Question

There are three imperative steps that need to be taken. The first is a strong commitment by leadership to this very high level of safety and quality. The leadership must set the goal and example for everyone in order to achieve high reliability. The second is to embed all of the principles and practice of a culture of safety throughout the organization which emphasizes trust, reporting of unsafe conditions, and highly effective improvement over time. The third step is to utilize powerful Robust Process Improvement tools like Six Sigma, Lean, and change management to create near perfect processes, similar to the tools that we see in industries like commercial aviation today, and sustain very high levels of safety over long periods of time.

—Dr. Mark R. Chassin

These three steps: commitment by leadership, development of a culture of safety, and the use of process improvement tools, are the core recommendations made by Dr. Chassin, the president of The Joint Commission and the president of the Joint Commission Center for Transforming Healthcare. A first step in identifying whether these recommendations are being met is to compare elements of an organization to criteria which have been identified as essential to high-reliability organizations.

To prepare for this Assignment:

Consider the three steps described by Dr. Chassin and the seven major criteria of the Baldridge Performance Excellence Program, and reflect on how these recommendations can apply to health care organizations, specifically to long-term care facilities.

The Assignment:

In this Assignment you will identify major elements of high-reliability organizations providing long-term care. According to the Baldrige Performance Excellence Program (MBNQA), the criteria are as follows:

• Leadership
• Strategic planning
• Customer and market focus
• Measurement, analysis, and knowledge management
• Human resource focus
• Process management
• Business/organizational performance results

Using the Highly Reliable Organization Matrix located in this week’s Learning Resources, complete the matrix by typing in the elements which meet the criteria in rows and columns. Describe each element briefly, give an example as to how this can be met in a long-term care facility, and explain the expected impact on patient care.

Based on the results of the Highly Reliable Organization Matrix, write a 1- to 2-page executive summary to the board of directors of the long-term care organization, describing elements which meet the criteria from the matrix and how any missing elements of the criteria for excellence can be met.

This is the chart needed.

Highly Reliable Organization Matrix
Criteria for Performance Excellence*	Inpatient	Skilled Nursing	Ambulatory Care	Public Hospitals	Private/Not for Profit
Leadership
Strategic planning
Customer and market focus
Measurement, analysis, and knowledge management
Human resource focus	Example: The staffing ratio of nurses to patients is lower in highly reliable health care organizations.
Process management
Business/organizational performance results

Answer 1

After a thorough analysis of the healthcare situation at the healthcare facility, a number of findings have been made. Most of the areas are performing quite well while others need to be improved. First, in regard to leadership in strategic nursing, the mandatory nursing upgrading program that was put into place for all the nurses should be enhanced. It has indeed improved the quality of services at the facility. Secondly, the patient’s referral program entered with not for profit organizations should be fully supported. However, there is need to improve on the ambulatory services. There is shortage in staffing and training for the response team.

The organization also needs to come up with a long term training program for the nurses. New healthcare challenges keep on coming up and it is crucial that the healthcare providers are well equipped in readiness for such eventualities. The annual free medical checkups that the organization carries out in collaboration with the charity organizations should be provided with more funds to extend to larger areas. The organization should also work towards implementing the proposed plan to work with public hospitals to provide services that may not be available at their facilities. Unlike private hospitals, public hospitals suffer from a shortage of staff.

It is also important for the organization to enhance measures of performance among the nurses so as to be in a position to effectively evaluate their performance. This will help to identify areas that could be deficient. The facility should also consider hiring more nurses to work with the currently available team. For the ambulatory services staff, it is important that more drivers are employed so that the team can work both during the day and at night. For those working late in the night, the move to give allowances and bonuses should be enhanced. Finally, the volunteer's program with not for profit organizations should be enhanced. The program has served a lot of patients within the last year and the results have been very positive. Generally, the performance has been good and impressive. A substantial number of patients have expressed their satisfaction with the facility but improvements on the areas identified could serve the organization quite well.

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