System Leadership
Problem Area of Impact
The problem identified in the current healthcare setting was the absence or deficiency of an effective patient tracking system. A tracking system is very important and crucial in the medical field. A patient can report to a hospital today with complaints related to a condition that they have been previously managed or admitted for. At the same time, a patient may be seeing different medical practitioners in more than one health institutions. This makes it difficult to coordinate and interrelate these so as to achieve the best modality to manage the patient’s condition.
This issue impacts all the three levels of organizational structure. The microsystem that is composed of the patients, their families and other close relatives and health service providers (Stein et al., 2015). Because none of these people has all the information regarding the patient, the doctor treats the condition as being primary. As a result, the root cause may not be properly dealt with or effectively managed because it may not be obvious to the doctor. This often leads to several court processions in which the doctor will be accused of negligence, malpractice and other claims that may put their career at risk.
The mesosystem which is basically composed of divisions in the healthcare system (Starr, S. R., & Nesse, R. E., 2016) are not spared either. Coordination between these departments is heavily hampered. Some disease conditions require input from multiple medical professionals with different specialties. Improper coordination or total lack of it leads to poor care of patients and this may result in overall failure of quality service provision to customers.
The macrosystem, which is the top level is mainly composed of the leaders and the management in general (Bender, M., 2016). The problem that has heavily impacted the lower levels of the system also hampers the functionality of the top management. There is a difficulty in resource allocation to various departments to suit the needs of their patients. They may also face the challenge of recruiting medical specialists in the different fields in the system because they lack a comprehensive report of the entire patient conditions and well-being. As a result, management will fail and the hospital will lose its customers to competitive centers. In general, the quality of services provided will not be satisfactory to customer’s needs.
The desired change should be applied mostly at the microsystem level. This is because this is the level at which the patient interacts one-on-one with healthcare providers. It is important that all information be obtained from the patient whether it is their first time or subsequent visit to the hospital. This information can then be uploaded to a common database system that can be accessed by approved persons only. This information may be edited, counterchecked or proofread by the relevant medical practitioners.
This problem will not be solely managed by focusing on the microsystem level. The other levels of the organizational structure must also be included in the process. For instance, the mesosystem level will be involved in classifying patients to departments where they can be treated by specialized practitioners. These departments will also roll out programs for coordination in the case where a patient needs the input of more than one specialist. The management level has the biggest role in ensuring success of the change. This will be achieved mainly by proper resource allocation to the various departments within the institution. Based on the number of patients in a given division and their conditions, resources allocated should be adequate to purchase the latest drug therapies and any other equipment that may be required. The management may also go ahead and recruit more professionals and specialists to the different divisions based on need and urgency. All these strategies are in an aim to ensure proper and quality delivery of services to patients.
Strategies and Techniques
The most effective strategy that would be required to solve this issue is conducting a throughput analysis. This is with the objective of assessing the amount of services that can be given to a patient in a given period of time (Faganel, A., & Janeš, A., 2015). The services to be gauged are the curative ones and health education for example nutrition, voluntary counselling and testing, exercise education, hygiene and sanitation practices, community outreach services among others.
This process should be coupled with identification of bottlenecks in the system. Bottlenecks are service providers, equipment or any other facilities that is handling its maximum at the time of assessment (Subanidja, S., & Hadiwidjojo, D., 2017). This is a useful tool as it can effectively guide on where improvements or new installations or purchases need to be instituted. For example, an assessment of the information and computer department may reveal that they can handle more than what they are currently undertaking. New duties and roles may then be instituted on the employees in this department. Such roles include coming up with a new software that will be used to record patient data, associate this data to relevant departments and specialists and draw interrelations or interactions between past and current disease conditions. All this information on a patient should then be uploaded to a cloud network that can only be accessed by authorized persons. On the other hand, clinicians will also be assessed to determine whether they can handle more patients or not. If they cannot, then more professionals need to be hired.
By identifying bottlenecks, it is possible to assign more roles to employees who are not overwhelmed already. By doing this, the throughput will increase because it will be easy and possible to provide more services to an even bigger number of patients. This strategy alone, though, may not be effective in handling the issue fully. Other strategies also need to be instituted such include the SWOT analysis. The objective of this is to identify the strengths, weaknesses, opportunities and threats in the system (Bull et al., 2016). For instance, poor tracking of patients is a weakness in the current state but it provides a great opportunity at the same time. By improving tracking systems, it will be easier for clinicians to effectively manage patient conditions. As such, quality services will be offered thus increasing the throughput of the institution.
These strategies are not limited to the microsystem level only. They cut across all levels of organizational structure. The mesosystem, as described earlier, is composed of the departments within the institution. This level actually carries the most important role. This is based on the fact that for service delivery to be maximized and optimized, their input is very crucial. These divisions will coordinate with others and settle on the best management therapies. Besides this, they will identify bottlenecks in their divisions and relieve them or recruit/ purchase more equipment. This contributes heavily to improvement of the institution’s throughput. The macrosystem will determine the role that each stakeholder in the company has to play towards solving the problem.
Implementation Plan
The proposed strategy to address the issue is incorporation of information and computer technology into the system. The objective of this strategy is to ensure that everything regarding the patient can be obtained at any time by a simple click. The significance of this strategy is supported by the fact that all the information about a patient since birth is crucial to effective patient care.
For this strategy to be successfully implemented, every stakeholder in the system and other outside sources has a role to play. These include:
- Government agencies- provide patient identification, family members, birth certificate and details, locations that they have lived in, education, occupations
- Patients- provide proper and legal identification documents, previous admissions and management therapies used
- Information and computer technology specialists- design a program that collates, synchronizes and coordinates data on a single individual, upload the data to a common site for easy access by authorized personnel
- Clinicians- integrate data provided and assign roles among themselves that will ensure wholesome management of patients. This process should also include other professionals such as nutritionists, geneticists, physiotherapists, hygiene and sanitation officers, psychologists, lawyers and the police department. The last two are for handling cases that involve legal matters such as domestic violence, sexual violence and crime among others.
- Management- allocate adequate resources to the various departments for purchase of equipment, hire more specialists, and oversee implementation of the plan.
The current process of patient care is guided by what the clinician finds out after the patient visits the institution unless the patient is a referral case:
Patient visits the hospital alone or in the company of their family or friends
Nurses and any other clinician obtains history from the patient
Information obtained is analyzed by the doctor who comes up with differential diagnoses
Tests are carried out to ascertain a diagnosis
Therapy is instituted
Performance of a gap analysis reveals defects and deficiencies in the current process (Dabestani, R., Shahin, A., & Saljoughian, M., 2017). For instance, the patient only provides information that they remember or that which they deem relevant. The patient may leave out information that may significantly affect the type of therapy to be applied. This system is also based on trial and error. Tests alone may not effectively direct or tell the patient’s condition. This is because different conditions present with the same abnormalities in body parameters such as electrolyte levels. Other components have a bearing for example, genetics, nutrition and occupation. In other cases, a patient may be given new drugs without the doctor considering therapy that the patient is on after diagnosis in another institution. As such, this process only addresses the current problem but may not avert future issues or recurrences. The proposed plan aimed at filling these gaps:
Patient visits the hospital alone or in the company of their family or friends
Nurses and other clinicians obtain current complaints from the patient and progression of the condition if it has been there for a while
Information obtained is compared with that available in the database
Relevant information is analyzed by a qualified specialist
Tests are carried out to determine the diagnosis
The most appropriate therapy is instituted considering the efficiency of previous ones, allergies to medications, their response and their genetic composition
This new plan addresses gaps that are present in the current system. For instance, all medical information regarding the patient, their past illnesses, past therapies, nutritional status, genetic predisposition and occupation are all taken into account when designing the appropriate management therapy.
For this new process to be successful, implementation of the strategy needs to be within these timelines:
Allocation of adequate resources to the various departments- 1 month
Design of a new software program that will contain all the information described- 6 months
Installation of computers in all doctors’ offices within hospitals- 8 months
Education of medical practitioners on usage of the new technology- 3 months
If this timeline is strictly adhered to, the new process of patient management will be feasible within the next 2 years
My Role as a DNP-prepared Leader
As a DNP-prepared leader, I understand very well that the current system does not effectively meet patient’s needs. Over the several years of practising as a nurse, I have seen many patients deteriorate because their conditions were not managed intensively. Many patients have also been readmitted because in this system, it is not easy to point out the causal factors and thus advise the patient to avoid exposure to it since the approach is not wholesome.
As a leader, I would use my communication skills to educate my colleagues on the significance of this initiative and how it is bound to benefit patients greatly. Our work as nurses would also be rewarding because we will be approaching the patient wholesomely and guide them on therapy and how they can avert future recurrences.
At the same time, I would use my position as a leader to delegate duties to other nurses. This is in a bid to ensure total involvement of everyone in the new process. This will make them appreciate its effectiveness and understand why they should embrace it.
Change is not easy to implement; there will always be people with objections to the entire process. I would handle such professionally. I will specifically visit them in their offices, invite them to my office or meet up with them out-of the workplace and engage with them. I would consider their take but most importantly, use the opportunity to educate them on how the proposed process will revolutionize and simplify medical practice and its benefits to patients. It would also be important to assure them that their contribution and input into the process will ensure its effectiveness and workability.
It is normal for people to lose the energy to drive the entire process through. As a leader, I will take my time to engage my colleagues in a variety of sessions to motivate them into putting effort into the process. It will also be important to educate them on cases on failure of the current system and encourage them to keep up their hard work in ensuring that the new system is implemented, utilize it effectively to ensure quality delivery care to patients.
Measurable Outcomes
Patient satisfaction is important in ensuring that more of them will visit an institution thus maintained or increased reimbursements. Patients are the customers in the health service industry. Therefore, their satisfaction is of importance to the management and the industry at large. The patient satisfaction survey is made up of many components that include: level or efficiency of interaction with doctors and nurses, responsiveness and willingness of medical professionals to offer help when called upon, management of pain by health service providers, education about medications prescribed, information given during discharge, hygiene status of the hospital environment and its conduciveness (Bleustein et al., 2014).
Another measure is nurse engagement. Nurses contribute the largest portion in entire medical profession. As such, their proper involvement is central to ensuring effectiveness of the system. Their concerns should be considered to enhance their fulfillment, reduce stress and retain them in the institution (Pfaff, K., Baxter, P., Jack, S., & Ploeg, J., 2014). On the other hand, clinical outcome is a measure that assesses whether patients were correctly diagnosed and their conditions effectively managed (Nelson et al., 2015).
All these measures that have been described are bound to raise should this new process be implemented. These measures will mostly be assessed at the microsystem and mesosystem levels. These are the levels that are in direct interaction with patients. Patients are customers and as such, they expect good treatment and effective management. Customers want to go back home or to their places of work with the feeling that doctors were well concerned about them and that they were treated. In the long run, quality customer service is central in ensuring continued presence and relevance of the institution in the society.
References
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Starr, S. R., & Nesse, R. E. (2016). 3 The Health Care Delivery System. Health Systems Science E-Book, 24.
Bender, M. (2016). Clinical nurse leader integration into practice: developing theory to guide best practice. Journal of Professional Nursing, 32(1), 32-40.
Faganel, A., & Janeš, A. (2015). Instruments and Methods for the Integration of Company’s Strategic Goals and Key Performance Indicators.
Subanidja, S., & Hadiwidjojo, D. (2017). The influence of knowledge management “bottleneck” on company’s performance. Management & Marketing, 12(3), 402-415.
Bull, J. W., Jobstvogt, N., Böhnke-Henrichs, A., Mascarenhas, A., Sitas, N., Baulcomb, C., … & Carter-Silk, E. (2016). Strengths, Weaknesses, Opportunities and Threats: A SWOT analysis of the ecosystem services framework. Ecosystem services, 17, 99-111.
Dabestani, R., Shahin, A., & Saljoughian, M. (2017). Evaluation and prioritization of service quality dimensions based on gap analysis with analytic network process. International journal of quality & reliability management, 34(4), 530-548.
Bleustein, C., Rothschild, D. B., Valen, A., Valatis, E., Schweitzer, L., & Jones, R. (2014). Wait times, patient satisfaction scores, and the perception of care. The American journal of managed care, 20(5), 393-400.
Pfaff, K., Baxter, P., Jack, S., & Ploeg, J. (2014). An integrative review of the factors influencing new graduate nurse engagement in interprofessional collaboration. Journal of advanced nursing, 70(1), 4-20.
Nelson, E. C., Eftimovska, E., Lind, C., Hager, A., Wasson, J. H., & Lindblad, S. (2015). Patient reported outcome measures in practice. Bmj, 350, g7818.
