Clinical Leadership in Nursing and Midwifery

This essay discusses the impact of medication errors in healthcare settings and the use of Lewin's model of change to implement an electronic medication system. It also explores the effectiveness of transformational leadership in managing change and potential aspects of resistance to change.

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Clinical leadership in Nursing and Midwifery
9/9/2018

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The essay brings about the discussion on the health care settings and the impact of
effective or ineffective medication system. The essay has represented through the scenario,
which has been used and shown that the electronic medication in nursing system has led to
safety of the medication administration. In every healthcare there are some issues related to
the patient diagnosis, treatment and the recovery, which is often the result of the ineffective
treatment therapy, or the human error. The major problems are sometimes identified as
human errors, which are called as ‘medication error’ (Cloete, 2015).
The term medication errors refers to any preventable event which may lead to the
harm to the patient by the wrong use of medications while the medication given to the patient
is in control of the healthcare professional or the patient/consumer. With the case of the two-
hundred bed hospital, there are some of the critical incidents identified. Incidents were
reported from the last three years and have been shown on the quality improvement website
by the state organisation. These incidents were reviewed by the nurse/midwifery in this case
and concluded that it is caused by the medication errors. There are many reasons behind the
occurrence of the medication errors in the healthcare (Scott, 2016).
Reasons of the medication errors
Medication errors are identified as a common problem in nursing and healthcare
leading to the major issues causing harm to the patient. The most common causes for the
medication errors in the hospitals or the health institution is due to the poor communication
between the doctors, or between the doctor and the patient. Wrong interpretation of the drugs
as medicines also leads to the medication errors. It can also be caused due to the short forms
or the abbreviations used in the medicines, which is found difficult by the nurses or the staff
of the hospital (Jones, 2014).
Lewin’s model of change – 3-step process
In a healthcare settings prescribing, preparation and the administration of the
medication is a complex procedure and performed in a complex system. Therefore, errors are
a common issue, which might occur even after proper care and management.
Organisations/healthcare needs to bring change regarding the development of effective
medication system. This can be done by the use of the electronic medication system in the

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hospitals. For the purpose of defining and establishing the mainframes the ‘Lewin’s model of
change’ has been used (Smith et al, 2016).
Lewin’s model of change relates to gaining an understanding of the human behaviour
as it related to the change and the patterns of resistance to the change in patients. A ‘3-step’
process which includes unfreezing, freezing, and refreezing. The ‘unfreezing’ step refers to
the identifications of the difficulties found in the healthcare and the developing the driving
force or reducing the effect of resistance. Freezing means the equalization of the opposing
force i.e. it is the step where the actual change takes place. The last step of refreezing refers
to the implementation of the project thereby producing the required change in the healthcare
(Manchester et al, 2014).
Plan for the project of identifying and solving issues of medication errors
Unfreezing stage – During the first stage of change management in the hospital, first
requires the implementation of the bar-code scanning system of medication delivery.
Communicating the system upgradation with all the key stakeholders such as nurse, staff,
frontline nurses, and the administration is essential step. It is a purposeful step to ensure the
safety and trust between the nurses and the patient by keeping the communication lines open,
and honest (Cummings, Bridgman & Brown, 2016).
Then it further requires a round-table discussion to clarify the driving and the
restraining forces in the hospital. This involves identifying the restraining forces such as
resistance shown by the patient to use the electronic system of medication, computerized
devices due to lack of experience and trust in these devices. Equalising them with the driving
forces such as financial investment in the support from the top-level managers, potential for
the ease in the use of such devices, and effective time-management skills; resulting into the
implementation of the BCMA in the healthcare. The implementation of devices, facilities and
other programs are the milestones to be achieved in the period of 2 months (Laumer et al,
2016).
Moving stage- the stage defines about the process through which actual change is
taking place in the healthcare. Efforts from the various different teams in the healthcare such
as IT staff, clinical nurse and the information services, and the other administrators in the
hospital. There are some of the areas that need to be considered while implementing such
facilities in the organisation such as educational training needs, effect on workflow or

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leadership. It also includes an analysis over the reliability of the equipment’s used. The goals
or the objectives stated here are the milestones to be achieved within the timeframe of
2months at least (Galani et al, 2014).
Refreezing stage - This final stage of the Lewin’s model of change in the healthcare
organisation, lead to the evaluation of the stability and effectiveness of the proposed change
in the hospitals. It mentions that a continuous support of the clinical nurses should be
regularly implemented to all the key stakeholders in the hospital. This is essential until the
change is deemed complete and the users are accustomed with the technology. The
milestones stated by this step are to be achieved within the timeframe of 2 months. Thus,
after the realisation of the operational system, an evaluation of the systems and problems
must be encountered. It also records about the success or effectiveness achieved during
process of change and challenges met for any future reference. Hence, the overall plan of the
change is expected to be achieved within the period of next 6 months (Bolster & Rourke,
2015).
Leadership style
Transformational leadership
With context to the problems identified in the hospital, and the plan implemented as
per the Lewin’s model of change, the change management process can be linked to the
leadership style. The style, which is suitable for this case, is the ‘Transformational
leadership’. Transformational leaders identify the problems, takes into consideration the
major stakeholders and their interest. These leaders are charismatic, intellectual, inspirational,
and considers the individual aspects. Transformational Leadership style includes the belief of
the leaders that involves stakeholders in the change management process. As the stakeholders
can support the change, maximize the success rate and reducing the possibility of resistance
by the staff or the patient. Therefore, this style of leadership is considered effective in such
healthcare practices (Shu, 2015).
Transformational leadership v/s Authoritarian leadership
The discussion here represents the comparison of the transformational leadership with
the Authoritarian style of leadership. The authoritarian style of leadership demonstrates the
scenario when the leader takes the decisions without considering input from their staff. Under
this style negative reinforcement and punishment is used by the managers/leaders to

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incorporate change. Mistakes are not accepted and found to be appropriate in the case of
emergency or chaotic conditions. Therefore, it can be analysed that the transformational
leadership is more effective in the nursing/healthcare leading to positive outcomes (Fischer,
2016).
Potential aspects of resistance to change
Managing change in context to the healthcare settings refers to the handling of the
complexities of the process. Therefore, it has been observed that many people resist to the
change to be introduced in the organisation. Prior to the changes in the healthcare, the plan
for the change in the hospital, there are some of the aspects considered for potential
resistance. The stakeholders in the hospital will mainly observe the two aspects of resistance
from change. As the support the change, thus they will be majorly impacted. The reasons can
be mistrust, loss of job-security, wrong timing, or individual’s predisposition towards change
(Tyler et al, 2014).
To conclude the above discussion, it has been analysed that the impact of medication
errors is a major concern in every healthcare. Therefore, the essay implied the application of
the Lewin’s model of change in the hospital. For explaining this, the leadership style is
exercised and applied which clearly defines the achievement of the proposed change in the
organisation. The essay also focused on the transformational leaders and their effectiveness,
which includes the description of the resistance to change and the aspects related. Hence, it
can be concluded that the use of electronic medication system improves the patient safety
standards, thus improving overall performance in the healthcare.

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Smith, O., Santiago, C., Butorac, E., Bell, K., Diston, M. T., Lewis, E. & Wannamaker, K.
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