Nursing and Management: Assignment

1Running head: NURSING AND MANAGEMENT
Nursing and Management
Name of student:
Name of university:
Author note:

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Part 1
Introduction
The contemporary healthcare system in Australia is witnessing major challenges
while delivering optimal quality healthcare services. Across all health systems, patient harm
and variability in care services are prominent despite the fact that concerted efforts are being
put forward. The blame is to be given on ineffective systems that indicate insufficient
knowledge and lack of governance and leadership (Lane et al., 2017). The Victorian
Government’s Department of Health and Human Services released a review report titled
Targeting zero: Supporting the Victorian hospital system to eliminate avoidable harm and
strengthen the quality of care. Report of the review of hospital safety and quality assurance in
Victoria’, that addressed the issue of hospital safety and quality assurance in Victoria. The
review was undertaken by Dr Stephen Duckett, Director of the health program, Grattan
Institute. The review was responsible for carrying out a rigorous examination of the extent to
which the departments had sufficient systems for ensuring safety and quality of care delivery.
It also aimed at providing suitable recommendations regarding how significant improvements
could be brought about for achieving modern-day best practices as highlighted by
international bodies and jurisdictions. The scope of the review was aligned with the objective
of undertaking an assessment of the systems of the department providing all in-hospital care
in both the public and private sectors (Duckett, 2016).
The present section of the paper is focused on highlighting the major healthcare
deficiencies addressed by the review under discussion. In addition, it brings into limelight the
National Safety and Quality Health Service Standards (NSQHSS) that these deficiencies
relate to.

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Major health care deficiencies addressed by the review
National health care policies of Australia are looked after by the Australian
Government who is under constant pressure to come up with novice strategies to address
pressing issues. At the ground level, Australian Government is mainly responsible for public
and community health. In Victoria, the Department of Health and Human Services is
accountable for this role. Understanding that the contemporary healthcare system of Victoria
is not up-to-the-mark, the Australian Commission on Safety and Quality in Health Care
(ACSQHC) was entrusted with the task of carrying out an independent review that would
highlight the critical issues faced by the department. The review by Stephen Duckett has been
successful in identifying a certain number of deficiencies and addressing them throughout the
review. These deficiencies relate to the inability to control the management system of the
hospitals. In addition, there was a concern of insufficient information for assuring that high
quality and safe care is being provided consistently (Canaway et al., 2017). The National
Safety and Quality Health Service Standards are eminent in providing nationally consistent
and uniform set of measures of safety and quality that are to be applied across health care
services. The deficiencies highlighted in the review and the corresponding NSQHSS they
relate to are to be elaborated as follows-
Lack of leadership
The key issue that the review highlighted was lack of adequate clinical leadership.
The department is to be accused of not exercising adequate leadership that holds the potential
to guide improvement initiatives (Duckett, 2016). The review highlighted that there is a
dearth of support provided from the department’s end that leads to lack of sustained
investment in the appropriate resources. Leadership ensures that all healthcare settings under
a certain department are linked through a common set of objectives for achieving the same

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goal of optimal care services. However, in the present case, the department was found not to
adhere to this principle and leave the hospitals on their own to create an approach towards
quality improvement that is not sufficient. In addition, no leadership approach had been taken
for sharing quality information between hospitals regarding improvements made. Had there
been sharing of information between different settings, one could have learnt from te
mistakes of others and avoided the same. Further, a lack of communication between the
department and external bodies added to the issue.
According to Grohar-Murray et al., (2016) the importance of leadership in the
healthcare sector is increasingly being felt at present. Healthcare facilities are a unique
environment where the prime priority is to care for the patients. For translating this mission
into practice, it is the responsibility of the concerned healthcare departments of the countries
to demonstrate suitable leadership skills and be in a position to be responsible for the
challenges faced. Since multiple healthcare settings work under a particular department of
health, leaders from the department must establish a strong collaborative relationship
amongst the different settings, so the work process is smooth. Such a relationship ensures
cooperation between hospitals that enables the exchange of health information (). Leadership
is imperative for handling pressures on service provision, improving ways of working and
addressing failures in care delivery.
The issue of lack of leadership is related to the NSQHS Standard 1 “Governance for
Safety and Quality in Health Service Organisations” (NHQHS, 2012). As per this standard,
all health care department must follow a quality framework for implementing safe care
systems. It is elementary for health care departments to exercise governance and leadership
traits that bring improvement in the performance of all organisations working under it. Such
improvement can be brought about when information on patient experience is exchanged
between settings. The two criteria for achieving the governance for safe and quality are

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‘Governance and quality improvement systems’ and ‘clinical practice’. The first criteria
relate to the integrated system of governance and leadership that can manage risks in patient
safety. The second criteria relate to use of best evidence for solving clinical issues. In the
present case, the Victorian health department is to have overarching governance for providing
sufficient resources and establishing a connection between the concerned hospitals.
Adverse patient events remaining unreported
The review highlighted that patient events, and errors are not being reported
adequately, giving rise to a significant issue. The findings were that the department did not
possess a robust functional incident management system that could encourage hospital
employees to report any incidents of patient harm (DHHS, 2016). The challenges that came
into the limelight was that extremes difficulties were faced while using The Victorian Health
Incident Management System (VHIMS). The reason for this was the poor designing of the
system and highly complex nature. An example that can be cited in here is the concern
prevailing regarding the incident classification element of the system as it has 1400
categories under it. Such an in-detailed classification makes the process complex and highly
time-consuming. Classification of the incidents is therefore inaccurate. It was highlighted that
the tragedies that took place at the Djerriwarrh were not reported in a timely manner and were
also inaccurate. In addition, the department’s performance monitoring framework was not
suitable for detecting failings that were catastrophic.
As highlighted by Pham et al., (2013) an incident reporting system that is
dysfunctional restricts the exchange of valuable information that pertains to recurrent
breaches in safety guidelines. The authors also stated that adverse patient incidents are to be
identified at the earliest so that such situations can be avoided in future. It is common for
healthcare organisations to make errors in the due process of delivering care. What is of more

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importance is that such incidents are to be reported timely so that strict actions can be taken
in future.
The above mentioned deficiency relates to the the NSQHS Standard 1 “Governance
for Safety and Quality in Health Service Organisations” (NHQHS, 2012). The criteria for
achieving the governance for safe and quality is ‘incident and complaints management’. As
per this standard, any complaints regarding safety guideline breach is to be reported by the
professionals. All organisations must ensure that undesirable incidents are identified, reported
and analysed thoroughly.
Unjustified dependence on accreditation
Over-dependence of the department on accreditation was highlighted in the report.
There was an indication that healthcare services such as the Djerriwarrh Health Services had
been consistently given the accreditation of high performer as it gained high scores at the end
of 2012-2013. The department, therefore, did not think it important to consider revising the
accreditation until 2015 when a number of avoidable patient injuries occurred. It was only
until such incidents of patient death occurred that the department reviewed the overall impact
of the accreditation. The key attributes resulting in the failure to uphold proper accreditation
were poor governance and supervision. Regular audits were not undertaken as identified by
the report (Duckett, 2016).
Clinical audits are a central part of operations for any healthcare organisation as
opined by Hamer and Collinson (214). The authors highlight that clinical audit acts as a
quality improvement process seeking to bring improvements in the quality of patient care
through systematic reviews undertaken a set of explicit criteria. It is fundamentally a way of
understanding whether the service being provided is aligned with the particular standards and
whether high ratings can be conferred on to them.