bed management information system after execution.
- 1 Durability and weakness
The thinking in a different way methodology was a robust tool in stimulating thinking and lots of ideas were recommended. However, this took time and triggered arguments as feasibility, advantages disadvantages and threat of each idea were all argued out. Also, traces of folks seeking to impose their ideas on others were seen while others brought up ideas that would satisfy their own interest.System Considering In Healthcare Nursing Essay.
4 System dynamics
System dynamics is an methodology and simulation way of studying and controlling complex responses systems, that have emerged in business and other public systems (SDS, 2009). Corresponding to Jun el at (1999), there has been increased use of simulation in medical care. This could be attributed to numerous success accounts of using simulation to address healthcare system problems and availability of simulation software packages.
The technique was used to estimate and manage the aggregate circulation of patient through a healthcare facility and its own environment. As the number of people browsing A&E increased, it in turn increased the quantity of men and women who needed hospital entrance. Also, as patients looking forward to bed increased, it triggered an increase in variety of patients that were discharged home early. That is illustrated in Figure 1.
There was the need to control the number of patients arriving through A& E. The availableness and use of other health care facilities such as GP practice, community treatment and nearby private hospitals would have a poor opinions on the inflow of patients into a&E. This might directly affect the number of patients needing admission. Most of the patients which were discharged home might possibly not have to return to A&E as community care could assist carter.System Considering In Healthcare Nursing Essay.
This technique helped a healthcare facility to forecast inflow of patients and ways that could be followed to regulate it. Community treatment services around were informed about the situation of things in a healthcare facility. Furthermore, ambulance bringing patients were enlightened ahead to make use of other clinics or GP techniques if condition of patient had not been too severe.
Figure 1: A model to show the movement of patients through the hospital
The complex aspect of health care system makes system thinking well-suited to deal with problems in this sector. The various methodology solutions used aided in better knowledge of the relationship between the various devices in Ashford clinic and its own environment. This showed that like any other system, no device in the hospital can be an island. The various methodologies applied in Ashford hospital situation yielded various positive outcomes that helped improved the difficult situation.
While a few of the methodologies used have their roots in action research, further participatory research will be carried out to investigate occupational work stress on the list of clinicians. This may help identify majors factors behind stress associated using their workflow, how it influences their relationships with others and with the patients in particular.System Considering In Healthcare Nursing Essay.