Nursing Management and Strategy Report: IHFD Strategy Evaluation

This report provides a comprehensive analysis of the Irish Hip Fracture Database (IHFD) strategy within the context of nursing management and the Irish healthcare system. The report begins with a description of an orthopaedic unit and introduces the IHFD strategy, which aims to improve care for hip fracture patients. It then explores the IHFD strategy's strengths, weaknesses, opportunities, and threats within the orthopaedic ward. The report examines how the IHFD strategy meets stakeholder expectations and promotes collaboration among healthcare professionals. Furthermore, it delves into the implementation process of the IHFD strategy, evaluating its impact on key clinical requirements and organizational objectives. The report also proposes improvements to the IHFD strategy and discusses strategic and management approaches to healthcare, including human resource management, organizational change, and partnership approaches. Finally, it critically evaluates management issues and the delivery of healthcare in Ireland, concluding with an assessment of the IHFD strategy's overall effectiveness and contribution to the healthcare system.

Nursing management and strategy
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Table of Contents
Introduction................................................................................................................................2
1 Description of the orthopaedic unit/ward and introduction to IHFD strategy for
orthopaedic ward........................................................................................................................3
2 IHFD strategy in the orthopaedic unit/ward.......................................................................4
3 IHFD strategy meeting the expectations of stakeholders and in promoting collaboration.6
4 Implementation process of IHFD strategy..........................................................................7
The IHFD measures the major clinical requirements for treating hip fracture patients and
focuses on optimizing the surgery process, medical, nursing rehabilitation and secondary
prevention care (.........................................................................................................................7
5 IHFD strategy proposed for the organization.....................................................................8
6 Two key learning................................................................................................................9
7 Strategic and management approaches to health care in various settings........................10
8 Effective human resource management components in health service delivery..............11
9 Management approaches for organisational change for nurse leaders.............................12
10 A critical discussion of partnership approaches to leading health care........................13
11 Critical evaluation of management issues.....................................................................13
12 Evaluation of health care delivery across open countries.............................................14
Conclusion................................................................................................................................16
References................................................................................................................................17
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Introduction
This assignment discusses the health care system of Ireland. The assignment has been taken
the orthopaedic part of the health care system and provides a relevant description of the
orthopaedic unit. The assignment chooses an Irish Hip Fracture database strategy for the
orthopaedic ward. This Irish hip fracture database strategy is operating across the sixteen
hospitals of Ireland. It measures the care for the people whose age is over than 60 and
admitted into the hospital with a fracture in the hip (Noca, 2019). IHFD data helps to improve
the quality of hip fracture care for the patients over the age of 60 in Ireland. It's the main
objective to provide high-quality surgical and medical management and rehabilitation of the
fracture in hip. It also provides effective prevention of further falls and fractures. It records
the complete data of hip fracture cases in all sixteen hospitals in Ireland. It helps to mobilize
the patient day after or on the day surgery. This assignment describes how the IHFD strategy
is addressing the significance in the orthopaedic ward, how the IHFD strategy promoting
collaboration and meeting the expectations of stakeholders. The assignment critically
analyses the implementation process of the IHFD strategy and how IHFD meets the vision
and mission of the organization. In addition, critically evaluates the management and
strategic approaches of the health care system. The assignment critically evaluates the
management issues and evaluates the health care delivery system considering the strategic
management practices.
1 Description of the orthopaedic unit/ward and introduction to IHFD strategy for
orthopaedic ward
The orthopaedic unit or ward in the medical centre is specialised ward dedicated to the
treatment and prevention of musculoskeletal disorders. Orthopaedic disorders can range from
minor problems like fractures and joint replacements to major chronic disorders like
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decreased bone density and lupus erythematosus. The treatment in the orthopaedic ward is
done by specialised orthopaedic surgeons and patients are taken care of by orthopaedic nurses
who possess specialised skills in neurovascular status monitoring (Gregersen et al., 2012).
Traction, passive motion therapy and casting. The nature of work conducted at the
orthopaedic work generally has two aspects to it. The first aspect is trauma consisting of the
injuries to the musculoskeletal system like fractured and dislocated bones and other
afflictions of the soft tissue. The second aspect is the congenital and degenerative conditions
of the musculoskeletal system and other infections and tumours in bones (Kanis et al., 2012).
The primary aspect is the trauma that directly affects the patient and requires immediate
medical attention whereas the degenerative conditions are generally long-lasting and should
be monitored continuously to prevent it from growing.
The national medical report of Ireland for the year 2008 showed that fall and fracture of
ageing population in Ireland is the major reason of hip fractures and is considered one of the
most serious injuries due to fall which led to long hospital admissions. These lengthy hospital
admissions made it the ongoing care in the high-cost health service and step-down facilities.
With almost 3000 people above the age of 50 sustaining hip fracture every year in Ireland,
the medical board of the country introduced the concept of the Irish Hip Fracture Database
(IHFD). The IHFD was introduced as a strategical solution to deal with the large number of
reported hip fracture cases that the orthopaedic ward was receiving in Ireland. To state the
concept of IHFD briefly, it is an accumulation of past fall and fracture cases reported to the
16 hospitals involved in the project which can be accessed by orthopaedic surgeons to learn
details of those case histories and treat future hip fracture based on the diagnosis (Patel et al.,
2013).
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2 IHFD strategy in the orthopaedic unit/ward
The core idea behind implementing the IHFD strategy for the orthopaedic ward was
introduced in 2008 by a group of clinicians representing Geriatrics and Orthopaedics who
gathered with a common goal of improving the hip fracture care for patients in Ireland
(Hughes et al. 2019). The implementation of IHFD provides certain strengths, weaknesses,
opportunities and threats to the orthopaedic ward which are discussed briefly below.
Strengths
The IHFD provides a large pool of case details of the past hip fractures of patients in Ireland
and allows doctors and clinicians to consult those to treat future hip fracture cases.
The IHFD data is collected through a web-based capture system which is a portal for
collecting and storing the information on the HIPE (Hospital In-Patient Enquiry) system and
supported by the HPO. The data from HIPE system like details about patients' age, gender,
admission source, etc. all are merged with the additional IHFD data and maintained in the
common database (Ellantiet al., 2014). This increases the convenience of orthopaedic
surgeons and is very helpful for treating future patients.
Weaknesses
However, despite the tremendous benefits that the orthopaedic ward receives due to the
introduction of IHFD, there are some weaknesses as well to this strategy. Along with the
inclusion criteria of cases in the database, there are some exclusion criteria as well (Brent et
al. 2017). The cases where the patients died as an inpatient are excluded from the
comparative analysis, although included in the rest of the report. By excluding the report of
the dead patients from the comparative analysis, the report becomes inconclusive, and doctors
are not able to faulty measures in those cases during their future diagnosis.
Opportunities
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At the present moment, all the sixteen hospitals in Ireland record their data of hip fracture
cases that occurred since 2012. The database can be further improved as more and more
hospitals start using it and even special cases for across the world are included in the database
thus making it a complete source of hip fracture diagnosis and treatment.
The percentage of patients admitted to the orthopaedic ward increased by 11% within 4
hours. As the database is enriched with more data collection from hip fracture cases, the
orthopaedic ward treatment can be further improved in the future.
Threats
As the database collects more and more recorded hip fracture cases, it slowly becomes
overcrowded with too many reports and becomes tough for the orthopaedic clinicians to
consult and find similar cases for their future diagnosis. In that case, instead of helping the
hip fracture treatment, it increases the time for treating the patients with appropriate medical
care in case of a fall and fracture case.
3 IHFD strategy meeting the expectations of stakeholders and in promoting
collaboration
Since the introduction of IHFD in 2008 and implantation in 2012, 16 of the major hospital
groups have been working together to enrich the database with their hip fracture cases
recorded since 2012 (Amazonaws, 2019). It forms a common database that can be accessed
by all doctors, clinicians and nurses working in these hospitals for providing medical care to
their patients based on similar case studies from the past. There are seven major hospital
groups that is involved with the development and accessing information from this database.
Additionally, there are multiple medical universities and hospitals under each of these
hospital groups that work collaboratively to enrich the collection of reported cases of hip
fracture in the database. The collaboration of geriatrics and orthopaedic department to
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introduce the IHFD strategy is also a big step towards the combined and collaborative effort
that they are doing to improve the treatment quality of hip fracture patients in Ireland. Ideas
and strategies like this promote the necessity of collaborative work in the healthcare sector,
and other countries can implement similar strategies to improve their healthcare facilities and
systems.
The major stakeholders in the IHFD strategy are the clinicians, doctors and nurses from the
geriatrics and orthopaedic wards, the patients with hip fracture, the hospital owners and the
external investors that provide the resources for the implementation for such strategies,
specifically the Irish government in this case. The expectation of each of these stakeholders
are fulfilled in some way through the IHFD strategy and they are described below.
Clinicians/ Doctors/ Nurses (Geriatrics/ Orthopaedic Ward): The orthopaedic doctors and
nurses can access the recorded past cases of hip fracture to better treat their patients and
provide the most optimal medical treatment based on the similarity of the cases with past
reports.
Patients suffering from Hip Fracture: The patients, especially elderly patients in Ireland
suffering from hip fracture get the best medical care and improved quality of treatment due to
the consultancy of past cases during their diagnosis.
Hospital Owners: The owners of the major hospital groups can contribute to their full
potential in the orthopaedic ward in cases of hip fracture due to the use of this strategy which
allows them to get future funding and government subsidies due to their exceptional
contribution in the medical field.
External Investors/ Government: Impressed with the improvement in hip fracture treatment,
the investors and government are willingly investing more on such similar strategies that
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enable the better treatment of patients in orthopaedics wards and other wards as well through
development of similar databases in the future.
4 Implementation process of IHFD strategy
The IHFD measures the major clinical requirements for treating hip fracture patients and
focuses on optimizing the surgery process, medical, nursing rehabilitation and secondary
prevention care (Johansen et al., 2017). The key objectives for implementing the IHFD
strategy was the high-quality surgical management of hip fracture, the better quality of
medical management in the orthopaedic ward, better rehabilitation procedures and the
effective prevention of further fall and fracture cases. Comparing the benefits obtained by the
orthopaedic ward after the inception of IHFD in 2012 with the desired aims and objectives
would help to determine if it worked in practice (Henderson et al., 2017). The benefits of
implementing IHFD strategy include the recording and collection of data from all sixteen
hospitals in Ireland and developing a common database for future references. It also helped
the national service to redesign the trauma bypass for hip fractures. In the orthopaedic ward,
the number of patients admitted within 4 hours of reporting has increased by 11%. The
number of patients receiving surgery within the first 48 hours has increased by 69%. The
percentage of patients mobilised on the day of or day after surgery has also increased by 77%
along with 50% of the patients diagnosed by Geriatrician. Even there was a 73% increase in
the patients receiving bone health and falls assessment for preventing future falls and
fractures. The coverage of hip fracture cases and completeness of data has increased by 95%
and 98% respectively (Amazonaws, 2019). These exceptional benefits go on to prove the
improvement of quality of medical treatment provided to the patients and the IHFD strategy
has successfully worked in favour of the desired objectives.
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5 IHFD strategy proposed for the organization
The organization responsible for implementing the IHFD strategy is the National Office of
Clinical Audit in Ireland. The organization has clearly established its vision and mission that
is ideal for providing medical treatment to their patients. The vision of the organization is to
develop an excellent healthcare system for Ireland supported by good information (Pitt
andKoufopoulos, 2012). The mission stated by the organization is to establish and maintain a
portfolio of prioritized national clinical audits across the Irish healthcare system. They also
plan to provide reliable and timely information to the people who use, manage and deliver
healthcare that is the doctors, clinicians and nurses. They also promote and support the use of
clinical audit as a fundamental component of improving the healthcare system. As described
above in the benefits of implementing IHFD strategy, it is evident that this strategy was able
to meet the mission and vision proposed by the NOCA and plans to improve further to fulfil
their desired goals, values, vision and mission.
6 Two key learning
If faced with a situation for implementing a similar strategic project, there are certain aspects
of the IHFD strategy that needs to be either avoided or actively promoted for the success of
the future project. Based on the analysis of the strategic development of IHFD, the two major
learnings that I think should be actively promoted are the standardization of the focused
medical field (Brent and Coffey, 2013). The IHFD has evolved over the past few years, and
various standards were created known as the Irish Hip Fracture Standard (IHFS) which is
determined by the Irish Hip Fracture Database Governance Committee. There is a total of
IHFS standards that I learned and I think that should be fulfilled during a reported case of hip
fracture to provide optimal medical treatment to the patient and faster recovery time and
mobilization. In case of any future similar strategic projects, standardisation of medical care
is ideal for maximizing the quality of treatment provided to the patients (Edgar and
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Stonehouse, 2017). Another key learning that needs to be actively promoted for future
strategies is the data collection method of participating hospitals for the development and
implementation of the new strategy. During the project I also gained the knowledge regarding
the various strategies of data collection and my presentation skill is also improved. Like
IHFD, audit coordinators are important who collect and enter data in the database along with
the guidance and support from the clinical lead and NOCA. My learning is very much clear
regarding the individual data collection process for maintaining the separate data base. These
auditing of data might include data coverage, case mix, patient’s pathway, outcomes and
specific standards for the completion of developing the new strategic project (Sáez-Lópezet
al., 2017). By conducting this project my analytical skills has also been developed and
learning regarding the strategy making is also gained.
7 Strategic and management approaches to health care in various settings
The management and strategic approach to the various settings of healthcare requires a
systematic plan that should be followed by the healthcare organization. The first step of the
management and strategic approach a clear definition of the plan of the organization
consisting of mission, vision, goals and values that they would pursue providing medical care
to their patients (Guiseppe, 2015). Also, to achieve organisational excellence, setting primary
targets for expanding and reducing the various sectors are important. The analysis of the
external context is also necessary for understanding the presence and type of competitors
along with internal context analysis which determines the mindset and attitude of the heart
team and organization structure (Khan and Huda, 2016). Even strategic targets like teamwork
and performance improvement are also necessary for management.
Furthermore, to successfully implement the strategies, a change in organizational culture is
also required to maintain a management standard within the organization (Parnell, 2012). In
addition to this, clinical program, performance, and reporting to drive improvement within
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the organization is also essential for maintaining a strategic approach. Other important
criteria include clinical research on the various fields and settings so that the employees can
play their respective role in the organization to their maximum potential. The two other
important factors for management and strategic approach are the geographic network and
implantation of information technology in the healthcare organization (Wager et al., 2017).
With the help of a network of hospitals, it is easier to perform collaboratively towards a
common goal (Ginter et al., 2018). However, this also requires a central control for managing
all the hospitals and maintain a systematic management system in all of them. Finally, the
implementation of information technology in the organizational infrastructure is essential to
reduce human labour and increase the efficiency of the entire management system.
8 Effective human resource management components in health service delivery
There are five major components of effective human resource management that are also
applicable in the health care sector as well. These four major components are discussed and
analysed below.
Serve Core HR Functions
The basic HR needs are handled by human resource management in the health care sector
like payroll, benefits and workforce management. As health service requires the hourly shift
of health workers it is essential for scheduling the shifts, recording the attendance and
tracking absence and sick days so that maximum health workers are available for providing
medical care to the patients (MacIntosh and MacLean, 2015).
Facilitate Team Management
Like other organizations, the health sector also requires team management for a collaborative
team work of the health workers towards the patients. Process of recruiting new staff
experienced in health care standards, onboarding, orientation, performance management and
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training and professional development is essential for health care workers to provide the
optimal medical care (Johnsonet al., 2013).
Encourage Employee Engagement
Encouraging the health care workers for engaging in collaborative efforts, learn more about
their duties and measuring their job satisfaction is essential to decrease employee turnover
and retain as many as healthcare workers as possible for benefit of the organization (Elarabi
and Johari, 2014).
Meet Compliance Standards
Like financial, insurance and public sector, the health sector also has some specified
regulations and standards that should be pursued by any organization operating in those
sectors. It is the duty of the HR department to make sure the organization is abiding by those
regulations and keep track of the frequently changed standards to make necessary
organizational changes (Mosadeghrad, 2014).
9 Management approaches for organisational change for nurse leaders
Various organizational changes and transitions are quite common in the healthcare
organizations and hospitals must respond to the rapid and unprecedented changes in the
paradigm shift of healthcare delivery (Gopee and Galloway, 2017). Due to the volatile nature
of the external environment, the nurse leaders like the chief nurse officers and chief nurse
executives must respond to those changes while also providing major leadership within the
organization (West et al., 2014). For managing successful change, several strategies are used
by the nurse leaders like the involvement of multidisciplinary teams and focusing on
transformational change is essential for developing a fundamental change on how things were
done differently previously (West and Lyubovnikova, 2013). Using evidence-based strategies
and management styles to achieve success is performed by the nurse leaders along with the
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application of highly abstract concepts in their daily practice. Also, apart from the existing
change theories, the nurse leaders must also guide the middle managers to change clinical
situations within the organizations (Melnyk et al., 2012). However, there are no detailed
studies on how nurse leaders identify problems within their wards and more research is
necessary for providing a conclusive report on this. However, the above-mentioned
approaches are enough to provide effective management of organizational change by the
nurse leaders based on the internal issues and transition of the external environment (Rosset
al., 2014).
10 A critical discussion of partnership approaches to leading health care
The strategic partnership is one of the significant approaches that will help to introduce the
IHFD in broader aspect (Knudson et al. 2016). It is very much true that the introduction of
the IHFD in the Irish hospital needs more elaboration to provide better service to the people
who are suffering from the Hip fracture. For that, various partnership approaches have been
associated such as:
Product partnership: Product partnership can be explained in a different way but the basic
formula is to produce the better assimilation of the product through the collaboration of
another association (Preston and Gasser, 2018). In this process, IHFD can introduce their
services through the market place or by using the application. This will connect more people
to know about the fact regarding the IHFD.
Marketing partnership: This approach deduces a clear understanding of marketing through
which the IHFD can get promoted more broadly in the market (Meier, 2016). It is essential to
promote the basic idea to aware people regarding Hip fracture. For this collaboration with the
various website, Google could be a successful partnership for leading health care where
people can know the services. It also can be said that by utilising the marketing partnership
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approaches people will come to know the process they should do if they suffer from the
major hip injury. Also, the leading health care could collect more data through this to provide
the elementary services following the IHFD standardization.
11 Critical evaluation of management issues
Clinical perspective
As the database collects more and more recorded hip fracture cases, it slowly becomes
overcrowded with too many reports and becomes tough for the orthopaedic clinicians to
consult and find similar cases for their future diagnosis. In that case, instead of helping the
hip fracture treatment, it increases the time for treating the patients with appropriate medical
care in case of a fall and fracture case. Moreover, there could be cases where the patients died
are excluded from the comparative analysis although included in the rest of the report
(Preventza et al. 2015). By excluding the report of the dead patients from the comparative
analysis, the report becomes inconclusive and doctors are not able to faulty measures in those
cases during their future diagnosis.
Organisational perspective
The IHFD data is collected through a web-based capture system which is a portal for
collecting and storing the information on the Hospital In-Patient Enquiry (HIPE) system and
supported by the HPO. The data from HIPE system like details about patients' age, gender,
admission source, etc. all are merged with the additional IHFD data and maintained in the
common database (Ellanti et al. 2014). This requires the management of the company to
influence change in the hospital management system.
12 Evaluation of health care delivery across open countries
The national medical report of Ireland showed that fall and fracture of Ireland’s ageing
population is the major reason of hip fractures and is considered one of the most serious
14

injuries due to fall which led to long hospital admissions. These lengthy hospital admissions
made ongoing care in the step-down facilities and high-cost health service. With almost 3000
people above the age of 50 sustaining hip fracture every year in Ireland, the medical board of
the country introduced the concept of the Irish Hip Fracture Database (IHFD) (Noca, 2019).
The IHFD as introduced as a strategic solution to deal with a large number of reported hip
fracture cases. To state the concept of IHFD briefly, it is an accumulation of past fall and
fracture cases reported to the 16 hospitals involved in the project which can be accessed by
orthopaedic surgeons to learn details of those case histories and treat future hip fracture based
on the diagnosis.
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Conclusion
The project report provides a conclusive view on the implementation of the recently
developed strategy in the orthopaedic ward, which is the Irish Hip Fracture Database. Along
with providing a brief description of the orthopaedic ward, the report provides a detailed
understanding of why the introduction of IHFD was essential in Irish hospitals. The critical
analysis of IHFD and how it worked out in practice as per the desired objectives have also
been pointed out in the report. In addition to the methods and contributions of IHFD, the
management and strategic approaches in the healthcare sector has also been provided along
with the role of HR management and nurses leaders in their respective organizations. This
makes the report ideal for a future secondary source of reference for any studies conducted on
a similar topic.
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