Improving Safety Reporting Culture in Victoria's Healthcare System

The assignment discusses the need for change in Victoria's healthcare system to improve patient safety and quality care. It proposes implementing a cultural change process to encourage reporting of safety concerns in ward settings. The essay reviews two key change theories, Lewin's theory of 1947 and Kotter's theory of 1996, as well as Weber's power theory. It suggests that Kotter's model be adopted due to its effectiveness in large organizations like healthcare facilities. Power plays a crucial role in organizational change, and the essay highlights the need for balancing power to bring about sustainable change.

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Major Health Deficiencies& Related NSQHS
Introduction
The Department of Health and Human Services of Victoria released a report by Dr. Stephene
Duckett. The report reviewed the state of safety and quality in Victorian hospitals. The review
delves deep into highlighting hospital governance issues in regard to safety and quality. The
report indicates that every modern health system have reported cases where patients suffer
frequent avoidable harm when still under care (DHHS, 2016). It is on this philosophy that the
report by Duckette identifies several deficiencies in Victorian health facilities on safety and care
quality, with recommendations on how to overcome them. This discussion will highlight the
different deficiencies highlighted with this review. The discussion will also indicate the National
Safety and Quality Health Service standards which relate to the identified deficiencies.
a. Inconsistency in Healthcare Practice Excellence
According to the study, one of the deficiencies identified includes the lack of consistency in
practice among hospitals in Victoria (Duckett, 2016). The study indicates that health facilities are
characterized majorly by pockets of practice excellence. While specialist hospitals in Victoria
aim at being the best in the world and as benchmarks, excellence in services is still not steady
(DHHS, 2016). The report also indicates that a section of health specialists in Victoria including
clinicians aspire to have their work serve as international benchmarks. A lot of them have had
their research and/or clinical innovations recognized world over. It is evident that majority of
these hospitals in Victoria have a committed leadership fully focused on patient-centered care.
Even so, the report indicates that the facilities have not been able to ensure consistent efforts so
that excellence is commonplace in within Victoria Hospitals. In the first place, existing data for
comparison purposes indicated that safety has a mixed picture. In this regard, a comparison

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between Victorian Hospitals and those in South Wales according to the report indicated that
Victoria is stronger than its counterpart in terms of quality indicators (adverse effects of drugs)
(DHHS, 2016). It is however weaker than South Wales in terms of surgical misadventures.
Compared with other states, it was also evident that Victoria is better in hospital facility
accreditation as compared to some states in Australia, but also worse than others (Duckett,
2016). The report indicates that majority of Victoria Hospitals seem to have focused more on
international acclaim and accreditation in comparison with others across the world rather than
committing themselves to their patients. Usually according to Tuan (2015) patients wish to have
a lesser risk in regard to avoidable complications as compared to what was the case in other
states. The policies and/or ambitions of the department of health in Victoria in regard to care
quality and safety did not reflect a full commitment to consistence in excellence.
Inconsistency in excellence in regard to patient safety and care quality can be related to the
first NSQHS item entitled “Governance for Safety and Quality in Health Service Organizations.”
One of the criterions under this standard that addresses for sustained efforts in ensuring
excellence is one that explains the aspect of “clinical practice.” According to this criterion, it is
imperative that clinical health providers offer patients under the guidance of latest best practice
and/or evidence based care (ACSQHC, 2012). Apparently, best practice calls for consistency in
the provision of healthcare, which must however be based on safety and quality standards
appropriate to every patient. Another criterion under this particular standard emphasizes the
need for integrated governance systems structured to manage safety and quality risks for patients
(ACSQHC, 2012). This system can help in ensuring that continuous excellence in regard to
ensuring the safety and their care quality is sustained.

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b. Inaccessibility of Critical Information by Clinicians & Hospitals
Information is imperative in the running of a hospital system towards persistent
improvement. However, this has not been the case in Victoria hospitals as information has been
flowing according to the report (DHHS, 2016). It was established that most essential data was
not; being collected, used, and availed in a form that is convenient. This usually limits the ability
of hospitals and clinicians to utilize the information in order to identify any existing
opportunities to improve and/or strengthen healthcare. An example is where despite the fact that
data on deaths resulting from preventable surgical and/or perinatal processes is collected the
department of health and the hospitals usually never access this particular information (Duckett,
2016). It was also established that there exists no standardized data collection on patient
outcomes despite the fact that this data can inform one on the progress of the patient’s pain and
functionality improvement occurred after treatment. In Victoria Hospitals, it was evident that
central monitoring and feedback on total in-hospital complications is only done for a small
fraction of them (DHHS, 2016). From the report, hospital managers in Victoria and the
department do not know the total number complaints launched against different individual
healthcare practitioners despite the understanding that such complains are very strong predictors
in terms of any future issues with particular clinicians. Such issues according to Tuan (2015) can
only emerge from ineffectiveness of available data and/or fragmented custodianship of crucial
data within the health system. For instance the report indicated that the Victorian Managed
Insurance Authority was not able to secure information on patient safety; which it required in
order to support health services fully with plans on risk management (Duckett, 2016). In
Victoria, there has been widespread reliance on paper-based health information record system as

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compared to electronic recording systems. Combined with non-existing unique patient identifier
this leads to difficulty in tracking the journeys of patients across the hospital system, and/or the
analysis of care by use of information from patient records (Duckett, 2016). The department is
reported to have missed realizing underperformance cases as a consequence of failure to utilize
use detailed data on complications acquired from hospitals, in routine datasets.
Inaccessibility of crucial information on patient safety and quality of care is related to the
NSQHS number one entitled “Governance for Safety and Quality in Health Service
Organizations.” The criterion of this standard where this deficiency falls within is one that calls
upon health facility management teams to ensure that there is proper incident and/or complaints
management from the part of the patients on care (ACSQHC, 2012). The standard dictates that it
is important for adverse patient events be identified, recognized, analyzed and reported. In the
case of Djerriwarrh Health Services, it is apparent that the stipulation has not been adhered to
especially having seen that there have been minimal identification, reporting and management of
adverse events (DHHS, 2016). This deficiency also related to number 5 of the NSQHS. This
standard calls for the departmental oversight committees and the management of a health facility
to have in place proper patient identification and/or procedure matching means. This according
to Duckett (2008) can help in correctly identifying patients so as to also match their identity
correctly with appropriate treatment.
c. Immaturity of safety & quality Monitoring System within the Department
According to the report, there exists no effective framework to monitor safety of patients and
the quality of care (Duckett, 2016). While there are a number of health indicators including the
sentinel event, there is limited timeliness and/or effectiveness of these programs. A case of The
Royal Women’s Hospital in Victoria, the Departmental staff agreed that till recently,

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performance meetings mainly focused on data on budget and activity (DHHS, 2016). Later, the
department the scope of such convened meetings to factor in patient care and/or governance
issues. Even so, the available data was limited and therefore would not be sufficient enough to be
relied on when the department wanted to probe the hospitals’ issues on governance. The report
also raises issues against the Australian Commission on Safety and Quality in Health Care. In
this regard, the performance monitoring framework of the department was not designed in a way
to detect any catastrophic failings as those that had happened at Victoria’s Djerriwarrh Health
Services (Duckett, 2016). As a matter of fact, it was apparent that Djerriwarrh had been given
excellent scores during performance assessment and further successfully accredited twice within
the same period the facility had catastrophic failure in both care and/or clinical governance.
According to the report, a certain independent review had established that the department’s
processes could not detect any significant deficiencies in terms of clinical governance at
Djerriwarrh (Duckett, 2016). This review further indicated that the department had no robust
capacity for undertaking routine surveillance of rampant serious clinical events apart from
sentinel events. The department also had poor capacity in regard to responding appropriately to
reports on incidents it used to receive. After conducting a broader review of the systems of the
department for the rest of the Hospitals in Victoria other than Djerriwarrh, the same conclusion
was arrived at (DHHS, 2016). It was evident that department had immature systems to conduct
routine monitoring of safety and care quality. Despite huge volume and/or diversity of existing
types of harm within the health system efforts and resources on monitoring are focused mainly
on a few safety indicators that have limited usefulness in the clinical context. The department
was by then 9 years behind the leading states in terms of utilizing routine data for monitoring
rates of hospital complication. The report established that the department was also 8 years behind

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in regard to its commitment to establishing special mechanisms to audit clinical governance in
the health services across Victoria. As the last Australian state to implement incident reporting
system state-widely, Victoria’s system had been plagued with issues on design and
implementation which made it useless to analyze statewide patient safety trends. By the date of
the report, about 400,000 incident reports that sat in the department’s system had never been
analyzed systematically (DHHS, 2016). Reviews particularly on mortality and/or severe
morbidity which are preventable were being carried out by other expert bodies operating outside
the health department. These bodies do not share this information with the department and also
never inform or investigate Victoria’s unsafe practitioners whenever they are identified (Duckett,
2016). More particularly, the case reviews done by these bodies only investigate different
individual incidents but not trends. This limits the usefulness of the reviews in bid to improve
safety as highlighted in Tuan (2015). It was established that at Djerriwarrh Health Services, an
external consultative council identified preventable deaths two years since the beginning of the
cluster of preventable deaths. This councils review processes had not been designed to detect this
cluster. It was thus likely that it would have been missed if it were not just for the fact that a
member of the council sat on the stillbirth review committee and/or the committee on perinatal
mortality. This particular member noticed a huge number of preventable death cases at
Djerriwarrh hospital including the similarities that existed between them. Duckett’s report
confirmed that the safety and quality of care management system was thus inadequate in terms of
establishing rates of avoidable deaths (Duckett, 2016). Having a dysfunctional system on
incident reporting implies that there is no reporting of potentially useful information mainly on
recurrent breaches of safety and quality. It also means that even the existing information where
obtained, can be misclassified and even lost right before it can reach the department (DHHS,

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2016). Limited numbers and/or minimal validity of indicators on performance imply that
Victoria hospitals could not be accountable broadly and meaningfully on safety and quality
aspects in their practice. The inability to fully use and/or integrate hospital data according to
Duckett (2016) also imply that there was failure in fulfilling the department’s main role as
manager of the system in the aggregation, integration and analysis of data on safety leading to
avoidable patient suffering.
A lack of robust patient safety and care quality monitoring system relates with the first
NSQHS standard entitled “Governance for Safety and Quality in Health Service Organizations.”
The specific criterion of this standard related to this deficiency is one that emphasizes that it is
necessary to implement a governance system which can undertake time-to-time clinical audits
(ACSQHC, 2012). These are important in ensuring that governance focuses equally on safety
and care quality as well as on other issues regarding a health facility. It is apparent that if these
audits would have been place in the majority of Victoria's hospitals, the failures would have been
identified and worked upon.
d. Lack of Capacity among Boards for Hospital safety and quality Monitoring
Looking at the failures at the Djerriwarrh Health Services Duckett (2016) indicated that they
were all attributed to its board which however later dissolved. While the board was fully
responsible for the failures, the ministerial appointment processes including the department’s
oversight charged with the role of ensuring overseeing the functions of the board was in
question. These two departmental roles needed to ensure that the boars exercised skills,
expertise and even information which were necessary in upholding the facility’s governance
responsibilities (Duckett, 2016). The failures occurred despite the fact that Djerriwarrh Health
Services facility directors had been recruited using the same process and provided with equal

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support as those from other boards of public hospitals in Australia. Duckett’s report indicates
that this particular highlight of Djerriwarrh was meant to show the probability of similar
problems on capacity currently in hospital boards in Victoria.
The Djerriwarrh Health Services was found to have had avoidable governance failures. It
was thus necessary that such a tragedy at the facility needed not to be approached with a
“business-as-usual” technique in the quest to manage safety and quality of care for patients
(DHHS, 2016). A lot of these departmental failures had also been noticed by three other
independent performance audits in the previous decade; yet they still were inadequately
addressed by the times the report by Duckett (2016) was being written. The Auditor-General had
noted in then recent report that their audit established systemic failures within the department
meaning that there was inadequate leadership and/or oversight that was effective enough. The
issues had been identified back in the year 2005 audit yet the department had done little in
providing sufficient priority to the safety of patients more than a decade later. The department
has instead focused on instigating further reviews, commissioning of expensive consultancies
and further, establishing several committees of experts all of which end up with minimally
tangible benefits to patients.
This deficiency is related to NSQHS number 1, entitled “Governance for Safety and Quality
in Health Service Organizations.” The deficiency can be addressed under the standard’s criterion
which emphasizes on the need for appropriate governance and/or quality improvement
healthcare systems. The criterion stipulates that integrated governance systems must be in place
so as to manage the safety of patients and related quality risks (ACSQHC, 2012). From the
inability of boards to monitor safety and quality of care, it reflects the failure of the department

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in this regard. This is also in consideration that underperformance cases go unnoticed and this
has over time endangered the lives of patients.
e. Lack of early Problem Detection
From the report, it was clear that different committees of experts within the department
were fragmented. Further, they were also insufficiently resourced such that they could not timely
detect problems on safety and quality of care for patients so as to carry out follow-up activities
towards preventing them (Duckett, 2016). Cultural barriers within the health care facilities also
contributed to inability in detecting problems on patient safety and care quality. In this regard, it
was established in several facilities that there was utter discouragement, ignoring, and dismissal
of staff complaints. The report indicated that the neither the internal management within the
health system nor the regulatory oversight from the department could detect problems and also
failed in addressing them.
It is clear that this particular deficiency is related to Standard 1 of the NSQHS which
emphasizes the need for “Governance for Safety and Quality in Health Service Organizations.’
Specifically, the inability to detect problems within the health system falls under this standard’s
criterion that emphasizes the need for appropriate management of incidents and complaints
(ACSQHC, 2012). This is because from the report, incidents involving patient safety and/or
quality of care were ignored, left unanalyzed and unused in improving safety systems over time.
Conclusion
In conclusion therefore the essay above presents a section of the review of Dr. Stephene
Duckett’s report. It brings out the main deficiencies identified in the Victorian hospitals in regard

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to safety and care quality of patients. The deficiencies include a lack of monitoring tools and
capabilities, lack of early problem detection, inconsistency in performance, inaccessibility of
important information among clinicians, over-reliance on incapacitated hospital boards among
others. The main NSQHS which the deficiencies relate is “Governance for Safety and Quality
in Health Service Organizations.” They tally with the varying criteria under this standard.
However, there is one deficiency which relates to NSQHS number 5 which emphasizes on the
need for proper patient identification and/or procedure matching means. The standards can be
useful in addressing the deficiencies as unearthed by Duckett (2016).
PART 2
Change Management
Introduction
Considering Stephen Duckett’s review of the state of hospital compliance to safety and
quality of care standards, it is apparent that there is need for changes particularly in regard to
reporting of adverse events. The necessary change should also focus on addressing concerns
raised among the staff and from patients within the health facilities. Change is universal and it is
very necessary in regard to health care understanding that the latter is dynamic and requires
continuous improvement over time (Martin et al, 2012). Usually, there are internal and/or
external factors which influence change. These factors thus require to be adapted to, and aligned
with organizational culture within which new realities are embraced as they emerge in a constant
way (Kumar et al, 2015). Change is inevitable especially where new and improved results are
required. Main proponents of change theories have insisted that there is need for personal change
in order to bring about organizational change. A large section of the population are usually
resistant especially to personal change, understanding well that change requires more time, effort

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and even persistence. This is particularly based on the fact that people feel to have lost their old
ways, making them redundant, without knowing that change brings about learning new things
and growing. Considering recommendation 2.14.1 of the report by Stephen Duckette (2016), it
is necessary for health practitioners to be encouraged to report to their managers any concerns on
patient safety and quality of care. It is also important that there is a culture among workers to
report any concerns on safety and quality within the health facilities. This presentation will focus
on describing an implementation plan that will improve ward culture on reporting concerns on
safety and quality of care, in line with principles of change management and various theories of
power.
Change Process
In order to increase the probability of embracing organization change in that it would be
effective in a ward or hospital setting, it is imperative that nurses among other health
professionals are enlightened on change theories (Mitchell, 2013). Hospital departmental
managers and leaders in different healthcare teams should be thoroughly aware of necessary
change models in order ensure implementation, compliance and/or follow-up to newly set
standards aimed at introducing change in hospital units (Martin et al, 2012). While there are
numerous model of change, studies indicate that health care setting requires the infamous
Lewin’s model of 1947 and John Kotter’s model. Both of these models can be used in planning
improvement approaches in regard to reporting culture on safety concerns in a ward setting.
Lewin’s Model (1947)
Kurt Lewin’s model on change offers managers and change agents a framework to be
used in implementing any planned change item. According to the model, there are three stages in

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implementing change. They include unfreezing, moving and then refreezing as stated in Kumar
et al (2015). In regard to the unfreezing stage the model requires that the current situation be
assessed after which the workers and/or groups should be convinced on the need for change. This
is then followed by the mobilization of resources necessary for supporting the implementation of
the change process (Allen, 2016). In this case, the hospital management should convince the
nurses and multidisciplinary team working in wards on the need for proactive reporting of
concerns on safety and health to the management. The management should introduce
methodologies and resources to support this reporting from individual wards in the facility. The
unfreezing stage requires that change agents identify problems, decide on the necessary change
and creates awareness to others regarding it (Martin et al, 2012). This acts as motivation and at
the same time disruption of status quo forces is done. As a result, the affected individuals get
unsettled and discounted, leading to the developing of the need for change. Secondly, the moving
stage according to the model is where the agent of change (the hospital management), does the
identification, planning and implementation of the change items. At this juncture, a successful
unfreezing stage will be realized by where the driving forces exceed any existing restraining
forces according to Allen (2016). Change process is dynamic and this means that time remains
an important factor. Individual workers in an organizational setting as a hospital will have to
assume new tasks and/or responsibilities a factor that will ultimately slow down the activities
initially. This will however improve along the learning curve. The third stage of Lewin’s model
is the refreezing stage and it includes stabilization if the change process for sustainability
purposes (Allen, 2016). There is need for staff members as in the case of a hospital to be
supported till there is full acceptance of the change. The success of the change process will be

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realized at the time the change agent terminates the supportive relationship that was in place
(Mitchell, 2013).
Even so, Lewin’s change model is mainly criticized on grounds that it is too simplistic. The three
stage approach has also been questioned noting that it is limited changes that are small-scale; in
stable conditions according to Allen (2016). According to the critics, the theory is unsuitable for
large-scale and/or ongoing change in larger organizations.
Kotter’s Change Model (1996)
Kotter’s change model can be used in implementing change in large organizations. The
theory proposes eight stages that can be used to plan and implement aspects of change in any
given institution such as hospitals. These steps have been discussed below in the light of
changing the culture in a ward to ensure that there is proactive reporting of concerns on safety
and quality of care in hospitals.
The first step of Kotter’s model involves the creating the need for urgency in regard to
change according to Small et al (2016). In this step, staff members need to be motivated in order
to welcome the aspects of change through stressing on the need for correcting a particular
pressing issue (low reporting of safety concerns). The most effective way in this regard includes
identifying any potential threat and the development of scenarios to serve as examples to the
members of staff within an organization (hospital). There is also need for honest discussions
including provision of dynamic and/or convincing reasons to make individuals to talk and think
about (Ead, 2015). In order to improve reporting culture on safety within the ward, the nurse unit

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manager (NUM) can for instance, show the ward interdisciplinary team the probability of
sentinel events that could result from poor handover practices, and poor communication among
them in the ward. This will trigger a sense of urgency among them and bring them to talks and
thoughts on best practice and a need for change.
The second step of Kotter’s model requires that a strong coalition be formed in order to
convince individuals in an organization that there dire need for change (Kumar et al, 2015). The
coalition should be composed of leaders who can influence others to understand that there is
need to adopt new ways of doing things (Small et al., 2016). In regard to improving reporting
culture on safety within the ward the lead coalition should be developed and have a NUM,
resource nurses, educators for nurses, and the facility’s administrative clinical supervisor. It can
also include senior nurses within a hospital, who are usually passionate on safety and/or
communication.
In the third step, there is need for the change agents to come up with a change vision
statement which staff members can easily grasp and remember according to Kumar et al, 2015).
There is also need to create different initiatives which will help in achieving the vision set while
at the same time communicating appropriately regarding the change (Bradbury, 2014). In this
regard, the main vision can be “Improving ward reporting culture on safety and quality of care.”
The leaders can enable the staff members to adopt this vision through the use of trigger factors
derived from recent adverse experiences among patients and staff members.
Fourthly, there is need to communicate the change vision effectively in order to sensitize
the implementing staff on the change aspects (Appelbaum et al, 2012). In this regard, the what,
how and why questions on the proposed change should be addressed by the guiding coalition. In

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a hospital setting, the ward staff can hold educative sessions and/or staff meetings on weekly
basis to address issues on the need for proactive reporting of safety issues (Small et al, 2016).
For the fifth step of Kotter’s model, it is important to empower people to directly and
indirectly act on the set vision through involving them (Appelbaum et al, 2012). According to
Small (2016), change needs both understanding and enthusiasm from the rest of the team. There
is also need for autonomy in adopting and implementing aspects of change where possible. In the
case of a ward the interdisciplinary team should be encouraged to provide their suggestions
regarding the ways through which organizational culture on safety reporting can be improved
within the ward. In case there is need for anonymity, the guiding coalition can provide a
suggestion box in which ideas can be dropped for assessment.
The sixth step in this change model requires that short term wins be created through an
all-inclusive approach (Appelbaum et al., 2012). The generation and outlining of quick wins
helps in creating momentum of the project in that, members of staff are able see immediate effect
of the changes and gest motivated (Kumar et al., 2015). In case where step 5 has a good plan
being implemented like the strict reliance on a clinical handover framework which can
immediately show ward assistants that they are more effective and have fewer mistakes; this will
be considered a quick win. Where members of staff are able to complete shifts more efficiently
and then leave in good time, this can also be considered to be a quick win.
The seventh step involves the creation of momentum to bring about change through the
production of change aspects and building on it (Small et al, 2016). Those organizations which
succeed in their support and implementation of change usually improve continuously with a
maintained vision according to Bradbury (2014). In regard to the ward setting, the guiding
coalition on change should remain proactive in encouraging staff members to keep focus on the

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vision of change. This brings about openness and/or excitement on the change ideas that could
come in the future.
The eighth and last step of Kotter’s model of change emphasizes on the need for
institutionalization and solidification of introduced aspects of change in order to make the
initially set vision be a norm (Small et al, 2016). The step is imperative in regard to long term
success since new behavior can degrade as a result of any alleviation of pressure for change,
when not well solidified in time. For the case of the ward, the aspects of the desired change can
be taught to any new member of staff including floating staff members in order to make the
change foundational in the identity of the unit, making it part of the ward practitioners’ culture.
As a summary, the above theories have different individual pros and cons. Even so, I suggest that
the Kotter’s model be adopted in improving the safety reporting culture as it can be effective in
large organizations as compared to Lewin’s change theory. Kotter’s change model will also be
easier to be followed and it gives a more detailed breakdown of the framework within which
change can be implemented in a healthcare setting (Small et al, 2016). It is adaptable to any
given organizational setting and thus can be effective in this particular case.
Theories of power
Theories of power go along with planning and implementation of change in any given
organizational setting. Power plays an important role in organizational change according to
Stewart et al (2016). Individuals taking part in the change process participate in line with their
position within the organization, the power they have in the department and their individual
interests. The change process thus must involve discussions on the organizational structure,
system structure and power balance within the organization (Ead, 2015). At this point different
interest groups within an organization attempt to secure positions of power with different

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objectives and/or interests. There is normally some reported resistance to change due to power
struggles that ensue where individuals try to escape from and/or attain power in the wake of the
change (Stewart et al, 2016). One of the common power theories, include Weber’s theory that is
relevant in a healthcare organization setting. According to the theory individuals that possess
power like health care professionals need to surrender part of it in order to enhance change in the
system to empower users of healthcare services. For the case of implementing a cultural change
process in order to improve reporting of safety concerns, it is important for the hospital
management to surrender some of its powers to ward nurses and their assistants to investigate
and share information on safety and care quality of themselves and that of patients under care.
Conclusion
Victoria’s current healthcare system continues to struggle in regard to safety of patients
and care quality. Apparently, the review by Duckette (2016), calls for change within the
healthcare system. While people are normally resistant to change there is need to incorporate
change and power theories in order create positive impact especially in improving the culture of
reporting safety concerns within ward settings in Victorian health facilities as discussed within
the above essay. In the essay, the main change theories that can be used in this regard included
Kurt Lewin’s theory of 1947 and John Kotter’s theory of 1996. Weber’s power theory has also
been used in indicating the relationship between change and power. It is thus important for
power balancing in order to bring about a sustainable change process. These approaches as
discussed can be useful in improving the culture of reporting safety concerns in a ward within
Victorian hospitals an increase the quality of care for patients.

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Reference
Allen, B. (2016). Effective design, implementation and management of change in healthcare.
Nursing Standard, 31(3), 58-71. doi:10.7748/ns.2016.e10375
Appelbaum, S. H., Habashy, S., Malo, J. L., & Shafiq, H. (2012). Back to the future: revisiting
Kotter's 1996 change model. Journal of Management Development, 31(8), 764-782.
doi:10.1108/02621711211253231
Atsalos, C., O'Brien, L., & Jackson, D. (2007). Against the odds: experiences of nurse leaders in
Clinical Development Units (nursing) in Australia. Journal of Advanced Nursing, 58(6),
576-584. doi:10.1111/j.1365-2648.2007.04249.x
Australian Commission on Safety and Quality in Health Care (ACSQHC). (2012). National
Safety and Quality Health Service Standards. Sydney, NSW:ACSQHC. Retrieved from:
https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-
Sept-2012.pdf
Bradbury, E. (2014). Integrated care communities: putting change theory into practice. Journal
of Integrated Care, 22(4), 132-141. doi:dx.doi.org/10.1108JICA-06-2014-0022
Carlopio, J., & Andrewartha, G. (2008). Developing management skills: a comprehensive guide
for leaders (4th ed.). Frenchs Forest, NSW: Pearson Prentice Hall.
Department of Health and Human Services. (2016). The Report of the review of hospital safety
and quality assurance in Victoria. Melbourne: Victoria. Retrieved from:
http://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/
hospital-safety-and-quality-review

NURSING LEADERSHIP AND MANAGEMENT (MASTER OF NURSING PRACTICE)
Duckett S. (2016). Targeting zero: supporting the Victorian hospital system to eliminate
avoidable harm and strengthen quality of care. Report of the review of hospital safety and
quality assurance in Victoria. Victorian government, Melbourne.
Duckett, S. J. (2008). The Australian health care system: reform, repair or replace? Australian
Health Review, 32(2), 322-329. doi:http://dx.doi.org/10.1071/AH080322
Ead, H. (2015). Change Fatigue in Health Care Professionals—An Issue of Workload or Human
Factors Engineering? Journal of PeriAnesthesia Nursing, 30(6), 504-515.
doi:http://dx.doi.org/10.1016/j.jopan.2014.02.007
Freshwater, D. (2014). Board editorial: The challenge of global leadership: managing change,
leading movement. Journal of Research in Nursing, 19(2), 93-97.
doi:10.1177/1744987114524872
Kumar, S., Kumar, N., Deshmukh, V., & Adhish, V. S. (2015). Change Management Skills.
Indian Journal of Community Medicine, 40(2), 85-89. doi:10.4103/0970-0218.153869
Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing:
theory and application (6th ed.). Philadelphia: Wolters Kluwer Health/Lippincot
Williams & Wilkins.
Martin, G., Weaver, S., & Currie, G. (2012). Innovation sustainability in challenging health-care
contexts: embedding clinically led change in routine practice. Health Services
Management Research, 25(4), 190 - 199.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing
Management, 20(1), 32-37.
Robinson, M. E., Travaglia, J. F., & Braithwaite, J. (2008). An overview of clinical governance
policies, practices and initiatives...Braithwaite J, Travaglia JF. An overview of clinical

NURSING LEADERSHIP AND MANAGEMENT (MASTER OF NURSING PRACTICE)
governance policies, practices and initiatives. Aust Health Rev 2008;32:10-22. Australian
Health Review, 32(3), 381-382.
Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using
Kotter's Change Model for Implementing Bedside Handoff. Journal of nursing care
quality, 31(4), 304-309. doi:10.1097/NCQ.0000000000000212
Stewart, E. A., Greer, S. L., Wilson, I., & Donnelly, P. D. (2016). Power to the people? An
international review of the democratizing effects of direct elections to healthcare
organizations. International Journal of Health Planning & Management, 31(2), e69-e85.
doi:10.1002/hpm.2282
Tuan, L. T. (2015). Nursing governance and clinical error control. International Journal of
Pharmaceutical and Healthcare Marketing, 9(2), 136-157.