Assessment 1: Nursing Leadership for Quality and Safety in Healthcare

This nursing assignment addresses key concepts in healthcare quality and safety, focusing on three short answer questions. The first question defines Total Quality Management (TQM) within a healthcare framework, emphasizing collaborative, patient-centered care and the principles of strategic improvement, integrated systems, decision-making, effective communication, a customer-centric approach, employee involvement, and continuous improvement. The second question explores patient safety, defining it as a continuous process of risk-free healthcare and highlighting the difference between patient safety and workplace safety. The third question defines safety culture in a healthcare organization as the integration of safety behaviors within the work culture, emphasizing the importance of organizational policies, measurement tools, and the impact of a poor safety culture on patient and staff well-being. The assignment draws on various research sources to support its arguments, reflecting the student's understanding of quality and safety in healthcare delivery.

Running head: NURSING
NURSING
Name of Student
Name of University
Author note

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ANSWER TO SHORT QUESTIONS
Response to question 1
1. Total Quality Management in a health framework means striving towards a more
efficient and effective collaborative patient centered care by all the health care
professionals working in the organizational framework. Firstly the most important
principle is a ‘Strategic Approach to Improvement’ – the health care organisation
must set up their infrastructure and services with a mission, a vision and a specific set
of goals, and mission (Al-Shdaifat, 2015). Having the right strategy towards
optimizing the level of patient satisfaction after having received a care and the quality
of service delivered. This principle requirement can be fulfilled through devising of
the right change health plans and strategies (by using the appropriate health change or
practice change model) by the policy makers and administrators of the health
organisation. Secondly the second principle ‘Integrated System’ is critical to Total
Quality management of health care industry. In health care organisation – there are
different departments and specialties such as neurology, orthopaedics, surgery,
radiology, blood banks, pathology, psychiatry, physical therapy department and many
more. Hence it is cardinal to have the governmental and organisation health care
policies integrated with the health care system (Vituri and Évora, 2015). The quality
policies, objectives along with the organisational quality standards must be clearly
integrated with all the departments present within organisational framework. Another
important principle of TQM is Decision Making. Empowering all the staffs (in
different health service hierarchies) and in a trans-disciplinary scenario – to take an
problem solving approach to making of effective decisions. The health administrators
along with medicals managers must the apt persons to take the most critical of
decision under the most challenging circumstances and take innovative steps towards

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health service quality change. Then comes the cardinal principle of communications –
it is highly vital that the health care organisation must maintain the right
communication with all its employees and the health care specialists and staffs must
also communicate effective to raise the quality of care. Effective communication
between the multidisciplinary staffs working in the same hospital is critical to avoid
workplace disruption and patient dissatisfaction and foster a streamlined clinical
operational flow. Taking a ‘Customer Centric Approach’ is imperative to the health
care quality development and to creating a space for continuous quality development
in patient servicing.it is highly important that in a health care framework – each and
every health care professional and supportive staffs take up a ‘patient centered care’
in order to raise the standards of TQI. Employee Involvement – involving and
engaging the staffs working in the health care organization effectively with their jobs
and key responsibility areas in such a way to that their esteem and belonging needs
are facilitated on a regular and continuous basis is vital to TQI (Marx, 2019). Hence,
employee engagement is the principle that is to be integrated with the organizational
employee policies. Continual Improvement – fostering a continuous change with the
modern biomedical technologies and the trained, educated health care staffs is vital.
Overall, ‘Lean thinking’ is a business methodology where creative, innovative
thinking is empowered in organizational culture to foster continuous quality
improvement. In all the above mentioned TQM principles applied to health care – this
business based quality improvement approach has to be taken up by all the health care
and supportive professionals to improvise their decision making to more effective
goal setting and achievement.

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Response to Question 2
‘Patient safety’ refer to the continuous process of delivering a safe risk free healthcare
service to the patient in an increasingly striving effort towards a high quality health care
service within an organization. Patient safety refers to the process of eliminating the risks
associated with lack of hand hygiene or sterilization of surgical instruments or cross
contaminations plus the risks of falls and other severely developed complications due to
missed areas of health care (McFadden, Stock & Gowen 2015). Overall the need for patient
safety is referred to as the continuous quality improvement in fostering a risk free clinical
service delivery (Copeland & Henry, 2017).. In health industry, there is a continuous scope
for quality development and the clinical environment in a health care framework requires
continuous quality check and up-gradation, in order the most effective forms of patient
centered care in a safe, risk free manner (Do Byon, Storr & Lipscomb, 2017). Total quality
management or continuous quality management are based on certain specific principles and it
can be correlated with health care. An integrated system of safe practice policy principles
with sustainable and continual development for the staffs is critical to bring about an effective
practice change (Aoun, Hasnan & Al-Aaraj, 2018)..
There is a major difference between patient safety and safety in health care which
must be taken into vital consideration. Patient safety, as mentioned refers to the act of
ensuring all possible care and interventions that eliminates the risks of patient’s health
deterioration or the development or causation of a life threating adverse clinical event. While
patient safety, by the term and meaning refers to delivery of a patient centred health care by
the health care professional working in an health care organisation in a collaborative,
complied evidence based practice approach – it is highly important that it should be separated
and understood differently from the ‘safety in health care’. The latter concept ‘safety in
health care’ is critical and must be given a separate and distinct emphasis other than patient

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safety. Safety in workplace refers to the environmental and occupational safety existent in a
workplace. While both the form of safety are to facilitated by TQM – it is important to know
that dangers and risks at workplace (occupational and environmental) has to be under control
and managed effectively so as not affect the lives of staffs but also of patients.
Risk management is a procedure of risk prevention, risk identification, risk
assessment that all together leads to the imperative process of risk management in a health
care setting. Having the fire extinguishers, emergency exit (in case of an environmental
accident), having the medication carts and the emergency patient servicing department ready
to save a patient’s life under the most critical circumstances – all comes under risk
management. Managing the hospital acquired infections is also important.
A problem solving and critical decision making approach by the health care providers
is an important step towards fostering of a risk free environment. Health and environmental
screening tools are very critical that can be used by a health care professional to foster safety
at workplace and patient safety along with staff safety at the same time, simultaneously along
with continuous quality development.
Response to Question 3
The term ‘safety culture’ in a health care organization refers to continuous ways of quality
improvement by the health care and supportive professional working in an organization.
Overall it is very important that safety behavior is integrated within the socio-dynamics and
work culture of professional groups and individuals working in a health care organization
(Fagan, Parker & Jackson, 2016).. The organizational cultural working towards the overall
safety of the patients and that of their own and visitors in terms of health and wellbeing – is
known as the safety culture. The safety culture is promoted by the organizational policies
regarding staff, behavior, action taking, decision making at a work place and all of these

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contributes to a safety culture of a health care organization. It can be measured by various
health servicing and health efficiency measurement tools – utilized within the framework of
an organization. These tools can be audits and screenings, psychological and psychometric
assessments of the staffs and the managers forming the hierarchy of the health care
organization. The other ways of measuring individual and joint ‘group’ compliance to the
very set of organizational ‘safety culture’ policies, rules and regulations is pertinent, under
the circumstances. Hence, interviewing the new and experienced doctors, nurses and other
health care professional directly involved with the patient care service delivery is imperative
and taking the feedback of the supportive workers such as the health care organizational
administrators and the medical managers working at different levels of care delivery is vital
to measurement of how safe is the health care delivering organization’s working and strategic
culture (Brandis, Rice & Schleimer, 2017). Both the technologies and the human workforce
can contribute to the measurement and assessment of the ‘quality level’ of the service and its
conjunction with the ‘organizational safety culture’.
A poor safety culture can lead various types of dangerous health affection and life
threatening events amongst the health care professionals and to the patients ( who are subjects
of health care priority) as well. An ineffective risk prevention, mitigation and management
team can lead to hampering of organizational ‘ safety culture’, thus consequently leading to
causation or development of dangerous environmental and human life risk events like fire
events, lockouts, patient symptoms aggravation and complication, patient’s complication of
symptoms further by hospital acquired infections and other complex psychosocial events
(Sadeh, 2017). Workplace disruption is a critical workplace risk scenario in health care
organizations and heavy compliance systems (with reward and punishment) policies are
generally used as reinforcement methods in a global health care scenario, to correct the
behavior of the health care professionals towards a more coherent ‘organization safety

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culture’. It is critical to understand that the improper training and education of staffs
regarding quality management of which safety culture is a very vital determinant is critical –
can be disastrous effect on dissolution of safety culture, thus affecting the overall quality of
patient care and safety at the workplace (Do Byon, Storr & Lipscomb, 2017). The psycho-
cultural and psychosocial elements of the risk causation management process are to be
utilized and analyzed in order ensure safety at the patient and staff level, in an health care
organizational framework.

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Reference
Al-Shdaifat, E.A., (2015). Implementation of total quality management in hospitals. Journal
of Taibah University Medical Sciences, 10(4), pp.461-466.
Aoun, M., Hasnan, N., & Al-Aaraj, H. (2018). Relationship between lean practices, soft total
quality management and innovation skills in Lebanese hospitals. Eastern
Mediterranean Health Journal, 24(3).
Brandis, S., Rice, J., & Schleimer, S. (2017). Dynamic workplace interactions for improving
patient safety climate. Journal of health organization and management, 31(1), 38-53.
Copeland, D., & Henry, M. (2017). Workplace violence and perceptions of safety among
emergency department staff members: Experiences, expectations, tolerance, reporting,
and recommendations. Journal of trauma nursing, 24(2), 65-77.
Do Byon, H., Storr, C. L., & Lipscomb, J. (2017). Latent classes of caregiver relationships
with patients: Workplace violence implications. Geriatric nursing, 38(4), 291-295.
Fagan, A., Parker, V., & Jackson, D. (2016). A concept analysis of undergraduate nursing
students speaking up for patient safety in the patient care environment. Journal of
advanced nursing, 72(10), 2346-2357.
Marx, D. (2019). Patient safety and the just culture. Obstetrics and gynecology clinics of
North America, 46(2), 239-245.
McFadden, K.L., Stock, G.N. & Gowen III, C.R., (2015). Leadership, safety climate, and
continuous quality improvement: impact on process quality and patient safety. Health
care management review, 40(1), pp.24-34.
Sadeh, E. (2017). Interrelationships among quality enablers, service quality, patients’
satisfaction and loyalty in hospitals. The TQM Journal, 29(1), 101-117.

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Vituri, D.W. and Évora, Y.D.M., (2015). Total Quality Management and hospital nursing: an
integrative literature review. Revista Brasileira de Enfermagem, 68(5), pp.945-952.