Improved Management of Emergency Cesarean Section
Part 1: Leadership Change Project
Change project topic
The change project topic is “Improved Management of Emergency Cesarean Section”. The staff of any section/department in a hospital have the moral and legal obligation to ensure that they deliver high quality patient care and that every opportunity is used to improve care. It is evident that medical personnel have an important and obvious role in patient safety and quality of care, and that this is a priority for them. In line with this, there is a need for staff at the emergency cesarean section to take responsibility for safety and quality outcomes. Towards this end, an improved management system that assigns specific responsibilities to the medical personnel is proposed as an opportunity to improve care quality and patient safety (Finkelman, 2019)Improved Management of Emergency Cesarean Section.
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As has been established, the change project is intended to improve management of the emergency cesarean section. In this case, it would improve patient care through enhanced work efficiency and better clinical decisions as medical personnel would be assigned to key focus care areas that they can competently address. For that matter, each medical personnel would know what to do when encountering a patient with all the responsibilities and input being complementary and additive. This is a strategy-centered approach that sets and plans strategies aligned with safety and quality goals. It connects the hospital care and quality agenda with improved performance in care and safety. In addition, the change project would improve care quality and compliance by allowing for data-centered and culture-centered approaches. The data-centered approaches would link the performance data to the specific management approaches, using the data to forge additional changes and taking corrective actions based on any adverse trends and incidents while providing feedback. The data from incident reporting tools would be used to support the change. The culture-centered approaches would encourage an organizational culture of quality improvement and safety norms while providing a powerful message of commitment to safety and quality as well as influencing the organization mission (Sherwood & Barnsteiner, 2021)Improved Management of Emergency Cesarean Section.
Change setting
In an emergency cesarean section, the patient is rushed back to the operating room and the environment is chaotic without role assignment for the clinicians involved or present. This creates opportunity for harm to the patient because staff are rushing, anxious, and unfocused. In addition, there is increased risk for errors to be made or important information is left out when informing support code staff of the patient situation. A rushed chaotic cesarean section department increases the patients’ risk for adverse outcome, compromises their safety, and could lead to additional complications. The medical doctor is rushed and does not have support staff who are calm and using closed loop communication causing yelling and screaming creating a hostile work environment. All members are now liable if anything negative happens. There needs to be clear assigned roles and closed loop standardized communication during the emergency cesarean section code. Effective and safe patient care in the emergency cesarean section is dependent on the teamwork of multidisciplinary healthcare professionals. Although teamwork is integrated into the core competency model of health care delivery in the department, there is some imbalance with a stronger focus on individual accountability, contribution and skills. This lack of focus on teaming represents a gap in care delivery. Through having clear assigned roles and closed loop standardized communication, there is an anticipation that best practice will be established for optimal patient care in the department (Finkelman, 2022)Improved Management of Emergency Cesarean Section.
Stakeholders
There are four groups of stakeholders. First, patients who receive medical care in the department. They receive care services from the providers and are beneficiary customers of the payors. The patients along with their family members expect that they will receive high quality care and that their safety will not be compromised. In addition, they have an interest in feeling that the facility provides them with the best possible care as this would improve their satisfaction levels (Bemker & Schreiner, 2017).
Second, health care providers (professionals) who operationalize health care delivery within the set protocols and policy frameworks. They have a professional responsibility to provide health services to the patients. The providers coordinate patient care as members of the same care team (Bemker & Schreiner, 2017)Improved Management of Emergency Cesarean Section.
Third, payors who operationalize the financial elements of the policy framework. They enroll patients as beneficiaries with an interest on reducing care costs without compromising quality and safety. They act on behalf of patients to procure care services while ensuring that the care provided is financially sustainable (Bemker & Schreiner, 2017).
Fourth, policy makers who are the jurisdictional entities that are responsible for establishing the protocols and frameworks within which the health care services are provided to the patients. They aggregate health care data from payors, providers and patients to develop metrics that inform health and health economic policies. Also, they determine who should receive what care services, who should provide the care, which services should be paid for, and what health care concerns should be taken into account (Bemker & Schreiner, 2017)Improved Management of Emergency Cesarean Section.
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Proposed change
The proposed change is to define the roles and responsibilities of the medical personnel in the emergency cesarean section. This involves having a staffing plan that designates staff roles and responsibilities at the beginning of each shift. TeamSTEPPS is an appropriate tool for the staffing plan. This tool focuses on the specific skills that support the medical personnel in team performance principles to include the cultural changes, human factors, behavioral methods and training requirements that would improve patient safety and care quality. It shifts attention away from individual performance towards team performance with emphasis on synergistic efforts within the team (Finkelman, 2022)Improved Management of Emergency Cesarean Section.
Evidence supporting change
Providers are the backbone of any health care system. Their commitment, work, skills and knowledge are pivotal to ensuring the quality of care and patient safety in the care setting. However, their efforts can only achieve the desired quality of care and patient safety if their roles are well defined and understood so that they avoid confusion within the health care system. This understanding identifies the need to formalize and structure the position of providers, especially concerning their professional responsibilities. This requires that the department have a clear understanding of the role of these providers with the understanding matching the actuality of the positon even as role confusion is avoided. This mismatch is best avoided if providers are well prepared for the role, especially in emergencies where every second counts. In such a situation, a systems-level approach would be appropriate as it addresses the quality and value of care services by formalizing expectations for providers in their professional positions. In essence, the systems-level approach is expected to identify the best providers for each job, and whether or not the identified provider meets the expectations (Johnson, Anderson & Rossow, 2020)Improved Management of Emergency Cesarean Section.
Implementation plan
A five-step implementation plan has been identified for the change project. First, communication in which effective and frequent communication will be applied at the individual, operational and strategic levels. This will inform the stakeholders about the change while allowing them to provide input. Second, fostering a team culture by ensuring participation of those who are expected to change. This involves setting clear expectations, what is expected of each person, roles, and fostering a sense of shared accountability. Third, identifying and empowering visible champions who are committed to the change goal and can lead others. These champions are empowered and given tools and resources needed to lead others in accepting the change. Fourth, applying the change. Fifth, providing feedback and positive reinforcement while making changes as required. This step shows whether the change is achieving the desired effect and if the new behaviors should be reinforced. It makes use of performance data and reports of results (Bemker & Schreiner, 2017)Improved Management of Emergency Cesarean Section.
Part 2: Including leadership in activities
Leadership is an important concept with leadership skills helping to improve performance in a leadership position. Effective leadership extends beyond the leadership responsibility to everyday activities. Simply put, everyday leadership entails taking daily and intentional actions to foster better community, communication and connection within the organization, while working together with others towards a shared mission/vision. It is something that every member of the team undertakes, from the team leader to the followers. For instance, a nurse can exhibit everyday leadership by finding the fortitude to power through a busy day and making the extra effort to talk to a patient’s family members in a pleasant tone such that she brings a smile to their faces even though the nurse may be having a bad day (DeNisco & Beauvais, 2020).
Leadership can be included in everyday activities in ten ways. First, coaching in which instead of simply telling others what to do, the individual tailors how he/she inspires and encourages others based on their individual personalities and moods. A leader must understand that there is no single right strategy. Rather, each situation requires that the strategy be tinkered to meet its unique parameters. There is no one-size-fits-all leadership formula, and the leader must identify the appropriate coaching approach to motivate others to do their best at work while inspiring them in the process (DeNisco & Beauvais, 2020) Improved Management of Emergency Cesarean Section.
Second, participation in which everyday leaders must show up and be present. This is especially important in this day and age where every person has more to do than the time to do it. Being present and following through on commitments can help in distinguishing an excellent leader from a mediocre leader. A leader must be willing to get his/her hands dirty and do whatever it takes to get the job done. A leader should be able to check in with others on a regular basis to put them at ease and show support (DeNisco & Beauvais, 2020).
Third, vision in which the individual ensures that everyday tasks are completed even as an eye is kept on the organization’s guiding vision. The individual must get the big picture while having a firm grasp of how individual roles contribute to that vision. This requires an understanding that when the goals or every person are aligned with the broader goals of the organization, and every person does his/her best, then it will be a win for the individual personnel and the organization. For instance, a nurse can go the extra mile to turn a bad patient experience around by calling in the attending physician when the patient is looking for a more detailed opinion. In such a case, the nurse would have a vision that is bigger than his/her current role, and would keep the patient happy and do his/her part in keeping the organization growing (DeNisco & Beauvais, 2020) Improved Management of Emergency Cesarean Section.
Fourth, emotional intelligence in which the individual is able to recognize, understand and manage his/her own emotions. Equally important, emotional intelligence is the ability to recognize, understand and influence the emotions of others. Having a high emotional intelligence is important for balancing the needs of the organization and the team, and understanding the complex mix of emotions and feelings involved. This requires that the individual (leader) take the time to listen to concerns that others present, and share feelings and thoughts when appropriate (Zaccagnini & Pechacek, 2019).
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Fifth, adaptability in which the individual quickly adapts to changing situations while not feeling compelled to stick to a scrip or the way in which things have always been done. It is not unusual to meet unique, unanticipated challenges. The individual should be able to think outside the box while learning to embrace new concepts and ideas that may be outside the comfort zone in order to address the everyday challenges. An everyday leader should understand that obstacles and challenges are all part of the personal development and growth process. For instance, a nurse who takes the extra time to explain an issue to a patient, even though she knows that doing so may increase the average time spent with each patient and count against her numbers, is a good example of adaptability (Zaccagnini & Pechacek, 2019) Improved Management of Emergency Cesarean Section.
Sixth, planning in which the individual manages projects, people or a combination of the two. It involves the ability to prepare a vision for the future of the team and organization, and strategizing solutions. With good planning skills, an individual is able to set objectives and determine the most efficient path to meet the objectives. Some of the skills applied in planning include logical reasoning, flexibility, critical thinking, business development, and cognitive skills (Zaccagnini & Pechacek, 2019).
Seventh, strategy in which the individual is able to spot inefficiencies and challenges, and quickly identify solutions. Part of this involves recognizing the steps that each member of the team should take in order to overcome the challenges and complete projects. Some of the skills applied in strategy are analytical thinking, creativity, conflict resolution, problem solving, and strategic thinking (Zaccagnini & Pechacek, 2019).
Eighth, leadership by taking responsibility in overseeing the work of others and motivating the team members towards a common goal. This can take the form of being responsible for supporting collaboration across teams and departments, assigning workloads, and leading meetings. Having well developed leadership skills helps with coordinating tasks and directing different parties to ensure that the work is finished on time and completed according to the plan. Handling leadership duties requires leadership skills that include motivating others, mentoring, integrity, empowerment, delegating tasks, constructive criticism, dependability, empathy, team building, and decisiveness (Erwin & Kulbok, 2018) Improved Management of Emergency Cesarean Section.
Ninth, communication in which the individual effectively leads projects and people by understanding the goals and needs of the organization and convening this information to others through straightforward and simple instructions. With well-developed communication skills, an individual is able to translate the most accurate information at the right time to the right people. In addition, persons with great communication skills are able to actively listen, retain the information well, and efficiently pass on the information to others. Some of the important communication skills include interviewing, written and verbal communication, public speaking, persuasion, negotiation, interpersonal communication, collaboration, and active listening (Erwin & Kulbok, 2018).
Finally, organization that allows the individual to balance many tasks at the same time. Often, taking on the role of a leader may mean overseeing multiple calendar events, deadlines and timelines, such as presentations, conferences and meetings. Excellent organizational skills can help the individual find information when needed most, keep up with critical dates, reduce stress, and stay on top of work. Staying organized helps to improve workflow and ensure that tasks are completed as efficiently as possible. In addition, good organizational skills help with setting a great example for others. Some of the important organizational skills include scheduling, recordkeeping, event coordinating, deadline management, time management, project management, administrative skills, and goal setting (Joel, 2018) Improved Management of Emergency Cesarean Section.
In addition to the ten mentioned ways of including leadership in daily activities, it is necessary to ask for feedback, finding a role model and seeking opportunities to lead. Asking for feedback helps with identifying areas that can be improved, and that would otherwise be missed. In knowing areas of strengths and weaknesses, an individual is able to develop the best attributes and work on improvement areas. This ensures readiness for demands of leadership role. In addition, finding a role model (both inside and outside the organization) and taking the time to observe how they interact with others to include their exhibited character traits, behavior under pressure, and responses when faced with complex challenges. While this takes experience and time, advice from an accomplished leader can help with understanding the circumstances and obstacles that an individual can face when leading others. Besides that, seeking opportunities to lead is important for practicing leadership skills. This helps the individual to prepare for an eventual leadership position while demonstrating leadership abilities to organization’s management that may be seeking leadership candidates (Joel, 2018)Improved Management of Emergency Cesarean Section.
References
Bemker, M., & Schreiner, B. (Eds.) (2017). The DNP Degree & Capstone Project: A Practical Guide. DEStech Publications, Inc.
DeNisco, S. M. & Beauvais, A. M. (2020). Advanced Practice Nursing: Essential Knowledge for the Profession (4th ed.). Jones & Bartlett Learning, LLC.
Ervin, N. E., & Kulbok, P. A. (2018). Advanced Public and Community Health Nursing Practice: Population Assessment, Program Planning, and Evaluation (2nd ed.). Springer Publishing Company.
Finkelman, A. (2019). Professional Nursing Concepts: Competencies for Quality Leadership (4th ed.). Jones & Bartlett Learning, LLC.
Finkelman, A. (2022). Quality Improvement: A Guide for Integration in Nursing (2nd ed.). Jones & Bartlett Learning, LLC.
Joel, L. A. (2018). Advanced Practice Nursing: Essentials for Role Development (4th ed.). F.A. Davis Company.
Johnson, J. A., Anderson, D. E., & Rossow, C. C. (2020). Health Systems Thinking: A Primer. Jones & Bartlett Learning, LLC.
Sherwood, G., & Barnsteiner, J. (Eds.) (2021). Quality and Safety in Nursing: A Competency Approach to Improving Outcomes (3rd ed.). John Wiley & Sons.
Zaccagnini, M., & Pechacek, J. M. (Eds.) (2019). The Doctor of Nursing Practice Essentials: A New Model for Advanced Practice Nursing (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC. Improved Management of Emergency Cesarean Section