Service Improvement in Acute Medical Units: Importance and Suggestions

This essay discusses the importance of service improvement in acute medical units and provides suggestions for improvement. It covers the subject of healthcare delivery systems and the National Health Services of the UK.

Running head: SUPPORTING SERVICE IMPROVEMENT
Essay
Name of the Student
Name of the University
Author Note

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Healthcare or health-service delivery systems are generally considered accessible,
safe, people-centred, integrated, and of high quality, which are imperative for working
towards widespread health coverage for all patients. The health service delivery systems have
been identified accountable for delivering appropriate health services to persons, patients,
their families, population and the communities in general, in addition to only caring for the
service users (Acharya et al. 2017). Patient-centred care approaches have been commonly
stated as the healthcare discipline that places a focus on all individuals seeking care service
that is the patients (Bell 2014). The concept of people-centred care incorporates a range of
clinical encounters and take account of detailed attention to the health of the affected people
in specific communities (Brownie and Nancarrow 2013). It also plays a critical role in
determining healthcare services and policies in a particular region. Health service delivery
systems should also take into account the wide spectrum of care that is related to the
prevention and promotion of health disorders, to rehabilitation, diagnostic, and palliative care
techniques. Furthermore, service delivery also encompasses different levels of care such as,
home care, self-care, primary care, community care, hospital care, and long-term care for
providing an integrated service, throughout the life of the patients.
The primary goal of service improvement encompasses formulation of strategies that
helps in achieving high quality experiences for all patients, higher than what the NHS is
presently achieving. In other words, the domain of service improvement can be defined as a
combination of a plethora of healthcare associated disciplines, with the aim of designing or
building a culture that is found to be extremely supportive of improvement (Fitzgerald et al.
2013). It also uses principles that are related to organisational development. The primary
objective of such programs is to combine the techniques and tools that focus on quality
improvement, in addition to effective leadership and organisational development. This essay

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will discuss on service improvement in an acute medical units, in accordance with the
National Health Services of the UK.
Importance of service improvement- Service improvement is necessary in healthcare
since the goal of the procedure is to obtain high quality experiences for all patients. The NHS
England is a non-departmental, executive public body that oversees planning, delivery,
operations and budgets of the health and social care services, as enforced by the Health and
Social Care Act 2012. In recent years, the NHS has been found to suffer from a range of
momentous operational and financial pressures, concomitant with a range of services that
struggle to maintain the principles of healthcare. This calls for the need of local and national
leaders of the NHS to put their attention on bringing about improvements in the quality and
delivery of healthcare services that are better in their values (Batalden et al. 2015). Hence, all
the NHS organisations should place due focus on enforcing strategies that would facilitate the
process of continuous improvement in the quality of care services, for all service users. This
commonly encompass strategies that would work towards improving the effectiveness, safety
and care experiences of the patients (Robert et al. 2015). This calls for the need of service
improvement.
Acute medical units act as the first entry point for all patients who have been referred
to hospitals as emergency cases by the general physicians. Owing to the fact that these acute
medical units (AMUs) have a busy environment and an estimated 30-50 patients get admitted
there every day, there is a need to bring about service improvement for enhancing the health
outcomes of the patients. These medical units should try enforcing service improvement
strategies since they have the primary role of maintaining highest care quality and treatment
for all service users. AMUs involve a huge number of professionals in the work, all
belonging to different disciplines such as, nursing, medical, therapies, administration and
therapies (Chotirmall et al. 2014). Service improvement is also required in the AMUs in three

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major areas namely (1) improvement in the quality of care services, (2) improvement in the
broader wellbeing and health of the entire population, and (3) improvement in the financial
efficiency. The fact that patients in the AMUs are not admitted for long-term stays in the
area, and are expected to get discharged or shifted to speciality wards within 24-48 hours of
admission can also be considered as a primary reason for implementing service improvement
approaches in the unit (University Hospital Southampton 2016).
All organisations under the NHS are required to take steps that would improve the
quality of the healthcare service that they deliver. The NHS has taken attempts at modifying
health services based on three different criteria such as, safety, experiences of care services,
and effectiveness of the care services. This makes the NHS make all organisations follow the
guidelines pertaining to not harming the patients, showing compassion, respect and dignity
towards all, and preventing premature death of the service users, thereby enhancing their
health-related quality of life (England.nhs.uk 2018).
The National Early Warning Score (NEWS) is one such approach adopted by the
NHS in ambulance and acute settings that facilitates the diagnosis and response to all forms
of clinical deterioration among adult patients. Thus, the NEWS acts as an essential element of
improving patient safety and subsequent health outcomes (England.nhs.uk 2018). The NHS
has also emphasised on the implementation of red trays in hospitals for assisting the medical
and nursing staff to identify patients who require extra attention while eating, or require foods
with modified textures in pureed or mashed forms. Thus, red trays are also another important
service improvement tactic that helps in monitoring patients in AMUs and verifies whether
their dietary requirements have been met (Sandwell and West Birmingham Hospitals 2013).
However, lack of uniform implementation across all hospitals in the UK, is a potential
disadvantage of the NEWS.

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Suggestions for improvement- Assistant practitioners refer to experienced healthcare
staff who work in supporting roles, along with qualified healthcare professionals in a hospital
setting. My role as an assistant practitioner requires me to have the necessary expertise and
skills in the acute medical units, my speciality of clinical practice. I have the role of working
under the supervision of health professionals such as, nurses, podiatrist, biomedical scientists
and dieticians. Some of the most common skills that are required to be operated upon patients
in the AMUs are holistic needs assessment, cannulation, phlebotomy, chemotherapy side
effects and symptom assessment, urinary catheterisation, X-rays, delivering radiotherapy,
delivering patient information, and medication administration (Costa et al. 2014).
Whiteboards are found to be widely used across the AMUs. Whiteboards are considered as a
reliable method of taking records that pertain to the status of all patients (Kendall et al. 2015).
Furthermore, the whiteboards also facilitate communication with the service user and their
family members and help in noting down the tasks that are intended to be performed, disease
diagnosis, and the team looking after the patients. However, failure to update them in an
accurate and prompt manner reduces their reliability and leads to subsequent delays,
duplications or other errors (O’Brien, Bassham and Lewis 2015). My role as an assistant
practitioner requires me to manually update all the whiteboards, thereby reducing the time of
patient care and succumbing to the pressing and immediate needs of the patients. Service
improvement can be brought about in the AMUs by replacing whiteboards with digital
boards. These boards would display the patient information in an organised manner and make
it easier for the service users and their family members to understand the proposed plan of
care (Rasmussen and Kushniruk 2013).
The information will be displayed in an easy-to-read typeface, when compared to
handwriting on whiteboards. They would also encourage all patients to act as active
participants in their care planning process (Rasmussen and Hertzum 2013). With the use of

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digital patient boards, I shall be able to simplify and explain the nursing acronyms used for
diets, mobility statuses and a range of clinical terms, thereby putting the patients in a position
die supporting care coordination of the initiatives. This would directly increase patient
satisfaction scores and increase the time devoted towards the patients. Use of patient booklet
can be another effective strategy for service improvement in the AMU. Patient information
booklets would allow the patients, carers, family and friends gain a sound understanding of
what is expected from the healthcare organisation. It will also facilitate gaining a sound
understanding of the fact that the best possible care standards are being utilised, while
treating all patients in the AMUs. Patient booklets are integral for improving communication
and create a positive impact on the quality of care services, medical decisions and eventual
discharge of patients (Little et al. 2013). Thus, the communication tool can be used for
explaining all aspects of AMU care, managing the expectations of the patients, keeping them
updated on the care development process, and outlining the steps that would follow. This
service improvement tool wold directly help in enhancing health outcomes, while
maintaining patient safety. I would also take responsibility of the ward stock inventory.
Appropriate use of medicines in AMUs is a multidisciplinary responsibility that
encompasses the selection and management of drugs, medication administration, drug
procurement, storage and review, and monitoring medicine effects (Uthayakumar and Priyan
2013). I would get directly involved with stock management of drugs. Stock management
would encompass replenishment of the bulk ward stock, individual medication orders, unit-
dose systems, and automated dispensing of medications. The pharmacies generally function
in the form of warehouse and are found to dispense bulk containers. Efforts will be taken to
review the individual medication orders for patients, in order to determine their
appropriateness. A track of the inventory will be kept at all times, in addition to replenishing
the stocks when the levels have been reached for the AMU (Coelho and Laporte 2014).

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Service improvement can also be facilitated by reducing the time needed for inventory
checking. Hospital discharge rates help in evaluating the number of patients who leave the
healthcare setting after receiving care services. Conduction of hospital discharge surveys
would be another essential service improvement approach. Once a patient has been admitted
to a hospital, the care plan development begins. Responses from a hospital discharge survey
would help in determining whether the patients required more care and would also facilitate
an assessment of their satisfaction (Buller et al. 2015). This would directly create an impact
on service improvement by determining whether the patients experienced delays in their
discharge, were involved in all decisions that were made in their care plan, and of the care
services were tailored to their preferences and needs. This would lead to gaining a deeper
understanding of the approaches that can be adopted to deliver tailored healthcare services
and would also help in implementation of high quality care standards to enhance patient
outcomes.
Infection control- This refers to a discipline that is concerned with the prevention of
healthcare-associated or nosocomial infections across hospital settings and is a major
component of public health practice (Sodhi et al. 2013). The primary aim of infection control
is to address the spread of infections within the healthcare units, monitor and investigate
them, and management their outbreak. Infection control can be considered as an essential
aspect of healthcare service improvement since transmission of infections within hospitals
have been recognised as a major problem that violates patient safety and adversely affects all
service users, their visitors and the healthcare staff involved in delivery of the care plans
(Tacconelli et al. 2014). Thus, prevention or control of such infections are a major
prerequisite for achieving the service improvement goals, outlined by the NHS. Some of the
common infection control practices that can be implemented encompass hand hygiene,
cleaning, sterilisation, disinfection, and use of personal protective equipment (PPE).

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Adherence to hand hygiene practices after coming in contact with the skin surface or
body fluids of patients are crucial for preventing the spread of germs. PPE include disposable
gloves, fluid-resistant gowns, and eye protection, or face masks that should be put on, after
assessing the risks of exposure to contaminated surfaces or body fluids (Rosenthal et al.
2014). Furthermore, maintaining appropriate respiratory hygiene and cough etiquette,
disinfecting all surfaces that are in contact with patient body, and use of sterilised instruments
are some of the approaches that will have been found effective in controlling HAIs, thereby
maintaining patient safety. One of the key attributes of the Health and Social Care Act of
2008 is prevention and control of infections. It advices the infection control teams to work in
close collaboration with the managers, members of the trust board, and all healthcare workers
to minimise the risks of infection to the patients. Conducting regular trainings on infection
control, in addition to weekly audits are some of the major strategies that have been found
effective in accomplishing the intended goals. The Act also states that good infection
prevention and cleanliness plans are indispensable for ensuring that the service users receive
effective and safe care (Department of Health 2015). Effective control and deterrence of
infection within healthcare settings have also been recognised a part of daily practice and
consistently applied across hospitals.
Good organisational and management processes are decisive in ensuring that the
highest infection prevention standards are established and maintained. The part 2 of the Code
of Practice also sets out 10 criteria that helps the Care Quality Commission (CQC) to judge
the compliance to infection prevention practices, as established by the regulations. The Code
of Practice states that healthcare systems must monitor and manage the control and
prevention of HAIs by conducting risk assessment and taking into account the susceptibility
of the patients to such conditions (Department of Health 2015). Furthermore, the guidelines
also illustrate the importance of providing and maintaining an appropriate and clean

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environment, use of antimicrobials for optimising patient outcomes, and providing accurate
information to the service users and visitors on infections.
In addition, people at a risk of developing such infections must be promptly
identified, provided secure isolation facilities and increased access to laboratory support
(Department of Health 2015). The NICE has also formulated a set of guidelines of quality
statements regarding antimicrobial stewardship, organisational responsibility, urinary
catheters, hand decontamination, vascular access device, and infection control education. A
major advantage of these guidelines can be attributed to the fact that they have taken into
account several aspects of antibiotic resistance and consider it essential to prescribe
antibiotics only when required, and not for the self-limitation of mild infections. In addition,
another advantage of the guidelines can be associated with the role of effective hand
decontamination in reducing transmission of potential pathogens and decrease in the
incidence of avoidable HAIs (Nice.org.uk 2018).
However, there are some disadvantages of the policies and benchmarks. At certain
instances, the healthcare workers fail to appropriately assess risks of contamination, prior to
interaction with patients due to lack of identifiable clues. Use of barriers can be accurately
implemented only when the healthcare workers have a clear medical knowledge of the
pathogens and their mode of transmission. Even after complete adherence to hand hygiene
protocols, some risks still persist regarding removal of pathogens from the hands. In other
words, most infection control strategies formulated by the government agencies have the
potential of lowering the risks of nosocomial infections.
Reflection- My reflective account is regarding the allocation of a healthcare personnel
for the use of pressure relieving device such as, pressure mattress. The primary objective of
installing these devices in the AMU is associated providing a confirmed support that has the

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ability to distribute the body weight of the patients over a uniform area. Pressure care
mattresses are designed in a way that prevents onset of pressure ulcer or pressure sores
among susceptible patients. These refer to pressure injuries that occur due to localised
damages to the skin and its underlying tissues, occurring over regions of bony prominence
due to pressure, friction and/or friction (Coleman et al. 2013). I intended to begin the use of
pressure mattresses upon finding patients at risks of pressure injuries in the AMUs, as
evidenced by proper clinical reasoning and risk assessment.
The pressure mattress was also envisioned to be used in situations where the risks of
pressure ulcer could not be mitigated by any other pressure management techniques or
equipment (McInnes et al. 2015). I had the directed vision of allocating the champion who
would inflate the pressure mattresses on the patient beds, in place of corridors, after matching
the mattress with the current and future pressure needs, comfort levels and transfer techniques
of the patients. The champion should also have the capability of identifying failure of
equipment and organising repairs (Meaume and Marty 2015). Furthermore, the champion
should be able to install the mattress on beds in a way that allows redistribution of the weight
of the patient, with the aim of relieving major pressure points.
The RAPSIES model can be used as an effective framework for bringing about this
change in the AMU. The model comprises of seven steps namely, (1) recognition of the need
for improving an essential practice element of solving a problem, (2) analysis of available
options that are associated to the contemplate change, (3) preparation for the change by
identifying change agent (a champion in this case), (4) choosing implementation strategies,
(5) change implementation, (6) effectiveness evaluation, and (7) change sustaining (Gopee
and Galloway 2013). The model requires the change initiator or the change agent to possess
liberty of adapting or modifying the steps of the model in accordance to the values of the
local setting and culture, thereby enhancing the likelihood of its effective implementation.

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Use of the model would facilitate the change management procedure in the acute medical
unit.
Thus, it can be concluded that service improvement in healthcare involves practices
that focus on making the healthcare effective, safe, patient-centred, efficient, timely and
equitable. The NHS has placed much focus on improving the overall quality of the healthcare
services that are delivered to all service users. It focuses on one essential aspect of the service
improvement agenda, quality improvement. Efforts are taken to identify appropriate
industrial or organisational approaches that are aimed at quality improvement. The primary
objective is to bring about measurable developments in hospital settings, which in turn is
facilitated by the application of pre-determined scientific methods. Thus, service
improvement also consists of continuous and systemic actions that result in
determinate improvement in the health status of the target patient groups.
Models of service improvement should most commonly encompass organisational
and personal development, systems and processes thinking and involving all carers, staff, and
users, with the aim of assessing the needs and experiences of the latter. Hence, clinical
practice are developed in a way that creates opportunities of progresses in every aspect of
healthcare. Furthermore, reduction of healthcare associated infections are one of the major
priority programs for service improvement. To conclude, there lies a scope of putting a range
of service improvement methodologies into healthcare practice, which in turn would help in
the effective spread of good practice and adherence to policy initiatives.

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