Increasing Risks That Force a Change - Term Paper Example

Spatial Quality Review: Proposal for Bed per Bay Reduction December 16, 2006 Executive Summary The following change proposal establishes a methodology for increasing quality in bed and bay assignments. Currently there are six beds per bay, which creates a certain amount of risk in injury and spread of infection as well as limits mobility of medical equipment. The tight spatial relations therefore require the development of a spatial quality review procedure. This proposal requests that communication between multiple departments be utilised to examine the issue in detail. The development of a spatial quality review procedure includes examining the legal and financial risks resulting from increased injury reporting from staff and nosocomial infections from clients. Furthermore, the medical staff team has initiated concerns towards the ability to reach necessary medical equipment including: locked medications, crash carts, and catheters/intestinal bags. Based on these concerns, the following proposal examines the current situation as increasing risks that force a change. The force field chart shows that the forces placing pressure on changing the current allocation of beds per bay is greater than the resistance forces, which means that there is an urgent need for further investigation. The proposal establishes that further investigation should develop towards business process re-engineering. It is under this premise that the proposal commits to meeting with facility stakeholders, identified as admissions, management, and staff, with the goal of developing a procedure for spatial quality review. Furthermore, the proposal establishes that there is a need to reduce the bed per bay count from six to four, based on the associated risks. This can not be done without further investigation and relative input from staff and clients as well as management. The facility must embrace quality control and review error reduction as a business imperative to continued growth. The adequate ability to access and distribute medical needs, and prevent injuries to staff and clients. The change strategy is to reduce the bed count to four beds per bay. This will reduce the possibility of legal ramifications from staff and clients. The forces against change are in strategic management. The current six bed per bay ratio allows the facility to hold more clients in smaller spaces, which increases revenue per bay and admissions. Therefore, the strategic management plan is to first gather input from admissions, legal, and financial departments. This includes examining the current benefits to higher than recommended beds per bay. The current state of space between beds must also be examined to establish if there is a health risk that outweighs the benefits of the status quo. The transition from a six-bed bay to a four-bed bay has strong benefits towards risk management, staff and client protection and establishing new parameters by which the facility can establish that we are enhanced, and not restricted, by quality control. Finally, the facility will be evaluated based on the modified process to examine if new behaviours in bed allocation are reducing or increasing the associated risks in staff and client injuries. Introduction 5 Analysis of Current Situation 6 Force Field Analysis 8 Overcoming Forces Against Change 9 Plan of Action 10 Business Process Re-engineering Time Table 12 Conclusion 13 References 14 Introduction The following proposal establishes that there is a need to evaluate the current use of space within client rooms, often referred to as ‘bays.’ The evidence suggests that the lack of adequate space is conflicting with medical needs, as well as causing minor injuries to staff and often presenting problems when administering medication. The main concern, however, is related to the spread of nosocomial infections due to the tight spatial relations of each client’s bed in relationship to the other clients. This presents a problem in preventing the spread of infection as clients are within touching range and often share furniture. The consequences of increased nosocomial infections and injuries can reach a legal financial risk that outweighs the financial gains of having six clients per bay rather than four clients per bay as proposed. The approach to overcome this concern is to propose a spatial quality review that significantly evaluates and implements changes to the allocation of beds and space per client. This is followed by an outline of the proposal action plan and a project management timetable based on the concept of business process re-engineering. Business process re-engineering (BPR) is applied at the local, managerial, and corporate levels of the business. This concept has a significant impact on the various phases of the business process, where the changes that occur can be related to the flow of information and products (Desel & Erwin, 2000). The crucial tenants of BPR is that it reduces tension between inter-organisational departments and business partners, particularly when the there is friction within the current process (McCormack & Johnson, 2000). Analysis of Current Situation The current situation is lack of space for effective treatment of clients. In each room, also referred to as ‘bay,’ there are six beds. This presents a concern for staff in that it restricts movement. Restricted staff movement through the bay represents significant concerns in the event of an emergency. The ability to access and distribute medical equipment during a cardiac arrest is significantly diminished in client bays. The current six beds per bay ratio also restrict access to locked medications. In some cases, it is necessary to move the client’s bed to reach the client’s medication locker. The medical team has also made statements of bruising due to the restricted movement ability. Several stationary and moveable furniture items have been broken due to this space issue. Most importantly, the risk of nosocomial infections is increased. A nosocomial infection is one that is acquired after a patient enters the facility. These infections are most commonly caused by endogenous flora from the patient's body, cross-contamination from staff, and exogenous flora that resides in the environment and objects like furniture, bedding, and other stationary objects. Patients can be released before the symptoms of a nosocomial infection begin, and generally the infection is only noticeable after a patient's release, making it difficult to determine the cause. The factors that contribute to nosocomial infections include: inadequate quality control and practices, especially in operating blood transfusions; invasive medical treatments (catheters, intravenous lines) without proper methods; contaminated intravenous fluids; antibiotic resistance; unsafe and unnecessary injections (Tietjen et al. p 202, 2003).The spread of nosocomial infections occurs by direct contact: Transmission attributes to the potential ease of spread throughout wards and healthcare facilities. Contaminated water, improperly sterilised equipment, dirty personal protective equipment (PPE), and general unsanitary conditions are all methods of direct contact transmission. Research studies have proved the spread of these organisms by direct contact. (Standiford and Aziz p 412 2005). Based on this, the proposal identifies the lack of adequate spacing within the facility as having a serious impact on clients and staff. This creates risks for staff and patients that are easily preventable. The reduction of accidental cross-contamination and exogenous contamination can have a drastic impact through re-allocation of space within the client bays. The current processes and systems are not effective enough to prevent contamination and injury. There is not a safe environment for the medical team and clients. The facility must embrace quality control and review error reduction as a business imperative, where the entire organisation is examined by the process flow perspective to understand the points of failure in the spread of nosocomial infections, the adequate ability to access and distribute medical needs, and prevent injuries to staff and clients. The cost of prevention is far less than the cost of liability in this case. An examination of system control issues should relatively recognise that the environment must be a pathogen free and physically safe place to give care. The responsibilities of quality review are to define and ensure the safety of patients and employees by an honest and committed approach that allows for the errors to be identified. This path of quality review is not only dedicated to the reduction of pathogens, but also an understanding of the health care culture, where errors are generally individualised to a doctor or hospital, but the issue of injuries that are preventable by initiating and utilising quality review techniques are the responsibility of organisational management techniques. The consequences of ignoring prevention are severe. This includes the possibility of complaints and lawsuits from client families and staffed employees. Force Field Analysis Forces For Change Change Strategy Forces Against Change Lack of spatial quality controls Implement Spatial Quality Controls. Reduce bed count to 4 beds per bay Develop quality control steps Possibility of Infection and Injury Re-assign space and beds Possible legal ramifications Re-Allocation Resources Lack of access to medical lockers Lack of mobility in emergency The force field analysis table simplifies the current situation. The forces for change are the lack of current spatial quality control systems. This should be rectified to include a developed quality control system. This is based on the possibility of infection and injury due to the lack of mobility and the transference of person to person infections because proper space between clients is not available. The lack of access to medicine lockers and emergency equipment is another identified force for change. The change strategy is to reduce the bed count to four beds per bay. This will reduce the possibility of legal ramifications from staff and clients. The forces against change are in strategic management. The current six bed per bay ratio allows the facility to hold more clients in smaller spaces, which increases revenue per bay and admissions. Re-assigning the extra two beds per bay will require an examination of the available rooms against admissions and services per client. Therefore, the forces against change are totalled as re-allocation of resources and the cost of developing spatial quality control procedures. These cost, however, are minute compared to the costs associated with increased nosocomial infections, staff injuries and client injuries due to the inability to provide adequate emergency and clinical services in the event of an emergency. Overcoming Forces Against Change Organisational change management strategies that rely on the theories may not fully examine their own nature and culture. Most management theories assume that change management is a process and not a continuous improvement event (McKelvey and Holmen 2006). Viewing change management as a single layered process rather than the circular concept of continuous improvement can lead again to a stagnant culture and organisational behaviour. To overcome the concern of re-allocating resources, it is important to realise that change management is not a single process, but will involve input from human resources, admissions, legal and janitorial departments as well as staff. Another assumption in change management is that individuals must change before the organisation can change (McKelvey and Holmen 2006). This assumption may not have any direct effects; however, it can be noted that for change management to be a continuous and organic event, the organisation must set the environment and culture to consistently encourage individual change. To this, the techniques in which the spatial quality control reviews will be developed and implemented will involve communication through the individual layers of management to discover what aspects of space and spatial mobility are causing problems. Change management also assumes that change is a gradual growth process that encompasses skills, culture and emotions (McKelvey and Holmen 2006). Another important theoretical assumption is that the organisation’s members are of the same social system, and that they will react similarly to a change event. The development and implementation of spatial quality control reviews will be accepted (or challenged) by various dimensions of the organisation structure, including medical staff, admissions and financing (considering the possible loss of admissions revenue associated with bed reductions) and management who will be responsible for the spatial quality control review. Encouraging change management means that the leadership must also know the social systems they are changing within the organisation, where it can not be assumed that each team member has the exact same reaction to a change. This is a main contributor to change resistance. Plan of Action Strategic management must look at the short-term and long-term goals by including a spatial quality review plan and declaring an objective of developing highly skilled and flexible planning and, thus, providing steady strategy for a reduced number of beds (Pearce and Robinson p 137 2003). The first item in the plan of action is then to decide who will be impacted by the re-allocation of beds from six beds per bay to four. This includes gathering input from medical staff management, who may have to re-arrange client rooms; janitorial services who may need to physically move the beds and other furniture items; admissions and financial department managers. A proactive declaration anticipates the needs of employees and customer expectations through employee satisfaction, loyalty and team commitments. It is therefore recommended that a strategic management plan be implemented that is “acceptable, flexible, measurable over time, motivating, suitable, understandable, and achievable” (Pearce and Robinson p 138 2003). The following outlines a strategic management plan: 1. Examine current state of client rooms, including the amount of space between bedding, employee accesses to equipment including medicine; determine cost of nosocomial infections. 2. Define acceptable goals for improving. The acceptable goal for improving the current situation is to develop the spatial quality review procedure, which will evaluate the dimensions of physical space in relation to the perceived costs, and resource re-allocation that must be conducted. 3. Define time-set goals. The spatial quality review should have specific times that the review is conducted that are communicated to the interested parties of the facility as defined above. 4. Motivate and communicate. Employees must be able to see that communication is a revolving door and their input in this is valued. The goals of this proposal should be communicated amongst the stakeholders, medical team, and clients. 5. Utilise business process re-engineering techniques that The benefits of using the BPR concept to promote spatial needs are that it connects information management (McCormack & Johnson, 2000); promotes cost saving activities through efficiency and communication (Horvath, 2001), and reduces financial risk in unsuccessful supply chains (Cross 2000). 6. Evaluate process. The process should be evaluated through discussion with management, staff and client’s to evaluate the spatial quality review procedures. Business Process Re-engineering Time Table Description Milestone Criteria Planned Date Define Spatial Quality Control Communicate with stakeholders Hold conference January 3 - 10 Project goals and scope defined Stakeholders identified Proposal reviewed Start Planning Spatial Quality Control Hold initial meeting with staff and team Scope and concept described Financial Risk and Costs Identify and discuss with admissions, financial January 12 Requirements agreed, project plan reviewed, resources committed January 30 Confirm Execution Implement Spatial Quality Review Plan February 2 - 14 System reviewed and stable Start Introduction Hold Conference February 14-28 Draft documentation Evaluate input from staff, clients, management, admissions and financial Release Communicate with clients and family Close Re-arrange beds, provide evaluation. March Conclusion The transition from a six-bed bay to a four-bed bay has strong benefits towards risk management, staff and client protection and establishing new parameters by which the facility can establish that we are enhanced, and not restricted, by quality control. This means that it becomes important for the facility to constantly evaluate and understand what we can do better to provide a safer environment for staff and clients. To evaluate the proposed spatial quality review, it is recommended that the provision of resources be compared to previous allocations. This should establish if the proposed review is correctly establishing adequate mobility and space for staff and clients. The evaluation will also examine the support system of the stakeholders and other agents within the proposal to evaluate what the benefits, limitations, and consequences of the proposal are. Finally, the facility will be evaluated based on the modified process to examine if new behaviours in bed allocation are reducing or increasing the associated risks in staff and client injuries. References Cross, G.J. (2000) How E-Business Is Transforming Supply Chain Management, Journal Of Business Strategy, Vol. 21 No.2, Pp.36-43 Desel, J. & Ervin, T. (2000). Modeling, Simulation And Analysis Of Business Processes. Business Process Management. Berlin: Springer Verlag Horvath, L. (2001). Collaboration: The Key To Value Creation In Supply Chain Management. Supply Chain Management: An International Journal, Volume 6 Issue 5 Pp 205-207. Mccormack, K. & Johnson, W. (2000). Business Process Orientation: Gaining The E-Business Competitive Advantage. Delray Beach, FL: St Lucie Press. Mckelvey And Holmen (2006) Flexibility And Stability In The Innovating Economy. Oxford University Press. London. Pearce, Jack And Robinson, Richard (2004) Strategic Management: Formulation, Implementation, And Control, 9e. 6e Copyright © 2004 The Mcgraw-Hill Companies EAST PATCHOGUE, NY, U.S.A ISBN : 007289024X Standiford, Darron And Aziz, Hassan (2005) Emerging Pathogens And Revisited Prevention Strategies For The Clinical Environment. Orthopaedic Nursing; Nov/Dec2005, Vol. 24 Issue 6, P406-413, 4p, 3 Graphs Tietjen, Linda; Bossemeyer, Debora And Mcintosh, Noel. (2003) Infection Prevention Guidelines For Healthcare Facilities With Limited Resources. JHPEIGO Corporation Baltimore, MA Read More