Chapter-14
1. The quality performance measure and the patient satisfaction measure of the medical center’s 1st and the 2nd quarterly report, when compared, indicated an overall negative trend in quality performance and patient satisfaction. Following the new pattern of nursing recruitment, there has been a noticeable increase in the rate of medication error, patient fall, caesarean, nosocomial infection, and X-ray discrepancies. The patient satisfaction rate with respect to overall service, clinical experience, cleanliness and quality have decreased considerably. These poor performance figures, could be a result of redesigning the nurse’s staffing pattern or a consequence of initial adjustment to the new change in the center. The benefits of the new system can be compared to the standards, to decide its overall acceptance and approval.
2. The nurses’ administrator did not sufficiently educate the board members with the recruitment pattern and its progress. The need for a changed design in the nurse’s staffing pattern is not well explained. It is not clear as to why a changed pattern was suggested, when the hospital was already doing good. The CEO could have explained how, when and where the change was implemented and the reason for choosing the changes.
3. I would recommend the nurse’s administrator to provide information on how something will be done to improve quality and performance when compared to a standard. The standard in this case is report of the first quarter.
4. The board can demand the performance measurement data of the nurses, based on which the new pattern was recommended. There needs to be standardized approach to developing and implementing change. Without knowledge on appropriate information, it is difficult to make a sensible decision and implement change.
5. The board needs to offer more constructive criticism, rather than blindly approving projects and recommendation. Hence I do not approve of the administration style and leadership approach.
Chapter-15
1. The fireman’s axe could have been left behind by a negligent worker or by someone with malicious intent. A further investigator would be required to know exactly who placed it in the locked facility.
2. The aim of hospital accreditation, certification and licensing, is to improve patient outcome, healthcare documentation, ensure patient safety, improve performance in patient care, governance, management and support process. The presence of axe in the locked facility reflects the compromise made in patient safety and the lackadaisical attitude of the management. The security of the patient and the staff visiting the locked facility is compromised.
3. A dangerous situation like in the present scenario, can be avoided by calling for a meeting and educating the staff on the potential harm of this incident. The background behind such incidents has to be investigated, and the persons who did this must be made to take responsibility for their negligent attitude. Inspection on a regular basis can be beneficial. Though this may be an isolated incident, it is always better to ensure that such mistakes are not repeated. The care facility has definitely a good infrastructure to care for dangerous psychotic patients. As special keys are needed to enter and exit the facility, it would be easy to trace back where the axe came from. There is no point in having safe door and windows when an acute psychotic patient in the facility gains access to an axe.
Chapter 16
1. Performance improvement activities are planned based on sensitive information. The report suggests the lacunae in the present system of handling information. From the report, one can understand that the infrastructure is not uniformly available to all departments in the center. This can affect the way data or information is reported. In addition, lack of knowledge of operating the computer software, can discourage staff from entering the required information. Information technology is a valuable tool that can help create the essential functional link between the individual, their services and the organizational objective. There is a lack of proper interfacing system at the facility and this can limit the use of information in the database. The organization needs to improve the quality and services of the health information system, by working on the lacunae pointed out in the report. This is important, as this information will help in determining what the customers need and will help the organization to be more result oriented. This information will help identify strengths and also areas where improvement is needed. It can also enhance internal and external communication. Information technology can make the employees responsible for their action and thus help to improve performance measures.
2. The Joint Commission standards are made with the idea of fully involving physicians and nurses in the success of patient care and safety improvement. The vision of the commission is to ensure that all patients receive safest, high quality and best value health care across all settings. These activities of the commission are data driven. A deficient healthcare information system can obstruct the employee’s response, investigation and immediate implementation of correctional reforms.
