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Task You are the General Manager of a metropolitan health service (Rubicon Health) that comprises a 300 bed acute care public hospital and four community health centres. You have only been in this position for eight weeks, however the Director of Clinical Services and Director of Nursing have been in their respective positions for 12 years and 15 years. Rubicon Health has just completed their two yearly accreditation survey, and the surveying team have identified a number of clinical, patient experience and non-clinical issues that have occurred in the past two years and are of concern. The surveying coordinator informs the Executive of Rubicon Health that accreditation will not be granted until these 12 areas are addressed. The return survey visit is scheduled for 90 days’ time, and the surveying team will expect an analysis of these issues and an action plan to improve the safety and quality of services. Following the survey team leaving, it becomes apparent that both directors identify the need for more staff to be the answer to the issues. Both directors are not overly concerned, as they believe that Rubicon Health delivers a high standard of care, and is certainly better than other similar health services in the metropolitan area. Both directors also indicate that they have seen surveyors come and go, and this group seemed to be particularly pedantic. The financial sustainability of Rubicon Health is vulnerable, and the board will not release funds for more staff. In fact, the Finance Manager is keen to reduce services in order to recoup some funds. You as the General Manager are now responsible for addressing these issues, in preparation for the return of the surveying team in 90 days. 1. Issues from clinical, patient experience and non-clinical. Selected Issue * Clinical : Pathology records indicate that the number of patients with a hospital-acquired infection (HAI) has increased by 20%. Again, Rubicon received an acknowledgement for low HAIs at the last survey. An expansion of surgical services, mostly uncomplicated orthopaedic and urologic procedures, occurred at Rubicon 18 months ago. The orthopaedic and urology surgeons are visiting medical officers, and therefore they only attend the hospital during their allocated theatre session times, and briefly (usually out of hours) to visit their patients. They do not attend the medical staff council meetings due to their private hospital commitments. These surgeons are of the opinion that an infection control nurse has nothing to offer and they have directed her not to communicate with them further as pathology will let them know if they have a problem. A letter was sent to the infection control nurse from them, advising her to focus on ensuring the hospital is properly cleaned and that the nurses follow their procedures, which they provided six years ago. * Patient experience: The number of patient complaints has increased by 30%, with the majority focussing on waiting times in the emergency department and alleged rudeness of staff (both front line and clinical). Both the directors of nursing and clinical services are dismissive of the significance of the information, pointing out that the community should be grateful for the care provided and stop complaining. Further analysis of the complaints shows that at best the response received by complainants is a standard form letter, indicating that the ‘matter will be investigated’. There are no records of any investigations having occurred. Surveyors were unable to identify an expected organisational process that is to be followed in the event of a complaint being received. * Non- clinical: Both sick leave and attrition rate for nursing staff has increased by 15%. The average duration of sick leave appears to be 1-2 days and without a medical certificate. There are also a number of nurses on long term sick leave due to work-related injuries. Information gained from the exit interviews shows two major themes of reasons for resignation – excessive workload and inability to meet individual professional standards for patient care. Clearly state in the Executive Summary of the document the three issues you have selected ie Clinical , Patient Experience , Non-clinical . 2. Recommend an action plan to address the three issues based on contemporary safety and quality frameworks and techniques. Your action plan should demonstrate clear linkage to the relevant criterion and action requirements of the relevant National safety and quality in health service -NSQHS (Australia) and address: • the stakeholders involved and possible organisational dynamics which may be contributing to the current situation(s); • why you think the chosen issues are important in relation to safety and quality; • possible resolution options for the selected issues to improve the safety and quality of the care delivered at Rubicon- Please note No funding available. So resolution cannot be based on funds • the preferred options, with corresponding justification.
