Journal

Critical appraisal of theories assists in identifying the quality of the operations. This assignment is prepared to identify and critically appraise theories of management in order to detect the management issues at a healthcare organization. To achieve this an incident from the journal which points towards certain management issues is taken up, analysed and reflected. Three weekly journal entries on the same incident are reported to get an outline of the whole incident and the actions that were taken to manage the issue. Scientific management theory is utilized to understand the issue and find suitable interventions to manage it. Personal changes with respect to healthcare settings as well as change management in the organization are also recognized and analysed. At the end of the assignment, recommendations are provided to prevent the recognized issue in future. It will also include recommendations on personal development to develop effective leadership. For the purpose of reflection, Rolfe et al (2001) framework is used which is based on Borton’s (1970) developmental model. The rationale for selecting this framework is the stimulating characteristics of the framework which is rooted in questions of ‘What?, So what? And Now what? It stimulates reflection and the framework can be used simply at the descriptive level for reflection. This framework is also action oriented and therefore provide a range of suggestions to improve practice of the professionals. The assignment will benefit in personal development through reflection to gain effective leadership.

One incident that came to my notice today confirmed my doubts that there is a lack of team work in the post-op ward. I observed a lack of coordination among different professionals several times. Today during one of my usual rounds, I noticed that the pain assessment form for one of the patients, who was operated a few days before, was not filled for the previous day. I asked him if the nurse and his attending doctor came for their usual rounds and he replied in affirmative. He also told me that his physiotherapy sessions were also started from yesterday. I asked if his pain assessment was done by the nurse and he replied in negative. I enquired about the attending nurse and the physiotherapist and called them. on being asked about the negligence of not conducting the pain assessment, nurse replied that since patient’s physiotherapy has started, she felt that conducting pain assessment and filling that form is physiotherapist’s responsibility. Physiotherapist said that he was not informed to fill any form about the pain assessment. However, daring his session he assessed patient’s pain but did not record it in writing. On hearing both the sides, I felt the mistake was not intentional and it happened only because both the professionals were not fully aware of their responsibilities which led to the redundancy of a task which was essential for case management. It is highly likely that when different professionals involved in service provision to a patient lack clarity in their roles, may get indulged in duplication or redundancy of a job. It mainly occurs because of overlapping of care domains between different professionals of health care sector.

22/07/2018

I again checked on the patient and I found both nurse and the physiotherapist did that patient’s pain assessment. Both of them kept a separate record in patient’s case file. I was satisfied with the changes as now patient’s care was done as per the guidelines and organizational policies. To prevent such incidences in future, I brought this issue in our management meeting. Several other supervisors from different departments also reported the incidents which clearly indicated a lack of team work. We discussed and analysed the incidents in detail. In the case that I reported, it was clear that there was a redundancy of a crucial task due to lack of clarity of roles. The main factors which were responsible for this problem were inefficient flow of communication (Keller, Eggenberger, Belkowitz, Sarsekeyeva, & Zito, 2013) and lack of training of the professionals to work in collaboration. In current times, complex disease which require multifaceted treatment have emerged (Lemieux-Charles & McGuire, 2006)fr. Therefore, it is essential that multidisciplinary team are formed and all the team members are trained to work in a team in order to maximize their contribution and gain best possible outcomes for service users (Nijagal, Kupperman, Nakagawa, & Cheng, 2015). The management professionals decided to outline a plan for changes at organizational level and asked the department supervisors to create a personalized plan for their own team. I worked on finding the shortcomings with my team functioning as well as my own errors. After a careful evaluation, I scheduled for a training program which will help in making people understand the importance of communication, coordination and team working (Elsevier, 2013). Further, it will also help in clearing their doubts.

I planned for a training program for my team which involved professionals from different department. The key themes of the training program were improving communication skills, personal contribution towards a healthy collaboration and personal development (Stewart, 2017). It was mandatory for the team members to attend the training and it was designed to be reviewed every two months. Experts on the subjects were invited to attend to the issue. In the meeting, a question-answer session was held in which several professionals asked a range of questions which clearly pointed towards one common issue of lack of coordination. They said it mainly occurred because they did not know who to talk to about their issues. I realized that I am failing to develop a smooth flow of communication in the hierarchy of the positions. To eliminate the issue, I created a plan which illustrated the hierarchy along with reporting, complaining and feedback mechanisms. The plan stated that which doubts and complains could be cleared through which professional. I distributed that plan among my team members and asked them to act accordingly. I made them realize that the goal of this plan is to improve our team functioning by eradicating the shortcomings such as poor communication, ambiguity of roles and poor coordination, to enhance our practice and give the best possible service to our service users.

29/07/2018

Rolfe et al framework is used to reflect on the incident. Through this framework, first I will reflect on the incident in order to describe it. In the next stage, I will develop personal theory and knowledge about the incident so that learning can be derived from it. Finally, I will reflect on action and consider the ways of improving the situation. I will also reflect on the outcomes of my actions (Rolfe, Freshwater, & Jasper, 2001).

In one of my usual rounds, I found out that in the post-op ward, the pain assessment form of a patient was not filled for the previous night. On investigating, I found out that the attending nurse of the patient did not conduct a pain assessment as she believed that it is the responsibility of the physiotherapist since patient’s physiotherapy started a day before. My role is to manage that my team is working efficiently but this incident made me realize that there is a lack of coordination and communication among my team members (Leijen-Zeelenberg, Raak, & Duimel-Peeters, 2015). I called both the nurse and physiotherapist and explained them the situation. I asked them to be aware of their roles and in case of doubts they should talk to each other or me. It was nurse’s duty to fill the form so I asked her to do it. I tried to make clarify their roles and promote coordination among them. The physiotherapist who conducted a verbal pain assessment was also instructed to document in separately in patient’s case file. Nurse and the physiotherapist followed my instructions and in my next visit I could see two different pain assessments documents in patient’s record file. I brought up the issue in management meeting in order to bring not only personal but also organizational change regarding the issue of interdisciplinary team functioning. Further actions were taken by them and I was asked to make a plan for my own team which led to me create a hierarchical outline of the team roles and conduction of training program. Patient said that by being assessed twice for pain in a day he could report the fluctuating nature of the pain which generally aggravated after physiotherapy session. He looked satisfied. I felt that by emforcing this coordination I was able to yield better management of my team. Further, the nurse an physiotherapist could improve their practice. Overall, it contributed towards achieving better care of the patient as it resulted in enhanced satisfaction of the patient, better record-keeping and improved team functioning which prevented redundancy of the task.

5/08/2018

The incident taught me that failure of service could take place from small miscommunications (W.Y.Kee, gKhoo, Lim, & Y.H.Koh, 2017). In this case, patient’s care could have been hampered as the nurse and physiotherapist had no clarity of their roles. While resolving the issue, I wanted the professionals involved to understand the significance of multidisciplinary team functioning in healthcare setting and the serious complications that could occur in case of lack of coordination (Babiker, et al., 2014). I based actions on the management guidelines by clearly stating each of the professionals their duties and their obligation to comply with them. I should have been aware of my team’s status regarding flow of communication and coordination so that I could take the required actions early. The common issues that I could identify from the incident was that the professionals are not trained to perform efficiently in multidisciplinary team. The reason I could identify was lack of robust communication structure which could yield a clarity in the roles and responsibilities and subsequent coordination.

I believe the frequent training program to enhance communication skills and team functioning will improve this situation (Reiersdal, 2018). As the most important skill, which will help me and other team members in collaborative working, is the effective communication skill. I suitably exchange information with the service users as well as the team members to ensure that there is no withholding of the information which may result in redundant service provision. The multidisciplinary team which comprises of several departments can increase the difficulty of the working which may result in duplication of task or redundancy. Hence, when the team members have clarity and are fully aware of their own and other team member’s role, then the consequence is improved and quick quality of care. I will also ensure that I maintain transparency and openness while working in teams to prevent the occurrence of misunderstanding and conflicts in the collaborated team (Mathieu et al., 2008). I believe in team working all the professionals must be given independence while working in coordination. All the team members should acknowledge and respect each other’s expertise and working strategy. In this way, everyone can work in coordinated manner efficiently and also enhance knowledge from other professionals.

Scientific management theory of management fundamentally evaluates and synthesizes workflows. The main purpose of the theory economic efficiency, especially labor productivity which is an essential element of team work. Some of the principles of this theory can be utilized in this incident. These are scientific selection and training of employees, teamwork between employees and management, maximum output and uniform allocation of responsibility.

• As the theory suggests that, the standard task should be set which a worker should do during a working day. By employing this aspect, clarity of roles and the responsibilities of the different health professionals can be defined.
• The theory also proposed the idea of Work Study which signifies a strategic,organized, analytical and critical evaluation of the efficacy of different functions. I believe by using the approach of work study supervision of all the operations can be done efficiently and I would have been able to acknowledge the ongoing poor team work in the early phase only.
• Scientific management theory also advocates the concept of standardization which also I believe can help immensely in setting guidelines for the employees. It will bring regulation and provide a direction to the employees. Therefore, attempts should be made to give standardized working culture. It will also assist in building a harmonious relationship between the professionals and the management
• Another benefit of the theory is that it proposes that management should plan scientific selection procedure so that the suitable employees are chosen for the suitable tasks like for this incident both physiotherapist and nurse were required to conduct pain assessment. This will help in better and most suitable utilization of the resources.
• Also by applying the standardization, professionals get thorough instructions and constant guidance of the professionals (Tomey, 2009).

The emphasis of scientific management theory was the production line, where the desired goal was a fully standardized physical product. So, it can be regarded as a valuable theory for mass producing a dependable physical commodity but the theory was criticized  when applied in service industry, where each service user is different and the service is customized to fulfil an individual’s requirements. The opponents of the theory argue that the principles of the scientific management theory are not in line with current healthcare management setting, where common goals are decided mutually by the manager and professionals, with target dates and completion dates assigned to each goal.

I understand that due to lack of effective communication from my side, such incidences of poor coordination are occurring, as it is my duty to effectively communicate my team’s goals and responsibilities. As I have to deal with my team members along with service-users of diverse communities, so I will enhance my range of communication skills to improve my leadership. When a range of disciplines are working together, it becomes crucial that the professionals involved must acknowledge and respect each other’s roles. The hierarchical scheme in the professional positions of several healthcare professional particularly results in conflicts and may become problematic  especially for junior level professionals in the team who find it difficult to practice full autonomy in their practice. In order to avoid such incidences my hierarchical plan of team roles will be fruitful. The hierarchical plan will also help in sufficient exchange of information among all the team members. In healthcare sector, sharing of information between different departments at the right time is essential to accomplish the desired goals as when the needed information is not shared or poorly exchanged, it can cause delay, interruption or error in service provision (Gawande, Zinner, Studdert, & Brennan, 2003). Training program will ensure that every team member is able to use the digital and other record-keeping equipment of their own and team’s usage to ensure that communication is not obstructed due to technical restraints. A robust communication system is crucial for functioning of a team and it becomes way more important when multiple practitioners from varying disciplines collaborate to work together for a common purpose.

While constructing and the inter-professional team, the management may face certain regulatory restrictions. Therefore, I will ask the organization to develop specific guidelines and strategies related to interdisciplinary professional partnership working (Batalden, Blue, Bowen, & Brandt, 2013). It will help the orgnisation, leaders as well as the employees to understand their roles and act accordingly. The multidisciplinary team must be constructed and operate by adhering to the relevant legal obligations (Lahey & Currie, 2005). The organisations must also build an efficient resolution strategy and appropriate policies to resolve conflict or disagreements in the team so that the likelihood of efficient team functioning can be increased. I also believe that the organizations must also provide appropriate training to their professional especially for team working. The new members should be trained for the same (IRVINE, KERRIDGE, MCPHEE, & FREEMAN, 2002). It is significant that all the professionals from different disciplines involved in a team members must agree on a well-defined and clearly stated goal. If there is a lack of shared goal between the team, the professionals won’t be able to move in the same direction and perform their role (D’amour & Oandasan, 2005). In interprofessional practice, every team member must acknowledge and appreciate each other’s contribution to interprofessional care (Sommerfeldt, 2013). In this particular case, a single area of care fell under two professional area, that is of nursing and physiotherapy due to which conflict of pain assessment arose. It mainly occurred because of the overlap of their territory (Booth & Hewison, 2002). However, with time and ecperience the overlap becomes a part of the multi-professional practice and the professionals consider it is as routine element of practice (Parr, 2011)

Conclusion

Reflection on this incident helped me identifying my assumptions about himself, other people, and the organization (Hinett & Weeden, 2010). I found that it is an active process of analysing, appraising and assessing the experiences by focusing on the past experiences and theoretical learning. By reflecting, I could plan my future actions for my practice by transforming the experiences attained through practice into genuine learning. I found that my team lacks in proper partnership working. Leadership is one of the key aspect of the teamwork operations in health care facilities. I believe when the team members will have faith in my leadership and knowledge of roles, then working will become efficient without any conflicts. A team with god leadership has guidance and motivation to offer the best possible care for the service-users (Mitchell, et al., 2012). In case of lack of an effective communication flow between the team member, exchange of information is dependent on chance of being available at the suitable place at the suiatble time like in the incident reported above (Pollard, Bugler, & Hayes, 2016). The professionals must put make full efforts to coordinate with other members of the multidisciplinary practice to make the process easy (ZWARENSTEIN, 2001b). Scientific theory of management can be applied to eliminate the issues faced in the case study which is based on standardization and scientific selection.

References

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