Management Structure at Nightingale Hospital

Task 1

Organisational structural analysis

According to Martin et al (2015), the grouping of several diverging care facilities for the purpose of specific treatment service provisioning towards assisting the psychologically ill patients could constitute the core structure of a mental healthcare treatment centre. These medical centres are structured for the purpose of providing treatment involving specified psychological health issues such as addiction and depression, often requiring healthcare dissertation help to explore their effectiveness and outcomes in addressing patient needs.

In this context, these are the general institutions which also could provide particularly specialised treatment facilities for a range of psychological ailments such as suicidal perceptive ideations, Substance Abuse Addition, Post Traumatic Stress Disorder (PTSD), anxiety disorders, behavioural disorders and others. In this context, the selection of the psychiatric facility of Nightingale Hospital has been premised upon the purpose to shed effective analytical gaze on the overview of management and leadership roles and the organisational structure within the health segment of significance. The psychiatric care centre is located at Marylebone, Lisson Grove, London, United Kingdom (nightingalehospital.co.uk, 2019).

Barr and Dowding (2019) have observed in this respect that development of effective healthcare leadership compliments within this healthcare organisation is premised upon the establishment of the direction to the care professionals working within the Nightingale Hospital and to ensure that these employees could be made to retain their commitment towards this particular direction. This necessitates the utilisation of proper vision, ideas and leadership elements to inspire the care professionals to enhance the scope of their services. On the other hand, Rycroft-Malone et al (2015) have specified that the management structure of the healthcare organisations such as the Nightingale Hospital, primarily pertain to the social discipline of controlling the human institutional involvement and the associated behaviour. This process is a dynamic one. However, Gould (2016) has observed that the nature of management within such a healthcare centre is primarily contingent upon the work processes, policies and work cultural values of the institution. This leads to the determination of the structure of this organisation to be a traditionally hierarchical bureaucratic format which overtly emphasises on the clarification of roles, designations and commands and setting of the most explicit measure of accountability regarding the exhibited care performance by the staff of the hospital.

Simonetx (2015) has further divided the managerial responsibilities of the Nightingale Hospital into three segments, namely the Informational, Interpersonal and Decisional responsibilities. The Informational could be further subdivided into monitoring (searching and acquisition of care service information), distribution of information (communication and dissemination of necessary instructions and data to the deserving recipients within the organisational structure) and public relationship management (providing accurate information to the patients and their representatives). Interpersonal could be subdivided into segments such as operational representation (completion of legal and social duties), training responsibilities and contact establishment with the external regulatory authorities such as the CQC, the NHS and the HCPC. The Decisional responsibilities could be subdivided into identification of new scopes of improvement and project management operations, management of conflicts and resolving the operational impediments which could arise during the discourse of operations and finally resource allocation. In this context, Davies and Challis (2018) have stated that the external environment and the organisational responsibility scenario influence the managerial roles related to the organisation.

In this context, the organisational working architecture has been identified to be McGuire (2016) of a traditional hierarchical nature where the apex controlling organisation is the Board of Administration. Under this particular apex organisation, four different divisional segments have been formulated to serve different care and administrative responsibilities. These are the Therapeutic services, the Information Services, the Diagnostic Services and the Support Services. The Therapeutic Services include the OPDs, the Nursing services, the therapeutic operations involving an extensive range of different psychiatric conditions amongst adults such as ADHD, Bipolar Disorder, Addiction of Substance Abuse, Depression, PTSD, Paranoia, Schizophrenia and Obsessive Compulsive Disorder. Further, the Information Services of the Nightingale Hospital involve admission and registration of the patients, billing, records compilation, hospital log maintenance and official data preservation. The Diagnostic Services of the hospital involve operations concerning the laboratories, infirmary and neurology sections. Finally, the Support Services involve transportation and maintenance sections concerning the different segments of the Therapeutic and Diagnostic Service departments.

Roles and responsibilities of external agencies

According to Glover-Thomas (2018), the Nightingale psychiatry and mental health facility is regulated by the designated body of the General Medical Council (GMC). The registration authority of the organisation is the Care Quality Commission (CQC) and the psychiatrists are individually registered by the GMC. Mehta (2019) have specified that the statutory regulatory authority of Health and Care Professions Council (HCPC) is central to the control of the health professionals of the hospital. This is primarily a standards and quality maintaining authority with the purpose of proficiency management. Further, the overarching authority which sets the benchmark of the professional standards management within the Nightingale psychiatry centre is the Professional Standards Authority for Health and Social Care (PSA). Under the auspices of the PSA, the HCPC operates as the designated regulatory body.

According to the research of Shaw and Middleton (2016) the public taxation structure funded health systems previously under operation within the UK has experienced considerable change in the form of increasing regulatory and supervisory roles of the successive national governments under which the state authorities have increasingly resorted to introducing market based management and incentive structures. These structures have been based upon the measurable effectiveness of the explicit performance of care facilities such as the Nightingale Hospital. In this context, Ferlie et al (2016) have commented that the strategic policies of the state and the associated budgetary considerations are presided upon by the Department of Health (DoH) and the NHS takes the responsibility to administer the same at the local and regional levels through the Clinical Commissioning Groups (CCGs) which are mostly statutory institutions.

According to Williams and Dickinson (2016) prior to the year 2013, the majority of the delegated responsibility of 85% of the annual £95.6 billion budgetary provisions of the NHS had been entitled to the Primary Care Trusts, however, the CCGs acquired this responsibility accordingly. In this context, Campbell et al (2008) have outlined that there have been three criteria on the basis of which the changes in the NHS operational structure had been instituted. These had been the stimulation of incentives which could be sustained by even the private healthcare organisations such as the Nightingale Hospital through the enhancement in the organisational performance in terms of clinical services improvement, the centralised assessment of such performance against the standards set by the NHS in spite of according greater autonomy to the private health operators such as the Nightingale psychiatric centre and the institution of a stringent model of standardisation and regulation implementation.

Individual functions

This is particularly significant since the hospital provides a dynamic care service regarding the apparently volatile care scenario involving psychiatric patients and elderly personnel suffering from effects of social seclusion and young personnel affected by addiction of substance abuse. Billings and De Weger (2015) have outlined that leveraging on personal capabilities and inspiring others to meet the care requirements have been central to healthcare process leadership. From a comprehensive standpoint, it could be observed that inspiration would be the commonest element in the differential leadership factors involving divergent operational discourses and the healthcare organisational leadership elements have to be comprehensively goal oriented though the leadership prospects are non-material from a tangibility perspective.

In this context, Almeda et al (2019) have particularised the fact that current healthcare organisations such as the one under consideration are increasingly experiencing the necessity to reinvent the organisational leadership and managerial perspectives. The underlying catalysts have been expanding expectations from the mental health services and the new fields of psychological complications which have emerged. The leaders and managerial personnel are increasingly experiencing particular situations where previous rules of operations could not be applied and development of executive competencies has become paramount in terms of significance so as to maintain accurate decision formulation processes.

Individual rights underpinning health and social care

In this context, the rights of the individuals which underpin the psychiatric practices of the Nightingale Hospital are enshrined in the Human Rights Act (1998) (Article 3, 5 and 8). According to Cowell (2017), the Article 3 specifies the Prohibition of degrading and inhuman treatment of the patients under treatment at the hospital facility. This entails the retention of healthy environment within the hospital wards where presence of detrimental atmosphere such as overcrowding, violence, dearth of proper sanitation facilities, improper arrangement of privacy and lack of proper ventilation could be avoided.

The Article 5(Section 1) outlines the right of the patients to have proper security and liberty in the manner of prohibiting the deprivation of individuals or groups of individuals of their liberty except in cases of lawful detention in the care facility under the established observation that the detained person/personnel are of unsound psychological conditions. Furthermore, the Section 4 of Article 5 establishes that every person who has been detained and deprived of his/her liberty is entitled to initiate the legal proceedings under which the legal justification of the detention within the mental care facility has to be decided upon by the court of law with prompt release ordered if such justification could be legally proven to be null and void.

Evaluation of the significance of such rights

The research of Barber, Brown and Martin (2016) has enumerated the requirement of ensuring the proper and careful enactment of executive competencies through the application of a range of differential support principles within the working architecture of the Nightingale Hospital. This gains further significance from the perspective that the hospital also provides considerable facilities of de-addiction from substance abuse practices. Williams (2017) have categorised the necessary support principles in the form of equal care provisioning prospects, accessibility facilitation from a universal approach and providing multiplicity of psychological and psychiatric care options for patients with critical ailments such as high levels of addition, suicidal tendencies and ADHD. Such principles of support are paramount in their significance in terms of enabling the most sophisticated care service provisioning to the most diverse category of patients in terms of their ethnic, cultural, financial and age based lineages.

McLaughlin, Leigh and Worsley (2015) have emphasised on the significance of the theoretical perspective application within the sector of mental healthcare of UK in the form of the basis on which all of the clinical practices are conceived. The ultimate policy formulation of any healthcare institution such as the Nightingale Hospital depends upon the utilisation of general theoretical models so as to properly comply with the existing legislative structures of control. Apart from these considerations, the theoretical models also assist in the development of proper leadership compliments within the working structure of any such healthcare organisation and provide effective guidance for future management process development as well. To this effect, the care principles observed at the UK are primarily formulated on the Humanistic Theory. According to Graham et al (2016) this highlights the significance of effective communication between patients and care providers through a person centred approach to maintain rights and dignity of the patients.

Task 2

According to nightingalehospital.co.uk (2019), the organisational structure of the Nightingale Hospital pertains to the traditional bureaucratic and hierarchical administrative configuration. This primarily involves a top-down approach for the purpose of innovation, quality and effectiveness maintenance. This is also meant to ensure that the responsibilities delegated by the NHS, through the Clinical Commissioning Groups (CCGs), which, also involve the budgetary responsibilities. The central aspects of such an organisational structure involving the apex Administration Board and the subsequent multiplicity of service divisions (Therapeutic, Information Services, Diagnostic Services and Support Services) are the formalisation of the legal framework, formulation of mechanisms through which integrated care could be imparted and the management of functional processes of psychiatric care. According to Morrison-Valfre (2016) another critical aspect has been the systems networking structure within the organisation under consideration through which formulation of effective interdisciplinary care structures has been achieved.

According to Care Quality Commission (2013), Care Quality Commission (CQC) monitors the mental and adult care services of the hospital under the purview of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014(Amended). According to Care Quality Commission (2012) the applied regulations are the Regulation 8 (General Services), Regulation 9 (Person Centric Care Management), Regulation 10 (Maintaining the fundamental standards of respect and dignity of patients), Regulation 11 (Consent necessity), Regulation 12 (Safety of Care), Regulation 13 (Fundamental standards of safeguarding from abuse), Regulation 14 (Hydration and nutritional necessity management), Regulation 15 (Equipment and premises maintenance), Regulation 16 (Complaints registration), Regulation 17 (Governance needs), Regulation 18 (Staff management) and Regulation 20A (Assessment and reporting of displayed performance).

Apart from these, Barber, Brown and Martin (2016) have determined the Care Quality Commission (Registration) Regulations 2009 is utilised to exert further control through the enlistment of regulations involving Regulation 12 (Statement of Operational Purpose), Regulation 13 (Finances), Regulation 14 (Absence Notification), Regulation 15 (Notification of changes), Regulation 16 (Mortification of psychiatric service subscriber), Regulation 17 (Extended) (Notification of mortification and unauthorised absence of any patient who could have been liable to be detained or had been detained under the regulations of the Mental Health Act, 1983), Regulation 18 (Notification of serious incidents), Regulation 19 (Payments) and Regulation 22A (Commission notification form). According to Delgadillo et al (2016) the underlying purpose of such regulations is to ensure that promotion of the best of the practices and excellence in care progression could be maintained.

According to Veitch (2017), the Mental Health Act (Amended) 2007 has been considerably inspired by the development of the Human Rights Act (1998). The drafting of the laws associated with mental health has been guided by the necessity to maintain a delicate balance in between protection of the public interest and ensuring of rights of individual patients. According to Dawson (2015) the white paper issued by the Department of Health (2000) under the nomenclature of Reforming Mental Health Act (Section 1 & 2), clarified that the necessity to formulate new legal regulations for the purpose of the protection of the rights of individuals in the health centres was paramount and this necessitated the amendment of the Mental Health Act (1983). This had culminated in the introduction of the respective legal safeguards into the Mental Health Act (2007), inspired by Human Rights Act 1998. According to Sampson et al (2016), the changes involve that patients could file for legal remedies such as damage claims through the UK courts when their rights could have been infringed upon. Hotzy et al (2018) have highlighted that the Human Rights Act 1998 (Section 3) does specify that the UK courts are obliged to interpret the provisions of the Mental Health Act (1983) in the manner which could be compatible to the stipulations of the International Human Rights Convention. Furthermore, the public authorities including the private healthcare organisations such as the Nightingale Hospital, individual general practitioners, trusts and public health authorities, psychiatrists and hospital managers, are obliged under the Section 8 of the MHA (1983) to desist from infringing the promulgations of the human rights convention. Such infringements could make the perpetrators liable for legal actions and court proceedings such as remedial injunctions against such unlawful activities. De Luc (2018) has considered these legal safeguards to be of significance in psychiatric practices since the mental illnesses make it obligatory often, for the practitioners and psychiatrists, to take their patients into protective detention.

In case of the Nightingale Hospital, as per the provisions of Section 5(4) of the Mental Health Act (1983), the nursing staff could restrict the personal liberty of movement of the patient until the doctor in charge of the care services or the nominated or delegated care professionals could formulate any decision regarding the detention of the patient under the provisions of Section 5(2). However, the duration of such preventive detention is not more than 6 hours. According to Nyttingnes, Ruud and Rugkåsa (2016), the doctors and other psychiatric healthcare professionals could determine to detain a patient for 72 hours under the provisions of Section 5(2) and prior to the completion of such a detention period, it would be obligatory for the hospital administrative authority to arrive at a decision regarding the whether to continue or discontinue the detention as per the guidelines of the MHA.

The impact of codes of practices and legislative regulations on the mental care services provided by Nightingale Hospital has been varied. One significant development has been the increment in the involvement of patient representatives. This has been a development towards greater patient centric approaches where an informal, operational partnership could be established in between the patients (especially those who require overcoming their addiction of substance abuse or bouts of depression). Thus, the impact of psychiatric care, provided at the individual levels, has been strengthened further. Furthermore, the impact of regulations and legislative policies has manifested itself through the implementation of greater accountability on part of the psychological treatment service providers. The research of Bensonn, Thistlethwaite and Moore (2018) has enumerated that the direction of the care policy formulation and execution of the same have considerably shifted the executive model of health services provisioning from the previously prevalent reactive approach to the proactive and patient centric approach. This has been particularly effective in terms of the avoidance of social exclusion aspect which has been a significant problem for various types of mental patients such as those undergoing de-addiction treatments.

As has been observed by McLean (2016), as per the provisions of the Human Rights Act (1998) Section 6(1), it is always considered to be unlawful for the care professionals of any health facility, including the public authorities of the NHS Trusts and the private psychiatrists, to treat the mental health patients in any manner which could be in contravention to the International Human Rights Convention. However, from a legal perspective, under the Section 6(2a) of the same act, if any previous legislation could have been in place which could have dictated such actions, then, the care professionals be exempted from the charges of contravening the human rights convention.

In this context, Hall et al (2018) have brought forth the case of Herczegfalvy v Austria (1993) to outline one of the external influences on the governmental decisions to formulate the various sections of the Mental Health Act (2007). This aforementioned case had outlined the incident when a convicted person had been transferred to a psychiatric hospital situated at Austria from a prison where the patient had suffered a collapse after a prolonged hunger strike. At the hospital, force feeding was applied on the patient apart from keeping him in a solitary confinement of the hospital. Further, the patient had been handcuffed to his bed and was forcefully administered neuroleptics. Ponce et al (2016) had stated that the International Human Rights Commission had initially considered that the treatment of the patient had been degrading and inhuman given the excessive utilisation of force and thus was in contravention to the stipulations of Article 3 which had contributed considerably to the degradation suffered by the patient.

However, the ruling of the European Court had earlier specified that in case of specific emergencies where the patient could be considered to be in active danger of harming himself/herself or could suffer further degradation of health or even death if the condition of the patient is left untreated, then, the necessary actions to restore the health of the patient could be considered to be therapeutic requirement. In such cases, the treatment meted out to the patient could not be regarding as either degrading or inhuman. Thus, regarding the Herczegfalvy v Austria (1993) case, the European Court had provided the verdict that the medical necessity dictated the apparently violent treatment provided to the patient under consideration and thus, the infringement of Article 3 had not taken place.

Finally, it could be considered that such codes of practices have been critical to determine an acceptable resolution of the fundamental question which remains regarding the justification of any hard handed treatment of patients at risk concerning their mental illness under the pretext of ensuring their health and security. This has been the source of the dilemma of operations for psychiatrists at the Nightingale Hospital. This has been exacerbated by the fact that many of the patients admitted into the hospital to undergo de-addiction from substance abuse propensities have been strenuously defying the administration of essential medical procedures. These aspects have been continuous sources of challenges for the care professionals. Thus, DeRidder et al (2016) have averred that such challenges have been the source of the development of the practice of obtaining second opinions from experienced senior psychiatrists. Thus, interdisciplinary teamwork has become invaluable.

Task 3

According to Beaussier et al (2016) the emphasis is required to be concentrated on the influence of the NHS administrative and corrective activities in relation to the implementation of the regulations stipulated by the DoH which have been enshrined into Mental Health Act (MHA) (2007). Concerning the facilities of care provided by the Nightingale Hospital and regarding the entire mental healthcare industry, the appointment of the reviewers of the MHA has been of prime significance. Such reviewers are selected from an extensive and variegated range of backgrounds and generally including doctors to lawyers. These reviewers are entitled to act in independent capacity from the respective care providing services such as the hospitals.

Davidson et al (2016) have researched that these reviewers could visit the patients interned within the Nightingale Hospital with prior notification and could meet the patients in private to determine their state of affairs and learn about their experiences as well. Apart from such direct interventionist approaches regarding the patients who could have been undergoing treatment for de-addiction from substance abuse practices, the MHA reviewers could as well review the cases of the patients who could have been discharged from the hospital under consideration on community treatment orders by the professionals.

The review service is oriented towards the performance of a host of different responsibilities such as learning about the issues which could exist in terms of proper adherence to the governmental guidelines and in conjunction with the previously mentioned Human Rights Act (1998), raising the concerns demonstrated by the patients and learnt from the visitations of the hospital wards to the ward managers, assist the patients concerned to voice their complaints through the proper administrative channels and file appropriate reports about the ward conditions to the proper authorities. However, the reviewers are not legally entitled to discharge any of the patients, arrange for the transfer or leave of the patients and provide any legal advice on behalf of the patient representatives.

According to Orthwein (2017), the application of proper care principles for the addiction relief purposes of the mental health patients undergoing treatment at the Nightingale Hospital should be concerned to be the primary impact of social value based attitudes. One such impact of the social values could be acknowledged to be the equality management in the care provisioning structure, the ensuring of the availability of universal mental healthcare access to the deserving patients and the maintenance of appropriate financial options through which individuals from every background could access such healthcare regardless of the ethnic, racial or class divisions.

Apart from this, another impact of person centred care principle and social value has been the formulation of the rights of the patients under the legal stipulations of the Mental Health Act (2007) and the Mental Capacity Act (2005). One such outcome of this impact has been the efforts instituted at the hospital under consideration to protect the patients from self-inflicted and externally induced harms. This social value has been reflective of the fact that mental care patients such as those affected by behavioural disorders or extensive substance abuse tendencies often experience considerable financial and physical difficulties apart from their psychological tribulations. Such difficulties often result in vulnerabilities on part of the patients involving potential harm and the practices of social and psychological safeguarding of such patients thus become critical. Gould (2016) has thus specified that the current policy mandates by the NHS have been particular regarding ensuring obligatory adherence of the healthcare professionals to the most stringent procedures of prevention of both abuse and negligence of patients. This reflects the aspect of accountability enforcement on part of the national health authorities of the UK over the existing care providers. Other social values include the protection of the confidentiality of clients as well as empowering the patients to retain their primary human rights so as to ensure that psychologically vulnerable mental patients could not be abused in the care facilities.

One significant development in this context has been, as per the opinion of McLaughlin, Leigh and Worsley (2015) that of the broadening of the definition of any psychological disorder in the stipulations of the MHA (2007). This definition pertains to the prospect of considering any behavioural disability or disorder related to the brain to be associated with an absolute psychological anomaly for the affected person, regardless of whether such disability or disorder could be temporary or permanent in nature. The point of emphasis is now completely on the measure of either disturbance or impairment of any mental functioning for the patient for the treatment to commence. This broadening of the definition has also served to make the necessity to clinically typify the patient into any medical category null and void. Psycho-pathological conditions ranging from personality or psychiatric disorders such as Schizophrenia to the addiction to intoxicants such as narcotics could now be considered to be serious psychological ailment for the personnel affected by the same.

One point of interest in this regard has been outlined by Cookson et al (2016) to be that of the apparent absence of any conflict between the expansion of the scope of definitions of the mental disorders and those of the rights of the patients ensured under the International Human Rights Convention. This has been achieved through the verdict of the European Court in the case of Winterwerp vs Netherlands (1979) where the court had not outlined any particular definition of the psychological disorders. The change of the definitions with specific cases and time has been a constant fact regarding the psychiatric management of patients in the UK healthcare industry.

Apart from these, social values of maintenance of the interests of the patients and ensuring the protection of vulnerable patients have culminated in the institution of differential criteria of treatment. Management of behavioural disorders has been the primary concern for the treatment regime without having to impart effective benefits on the patients at the hospital under consideration. Again, this has not been subject to any contravention of the human rights convention or of the judgements which had been delivered by either the European Court or the European Commission. Williams (2017) has brought forth the case of Ashingdane vs UK (1985) for retrograde reference in this context since in this case, the European Court had passed the judgement that it is not necessary for the care facilities to administer any form of treatment while the patient could be subjected to preliminary detention for the purpose of diagnosis and observation of the actual psychological disorder. This had not been challenged under the provisions of Article 5(1e) of the Human Rights Act which prohibits any arbitrary detention of any person suspected to be suffering from any psychological disorder. However, as per the verdict of the Court in the aforementioned case, it is now necessary for every mental care facility such as the Nightingale Hospital to establish logical linkages between the permissibility of deprivation of liberty in the form of detention of the patients and the conditions which could prompt such decisions. This is, in principle, related to the suitability of conditions of treatment administration.

Thus, Wright et al (2016) have specified that the MHA (2007) clearly has outlined the conditions under which any patient could be detained within the care facilities against his/ her consent for a definite period of time. These are the situations when the patient could be irrefutably diagnosed to have psychological disorder, when the ailment could warrant specialised psychiatric treatment, when critical therapeutic benefits could be imparted to the patients and when the protection of others from the potential risks emanating from the patient could be considered to be of prime necessity to successfully manage behavioural disorders.

According to Sharp et al (2015), a range of environmental and personal factors formulate the barriers to access proper care facilities for mental health patients through affecting the process of availability of such facilities. The factors could be categorised into five segments. The initial one is the inability of recognising the symptoms of psychological disorder as well as the unwillingness on part of the patients to accept the diagnosis results. The next is the often prevalent absence of the social and familial networks through which discussion on the behavioural problems could be undertaken and the decision of accessing treatment facilities could be arrived at. The third has been the social stigma which is integral with the prospect of receiving psychiatric treatment in various cultural lineages. This is the arguably the most powerful potential barrier in accessing treatment involving since particular cultural backgrounds could even make it complicated for the coping up mechanisms to work properly for the patients. This could be expanded to include the cultural naivety and abject insensitivity on part of the care providers to understand the experiences of patients. The fourth factor is the financial burden which has to be shouldered to avail the complementary therapies and medications since these are excluded from the purview of the NHS. Finally, the ultimate barrier pertains to the problem of communication which gets caused more often by linguistic barriers. This is exacerbated by the inability of patients to actually voice their problems in explanatory modes (Dockery et al. 2015). This results in additional stress factors and inappropriate treatment availability. In case of the Nightingale Hospital, the removal of all such barriers has not been a success. However, certain factors such as the communication problems have been overcome through better training of the counsellors and psychiatric staff to comprehend the nature of the problems expressed by the patients from differential sources of information such as through consulting the patient representatives. Apart from this, the hospital has been actively attempting to institute medical insurance policies to support the patients with the extra financial burden of medications which they have to endure.

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