Learning Outcomes:
On successful completion of this module students will be able to:
1. Evaluate current strategies and practices for leading healthcare quality.
2. Evaluate a leadership framework which is appropriate for quality improvement.
3. Critically discuss accreditation and standards as an external assessment of the leadership of continuous quality improvement in healthcare services.
4. Evaluate the use of healthcare and clinical governance frameworks to support the leadership of quality in healthcare organisations.
5. Demonstrate ability to effectively and concisely communicate the key concepts of leadership of quality in healthcare to meet the requirements of an academic poster.
Assignment:
[Please write in format of: Introduction, Background, Discussion, Conclusion, References (I have attached some references to my orderbut in addition to them you can use extra references)].
Part A: Leading a quality improvement (2,000 words +/- 10%): [Assesses learning outcomes 1, 2, 3 & 4]
Identify a service or service process in your department/ organisation which provides an opportunity for quality improvement. Provide an evidence-based rationale for this improvement and outline how you would lead its implementation. As part of your answer, critically evaluate your planned leadership approach to the quality improvement.
As you know from my previous assignment in which I have suggested to develop Home Based Treatment team (HBTT) in psychiatric hospitals in Republic of Ireland(I have put it as “My Proposal for Change in the Organisation” in below just as reminding you):
For Improvement of the quality of it, my some suggestions are as below (The writer can suggest other things in addition to these suggestions or some other totally different suggestions):
– The staff can go to the patient’s house to assess patient’s risk (suicidal, etc.) and evaluate that whether patient needs admission in acute psychiatric ward of hospital or the HBTT staff can visit the patient on daily basis at home)
– The hours of working of staff from current 10 hours increase to 24 hours daily.
– HBTT are attended by other disciplines such as social worker (help re solving patient’s financial and/or accommodation issues), bereavement counsellor (as sometimes the acute symptoms of presentations by patients are due to recent bereavement)
– Liaise more with patient’s GP during course of treatment rather than informing GP after discharging from HBTT’s care.
Part B: Poster (word count N/A): [Assesses learning outcome 5]
Construct a poster(according to attached poster template) which summarises and communicates the proposed quality improvement and its leadership.
Please submit a SINGLE PowerPoint file with a SINGLE slide as your poster.
PROPOSAL FOR CHANGE IN THE ORGANISATION
Substitution of an In-Patient Setup with an Efficient Home-Based Treatment Team (HBTT)
This paper intends to propose a change in the operation model of the psychiatric hospital. The change to be implemented is designed to substitute an in-patient setup with an efficient home-based treatment team (HBTT). In my role as a middle-grade psychiatrist, I have the mandate to advocate for change and express my opinions regarding various aspects of caregiving. This proposal is drafted with the focus on enhancing healthcare for the psychiatric patients and their families, while at the same time taking into account the impact of the change to the organisation and various stakeholders (Stewart, 2011). In this light, the proposal seeks to satisfy the increased national and international calls for high-quality caregiving, reduced cost of operation, and a sustainable approach to providing health care. According to Uddin (2006), the National Service Framework for Mental Health highlights various standards that should be met by organisations working in mental care. These provisions include promoting the provision of mental health care, satisfying the needs of informal caregivers, quality healthcare services, increased access to medical services, care for persons with severe enduring mental health conditions, and reducing the suicide rates. From these considerations, the implementation of the HBTT approach will certainly drive the organisation in the right direction in meeting the expectations and requirements of mental health care provision.
AIM AND OBJECTIVES
The effective management of change is fostered by establishing the objectives that need to be met to facilitate the effectiveness and coordination of activities between the stakeholders that are affected by the change. The aims of the project include:
• To facilitate person-centred treatment
• To ensure adequate care is available for those who are critically ill in through in-patient care
• To reduce the cost of inpatient care
The specific objectives that will be met by the HBTT model of treatment include:
• To ensure there is a decline in the total number of inappropriate admissions to inpatient units, subsequently enhancing the quality of healthcare to the patients who need admission.
• To streamline access to psychiatric services where admission is likely to be done while increasing efficiency in personalized care services.
• Increase the availability of out-of-hours communal psychiatric services at the time of need.
ORGANISATIONAL CONTEXT
Despite the increased advocacy and shift to community-based mental care delivery in the last three decades, the in-patient treatment model remains a challenge regarding the cost in organisations that offer integrated services. Insights from Burns et al. (2001) show that the challenge experienced due to the expenses incurred in in-patient care is a key impediment to the expansion of mental health care provisions in the community. Despite this, there are a variety of models of community services that have been implemented. Their subsequent success shows that home-based care can be effective and a solution to the high costs of in-patient treatment. The HBTT alludes to crisis resolution and home treatment medical personnel, who are focused on offering rapid assessment for mental health patients and where possible to administer intensive home treatment instead of acute admission in the psychiatric hospital (Uddin, 2006).
The services that offered by the HBTT will be aimed at clients between the age of 16 and 65 years. Also, persons over the age of 65 years who experience functional illnesses that include depression, anxiety, severe agitation, and those who have extreme mental health conditions, that without the engagement of HBTT, hospitalization will be required. Nevertheless, there are many and varied crises that warrant the involvement of HBTT. These conditions include a breakdown in the normal coping abilities of a patient, a substantial deterioration in the mood of an individual coupled with suicidal thoughts, a detrimental change in psychotic symptoms, and reduced social performance or social withdrawal (which may be seen in depression, simple type of schizophrenia, etc.) among other conditions. The crisis can be experienced as developmental symptoms among patients who already have mental health issues. Additionally, they might be triggered by certain experiences in the individual’s daily life. For instance, the loss of a job can trigger suicidal thoughts. Different risk factors can warrant the patient being seen within 24 hours. With the adoption of an effective operation model, the HBTT can offer rapid assessment and a variety of psychotherapeutic solutions as a substitute for inpatient care.
The proposed operation model for the HBTT involves a strategic approach that involves the cooperation of the medical personnel, management, patients, and their relatives. The coordinator of the HBTT will be required to discuss if the referral made is appropriate for the parties who refer the patient (National Vision for Change Working Group, 2012). During this engagement, the actual and potential risks are discussed via phone and approximations on when the patient might be seen will be communicated (Johnson, 2013). The HBTT personnel will have 24 hours from the time the referral is made within which they can offer services to the patient. Once the coordinator accepts the referral, a team is assigned to the patient for assessment to be made. Determining the appropriateness of the patient to engage in the HBTT model of treatment or being referred to inpatient treatment can be facilitated using various tools that include an assessment by completing various questionnaires (Uddin, 2006). The HBTT will offer the clients leaflets that will highlight the team’s expectations and limitations to ensure that the people are aware of their effectiveness in different situations. After the engagement with the patient, the HBTT will discuss the patient at the next possible meeting in the office to formulate the next step in treatment based on the emerging factors.
The period of treatment can last between a day to about six weeks. The period of treatment is determined by the needs and the circumstances under which the referral is made to the HBTT. A period of open contact can be offered, which is the time a patient or family member can contact the team if the patient experiences any form of deterioration in their mental condition. The undertakings of the HBTT personnel that includes the assessments and treatments offered must be well documented. Also, the feedback from the patients should be gathered to identify the complaints, the effectiveness of the treatment provided, details of progress, details of medication, and any arrangements made after discharge with the HBTT personnel. After all the paperwork is completed, it will be filed for archiving. In this context, paperwork can be used, or alternative technologies can be used to integrate the change to other developments in the medical field, such as the use of electronic health records. In cases where the patient experiences acute conditions that cannot be maintained in the home setting, the recommendation will be made for the appropriate time they should stay in the hospital and then the HBTT approach can be reinstalled as a follow-up procedure (Uddin, 2006). In this context, the organisation is required to establish a link worker post that will facilitate the integration of HBTT activities with inpatient care. The link worker will be responsible in supporting the hospitalized patients in in-patient care and engage in planning the discharge of the individual once their mental health is appropriate for home-based care and the subsequent transition to HBTT care. The consideration is appropriate for the patient to retain the same personalized care with the key health workers and facilitate continuity of care that focuses on the client rather than the systems. On the same note, once patients are discharged from the health centre, the HBTT personnel will engage in follow-up interventions for further-two weeks to ensure the sustainability and quality of care and reduce the number of readmissions, which further increases the costs incurred by the organisation.
STAKEHOLDERS
The proposed change will involve and affect various stakeholders in the organisation. These include internal and external stakeholders. Effective change management will require effective communication across all stakeholders and their participation in the change process.
The internal stakeholders include:
Management
The hospital management will play a critical role in the leadership and management of change. The management is required to provide the resources and personnel required to facilitate the effective transition. Also, the management is expected to facilitate communication and collaboration between the various stakeholders involved in the change process.
Medical personnel
These include psychiatrists, nurses, therapists, and other practitioners who facilitate care delivery to people with mental health conditions. They also form the largest group of participants in the change process. Due to their role in the whole initiative, their input in the management of change, and the key aspects of the HBTT are fundamental. Additionally, progress to implement the change will require effective leadership among the workers to ensure that there is cooperation between different departments, increased employee productivity, and organisational performance, and mitigation of resistance to change (Stewart, 2011; Iles & Sutherland, 2001).
The external stakeholders include:
Patients
The patients are at the centre of the change programme. The initiative is focused on reducing the expenses incurred in in-patient care and ensuring that the organisation offers quality person-centred care. Consultation with the patients will be required to determine the different aspects that should be included in the HBTT care initiative. Also, the patients will have to be educated on how to make referrals and their role in the treatment, which includes giving feedback where appropriate.
Patients’ relatives
In most cases, persons with mental conditions might not be in a position to make calls to the hospital and make referrals. In such cases, the next of kin becomes imperative stakeholders in the HBTT model. Their participation in the change process is important because they are the people who will make referrals, meet the medical personnel, offer feedback, and report on the progress of the patient.
Other stakeholders who can facilitate and support the change program include the government through effective policy, tax cuts, and financial support to implement the initiative. Also, non-governmental organisations, which operate in the healthcare industry can engage in supporting the initiative or conducting studies that can be used to enhance the HBTT model.
RATIONALE FOR SELECTING THE PROJECT
The ideology in the proposed change focuses on reducing the cost of operation and increased personalized care. The HBTT approach will enable care providers and the organisation to interact with the community, which is a valuable resource and a key player in the core interventions offered by the HBTT team. The home-based care will cut expenses for the hospital and the family will at the same time increasing the availability of quality services. The new model will also promote the effectiveness and quality of care offered to those admitted to the hospital. There will be reduced congestion in the hospital, offering an opportunity for those who need intensive care to be taken care of appropriately. The HBTT is also a development in the care system that is embedded in policies that are focused on enhancing mental care services. Subsequently, it is ethical for the organisation to take these standards of care to account in its development.
ORGANISATIONAL IMPACT AND EXPECTED OUTCOME(S)
It is difficult to predict the impact of the change (Weick& Quinn, 1999). Nevertheless, there is growing evidence that use of home-based treatment programs is increasingly leading to improved health outcomes and reduced costs in in-patient care. In this light, the expected impact is that there will be a reduction in the number of admitted patients. The new initiative will offer new employment opportunities for the organisation to meet the needs of patients in different places. In this light, there will be the need to invest in tools and equipment, which include facilitating the means of transportation to different areas. Suggestively, the organisation will require being financially stable for the impact of the change process not to affect care delivery. Another major impact is the change in the organisational culture due to the substitution of inpatient care.
The expected outcomes include reduced cost of operation in the in-patient sector. The new personnel will increase the organisational performance and subsequent profitability of the business. The organisation expects that the high levels of satisfaction among the customers will increase the reputation and client base, which will further expand the coverage of the organisation in the mental care service business.
