Improving Oral Hygiene for Patients

Chapter 1
This paper is an 8,000-word submission in which it will discuss the
importance of service improvement (SI) and identifies the SI framework or tool with a
clear rationale for utilisation. Next, the author analyses of preparedness for change
and identifies various drivers and stakeholders that may influence the proposed SI.
Finally, the author presents different strategies to measure the effectiveness of the SI
and reflects on the personal and professional skills that require identifying a plan and
implementing and evaluating the proposed SI. This paper upholds the principles of
consent and confidentiality and adheres to the School of Health and Social Care
guidelines on presentation and referencing.
Service improvement (SI) is a systematic approach that uses specific
techniques to measure and deliver sustained growth in quality of care (The Health
Foundation 2013). Batalden and Davidoff (2007) define SI as the combined and
unceasing effort of everyone such as healthcare professionals, patients and their
families, researchers, planners, and educators to make changes that will lead to better
patient outcomes, a better system of care, and better professional development. SI has
been part of healthcare since the 1900s (Boaden et al. 2008) and has been responsible
for patient safety measures such as the introduction of the SSKIN bundle to manage
and prevent pressure damage (NHS Improvement 2016). According to the Nursing
and Midwifery Council (NMC 2018), nurses need to practise effectively by sharing
their skills, knowledge, and experience for the benefit of their patients.
Moreover, SI is used in healthcare to reduce the risk of harm to patients while
they are using the service. Questions have arisen from the finding of the Francis
Report (2013) about the significant factors of the nursing profession including
leadership quality, organization power and patient safety that can lead to the suffering
and death of the patients.The Francis Report has become a driving force to promote
change, lead, fund, shape, and improve all aspect of healthcare to ensure that patients
receive the support, care, and treatment with the compassion, respect, and dignity they
deserve (Department of Health 2015).
On the other hand, the challenge of sustaining an SI is convincing healthcare
workers that there is a real problem to be addressed. Clinicians and others may argue
that a concern being targeted by an improvement intervention is not a real problem
(Dixon-Woods and Martin 2012). Clinical team with a core belief that the present
system is correctly working will be hard to convince to support any further change
unless it can be demonstrated.
Therefore, those who design and plan interventions should be careful when
targeting problems, as these are likely not to be accepted as real. Possible strategies
for framing an issue as a problem could include hard data to demonstrate its existence
and stories of particular service users (The Health Foundation Inspiring Improvement
2015). Sustaining implies an act of involvement and ownership of frontline leaders
and their teams, which enables organisations to identify what needs to be done and
how to develop their solution to ensure and enhance the sustainability of SI (Parand et
al. 2018).
The NHS is under a lot of pressure – each year staff asking for more service as
the population grows and changes. However, public funding for the NHS is not
growing as fast (The King’s Fund 2019). Lots of NHS trusts and foundations are
facing challenges such as longer life expectancy, increased service usage, and surging
costs, which adds to the pressure on the NHS. Demand for NHS care is expected to
increase due to longer lifespans and the rising cost of treatment (NHS 2015).

An increase in long-term conditions has also contributed to a rise in demands
for nursing staff to support patients in managing their health and promoting self-care
(Goodwin et al. 2010). The recent ‘Five-Year Forward View’ policy sets out a clear
direction for the NHS, which shows the needs of the change is needed and give an
insight into the improved NHS (NHS England 2014). The NHS’s task is to meet the
nation’s health needs within its budget. However, the organisation extends its services
and maintains or improves the quality of what it does while simultaneously trying to
be cost-effective (The King’s Fund, 2019). Therefore, the NHS must work together
with local communities, individual staff, work teams, and social care organisations to
remodel the healthcare system (Craig 2018). The collaborative contribution of
everyone can design a system to deliver high-quality, affordable care and better
outcomes for patients (Hewison 2010). The expected benefits of improving the
service include better care for patients, benefits for staff, financial sustainability, and
implementation of best practice (Alderwick et al. 2017).
The role of nurses involves all the critical and vital aspects,
including patient’s care, data collection, assisting surgeries and
operations, and so on. However, the principal responsibility of a
nurse is an assessment of the treatment result and applying
immediate interventions to prevent any health risk of the patients.
The federal government mandates fueled the development of
hospital-related care. The magnet recognition is one of the most
relevant to nursing quality improvement program by the
government. Developed by American Nurses Credentialing Center
(ANCC), the program helps to recognize the hospitals, delivering
nursing excellence. This program ensures the strong involvement
of nurses in all level of hospital activity. This program is an
excellent approach to increase the quality of care, high retention of
nurses, empower nurses as well as reduce the mortality rates and
should be strictly enforced to all the hospital. A team with well-
trained professionals increase the probability of high-quality care.
To ensure the quality of care, all the nurses should be well-trained,
and the number of the training program should be increased to
ensure the availability of them. According to the journal “Improving
the oral health of older people in the hospital” daily intervention
can improve the oral cleanliness of the patients. The similar result
is found in the case of nurses with specific training in oral health
maintenance (Ball 2017).
Nurses work closely with patients to deliver care, and they can identify and
assess the status of healthcare services and work towards improving the processes of
provided services (The King’s Fund 2012). According to the NMC (2018), nurses
have a responsibility and duty to ensure that they provide good quality care to
patients. Student nurses can observe the lag of the system and suggest potential
changes in the intervention that are ignored by the old staffs (Kieft et al. 2014).
Student nurses can also identify issues in trust and implement improvement. When
considering how to improve care, they can reflect on situations when they have felt
that optimal care was not provided.
To implement an SI, healthcare professionals must have excellent teamwork
skills to collaborate with various people, such as staff new to them, to assess their
ideas or patients (Jones, Vaux and Olsson-Brown 2019). They also need excellent
leadership skills for SI, as they need to be able to lead their team to assess the

problems, identify opportunities, and change the mindset of opposition (Aarons et al.
2015). Time management is a vital skill to help in reducing stress and burnout. It will
also increase healthcare professional efficiency and effectiveness in their work
(Shalini 2018).
Service improvement involves giving quality care in every single aspect of
health care. Priority has given to critical surgeries, and diseases often lead to
negligence in primary hygiene and care of the patient, elongating the health
improvement. Some health problem can be prolonged with ignorance of basic
sanitation, like oral hygiene of the patient. The older people grow the susceptibility to
chronic issues with age, which can be worsened if associated with poor oral hygiene
(van der Putten
et al. 2014 ). According to the World Health Organisation
(WHO 2017), providing good oral healthcare is vital in preventing oral diseases, pain,
or infections that may limit an individual’s ability to eat, communicate, and socialize.
The following chapter will discuss the importance of oral hygiene in hospitals to
reduce patients’ length of stay. Oral hygiene in hospitals is often neglected due to
many reasons, such as staffing level and lack of training (Chuang et al. 2000).