Change Management Essay - Nursing Leadership and Management

Running head: NURSING LEADERSHIP AND MANAGEMENT 1
Change Management Essay
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Change Management Essay
PART 1 Major Health Deficiency Addressed by the Review and Relation with National Safety
and Quality Health Service Standards
Introduction
In 2015, the Consultative Council reported to the Department of Health and Human Services
that the number of perinatal deaths has increased at Djerriwarrh Health Services in the year 2013 and
2014. The Australian Commission on Safety and Quality Health Care(ACSQHC) was requested to
conduct a review on Djerriwarrh Health Services’ actions in detecting, responding and managing the
perinatal deaths and their capacity to respond to current critical health concerns in the public health
system(Duckett, Cuddily, & Newnham, 2016). Regarding the perinatal deaths and obstetric
emergencies, ACSQHC found that Djerriwarrh had significant deficiencies in conducting appropriate
clinical governance, undertaking routing surveillance when it comes to adverse clinical situations and
the health service was unable to respond to adverse incidents. Furthermore, Professor Euan Wallace
conducted a further review where he identified seven perinatal deaths that were potentially avoidable.
He concluded that there was inadequate clinical governance in the region which lead to poor
responding and monitoring of adverse clinical outcomes(Duckett et al., 2016). Due to these facts, the
Minister for Health requested the review of the department’s current methods of governance and
assurance of safety and quality care in hospitals and recommend where there was a deficiency. This
study seeks to give some of the deficiency found relating them to the National Safety and Quality
Health Standards of the nation.

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Major Health Deficiencies
Inadequate Patient Quality and Safety standards
The current health care system is complex due change in technology, increase in chronic and
complicated diseases, enhancement of treatment methods and the rise of new medicines(Australian
Commission on Safety and Quality in Health Care, 2016). This has lead to difficulties in decision
making for healthcare workers which often lead to errors during care delivery. Patients are usually
subjected to these errors and adverse effects during care delivery(Twigg, Duffield, & Evans, 2013).
However, some of these adverse effects and errors are avoidable and health care workers should
always have a comprehensive system that makes sure patients are not subjected to such
harms(Schrauf, 2014). In addition, the health care team in a hospital and its department should
always be ready to respond to such errors when they arise(Nathan, 2012). Avoidable patient harm
means individuals suffered while receiving care but not because of their illness or lack of knowledge
in medication or treatment.
There may have been poor quality and safety problems related to obstetric services in
Djerriwarrh. Some of the indicators for poor quality and safety in the region include failure of various
health systems, culture and processes(Livingston, 2017). In 2013, the Djerriwarrh was under
investigation by the Ministry of Health concerning the issues of maternal services in the West of
Melbourne(Duckett et al., 2016). In addition, the nursing and midwifery union had initialized the
investigation claiming the hospital had no met allowed accreditation standards. In both cases, the
hospital promised to change but after the review in 2015, there was little or no change in terms of
quality and safety standards.
The staff in both instances directed the blame on hospital management. There were, however,
some issues arising from the operations in the hospital but the management failed to follow up for

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proper implementation thus resulting in inappropriate accountability. A review carried out by the
concerned department at Djerriwarrh found that the Health Service Performance and Programs were
aware of the cluster of deaths but acted little(Duckett et al., 2016). There would be improvement had
they had put a more robust oversight system at place.
Inadequate Clinical Governance
The concerned department at Djerriwarrh demonstrated to lack responsibility in terms of
oversight of the systems, monitoring, and board governance(Duckett et al., 2016). Board governance
is crucial in all healthcare systems as it oversees and regulates hospital leadership and
management(Moran & Brightman, 2013). A board that lacks an understanding of contemporary and
health service challenges become very dependent on the CEO thus it does not execute the right
functions(Duckett et al., 2016). This, in turn, leads to a poor balance of responsibilities between the
CEO and the board thus leading to negative outcomes. Good board governance always leads to
avoidance of negative organization culture, inadequate financial management and promote clinical
care.
Djerriwarrh health services have demonstrated to have significant failures across all the
departments in terms of clinical governance. The review by Department of Health found that the
board of Djeriiwarrh was the only one out of 86 in Victoria that was unable to address problems in a
timely manner(Duckett et al., 2016). This is due to the poor appointment of board members who lack
enough skills. For instance, at the Djerriwarrh, out of nine board members, only four proved they
have skills in clinical governance(Duckett et al., 2016). In addition, the board was likely to have
anomalies in terms of selection of the members. The board's members could have been selected from
areas that have greater potential problems(Duckett et al., 2016). Other than that, almost all of the

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board members did not understand or lack clinical expertise in terms of medical administration skills
thus they could not understand most of the .clinical issues.
Knowledge and skills are the key elements to be considered when choosing a board
member(South Australia Health, 2014). Recent academic research has found that Victoria lack board
members who have sufficient knowledge. A research published by the ministry between the year
2013 and 2014 showed that one out of five of the boards did not offer formal training of the board
members and still lack enough quality performance(Duckett et al., 2016). Although most of the
boards believed they deliver quality performance, about half of them did not benchmark their work
against the external boards(Duckett et al., 2016). The Mistry of Health acknowledges that it is
difficult to appoint the board members but also recommend they should be highly screened in order
to choose those who have interest in quality and safety but not for business purposes.
Djerriwarrh case has proved inadequate as the systems put in place have not been able to function
as expected(Duckett et al., 2016). This well explains why when there are differences in both the
responsible board and the department, failures are likely to happen thus hindering or halting proper
service delivery in any organization. It is therefore of great importance to ensure proper ways are
followed to ensure there is harmonious cooperation between them(Victorian Council of Social
Service, 2013). Catastrophic failures in all levels occurred at Djerrwarrh health facilities in clinical
governance with no exception including the board. The review found that majority of boards were
having difficulties in noting and finding solutions to problems arising in a timely manner(Duckett et
al., 2016). Another problem that stood out was the appointment of board members in the vast region
of Victoria. There was no proper assessments and instead applicants were told to carry out self-
analysis on their competence in various areas. The answer was shallow as there was no in-depth
explanation and therefore not being able to identify underlying issues. Another great issue that stood

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out Djerriwarrh board is the health services being moderate in size which was located in urban
regions with high population and from where the majority of board members came from(Duckett et
al., 2016). This meant that small public hospitals had a lower hand in terms of expertise of the board
members as theirs didn’t come from privileged areas.
The issue of term limits for members of the board played a key role in their independence and
also continuous internal renewal. While having a quality committee on a board does not necessarily
mean good governance in clinical matters, it helps create better performance in quality(Cifalinò &
Villa, 2016). There are differences in the appointment of board members between small and big
public hospitals. Smaller public hospitals have a greater role in interviews carried out than bigger
health facilities. The procedure followed in public sector yields more liberty on local interests in
terms of merit of those appointed in boards(Australian Commission on Safety and Quality in
Healthcare, 2011). This independence brings diversity in the boards and prevents them from having a
clique of special members. It was, therefore, suggested an amendment to the various broad areas in
order to improve service delivery. A proposal was tabled for the introduction of a rigorous process in
board appointment(Duckett et al., 2016). This was to make sure that there was a variety of skills in
those boards especially on clinical, financial as well as legal expertise. This enables the hospital to
have an abundance of skills which will enable better service delivery.
Consumer representation is a matter which needed to put into consideration as they are the
recipients of services those hospitals offer(Royal College of Paediatrics and Child Health, 2015). A
patient concerns are well taken care of if he/she is given representation and the board thus
concentrates on quality of the healthcare(Australian Commission on Safety and Quality in
Healthcare, 2016). This will be possible if the person is able to bring the expertise necessary to get
the views of the patients. The main advantage of this model is that the board got firsthand