Case Study: Leadership and Management in Priory Hospital Nursing

This case study examines the leadership and management practices within Priory Hospital, focusing on the actions of a lead nurse, Majid Mouratsing, and their impact on patient care. The analysis delves into the timeline of events, highlighting breaches in patient safety and the nurse's fitness to practice, as per NMC guidelines. The assignment covers relevant national and local health policies, ethical considerations, and the roles and responsibilities of a qualified nurse. It explores leadership styles, team working, and clinical governance, offering recommendations for improving leadership and management. The study emphasizes the importance of ethical practice, adherence to the NMC code, and the application of leadership theories to enhance patient outcomes and overall healthcare quality. The case study identifies potential barriers to change and suggests strategies for improvement, including the implementation of autocratic and Laissez Faire leadership styles to improve critical thinking among nursing professionals. The document analyzes how these factors contributed to the events and identifies areas for improvement in leadership and management to prevent similar incidents in the future, ensuring adherence to the 6 C's of nursing: compassion, competence, communication, courage, commitment, and care.

INTERPRETATION REFLECTION
AND CRITICAL EVALUATION OF
IMPAIRMENT TO PRACTICE IN
NURSING
PRIORY HOSPITAL CASE STUDY
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Introduction
 The following presentation aims to perform a critical analysis of effective
leadership along with other management strategies in health and social
care in relation to a case study
 The presentation will also include a detailed illustrations on fitness to
practice in relation to the case study
 The potential barriers to change in practice will be highlighted with
subsequent recommendation to change

Background
 The case centers on a lead nurse, Majid Mouratsing who worked an
experienced staff nurse on the Dove Ward of Priory Hospital
 All the facts highlighted in the series of events went against the nurse only
one facts is yet to be prove
 The fitness to practice evolved is impaired
 Below is a detailed illustrations of the timeline of the events leading to the
series of mistakes and gap in patient care

Timeline of events
• 24th August 2017 (Night)
• Patient A was allowed out o rear garded (time: 22:00 hours)
• Patient has cigarette with three other patients
• Patient A was left unsupervised in the garden
• Patient A went absconding
First event: 24th August 2017 (Night)

Title and Content Layout with List
 Current National and Local health policy
 Ethics and laws and their influence on professional nursing
 Roles and responsibilities of a qualified nursing professional
 Leadership, management and team working, clinical governance and
accountability in relation to nursing professional and interprofessional
practices
 Decision making and problem solving skills in relation to nursing profession

Current National and Local health policy
According to the Nursing and Midwifery Council of UK : Fitness to Practise
 Being fit to practise requires a nursing professionals to have the required
skills, knowledge and health to execute the professional responsibilities
safely and effectively
 The code mainly sets out professional standards of the nursing code of
conduct
 If any nursing professional is found unfit for practice as per NMC
investigation, NMC has right to remove them from register for a definite
period of or permanently. This is known as "struck-off",

Current National and Local Health policy
 The current NHS Plan provides more power for patients, more doctors and
nurses, more hospitals and beds, shorter waiting times for taking
appointments, enhanced health care services for the aged community and
some strict standards for the NHS organizations.
 The NHS excels in providing quality care in areas of efficiency, quality, care
access, health equity and health lives. Local NHS and local government’s
Director of Social Services share a common responsibility of social care
service and is managed by the Department of Health (Smith & Blenkinsopp,
2014).
 A combination of ten Strategic Health Authorities manage the actual health
care service and includes some local trusts and healthcare bodies.
 The various health programs acclaimed by urban UK includes Department
of Health, Primary Care Trusts and Strategic Health Authorities. Rural UK
has the Country Side agency and the Institute of Rural Health.

Current National and Local Health policy
 National Service Framework was developed to improve specialty care in cancer,
coronary diseases, diabetes and mental health illness.
 The Quality and Outcome Framework measures the quality of care delivered by
the health practitioners in the country and are rewarded for the excellency in
healthcare services.
 NHS provides extra care for patients with special needs like improved care for old
aged patients, extension of service accessibility for them, fair and long-term
health service funding, disability living allowance and attendance allowance for
the disabled patients (Kash, Spaulding & Gamm, 2014).
 The NHS complies with the Health and Safety at Work Act, 1974 and aims at
protecting the welfare of staffs, patients, visitors, conductors and public at large.
 NHS ensures that health and safety responsibilities are clearly understood,
allocated, monitored and fulfilled. Staffs are empowered to ensure their
competence in their work area.

Current National and Local Health policy
 Regular risk review and monitoring is conducted every two years by NHS to identity health hazards
and provide better alternative for control measures.
 NHS is liable in protection of corporate governance documents, freedom of information policy,
security policy, data protection policy, external whistle blowing policy, staff concern policy, standing
order policy, delegation scheme policy, safeguarding policy, complaint policy and complaint
procedure policy and patient and public participation policy (Monteverde, 2014).
 The Nursing and Midwifery Council is the independent regulator of nurses, midwives and nursing
associates in UK and holds a register record of who can practice in UK and England.
 The Nursing and Midwifery Council (NMC) provides better patient care by providing registered
nurses to support healthcare professionals in their work. They make sure that nurses and midwives
are well-skilled and they care patients with safety, integrity, respect, compassion and quality
expertise.
 Openness is encouraged among health professionals for improved care and public safety. When
discrepancies happen the NMC supports patients parties and provide them the platform to raise
their voices.
 Equality, diversity and inclusion (EDI) help NMC in protecting the public interests in healthcare. The
regulatory processes are consistent, fair and un-biased and provide inclusive healthcare regulatory
opportunities.

Ethics and laws related to healthcare
 Ethical practice is very significant in nursing and is a moral code that determines whether something
is right or wrong. It dictates on conscience and provides justification to what should be done or should
not be done. Ethical practice supports truthfulness and fidelity of equality in the eyes of law.
 In order to impart quality service to patients every healthcare provider need to abide by the set of
ethical codes of conduct by NHS.
 Health practitioners should refrain themselves from involving in unlawful conducts that will cause
their professional defamation and will adversely impact other co-workers as well.
 Health practitioners should provide the correct information about their educational credentials and
experiences.
 The honor of intellectual property rights need to be maintained by every health professional. Business
confidentiality should also be maintained. Any potential conflict situation should be informed to the
earliest so that timely action measure is taken.
 Ethical practice is supported by autonomy, beneficence and the principle of non-maleficence. Virtue
ethics supports ethical practice in nursing more in comparison to concerned obligations of laws
(Monteverde, 2014).
 In order to maintain proper code of conduct and ethical support health professionals at times face
dilemma and find it really difficult to choose among the alternatives.

Roles and responsibilities of a qualified registered nurse
 The NMC provides a number of skills required for a qualified registered nurse such
as, accountable professional, promotion of quality health and prevention of ill-
health, assessing needs and care planning, providing and evaluating care,
managing and leading nursing care and team work, quality care and safety
improvement and care co-ordination (Kash, Spaulding & Gamm, 2014).
 A qualified health practitioner should ensure that the patient gets the appropriate
service and the frequency and duration of care should be apt so that excessive
and unnecessary treatment is not provided.
 Communication and interaction with patients, co-workers, senior experts should
be timely and open so that no discrepancy emerges.
 Right information should be provided so that the transparency of health care
remains high and the client are aware of every aspect of their health issues.
 In any circumstance the health professional should not break the ethical norms
and code of conduct of their professionalism.

Roles and responsibilities of a qualified registered nurse
 The health practitioners should be empathetic towards their patients and should have
higher level of emotional intelligence. They should provide quality care in any field of
illness be it disability, mental health, childcare or aged care.
 The systematic record of the care service plans should be maintained and summarized
with regular updates available.
 The health care providers are responsible to respond to crisis situations without any delay
and they should be well-versed with latest health improvements and technical
upgradations.
 Various staff meetings, training programs and relevant probationary meetings should be
actively participated by the nurses and medical supervisors should be contacted for care
history updating.
 The Care Quality Commission (CQC) under NHS need to be complied with and their duty
of candor should be performed cautiously, without causing any harm to the clients .
 The health practitioner should follow the 6C’s namely compassion, competence,
communication, courage, commitment, and care.

Leadership and Management
 Leadership and Management focuses on the requirement along with preferences
of the patients and taking responsibility for satisfying those needs in order to
improve the overall quality of healthcare
 However, the nurse Mouratsing failed to abide by proper leadership qualities
while giving care for Patient A he also set wrong examples for his team mates.
 The leadership style that is highlighted in the concerned hospital is Laissez-Faire
leadership.
 The hospital also failed to monitor its patients and staffs thus overlooking gaps
in practice.

Recommendation for Leadership and Management
Style
 The leadership style that will be suitable under the hospital setting is Autocratic
Leadership
 Under this leadership style, the leader assumes that the individuals are
motivated by external forces
 Here the leaders makes all the decisions and directs the followers' behaviour
 This kind of leadership provides a strict scrutiny to follower's work and thus
reducing the chances of error.
 However, autocratic leadership hamper the process of critical thinking among
the nursing professionals
 Thus under the hospital environment the leadership will be a mixture of the
autocratic and Lassiez Faire leadership and autocratic leadership in order to
provide scope for critical thinking among nursing professionals (Monteverde,
2014)

Leadership, management and team working
 The current complexity and enhanced philosophical support of NHS has
emphasized the leadership theories and styles considerably. Increased policy
documentation has widened the need of strong leadership in clinical care and
health system. NHS is ready to adopt the cultural shift it has planned for in its core
leadership and management system.
 Personal responsibility is one of the main criteria for good and efficient leadership.
For achieving high quality care for patients every small need and preferences of the
patients should be focused upon. It is not that only higher level management is
responsible for building a strong leadership framework, every health provider
should be able to lead any situation to their best (Monteverde, 2014).
 Maintaining the relationship is the primary focus of the leaders. And leadership
cannot go well if the management system itself is not up to the mark. Leadership
and management are integral parts of organizational success.
 Leaders and mangers have different set of attributes but if mangers have some
leadership skills then the effectiveness increases manifold.

Leadership, management and team working
 The core functions of management are planning, organizing, directing,
coordinating and controlling. Management activities are not limited to some
areas of interest but includes every function in the organization like staffing,
recruitment, leave monitoring, staff morale and advocacy, budgeting,
control ill-management practices, delegation, conflict resolution, complaint
dealings, auditing, quality assurance, risk management, grievance handling
and disciplinary actions, statutory training, information sharing, clinical care
delivery and staff supervision.
 The conventional management theories of trait theory, functional theory,
behavioral theory, classical theory, human relations theory, system theory
and contingency theory provide support to health practitioners in
situational crisis management (Monteverde, 2014).
 The managerial grid framework includes ‘concern for people’ and ‘concern
for productivity’ and it is the (9,9) management quadrant of team leader
(high people & high task) that adds maximum effectiveness to structure.

Leadership, management and team working
 Effective leadership affects change, development and improvement in a positive
manner. Magnet and non-magnet nursing leadership supports participatory
management style and promotes quality care for patients.
 Leaders need to focus on task needs, individual needs and team maintenance
needs and strive to fulfil them simultaneously.
 Delegation of authority is one of the core functions of a good leader and is way
more perspective and goes well participative leadership styles ( Delmatoff &
Lazarus, 2014).
 Transformational leaders are best in delivering effective organizational success.
Change management is supported with extensive team support. Co-operation is
promoted holistically and is best for health practitioners.
 Followership need to be appropriate as well and courage can be demonstrated by
responsibility assuming, serving their leaders and co-workers, transformational
activity participation, role challenges and finally taking moral actions.

Leadership, management and team working
 NHS has a strong leadership model and incorporates leading with care,
vision sharing, team engagement, result influence, information evaluation,
shared purpose inspiring, service connection, accountability and capability
development.
 Motivation is one of the key factors that help in increasing the effectiveness
of health services and theory Y employees are best suited for this job role of
healthcare providers. Regular employee appraisal help in motivating health
practitioners to perform better.
 Lack of education and knowledge could act as barrier for improvement and
the management system will face difficulties in managing its core functions.
 In order to have a well framed and well-structured organization in health
care providence NHS has developed the framework of Clinical Governance
to ensure better patient safety and quality risk management in
organizations.

Clinical governance and accountability
 Clinical governance is simply a patient-professional partnership framework. The
NHS organizations are accountable for continuous service quality improvement
and is responsible for safeguarding high care standard in an environment where
clinical care excellence flourishes. Quality care involves patient experience,
patient safety and clinical effectiveness.
 Risk management during crisis is the core function of clinical governance where it
includes other measures as well like, clinical effectiveness, patient experience,
communication effectiveness, resource effectiveness, strategic effectiveness and
learning effectiveness.
 It supports system awareness, teamwork, communication, ownership and
leadership.
 Clinical Governance in NHS is based on trust and provides advice, support and
system assurance. The major parts of clinical governance are corporate team
support, incident coverage, investigation inquests, complaint claims and clinical
audit mortality.

Clinical governance and accountability
 Risk management is one of the pivotal objective of NHS system. First and
foremost, the content is established, risk is then identified, assessed and is
either tolerated, transferred, terminated or treated wisely. Communication
and consultation and monitoring and review are carried on simultaneously
to find the actual risk accountability.
 Professional accountability is either accountability of the quality of one’s
own work or accountability with other co-health providers or may be
accountability with other senior supervisors and local health experts.
 Providing quality clinical care to the patients is the main accountability of
the health practitioners and they should guarantee the interest of all parties
is met.
 Accountability along with clinical governance will help NHS and other health
organizations in UK to regain the public trust and confidence back by
providing a empathetic and friendly internal organizational culture.

Decision making and problem solving in relation to
health practitioners
 Decision-making is a very important aspect of health care and need to
incorporate all aspects possible in deciding upon a conclusion. Wrong
decision making can be fatal both for the organization as well as the
employees and the patients.
 Information sharing at the right time and at the right context plays
important role in adding effectiveness to the decision making process.
 Any sort of misconduct and distortion of information will cause negative
results and the reputation of the health organization will be under scrutiny.
 Generally a council and board member meeting is formed to take the most
effective decision keeping in compliance with legal rules and regulations.
Unbiased decision making is supported in healthcare.
 Problem solving is done through a systematic process of steps where the
casualty of the issue is judged first. Based on the probable consequences
decision making is done.

Decision making and problem solving in relation to
health practitioners
 The management not alone is responsible for decision-making, it incorporates the
NMC members, NHS members, hospital management, a third party advisory person
and. Both parties are listened and then an unbiased decision is made based on the
case history. The guilty proven is punished with the level of punishment right for that
misconduct.
 Public safety and interest is considered while deciding upon the end results. Every
health organization aims to provide better quality care to the patients and for that
every health practitioners strive to give their level best (Monteverde, 2014).
 In case of emergencies and ethical misconducts the organization abide by the code of
ethics of NHS and NMC and also their own organizational policies. Legal procedures
are followed if the severity of the case is high and is catastrophic in nature.
 There is a rule of impairment to practice in health professional and nursing
impairment is one of the common health practice impairments. It may be due to mind
altering (by use of drugs and alcohol), distorted thought process, disabled learning or
disturbed psychological conditions of stress and work pressure.

Decision making and problem solving in relation to
health practitioners
 In this context critical thinking in problem solving and decision making is
important. All relevant factors of issue description, analysis and evaluation
need to be studied in detail. Description tries to answer what? when? who?
and where?, analysis provides answer to why? and how? And final
evaluation answer what if? So what? and what next?
 Critical thinking provides all loops and holes of the issue and supports the
most effective decision making in organizations.
 Having an open door policy help in effective decision making by lowering
risk of conflicting situations and support team spirit. Change is inevitable in
organizations and it is better to respect diversity ( Delmatoff & Lazarus,
2014)..
 A well organized guideline to problem solving and decision making will help
the organization resolve the crisis situation in the most effective manner.

Decision making and problem solving in relation to
health practitioners
 First is problem identification/ defining the problem, then looking for potential
source of the problem, then alternative identification for problem resolution,
then selection of the most suitable approach, followed by implementation
planning of the same, next is monitoring the implementation process and final
verification of problem resolution that is if the ultimate issue is resolved or not.
 Decision-making process is a lengthy and elaborate process but can be quick
and precise as per situational demands and severity of issue.
 Decision making is the most difficult in mental health services, because the
patient is at higher risk of health problem and needs increased level of
intensive care and monitoring. Resolving issues of such cases is very risky as
life support is higher in such cases.
 Decision taken should be fair, transparent and in accordance with the NHS
rules and regulations. Both organizational interest and patient party interest
should be integrated with dignity and mutual trust worthiness.

Conclusion
 The learning outcomes are well integrated in the presentation with end
notes linking them to the case study of Priory Hospital, impairment to
practice in nursing. The case is explained in relation to the learning
outcomes and the ultimate decision making process of the case is
evaluated based on the various health policies and procedures of NHS in
general. The NMC and its procedures are mentioned previously and based
on that the ultimate decision of misconduct by the nurse is taken. What can
be concluded from the presentation paper is that every health practitioner
need to abide by the rules and regulations of the health institutions and
other government health regulatory bodies and breach of any code at any
point of time will result in punishment and even termination of health
practice.

References
 Delmatoff, j., & Lazarus, I. R. (2014). The most effective leadership style for the new
landscape of healthcare. Journal of healthcare management, 59(4), 245-249.
 Kash, b. A., Spaulding, A., Johnson, C. E., & Gamm, L. (2014). Success factors for strategic
change initiatives: A qualitative study of healthcare administrators' perspectives. Journal of
healthcare management, 59(1), 65-81.
 Monteverde, s. (2014). Undergraduate healthcare ethics education, moral resilience, and the
role of ethical theories. Nursing ethics, 21(4), 385-401.
 Smith, a., Latter, S., & Blenkinsopp, A. (2014). Safety and quality of nurse independent
prescribing: a national study of experiences of education, continuing professional development
clinical governance. Journal of advanced nursing, 70(11), 2506-2517.