Building an effective healthcare organization requires leadership that goes beyond just best practices. The increasing competition in the health sector requires the use of effective leadership to shape the organizational culture and drive the implementation of reforms. One best mechanism that is used by leaders in today’s dynamic healthcare system is the patient and family-centered approach. Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families (Fix et al., 2018). The approach emphasizes respect for patient values in individual care decisions as well as the role of the family in promoting the well-being of the patient. In this discussion, an analysis of different parts of healthcare organizational leadership is provided together with how improvement can be done regarding patient and family-centered care.
- Business Practices
Business practices in healthcare represent the way facilities organize to provide care to patients through the incorporation of policies, procedures, and system processes (Herrin et al., 2016). Healthcare providers offer patients unique services to attract customers but such services alone do not guarantee success. The incorporation of value-based approaches together with technological advancements help boost the business part of healthcare institutions. Secondly, the healthcare industry is now focusing on reaching out to many people through advertisements. The advertisements help in keeping the organization on the watch while ensuring quality care is provided to maintain the required standards. Such business practices have a huge influence on patient-centered care.
Healthcare is guided by rules and regulations put in place by various professional bodies to ensure patient safety and establish basic standards of care. Regulatory requirements must be followed to the latter by all organizations and violation of the rules subjects the institution to legal issues. In the United States, healthcare organizations strive to demonstrate a high degree of patient-centered care to attain Magnet recognition status. Together with other regulatory requirements by the state and the national government, the institutions are kept on the check to provide quality care.
Healthcare providers are paid by insurance or government payers through a system of reimbursement. Depending on the quality of care provided, healthcare organizations can receive a large amount of financial support from Medicare and Medicaid Services. One common parameter used for reimbursement is the use of HIPAA scores. The scores describe the quality of care provided to patients and sometimes fail to achieve certain standards that can lead to reduced reimbursements. Therefore, healthcare organizations strive to provide patient-centered care to ensure patients score the facility high translating to more financial allocations.
- Self Assessment Tool
Please find separately the attached document for the completed PFCC Tool.
B1. Setting Description
Kindred Hospital Los Angeles is a hospital located in California offering specialized care to patients from all populations. The facility has a total of 81 beds and it offers services such as emergency care, occupational therapy, pediatric care including ICU services, and various medical-surgical services (Kindred Hospital Los Angeles, 2020). Being acute long-term care and teaching hospital facility, Kindred Hospital is among the top-performing healthcare institutions in Los Angeles. When one is referred to the facility, a team of skilled professionals works to provide specialized care to address all complex medical needs of the patient. The physician-led care team will visit daily to review and assess the patient’s condition so that one can recover to the fullest extent possible.
Kindred Hospital-Los Angeles provides healthcare service to a variety of patients including those residing in the county and referrals from other areas. Los Angeles has a population of 9, 974, 203. This population explains the huge number of patients handled in the facility. Narrowing down the statistics, adults aged 18 to 44 years form the largest group of people in the region. As a result, most people that seek healthcare in Kindred Hospital are adults. Los Angeles is inhabited by people from different racial groups with majority being of Hispanic or Latino origin. The Asians occupy 13.8%, whites 27.2% and 8.0% is represented by Black or African Americans.
B2. Strengths and Weaknesses
| Domain | Strength | Weakness |
| Leadership/Operations | There is clear establishment of goals for the organization including aspects of patient-centered care.
There is a strong endorsement of values and mission of the facility.
|
No weakness Identified. |
| Mission, Vision, Values | There is a strong mission and value system that has been adopted by healthcare professionals.
The patient’s bill of rights is clearly written and posted in every unit. |
No weakness identified |
| Advisors | The facility recognizes the need for advisory councils and committees for addressing of patient and organizational issues. | There is limited involvement of patient and families in safety and quality rounds.
Representation of patients and family members in the committee does not reflect the uniqueness of the population served. |
| Quality Improvement | Well established quality improvement team that incorporates healthcare providers and patients/families. | Quality improvement processes have less focus on families and patient as observed through minimum involvement.
|
| Personnel | The organization and healthcare providers are ready to provide patient-centered care. | Involvement of patients to welcome new employees is limited.
There is minimal collaboration between patients and the organization. Decision making is likely based on the management since there is minimal collaboration with the patients and families. |
| Environment & Design | Kindred Hospital Los Angeles is a state-of-the-art facility that has received ongoing renovation. Units have quiet times that allow patients to rest. | The environment is less supportive of family presence. Clinical design of projects does not involve the patients and families. |
| Information/Education | Information for education is readily available to patients through handouts.
Patient portal is available to allow patients to view their records and communicate to their primary care provider. |
Education in the facility is not fully focused on patient experiences or rather their knowledge. This is likely due failed collaborative practices between the healthcare providers and the patients. |
| Diversity & Disparities | Educational materials are available at appropriate literacy levels.
The organization allows patients from diverse backgrounds and provides interpreter services when required. |
No weakness identified.
|
| Charting & Documentation | Patients have full access to their information in the patient portals and are always provided with manual copies of information when requested. | Patients and their families have limited knowledge on charting. |
| Care Support | Patients and families are always encouraged to take part in daily goal setting.
The family has a 24-hour access to the patient including visiting and staying with the patient overnight. |
Participation of the patient families in shift change reports is limited. |
| Care | Regular updates about patient care are provided during the patient rounds.
Patients and families are encouraged to participate in daily goal setting. Care involves the healthcare team, supportive staff and family members. |
Some aspects of patient care such as pain management is not well achieved due to limited collaborative practice. |
- Area of Improvement
Collaboration between patients and healthcare providers is an important aspect of patient-centered care in today’s healthcare system. Poor collaboration leads to patient dissatisfaction thus hindering the way the patients interact with the healthcare providers. The advisory domain in the PFCC tool is among the important areas of focus when analyzing patient-centered care. After a careful analysis of this domain, it is observed that there is minimal participation of the patients and families in quality and safety rounds.
It is the norm of every healthcare organization to perform regular safety and quality checks to ensure patients and healthcare workers are free from harm. These rounds serve as an opportunity to allow patients, healthcare workers and the organization to work together for a common goal. Apart from the teamwork observed, quality and safety rounds demonstrate the virtue of employee engagement in process improvement. Quality and safety rounds are conducted in various departments including theatre, radiology department, intensive care units, laboratories, and also the physical environment safety. Therefore, there is a need for the involvement of patients and families in the quality and safety rounds for assurance of their safety and security.
C1. Improvement Strategy
Engaging patients and families as a way to improve the quality and safety of care have been widely endorsed by leading healthcare organizations including the Institute of Medicine. The practice is shown to improve the health outcomes of patients because they are involved in designing their care. Consequently, engaged patients and families become satisfied and this can have a positive impact on the organization (Meguid et al., 2015). To improve the participation of patients and families in safety and quality rounds, a multidisciplinary team consisting of various healthcare professionals will be selected to monitor the process. The team will ensure that every time the rounds are conducted, there will be a representation from the patient and the family.
C1A. System or Change Theory
The implementation of the identified strategy will involve the use of Kotter’s 8-step change model. The model describes how new practices can be incorporated into an organization while involving the employees. In the initial stage, Kotter explains that there is a need for the creation of the urgency that change is required in the organization(Mørk et al., 2018). To ensure that the need is created, it is necessary to examine the threats and opportunities that could be realized from the new practice. This stage will be utilized by creating awareness among the patients and healthcare providers of the need for their involvement in quality and safety rounds.
Step two of the model describes the formation of a coalition with leaders. These leaders or managers in the institution are crucial in pushing the new change forward and without their support, the process may not work. Communication with the hospital management will ensure that they are aware of the new strategy and how it can benefit the institution. Step three of the model describes the need to create a strong vision that highlights values and strategies to be used during the implementation of the new change. The multidisciplinary team will be charged with the creation of the goals and means to achieve the set target. The fourth stage of achieving change involves the communication of change to the people and relevant authorities. Communication will be done during daily rounding and also through respective departmental heads.
The fifth step involves assessing threats and removing obstacles. Kotter explains that there is a need to involve experts and leaders with the experience to determine which areas might require adjustment. The multidisciplinary team will evaluate the progress of the change and provide feedback to the patients and organizational management. The seventh step of the model describes how building on the new practice is essential to prevent failure(Mørk et al., 2018). Most organizations are observed to set clear goals and use process analysis methods to prevent the collapse of their projects. The last stage involves anchoring the change in corporate culture. Anchoring the change means setting strategies, forming new rules, and making the practice public so that every employee knows it to be part of the organizational practices. The involvement of patients and families in quality and safety rounding will be a policy for the facility to ensure the sustainability of the change.
C2. Financial Implications
Organizational change requires the use of resources both human and financial to achieve the set goals and standards. Quality and safety rounds are performed to ensure that equipment, supplies, and machines are in good working condition to support patient care. Additionally, safety rounds focus on the environment to include organizational security inside and outside the facility. To ensure the plan is successful, the organization will be required to purchase extra protective gear for the patient and family members who will participate in the safety and quality rounds. Protective gear will involve the purchase of gumboots, masks, gowns, helmets and other equipment like glasses to be used in areas that require full body cover. There will be a need for organization of meetings, communication of findings, and perhaps education before the rounds which will require extra finances.
C3: Methods
Long term and short strategies will be used to evaluate the effectiveness of the new change. Regarding short term evaluation, the multidisciplinary team will compile reports on the quality and safety rounding and present the findings to the administration. The reports will focus on the feedback from the patient, families, and healthcare providers regarding the effectiveness of the new change. Long term evaluation of the strategy will use the HCAHPS scores. HCAHPS survey is a tool that provides an analysis of the patient’s experience in the hospital. Upon implementation of the strategy, it is anticipated that patient satisfaction will increase translating to improved HCAHPS scores. Being a long term measure, a benchmark evaluation at the end of the year will depict if the new change was a success or more changes will be required.
D: Multidisciplinary Team
The multidisciplinary team that will be involved in the implementation of the strategy will involve the hospital administration, nurses, doctors, and patients/families. The team will work together to ensure that the strategy is a success.
The hospital administration will be involved in approving the new strategy, allocation of funds to support the implementation of the new change, and coordination of activities during implementation. The nursing team will be represented by the clinical nurse educator who will be responsible for educating the patients, families, and other healthcare professionals on the relevance of the new change. Other nurses will also be part of the team that will assess the fitness of the patient and family members to attend the safety and quality rounds. The nurses will also participate in giving short term feedback regarding the progress of the project. The doctors will actively participate in the quality and safety rounds. They will be involved in the selection of well patients and family members to participate in the project. Additionally, the team will provide feedback to the managers on the effectiveness of the new change.
D1. Team Diversity
Cultural diversity is the existence of a variety of cultural groups within a society. These groups can share many characteristics including age, religion, language, gender, culture, ethnicity among many others. Cultural diversity is important because it gives the patient an opportunity to chose the individual they are comfortable with regarding healthcare service delivery. Considering Los Angeles has patients from diverse ethnic groups, it is necessary to practice team diversity when selecting teams for implementing new change. Additionally, diversity ensures that everybody can take part on their own terms without being forced. Diversity in the multidisciplinary team will promote partnership and understanding which will enhance the achievement of set goals.
D2. Leadership Theories
I will use the transactional leadership style to develop my team. The transactional leadership style was developed by Max Weber in the mid-20th century and up to date, it guides several organizations in leadership. The key concept behind this leadership style is that employees are motivated through punishment and the use of incentives. Once an employee receives punishment they become more keen not to repeat the same mistake. Consequently, the use of incentives is observed to spark motivation among staff to work hard. This leadership style prepares managers to lead by focusing on organizing, controlling, and short-term planning (McCleskey, 2014). The use of transactional leadership will ensure that all the healthcare teams become vigilant to incorporate the new change into routine practice.
D3: Implementation of Strategy
A step by step approach will be used to put the described plan into action. The first step will involve contacting the hospital administration for approval of the new change. A budget will be submitted by the team consisting of all supplies required for the implementation of the change strategy. The second step will involve the education of the healthcare providers and patients on the relevance of their involvement in quality and safety rounds. The third stage will involve actual steps towards quality and safety checks in the institution focusing on the identified departments. The rounds will be conducted on a weekly basis with the team leader getting feedback from the rounds. The multidisciplinary team will then analyze the short-term outcomes of the project and communicate with the patients, healthcare workers, and hospital management. Continuous monitoring will then be used as a strategy to ensure the practice is well-anchored to the organizational practices.
D4. Communication to Organization
Communication is an important tool during project management. It ensures all parties are informed about the progress of the change while identifying necessary adjustments that might be required. Communication with the organization will be done through weekly meetings. The aim of the meetings will be to report the progress of the report and to address any concerns that may arise. Communication will also be extended to employees and patients/families. Internal means of communicating will involve the use of emails, posters, hospital newspapers, and the unit in-charges. External communication will also be done using the hospital website and local newspapers.
D5. Tools for the Team
The Keirsey temperament sorter (KTS) will be the tool of choice for employee self-assessment. Developed in the 1970s, the Keiser Temperament Sorter is a tool that is used to assess the four temperament types present in people that define how one behaves while interacting with others (Burian et al., 2014). The tool contains 70 questions that upon answering groups one’s temperament into that of an artisan, guardian, idealist, or rationalist. Artisans represent the category of individuals that are concrete and utilitarian. These groups of people are focused on what works. The guardians are those that are concrete and cooperative. They always focus on what is right. The third group represents the idealists who talk about ideas and know how to put them into practice. Rational individuals have both utilitarian and abstract behavior whereby they talk about ideas and focus on what works.
References
Burian, P. E., Maffei III, F. S., Burian, P. S., & Pieffer, M. A. (2014). Leadership systems model: An integration of people, process, and behaviors in a dynamic and evolving environment. International Journal of Management & Information Systems (IJMIS), 18(4), 261-270. DOI: https://doi.org/10.19030/ijmis.v18i4.8821
Fix, G. M., VanDeusen Lukas, C., Bolton, R. E., Hill, J. N., Mueller, N., LaVela, S. L., & Bokhour, B. G. (2018). Patient-centred care is a way of doing things: How healthcare employees conceptualize patient-centred care. Health expectations : an International Journal of Public Participation in Health Care and Health Policy, 21(1), 300–307. https://doi.org/10.1111/hex.12615
Herrin, J., Harris, K. G., Kenward, K., Hines, S., Joshi, M. S., & Frosch, D. L. (2016). Patient and family engagement: a survey of US hospital practices. BMJ Quality & Safety, 25(3), 182-189. DOI: 10.1136/bmjqs-2015-004006
Kindred Hospital Los Angeles. (2020). Transitional care hospitals. Retrieved from https://www.kindredhealthcare.com/our-services/transitional-care-hospitals
McCleskey, J. A. (2014). Situational, transformational, and transactional leadership and leadership development. Journal of Business Studies Quarterly, 5(4), 117. Retrieved from https://search.proquest.com/openview/e03631119c37d022b66d4ea5fe176e3f/1?pq-origsite=gscholar&cbl=1056382
Meguid, C., Ryan, C. E., Edil, B. H., Schulick, R. D., Gajdos, C., Boniface, M., … & McCarter, M. (2015). Establishing a framework for building multidisciplinary programs. Journal of Multidisciplinary Healthcare, 8, 519. doi: 10.2147/JMDH.S96415
Mørk, A., Krupp, A., Hankwitz, J., & Malec, A. (2018). Using Kotter’s change framework to implement and sustain multiple complementary ICU initiatives. Journal of Nursing Care Quality, 33(1), 38-45. DOI: https://doi.org/10.1097/NCQ.0000000000000263
