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Leadership Challenges and Poor Governance in Mid Staffordshire NHS Foundation Trust

Discuss about the Leadership In Health Care and Standards Of The Mid Staffordshire NHS Foundation.

Health care institutions play an important role in the health care system .The success of a health care system lies in the staff workforce, competence of the medical and the professional staffs, the inpatient facilities. They are liable to deliver medical and nursing related service to patients throughout the day (Stanley 2016).

One of the leadership challenges was to improve the poor governance of the Mid Staffordshire NHS foundation trust.

Clinical governance and clinical quality has become a major movement in the health care system of most of the countries and the main concern is to provide a highest possible standard for the service provided and to meet the individual requirements of the patients.

In most of the cases the health care managers fails to strive for the continuous improvement of the quality services. Hospital staffing plays a critical role in determining the quality of care in the hospital. Twenty four hours nursing care is a hall mark for a good quality of the inpatient care. Lack of a proper work force and excessive patient load have deteriorated the type of care provided by the Mid Staffordshire NHS foundation trust, bringing in an augmented rate of mortality and morbidity.

This paper describes about the about the sectors in which the hospital have breached the standard. While focusing on the standards one gets to know that the sole reason behind the degrading standard is the absence of proper leadership skills and competent work force. Reflecting on that the paper provides a way to the development of the leadership for the individuals, the probable stakeholders related to the issue and connection of the leadership qualities in health care to the contemporary leadership theories.

This report is based on a public enquiry caused by under the Inquires Act 2009, due to the deteriorating standards of the Mid Staffordshire NHS foundation trust. It was based on the reports of the complaints lodged by the suffering patients. The factors included misbehavior with the patients, improper and unsafe care delivery, lack of cleanliness in the hospital wards and the toilets, lack of competent work force, breaching of privacy and confidentiality of the patients, untrained staffs in the triage and even the cases of death were denied. Overall there was an absence of the basic care across the wards. It was found that the culture of the organization was not at all conducive for a positive change. There was a failure in the management of the staffs and lack of proper governance. Internal and external transparency was absent in the clinical setting. Furthermore there had been a drastic increase in the morbidity and mortality of the patients that is directly related to the standards of care. Normally NHS is a service that provides Medicare, offers free or low cost medications, hospital care facilities to the residents at low cost. Moreover it is a type of care that Australia should feel proud of. It is a service that is staffed by many dedicated staffs and managers. Hence it was quite surprising for such a repudiated organization. As per the summary, none of the local regulators, such as the local councillors or the secretary of the state did anything to address the issues.

Clinical Standards and Increased Morbidity and Mortality Rates

One of the health issues that have been identified from Mid Staffordshire NHS Foundation Trust Public Inquiry (Executive Summary), is that the clinical standards had fallen drastically, which is evident from the increased mortality rates that had been significantly higher than the average since the year 2003. The first enquiry involved personal stories from the experienced patients and their families about the deteriorating type of care to receive at the trust. A set of complaints were lodged among which the key issue is that the hospital wards and the toilets were left in filthy conditions.

Increased mortality rates can be due to hospital associated infections, medication errors, improper documentation of the patient’s conditions, surgical complications. All these are the markers of incompetent work force and Most of the factors have been found to be unavoidable and are mostly the measures of nursing standards and professional conduct. Since the chosen topic is to identify the leadership qualities required to address the changes related to infection in the health care setting, the stakeholders that should be involved in this can be the health care staffs and the assistants, the nurses and the midwives, the medical manager. It has been found that proper leadership qualities across the hospital settings can improve gaps that are left in terms of health care (Hughes 2012).

One of the key recommendation that aroused from the enquiry board is that there is a need for an independent examination of the operation for the each supervisory and the regulatory body, with respect to the monitoring function and the capability for identifying the hospitals failing for providing a safe care. It has to be remembered that in a level of care in a hospital follows a hierarchical pattern and hence assessment should be done in all the levels. Problem can lie in any of the regulatory boards and hence there is a requirement for scrutinizing of each of the departments.   In such a case the information control personnel, in the administrative level plays an important role in preventing the health care infections and the cleanliness of the hospital wards. These personnel should be able to display the leadership qualities by proving proper training to the staffs. There should be proper methodologies used by the leaders for an effective monitoring of the hospital standards. According to Ravaghi et al.,(2013) monitoring the progress and the evaluation of the results helps to improve the performance of those responsible to implement the health services. As stated by Browne et al. (2013) a leader should always be updated with the new advancements in the field of health care by gaining education regarding the surveillance of the hospital wards, epidemiology from the current articles and journals and major training courses from the professional organizations or health care institutions (West et al. 2014).

Stakeholders Involved in Addressing the Issue

The clinical staffs and other health care workers stay in the frontline defense for safe care practices for preventing infections or mortality in patients. Managers in health care have a legal and moral obligation for ensuring a high quality of care and strive to improve the care. These managers are in a position to mandate the policies, procedures and organization climates. As per the studies, in most f the cases the managerial time spent on the hospital quality and safety is not enough (Daly et al., 2014). There is a broad range of quality and safety related activities that can be taken up such as strategy centered, data centered and culture centered. In most of the cases the leader fails to establish the strategic goals for identifying the targets or aim to create a quality plan.  One of the greatest allegations that have been found was that the trust management did not hear the patients, which proves that there were inadequate processes for dealing with the complaints and the serious incidents..

The activities aiming at enhancement of the patient safety has emerged from several cultures across the organizational tiers. It is to be remembered that only medical managers and organizational heads cannot look after the safety of the patients (Daly et al., 2014). There lie the responsibilities of the nurses and the other hospital staffs. for example, the clinical care nurses can directly prevent infection by monitoring, performing and by complying with the aseptic techniques and by providing a knowledgeable collaborative oversight on the environmental decontamination for preventing the transmission of the microorganisms from patients to patient and act as the primary resource for identifying the ill staffs or the patients (Hughes 2012). These can be again reported to the hygiene and safety manager.

Medical leadership is being considered to be important for improving the quality of the health care delivery and for maintaining the sustainability of the health care (Al-Sawai 2013). Medical leadership is necessary for overcoming the division between the managerial and the medical logics. The medical managers acts as a  " linking pin' between the professionals and the management. Again medical leadership is an intrinsic component of the daily work of the physicians. These leadership roles are the informal roles that surpass the formal managerial tasks unlike the doctors (Berghout et al. 2017).

It is the duty of a medical manager to look after the fact that the ward occupancy does not exceed the capacity for which it is designed or staffed and hence the workload should be managed accordingly (Zingg et al. 2015).  

Independent Examination of Supervisory and Regulatory Bodies Needed

Zingg  et al.(2015) have stated that leadership plays a significant role in health care turnover and the performance. Distributive leadership is highly prevalent and is practiced in different levels of health care. Stanley, (2016) have studied an integrative project involving multiple health care organization and found that that these organizations have developed a project leadership that were able to mobilize knowledge, authority(Parand et al. 2014). A review of literature has identified different ways in conceptualizing the plural leadership and how it impacts on the teams. According to some approaches the distributional leadership focuses on the top and the rest emanates for the different levels (Al-Sawai 2013).

Shared leadership or participatory leadership can go can go parallel to distributed leadership (Stanley, 2016). Distributed leadership hold a special position in health care for its increasing complexity. In this case it can be seen that the appalling condition of the concerned clinical setting (West et al. 2013). In case of managing the deterioration of the patient’s health and the cleanliness of the hospital wards the stakeholders that has to be involved are the medical managers, the clinical nurses and other health care staffs (Daly et al., 2014). Each group may consist of one leader that may take care of their respective duties and train their peers to address the issue.  Chrei and MacNaughton (2016) have supported to the fact that correct decisions and actions in complex health care organizations are likely to be the product of more than one leader. Participatory or shared leadership helps the division of the task force and workload. A health care system requires a more collective and systematic perception of the leadership as a social process (Berghout et al. 2018).

One of the importances of distributive leadership is that it is shaped by the interactions between the leaders (Stanley, 2016). Provision of a high quality of care to the patient does not depend upon a single leader rather the leadership structure creates a web of relationships that are interconnected. The cross disciplinary needs of the patients calls for the formal cooperation of the between the different organizational units. The necessary steps possible within their scope of practiced can be done by them, but then regarding the infrastructure or other forms of clinical governance outside their scope of practice should be communicated to the medical managers (Leggat & Balding, 2013). It is the duty of the physician to look after the type of care provided or if there lays any chances of medical error or identification of the high risk patients. Al-Sawai (2013) have stated that most of the hospitals have too many committees are less productive than they promise. One has to be solution oriented and should exclusively focus on how to cross the barriers rather than just making plans and committees.

Development of Leadership Qualities in Health Care

It has to be remembered that in order to provide a satisfactory treatment to the patient the type of care need to share a same objective and ample knowledge. As stated by Chreim and MacNaughton (2016) DL can be used to manage task contingencies among the organizational setting. Malila et al. (2018) have argued that in the perspective of an organization a distributive leadership is difficult to be performed due to the hierarchical organizational structure. Sometimes the power remains to the specialists. The hospital and the health system leaders generally begin by setting a specific, visible and measurable goal within stipulated time period for reducing the mortality. A successful leader aligns his/ her quality improvement activities by generating a visual map (Evans 2014). A successful leader should be accountable for any breaching of standards and should integrate the efforts of improvement in the quality improvement program and develop an appropriate action plan, which was found to be lacking in the concerned hospital trust (Chreim and MacNaughton 2016).

The Transformational leadership is normally considered as one of the most influential quality of leadership that is practiced in health care settings. Transformational leadership qualities are normally found in the nurses and mainly involve the elevation and broadening of the interest of the employees (Malila et al. 2018). Evans (2014) have argued over this fact and has clearly stated that permanent employees in the institutions like Mid Staffordshire NHS foundation trust, it is very difficult to manipulate the employees are most of them are long term employees and generally travels with a predetermined notion.

It is to be noted that successful leader can articulate the organizational structure perfectly and can communicate with the tasks successfully. A successful leader would be able to foster beneficial changes in the health care and the credit lies in incorporating the other clinical staffs into practice (Zingg et al. 2015). A perfect leader should be able to cultivate the leadership skills in those people they supervise and also conveying the goals rather than supervising the details of the staffs(Best et al. 2012). Zingg et al. (2015) have stated that most of the hospitals have too many committees are less productive than they promise. One has to be solution oriented and should exclusively focus on how to cross the barriers rather than just making plans and committees.

Giltinane (2013) argued that there are certain barriers to leaderships and thus will not be able to solve all kinds of organizational problems. It is the rigid employment rules in the public clinical settings that actually make the health care staffs reluctant to patient care. For example, if a staff is full time for three years then he is permanent, and hence the extent of punishment for breaching of standards is just the person can be transferred, but that has to be for high crimes (Jeon et al. 2013). This lack of stringencies in the rules actually gives chances to those indulging in malpractices. A manager or a leader cannot go beyond their scope of practice to punish the wrong doers other than just warning them or just lodging a written complaint against the malpractices.

Connection of Leadership Qualities to Contemporary Leadership Theories

Conclusion

Overall the report provided the fact that the culture of the trust was one of self promotion and not of critical analysis of openness. Proper leadership strategies at different organizational levels are required to promote changes. The degree of the passivity has to be reduced which can only be done by proper leadership strategies. The summary of the Mid Staffordshire NHS foundation trust clearly depicts that the complaints brought up against the hospital organization were valid and are purely due to the lack of competent staffs and organizational leadership. The leaderships play a crucial role in governance. It had been found that a distributional pattern of leadership that follows a hierarchy is normally effective in fostering changes in several levels of the health care. It can be said that successful leaders would always focus on cultivating a culture of excellence. They should be solution oriented and hence should focus of overcoming the barriers other than just overcoming it. Successful leaders should inspire the staffs and should be able to inspire the ones the supervised. Furthermore they work strategically and mainly focus on long term outcomes other than short term outcomes. The paper finally confesses that the lenient rules of the health care settings often deters the leaders from taking hold of certain situations and hence emphasizes on the application of penalties for the breaching of professional standards.

References

Al-Sawai, A., 2013. Leadership of healthcare professionals: where do we stand?. Oman medical journal, 28(4), p.285.

Berghout, M, Fabbricotti, I, Buljac-Samardži?, M, and Hilders, C 2017, 'Medical leaders or masters?—A systematic review of medical leadership in hospital settings', Plos ONE, 12, 9, pp. 1-24, Academic Search Complete, EBSCOhost, viewed 23 April 2018.

Best, A., Greenhalgh, T., Lewis, S., Saul, J.E., Carroll, S. and Bitz, J., 2012. Large?system transformation in health care: a realist review. The Milbank Quarterly, 90(3), pp.421-456.

Brach, C., Keller, D., Hernandez, L.M., Baur, C., Dreyer, B., Schyve, P., Lemerise, A.J. and Schillinger, D., 2012. Ten attributes of health literate health care organizations (pp. 1-26). Washington, DC: Institute of Medicine of the National Academies.

Browne, A.J., Varcoe, C.M., Wong, S.T., Smye, V.L., Lavoie, J., Littlejohn, D., Tu, D., Godwin, O., Krause, M., Khan, K.B. and Fridkin, A., 2012. Closing the health equity gap: evidence-based strategies for primary health care organizations. International Journal for Equity in Health, 11(1), p.59.

Chreim, S. and MacNaughton, K., 2016. Distributed leadership in health care teams: Constellation role distribution and leadership practices. Health care management review, 41(3), pp.200-212.

Clark, J., 2012. Medical leadership and engagement: no longer an optional extra. Journal of health organization and management, 26(4), pp.437-443.

Daly, J., Jackson, D., Mannix, J., Davidson, P., & Hutchinson, M. (2014). The importance of clinical leadership in the hospital setting. Journal of Healthcare Leadership.

Evans, J 2014, 'Evolving Leadership in Healthcare Design', Health Environments Research & Design Journal (HERD) (Vendome Group LLC), vol. 7, no. 4, pp. 9-12.

Giltinane, C.L., 2013. Leadership styles and theories. Nursing Standard (through 2013), 27(41), p.35.

Hughes, R. ed., 2012. Patient safety and quality: An evidence-based handbook for nurses (Vol. 3). Rockville, MD: Agency for Healthcare Research and Quality.

Jeon, SH, Park, M, Choi, K, and Kim, MK 2018, 'An ethical leadership program for nursing unit managers', Nurse Education Today, vol. 62, pp. 30-35. Available from: 10.1016/j.nedt.2017.12.017. [23 April 2018].

Leggat, S. G, and Balding, C., 2013. Achieving organisational competence for clinical leadership: the role of high performance work systems. Journal of health organization and management, 27(3), 312-329.

Malila, N, Lunkka, N, and Suhonen, M 2018, 'Authentic leadership in healthcare: a scoping review', Leadership in Health Services (1751-1879), vol. 31, no. 1, pp. 129-146. Available from: 10.1108/LHS-02-2017-0007. [23 April 2018].

Parand, A., Dopson, S., Renz, A. and Vincent, C., 2014. The role of hospital managers in quality and patient safety: a systematic review. BMJ open, 4(9), p.e005055.

Ravaghi, H., Heidarpour, P., Mohseni, M.,and Rafiei, S., 2013. Senior managers’ viewpoints toward challenges of implementing clinical governance: A national study in Iran. International journal of health policy and management, 1(4), 295.

Stanley, D 2016, Clinical leadership in nursing and healthcare : values into action / edited by David Stanley, Hoboken, NJ : Wiley-Blackwell, 2016.

West, M.A., Eckert, R., Steward, K. and Pasmore, W.A., 2014. Developing collective leadership for health care. King's Fund.

Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L., Allegranzi, B., Magiorakos, A.P. and Pittet, D., 2015. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. The Lancet Infectious Diseases, 15(2), pp.212-224.

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