Question

Read the case study and answer 3 questions

Box 21.2: Case study 1: The Royal Saint Everywhere NHS Trust under a microscope The situation Within two years of each other, the Royal Saint Everywhere NHS Trust experienced two incidents of widespread media interest. The first was the case of three deaths in quick succession in the accident and emergency department's waiting area. The second was a series of adverse events involving the orthopaedic surgeons, who appeared to have much higher than average infection rates. The department was characterized by many battles and fights within operating theatres, e.g, between the surgeons and anaesthetists, and within the surgeons' own ranks, but also between the surgeons and other wards, units and departments. An inquiry into the Trust revealed that (a) the staff in emergency department seemed uncaring, and unwilling to make improvements but the series of deaths did not seem to be anyone's fault and reflected merely an unexplained cluster; tb) the orthopaedic surgeons did seem to have some practices which were inappropriate for the modern era including constant inability to work effectively together and with others, poor handwashing compliance and little in the way of handover or other communication within orthopaedics and between these staff and others. Your responses Consider the facts above. What is going on here? What are your initial impressions? What do you think you will do about these issues in the short, medium and long

Answer 1

1.The first impression by the facts provided in the case study suggests that there is no administrative officer to look after all these issues. The policies and law and regulations are not being followed neither by the hospital nor by its working staff. It's just made to earn money ,not to provide services to the population. Staffs are not following the protocols , there is no togetherness inbetween the staff members , just blindly doing whatever they want to do in their own way.

a)On being appointed as the general manager of the Royal Saint Everywhere NHS Trust , I did a thorough analysis and in depth surveillance of the institution and it was found that the problem was at the base , a strong base is needed for anything to function properly. The administration was not performing its responsibility , it was just accumulating the money which they were getting in response to the unprofessional and unethical care they provided to the patients.

There were no documentation of any of the documents , procedures, the policies which was supposed to follow in the hospital , no documentation of the costly equipments which were bought . Everything was out of papers .

b) and c) It will take time to wash out the unethical practices and policies which are going on in the hospital. But time is not the matter , ethics and quality of life has the vital importance. Hospital is an institute where patients come to get the treatment with full trust on the staffs and other administrative ,and it's the duty of the healthcare organisation to provide quality care to its patients ,to serve its patients.

First off all a well planned and educated people are needed to the administration so, recruitment of people with higher qualification and those who are retired from higher positions should be enrolled in the monitoring department.

Every month monitoring of all the staff , procedures ,legal action , equipments etc has to be done under supervision of the incharges.

Amendments in the hospital policies has to be made according to the requirements of the staffs to avoid fights inbetween staff due to double duty ,extra time of work etc .

Regular surveillance of each department has to be done and a feedback has to be given

Strict legal actions has to be taken against those who don't follow the rules and regulations of the institution.

Proper counseling session of staff and others who face difficulty in working with others .

Rotation of staffs to avoid bias and fights inbetween staff incharges.

Training programs for all the staff of different departments every month to enhance their knowledge and quality of care provided to patients.

d) Democratic leadership style will be used and the tool or framework used here will be strategic planning which will include assessment , prioritising problems , framing objectives , planning and implementation and then evaluation of the amendments made.

2. As mentioned above the strategic planning will include :-

- assessment of the issues

- prioritising problems

-framing objectives

- planning

-implementation of the plan

- evaluation of the amendments made.

All this will be done under proper monitoring and permission will be taken from the higher authorities.

3.There are high chances of success ,because here we are fighting for truth , ethical principles , for the rights of the patients. And aslo the issues which are being faced by the staffs working there are kept first as they are brigding stones of an organisation . When the problems of staffs are solved ,and amendments in the policies and regulations which are favourable for staff and patients will definitely lead to skies ,as resolve of problems will motivate them to work hard ,with full devotion which ultimately lead to provision of high quality of care which is patient centred and feasible.