Analyzing Healthcare Quality: Staff Retention, Strategies and Audit

This report delves into the critical aspects of healthcare quality improvement, addressing staff retention challenges within healthcare organizations. It begins by defining clinical governance and its role in enhancing patient care and satisfaction. The report then utilizes Ishikawa's Fishbone diagram to analyze the causes of nurse attrition in Hong Kong hospitals, exploring factors such as overcrowding, staff issues, and poor remuneration. Strategies for mitigating these issues, including flexible working conditions, improved communication, and fair compensation, are proposed. Lewin's Force Field analysis is introduced as a tool for managing change within healthcare practices. The importance of clinical governance strategies, SMART standards, and audit processes for monitoring and sustaining improvements is also highlighted. The report concludes by emphasizing the need for continuous improvement and adaptation in healthcare management to ensure long-term quality and staff well-being.

Improving the quality of healthcare

Table of Contents
Introduction...................................................................................................................................3
Strengths and limitations of Ishikawa’s Fishbone............................................................................3
Analysing causes from the above scenario.......................................................................................6
Strategies to reduce causes identified from Fishbone.......................................................................7
Role of Lewin’s Force Field analysis for helping staff to change the practice...................................8
Clinical governance strategies.........................................................................................................9
Importance of SMART standards.................................................................................................11
Role and methods of Audit used for monitoring change................................................................11
Conclusion....................................................................................................................................12
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Introduction
Clinical governance is defined as the process used for continuously improving overall process
for improving quality (Adepoju et al. 2015) in a health care organisation. It is used for
safeguarding the interests of the people admitted at the hospitals and maintains a quality
environment in the clinical organisation. It is used for providing top quality and satisfaction
service for the patients admitted at the (Wong et al. 2016) hospitals. The study on the quality of
health care focuses on implementing the correct strategies required for improving the overall
staff practices at the organisation. The study provides a brief overview of the relevant conditions
at the hospital by using Ishikawa’s Fishbone framework. The use of the framework in the
underlined scenario helps to analyse causes for leaving of nurse from the hospitals in Hong
Kong. It helps to measure possible causes and helps to improve overall quality process at the
health care organization. Nurses at Hong Kong leave due to problems of overcrowding. Nurses
get disturbed both physically and mentally. They move out of exhaustion. Patients and doctors
get stretched up to the point breaking. Stressful situations cause nurses to move out of the
hospital premises.
The study helps to implement correct strategies for understanding overall problems regarding
handling staff at the hospitals. The various strategies used for reducing overall problem in
maintaining staff at the hospital is by creating quality circles and improving complaints
management process for the hospitals. It helps to shed light on analysing role of clinical
governance and improving overall health care environment process. The study provides a brief
analysis of the audit process used for monitoring overall change process in the management of
the hospitals. It helps to analyse weakness in the functions of the management of the hospitals
and provide quality service to the patients at the hospitals. It is necessary for maintaining quality
principles by staff at the hospital and improving overall process in the future. The study focuses
on establishing correct smart standards and developing the process by providing solutions for
implementing change in the management. A change is necessary for maintaining long term
quality standards and reducing overall issues in the health care management process.
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Strengths and limitations of Ishikawa’s Fishbone
Cause and effect diagrams or the Ishikawa’s fishbone diagram has proven to be real handy tools
while seeking the cause of some kind of an effect. Such diagrams help in the exploration of the
different causes followed by the display of such causes in the form of proper structures (Vetter et
al., 2016). The role of the fishbone diagram is to bring about the relationship that exists between
the cause and the effect and presents such a relation in the form of graphical representation or
diagrams. The representations explain the causes that lead to the effects and the bond that makes
it all happen. The fishbone diagram is a very important tool to that actually play important roles
in the identification of the many dormant factors that otherwise lay hidden and leads to
insufficiency in the healthcare services. The complete treatment procedures transparency of each
and every single bit of information related to the cause of the problem to be dealt with. Fishbone
diagrams do its part to reflect the dormant facts that stand as obstacles hindering the progress of
the efficient and uninterrupted procedures of treatment (Gartlehner et al., 2017). Fishbone diagrams
serve as a medium enabling the team in action to focus their attention over the areas that demand
strict improvements and other progressive procedures for serving people better. The areas that
demand improvements are brought into light via the graphical representations made via the
fishbone diagrams. It acts as a great tool for the teams who demand emergent information for
strict implementation of actions without any kind of delay. The diagram is so designed that each
arm of the diagram is the result of some kind of a contribution by the members who are
associated with the team in action. Each arm of the diagram is informative, that is, it has
something in particular to deliver, as in some kind of information (Rodgers and Oppenheim, 2019).
The generation of such kind of information is the result of some real brain-cracking actions, the
pain of which is taken up by the various members involved with the team identifying the cause
and the effect of a problem. For example the right people with right skills would be needed to
sort situations out. The problem needs to be discussed and clarity is to be attained to acquire
solutions.
Fishbone acts as the most effective tool when implemented via the combined efforts and actions
of a team in action (Wong et al., 2016). The problem arises when the team does not work as a
strong and single unit united by a sense of purpose and determined to seek the answer the
question that starts with a why.
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People
Place
Policies
Procedure
Peripher
al
cannula
linked
infection
s
Role
models
Poor technical
expertise
No designated
area
Perceived lack of
need
Inappropriate use of
equipment
Not following
procedures
Ti
me
Poor hand
washing
Lack of guidance /
policies
Reduced staffing
levels
Figure 1:
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Analysing causes from the above scenario
The above scenario focuses on problems related to resolve issues regarding staff retention at the
hospitals. It is clear from the above scenario that most of the nurses are leaving their jobs from
the hospitals due to bad working conditions at the hospitals. There are various causes which lead
to possible leaving of work by the nurses from the hospitals. The retention of nurses is essential
for providing correct treatment for the patients. It helps to maintain overall quality of the services
offered by the hospitals (Adepoju et al.2015). The non-cooperation of staff with the nurses,
absence of providing correct training facilities for the nurses and poor re-numeration system
affect the working process of the nurses at the hospitals. It provides a negative image to the
nurses and nurses are not willing to participate in the process carried out by the hospitals. Ex-
The nurses do not provide basic information to relatives of patients regarding use of correct
methods for treating people in the hospitals. There is a severe dis- agreement between the two
parties and non-maintenance of co-operation
 Non-cooperation of the staff with nurses
In the above scenario there is lack in collaboration with the nurses and the staff of the hospitals.
It affects overall retention of the nurses and they feel unhappy to work in the current
environment. The nurses are treated lower than the other staff working at the hospitals. It affects
the performance of the nurses and leads to leaving of jobs by the nurses from the hospitals
(Sweeney et al. 2015). They are given lower respect than other staff in the hospitals which has a
negative effect on the nurses.
 Poor remuneration system
A poor remuneration system is also another cause responsible for leaving of jobs by the nurses
from the hospitals. The nurses are not given proper respect and not provided with correct wages
at the hospitals. The poor re-numeration system is a major cause for shortage of nurses from the
hospitals (Yew et al. 2018). They are not paid correct wages in accordance with the performance
at the hospitals. It causes discrepancy and there has been a tremendous reduction in the
population in the last few months.
 Absence of correct training equipment
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Training is considered to be a primary part in retention of population of nurses at the hospitals.
The presence of correct equipment is necessary for providing correct treatment to the patients at
the hospitals. There has been a lack in the total number of equipment for providing quality
training for the nurses. It leads to dissatisfaction of work shown by the nurses and affects overall
staff retention process (Zingg et al. 2015).
Strategies to reduce causes identified from Ishikawa’s Fishbone Diagram
The Fishbone diagram is used for identifying possible causes related to staff retention of the
nurses for the hospitals. There can be use of correct strategies for reducing staff retention of
nurses at the hospitals. The main strategies used for attracting more nurses are as follows:
 Provide more flexible working conditions
It is necessary for maintaining flexible working conditions for the staff at the hospitals. This
helps to retain much more members in the hospitals by maintaining a separate committee for the
staff members at the hospitals. It helps to increase overall part time workers and manage more
staff members at the hospitals (Choy et al. 2018).
 Develop more communication and collaboration with the nurses
There is a need for maintaining better communication methods with the staff members of the
hospitals. It helps to analyse overall working problems of the nurses and eradicate possible ways
for communicating in a better way with the nurses (Dabholkar, 2015). A separate HR department
has to be set up for listening to the needs and problems of the nurses. It helps to identify correct
working problems faced by the nurses at the hospitals and asses need for bringing in correct
policies for the staff members at the hospital.
 Maintain correct remuneration system
The remuneration system is regarded as one of the main methods for maintaining nurse retention
at the hospital. There should be equal payment of wages for every member working in the
hospitals. It helps to provide equal respect for the members working at the hospital (Slade et
al.2018). The remuneration system should be based on good working process provided by the
staff. It helps to maintain balance of work between the nurses and satisfy staff at the hospitals.
 Develop a structured planning system for providing transparency in the system
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There is a need to develop a new way of recruiting staff for the hospitals. It will help to develop
a new integration system with the HR department and maintain retention of nurses. The process
of adopting new recruitment system for the hospitals helps to provide positive ways for assessing
talents of the working members at the hospital (Epstein et al. 2017). It improves the efficiency
of the recruiting system.
 Maintenance of good working conditions
The maintenance of good working conditions at the hospitals helps to satisfy nurses working at
the hospitals. There should be less stress work applied on the nurses which helps to increase
overall morale of the employees. There should be introduction of rotational shift and specified
working hours for the nurses. It helps to boost nurses and they feel free to work with an open
mind by treating patents. It is regarded as a well-structured planning method for retaining most
of the nurses at the hospitals (Fougère et al. 2016). The good working conditions are responsible
for reducing problems of the nurses and act as a performance indicator.
Role of Lewin’s Force Field analysis for helping staff to change the practice
Lewin's Force Field anlaysis is regarded as one of the most effective tools used for analysing
need for change in both internal and external environment. It helps to assess driving forces which
are needed for bringing about necessary change in the working environment. There are two types
of forces present in the method. It is used for understanding the growth factor and the other force
which decreases overall efficiency of the company (Reiss-Brennan et al. 2016). According to
this case scenario, the model is efficient for understanding the cause of the problem and provides
correct strategies for reducing the problems. According to the Lewin’s model, there is a need for
bringing about a change in the decisions taken by the management. The change strategies have to
be implemented by the management for evaluating problem and maintain retention of staff at the
hospitals.
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A change is necessary for the healthcare environment. The Lewin’s Model suggests that various
outcomes of the restraining forces were working in collaboration, better communication, solving
of ethical issues and providing utmost care for the nurses. It helps to identify correct factors for
identifying various operational problems at the hospitals. This model is efficient for solving
numerous problems of retaining staff operation at the hospitals. It provides a guideline for
understanding correct forces operating behind decrease in number of nurse members from the
hospitals (Glazer et al. 2017). There is a need for elimination of the operations and maintain
correct nurse retention strategies for the hospitals in the future.
Clinical governance strategies
There is a need for implementing correct clinical governance strategies for assessing overall staff
retention policies by the hospitals. The two clinical governance strategies adopted for
maintaining overall quality and nurse retention for the hospitals are as follows:
 Training and education
This strategy is used for promoting change and improvement in the process of the management
by the hospital. It is important for providing correct treatment to the patients at the hospital.
There is a necessity for providing correct medical and training equipment for the nurses. It helps
in assessing overall treatment facilities of the hospitals. Ex- The nurses adopting correct training
methods helps to understand problems of the patients and provides improved health care
conditions.
The management has to provide advanced medical equipment and opportunities in training for
bringing in professional development of the nurses (Reeves et al. 2017). This helps to provide
more confidence of performing better work by the nurses. The main way of implementing the
strategy is to create more simulation classes and training activities for nurses and doctors. It
helps to provide more work support for the nurses and improve overall performance of the staff
members (Hardyman et al. 2015). The availability of enhanced training helps to regulate the
activities of the nurses at regular intervals. There should be introduction of group discussion and
addition of seminars and workshops for providing proper training for the nurses. The process is
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necessary for increasing attributes and skills of the nurses and help to recruit more staff in the
future. It helps to assess future costs and create proper strategies for the organization. This is
essential for creating supportive operations within the organization. Ex- There is a coordination
among various department within the organization.
 Complaint management
This strategy is used for maintaining continuous improvement in the management system of the
hospital. There is a necessity to gather patients and feedback of the staff at the same time. The
HA advises that proper care should be a taken for handling various complaints against the
patiemts.method is adapted for gathering valuable data feedback and maintaining quality
improvement (Hayes et al. 2015). The following system can be used for getting valuable
feedback from the patients:
 Proper ensurity of taking good care of the patients admitted at the hospital by the staff
members.
 Maintaining an efficient feedback system for regularly listening to the problems of the
patients
 Regular maintenance of the feedback system and performance review of the staff
members
The entire complaint management system is made up of five elements. The five elements are as
follows:
People
The person responsible for handling complaint process has to be professionally skilled and
trained.
Culture
The complaints have to be attended in a proper way for improving overall relationship with the
patients. It helps to asses long term relation with the patients and maintain a quality image in the
market.
Process
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The complaint handling process has to be divided into seven stages like assessment, planning,
response, investigation, efficiency, integration and ability to respond.
Principles
The complaint handling system should be fair, effective and quickly respond to any problem.
Analysis
The information gathered from the patient has to be reviewed and assessed n a correct way for
improving overall image of the organization.
These issues can be resolved by creating safe complaint procedure and fulfilling guidelines in the
organization. There is poor staff retention in an organization due to bad behavior shown by the
administration. These have to be resolved by creating long term relationship with the staff
working for the company. It helps to improve workplace procedure.
Importance of SMART standards
The standards are considered to be an important aspect of the business and help to create future
direction for managing the staff at the hospital. It helps to motivate the performance of the nurses
and set future targets for the management (Johnson et al. 2015). This focuses on every criterion
necessary for achieving overall objectives in the future. The standards are referred to as specific,
measurable, achievable, reliable and time table. It helps to set clear goals for the organisation and
evaluate correct methods for achieving goals at a quick time.
The standards for each of the clinical governance strategies are as follows:
Handling complaints- Stability in workforce
Education and complaints management – staff retention
Analyzing trends- Financial management
Training and education management- Retention of nurses
Role and methods of Audit used for monitoring change
The audit is considered to be an effective strategy used for handling various problems in the field
of clinical governance. The clinical audit is referred to as critical analysis of quality health care
process followed in the organization. It is used to analyze effective feedback data from the
patients and provide correct methods to improve care offered for the patients within thesystem
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