Leadership and Service Improvement

Introduction

In healthcare, leadership is necessary for service improvement because the leaders act to shape the direction of the improvement, open up possibilities, assist individuals to achieve improvement, communicate and deliver plans for improvement. The leadership also assist in developing approachable behaviour of the staff in healthcare required for successful service improvement (Kalaitzi et al., 2019). Thus, in this assignment, a reflection regarding critical incident requiring service improvement is to be mentioned. Thereafter, the leadership theories and model guiding the role of the nurse in service improvement about the incident is to be appraised. The tools to assess the impact of the critical event and the nurse’s role as a leader is to be described. Moreover, the impact of the team working in making healthcare dissertation help service improvement is also to be discussed.

Part 1: Reflective Statement

Rolfe’s reflective cycle is to be used in framing the self-reflection of the critical event faced in the placement. This is because the model is simple to be implemented in making systematic reflection and assist in clarified understanding of the strength as well as weaknesses regarding the situation being reflected (Grung, 2021).

What?

In the placement, I was allocated to look after patient M who is 67 years old admitted to the hospital due to exacerbation for his condition of Parkinson’s disease. In the situation, my role was to administer medication to the patient and assist in caring for her needs with the help of other senior nurses. The patient allocated in the elderly ward included 6 other bed in which elderly of different ages suffering from varied condition was being cared. The difficulty raised in the context was that I made medication error for the patient due to confusion between the name of the drugs and complicated situations created due to watching the suffering of other patients in the ward. It is evident as the doctor prescribed delivery of Sinemet is to be made for M, but I provided Simvastatin to him instead of the prescribed drug which was allocated to be provided to the patient by the side of his bed. On identifying the error, I discussed the matter with other senior nurses in the ward who immediately asked me to report it to the doctor in charge of M’s care to determine further actions. It was seen that M did not express any symptoms for the medication error and the doctor mentioned to give the right medication immediately and keep close observation of M. I also reported the incident and its impact to M and his family members.

So What?

The experience led me feel terrified of the consequence to be experienced by the patient due to the medication error. However, I managed myself and reported the incident to the patient and their family as otherwise, it would violation of policy in care. This is because NMC Code mentions that in medication error nurses are take ownership of the condition, take effective action to overcome the mistake and is report to the patient and their family member to make them aware of the incident (NMC, 2018). The incident led me to determine that I have poor dedication to excellence, hindered emotional intelligence, ability to take major responsibilities and poor adaptability. This is because I expressed hindered ability to manage my own emotions in the condition and failed to effectively perform my delegated responsibility. However, I expressed enhanced team working ability, communication, awareness of care policies and legislation, showcasing of compassion and empathy.

Now What?

The thing I determined to do further to make things better is taking control of my emotions to avoid further error at work. Moreover, I determined to involve in medication administration and management training to develop skills to avoid further medication error. I also determined to get involved in accessing information regarding quality care delivery ways through discussion with experienced nurses in the care environment. This is because experienced nurses have the practical experience to support student nurses develop the idea to multi-task in care with efficiency.

Part 2: Critical Appraisal

Question 1

In nursing practice, the role of the nurse as a leader is vital for supporting quality care delivery. The behavioural leadership theory informs that leaders are to be self-aware of their behaviour and required to have the ability to recognise the way their behaviour would influence the productivity as well as morale of the team (Bowles et al., 2018). This is because it makes them understand the way leaders are to be responsible and makes them control their action in shaping better opportunity for the team to work (McKay and Vanaskie, 2018). Thus, this theoretical context informs regarding my critical incident event that to become a greater leader, I need to be observant of my behaviour which is reason of causing the medication error. Moreover, I need to determine the way my behaviour may impact others in my team such as lack of trust towards nurses by other patients. It is required because such action would encourage me to understand way to lead with efficiency and avoid making error.

The behavioural leadership theory mentions that success of a leader is based on the behaviour rather than the natural attributes of the person. This is because behaviour defines the way an individual act in any situation by conjunction with their personal self or their environment irrespective of the natural attributes present in them. It indicates that leadership is learned and not inherent characteristics in people (Brohi et al., 2018). This theoretical overview of leadership informs regarding described critical event that being a nurse I fail in leading the condition because I never learned the attributes to be leader and became concerned with presence of natural attributes to support me to be act as greater leader. As criticised by Knight and Paterson (2018), behavioural leadership theory fails to mention the guidance that constitute effective leadership in different circumstances. This perspective informs that behavioural leadership use in the critical event would have failed to inform me regarding specific leadership qualities to be present to become a better leader in different complex situation.

The NHS leadership model mentions that to become effective leader, shared purpose is to be created by them (NHS, 2018). This is because it causes development of belief among the followers in shared values and makes them behave in a way that ensures improvement in their working for delivering better care (Xu, 2017). This theory informs regarding the critical incident event that as a leader I need to create shared purpose in the care environment so that other nurses act with increased values to avoid making similar error. The NHS leadership model mentions that effective leaders understand the unique needs and qualities of the team as well as offer them effective support in executing their jobs (NHS, 2018). The model influences the critical incident event by explaining that there was lack of effective understanding of the needs and qualities of the team members by my leader due to which I failed to act effectively and made error. This is because resources to overcome my needs were not present in the situation.

The NHS Leadership Theory mentions that varied information is to be collected and they are to be used in generating new ideas as well as plan in making any change (NHS, 2018). This is because the varied information contains sources from which ideas can be created in achieving better care (Alilyyani et al., 2021). Thus, the aspect of the model informs regarding the critical incident event that effective information regarding the cause of medication error is to be gathered so that ideas can be generated by evaluating the information to frame strategies to avoid such events in future care.

Question 2

The clinical audit is one of the methods to be used to determine the impact of the developed event. This is because the audit assists in reviewing each aspect of the care delivered and evaluate the efficiency of care along with its impact on the patients to improve their health (Johansen et al., 2017). As argued by Haghdoost (2019), lack of clinical audit would lead the healthcare workers unaware of the safety issues experienced in care and range of care standards met in the care environment. Thus, the clinical audit is necessary to understand the impact of the critical incident of medication error as it makes the nurses aware of the way the actions has impacted them as well as way it has impacted the patients other than M.

In order to develop a change in service or to make service improvement, the root cause analysis which is a risk management tool is to be used. This is because root cause analysis (RCA) assist in detecting the key causes and factors related to the occurrence of the problem. It helps in creating permanent solutions for the problem so that its re-occurrence can be eliminated or reduced leading to improvement in existing services (Black, 2019). Thus, use of RCA would help in determining the key causes and factors that are related to my medication error and assist in developing solutions to ensure service improvement by avoiding its reoccurrence. According to Paulsen (2021), RCA assist in developing logical approach for solving any problem. This is because the model mentions that after identifying any cause of the problem, effect problem-solving methods to be applied in identifying ways to resolve the issue. Thus, RCA use in the critical incident event would help in develop logical analysis of the medication error and implement effective problem-solving methods to resolve the issue.

The study by Sluggett et al. (2020) argued that RCA leads to assume as well as focus on one root cause of any problem, but in real condition the situation may be complex which led to the occurrence of the problem. Thus, using RCA in the described critical incident event would led to resolve one source of the problem of medication error and would led the other key issues leading to the problem unattended which could later widen the problem. It indicates that additional assessment is required to determine the impact of the incident and enhance service improvement. In occurrence of any care action, the performance assessment of the individuals involved in delivering care is necessary. This is to understand the efficiency with which the individual worked in making the care successful and hindered actions performed by them which negatively affected the care for which service improved is required (Kim, 2017). Thus, the 360-degree feedback assessment method is to be used in understanding the impact of care leading to the critical incident and way improvement in services can be made.

The 360-degree feedback assessment method involves accessing feedback regarding any work by a staff from their subordinates. supervisors and colleagues (Samadi et al., 2019). The advantage of using this assessment process is that it leads to fair and accurate analysis regarding the performance of the employee and ensure self-development of the individual through persuasive opinions gathered from the participants involved in the feedback (Djunaidi et al., 2019). Thus, the use of the method would impact in the critical incident event to make me as the nurse delivering care understand the gap in skills and knolwdege present which led to the incident of medication error. Further, the opinions gathered from the assessment would help me determine the actions to be taken to improve my skills in making service improvement. However, the issue with the method is that it is time-consuming and require effective training for executing the assessment.

Question 3

The nurses’ role as role models and change agent in the described critical incident of medication error is to act introspectively. This is because introspective actions by nurses allow them to examine their professional efficiency and clinical actions against the standards of care to determine the best-practice recommendation for further better change (Clifton, 2021). As argued by Pesut and Thompson (2018), lack of introspectiveness leads the nurses unable to analyse their daily actions to improve them. This is because it causes them to avoid reflecting on their nursing care and determine the gaps or weakness to be fulfilled or improved to become better professionals as well as make positive changes in care delivery. The other role of the nurse in the critical incident event to act as role model and change agent or leader was to be easily approachable and openly visible to others so that individuals from any level of the organisation can interact with them. This is important as approachability and open visibility allows the leaders in nursing to be easily communicated by potential followers and managers of different level of the organisation to discuss any event to be improved (Petronio-Coia and Schwartz-Barcott, 2020). The role was effectively played as me who was the nurse in-charge of care could be easily contacted by my subordinates and other sensor nurses to report any actions or discuss any ideas in care.

In the course of the event, as a nurse demonstrating leadership, I acted with integrity and enhanced communication ability to control the worsening of the critical situation of medication error. It is evident as I reported my act of medication error with full responsibility and performed required communication to avoid adversity for the patients due to the error. The leaders are to act with integrity as leads them to motivate development of ethical behaviour in the work and gain trust from colleagues out of being trustful and honest (Rainer et al., 2018). As argued by Hughes (2018), hindered integrity by leaders makes them regarded to be deceiving and show lack of loyalty. This leads to create untrusted working environment as the workers feel they may be blamed for deeds not done by them by the leader to escape criticism. Moreover, effective communication ability of the leaders in nursing makes them share ideas and information with colleagues to determine best practice to be performed in managing any situation (Cummings et al., 2021). As argued by Hicks (2020), failure to make communication by leader makes them remain inexpressive and fail to inform actions they are expecting from others. Thus, I ensure making effective communication with the doctor in-charge of M’s care and with other senior nurses to discuss the next set of actions to be taken holistically in resolving the issue.

In the critical incident event, as a nurse to demonstrate leadership, I expressed effective critical thinking ability. This is evident as I critically thought about the impact of the medication error would have on the patient as well as the organisation. It intended me to immediately take actions to control the situation by interacting with the doctor in-charge. The critical thinking for nurse leader is important as it makes them understand the impact of any of their decision on the goals of the organisation, care quality and accountability in care (Kang and Kim, 2017). However, it is argued by Lee et al. (2017), lack of critical thinking makes the leaders in nursing unable to grow the productivity of the organisation as it makes them develop hindered decision that inappropriately affected for their success. The demonstration of the leadership in the critical incident event of medication error influences other nurses in the ward to understand the actions which could lead to such error. It supported them to determine the deeds to be avoided for avoiding such similar event in future.

Question 4

In the critical incident event, the team involved in resolving the error consisted of the doctor in-charge and me as the nurse in-charge of the patient M along with other senior nurses in the ward. In the event, team working was established as a nurse I acted along with the doctor and other nurses to control the medication error situation for M. The contribution of the team in care environment is that they help in sharing best ideas to be followed at work so that less obstacles are faced and enhanced quality care to be provided (Lindh Falk et al., 2018). It is evident as in the critical incident event by working as a team with other senior nurses, I realised the idea of consulting the doctor in-charge for the patient is best instead of personally managing the situation as per my thoughts. This is because the senior nurses made me realise it is acceptable to be scolded for my action, but without consulting the doctor it would led me to put the life of the patient in danger as well as would led me to act irresponsibly.

According to NMC, the contribution of the team in team working is to share information in identifying and reducing risk for the patient (NMC, 2018). The contribution was seen in the incident which is evident as discussion with the senior nurse regarding the medication error led me to identify the varied risk to be faced by the patient due to the condition and way it could be strategically reduced to ensure safety of the patient. As argued by Azizan et al. (2017), teamworking contributes to enhance personal efficiency of the workers as well as care quality of the patient. This is because team working helps to share innovative ideas and skills between workers to enhance their ability in taking better care action which in turn helps to delivery better quality care to the patients. In the current event, the contribution of the team working was that senior nurses shared innovative ideas with me regarding the way to control my panicked situation and strategically report the error to the doctor to allow taking enhanced charge of care for the patients to avoid deterioration of their health.

The team working in care environment impact to create better outcomes for the patients (Ellis, 2021). It is evident from the context of the critical event incident of medication error in which team working between me and the doctor helped in taking control of the error for M. The doctor informed me about the observations to be made and when to report in case of worsening of health of the patient due to error as well as way to control further error. The team working impact to create less managerial interference as employees work as a team to share ideas in resolving raised problem and obstacles to show corrected behaviour and actions (Hales et al., 2020). In the incident, similar impact was seen from the team working as the medication error management for M did not required any nursing manager to intervene in controlling the situation.

Conclusion

The above discussion mentioned that in caring for M who has Parkinson’s disease, the critical incident faced is medication error. The behavioural leadership theory and NHS leadership theory explains the actions to be taken in the situation to show better leadership. In the incident, it was seen that introspective, critical thinking, effective communication and other key leadership shill were used to control the situation. The team working in the incident was effective as it helped in controlling the risk and promotes the safety of M in the situation.

Dig deeper into Leadership and Organizational Change Models with our selection of articles.

References

Alilyyani, B., Kerr, M.S., Wong, C. and Wazqar, D.Y., 2021. An integrative review of nursing leadership in Saudi Arabia. Nursing Open.

Azizan, F.L., Darus, A. and Othman, N., 2017. Team coordination influencing team effectiveness: a study of nursing team. International Journal of Management Research and Reviews, 7(9), pp.893-901.

Black, J.M., 2019. Root cause analysis for hospital-acquired pressure injury. Journal of Wound Ostomy & Continence Nursing, 46(4), pp.298-304.

Bowles, J.R., Adams, J.M., Batcheller, J., Zimmermann, D. and Pappas, S., 2018. The role of the nurse leader in advancing the Quadruple Aim. Nurse Leader, 16(4), pp.244-248.

Brohi, N.A., Jantan, A.H., Qureshi, M.A., Bin Jaffar, A.R., Bin Ali, J. and Bin Ab Hamid, K., 2018. The impact of servant leadership on employees attitudinal and behavioural outcomes. Cogent Business & Management, 5(1), p.1542652.

Clifton, J.M., 2021. Leadership in Correctional Nursing: The First Step. Journal of Correctional Health Care.pp.67-123.

Cummings, G.G., Lee, S., Tate, K., Penconek, T., Micaroni, S.P., Paananen, T. and Chatterjee, G.E., 2021. The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International journal of nursing studies, 115, p.103842.

Djunaidi, M., Kumaraningrum, V.S., Pratiwi, I. and Munawir, H., 2019. Integration of 360-degree feedback methods and AHP for employee performance measurement. In Proc. Int. Conf. Ind. Eng. Oper. Manag (Vol. 2019, No. MAR, pp. 2616-2623).

Grung, A.H., 2021. The complexities of practices: a reality check: Exploring the learning possibilities in a plural practice module of chaplaincy and religious leadership in 2020 while practicing social distancing. Studia Theologica-Nordic Journal of Theology, 75(1), pp.67-78.

Haghdoost, M., 2019. Clinical Audit of Nurses in the Prevention of Ventilator-associated Pneumonia. Journal of Nursing Education, 7(5), pp.31-37.

Hughes, V., 2018. Authentic leadership: Practices to promote integrity. Journal of Christian Nursing, 35(2), pp.E28-E31.

Johansen, A., Boulton, C., Hertz, K., Ellis, M., Burgon, V., Rai, S. and Wakeman, R., 2017. The National Hip Fracture Database (NHFD)–using a national clinical audit to raise standards of nursing care. International journal of orthopaedic and trauma nursing, 26, pp.3-6.

Kalaitzi, S., Czabanowska, K., Azzopardi-Muscat, N., Cuschieri, L., Petelos, E., Papadakaki, M. and Babich, S., 2019. Women, healthcare leadership and societal culture: a qualitative study. Journal of healthcare leadership, 11, p.43.

Kang, H.S. and Kim, Y.Y., 2017. Influence of self-efficacy and critical thinking disposition on self-leadership of nursing students. Journal of the Korea Academia-Industrial cooperation Society, 18(5), pp.617-625.

Kim, E.J., 2017. The relationships among learning motivation, perceived achievement, and actual achievement on nursing skill performance assessment. The Journal of Korean Academic Society of Nursing Education, 23(1), pp.48-56.

Knight, B. and Paterson, F., 2018. Behavioural competencies of sustainability leaders: an empirical investigation. Journal of Organizational Change Management.pp.56-89.

Lee, D.S., Abdullah, K.L., Subramanian, P., Bachmann, R.T. and Ong, S.L., 2017. An integrated review of the correlation between critical thinking ability and clinical decision‐making in nursing. Journal of Clinical Nursing, 26(23-24), pp.4065-4079.

Lindh Falk, A., Hult, H., Hammar, M., Hopwood, N. and Abrandt Dahlgren, M., 2018. Nursing assistants matters—An ethnographic study of knowledge sharing in interprofessional practice. Nursing inquiry, 25(2), p.e12216.

McKay, C. and Vanaskie, K., 2018. Partnering for success: the role of the nurse leader in health information technology implementation for coordination of care. Nurse Leader, 16(6), pp.385-388.

NHS 2019, Healthcare Leadership Model, Available at: https://www.leadershipacademy.nhs.uk/wp-content/uploads/2014/10/NHSLeadership-LeadershipModel-colour.pdf [Accessed on: 23 December 2021]

NMC 2018, The Code, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 23 December 2021]

Pesut, D.J. and Thompson, S.A., 2018. Nursing leadership in academic nursing: The wisdom of development and the development of wisdom. Journal of Professional Nursing, 34(2), pp.122-127.

Petronio-Coia, B.J. and Schwartz-Barcott, D., 2020. A description of approachable nurses: An exploratory study, the voice of the hospitalized child. Journal of pediatric nursing, 54, pp.18-23.

Samadi, N., Sh, V., Sh, G., Allahyari, I. and Sh, M., 2019. Effect of 360-Degree Feedback on the Evaluation of the Clinical Skills of Nursing Students of Ardabil University of Medical Sciences. Journal of Clinical Nursing and Mid-wifery, 7(4), pp.250-257.

Sluggett, J.K., Lalic, S., Hosking, S.M., Ritchie, B., McLoughlin, J., Shortt, T., Robson, L., Cooper, T., Cairns, K.A., Ilomäki, J. and Visvanathan, R., 2020. Root cause analysis to identify medication and non-medication strategies to prevent infection-related hospitalizations from Australian residential aged care services. International journal of environmental research and public health, 17(9), p.3282.

Xu, J.H., 2017. Leadership theory in clinical practice. Chinese Nursing Research, 4(4), pp.155-157.