Influencing Practice For Service Improvement In Primary Care Nursing Essay

Influencing Practice For Service Improvement In Primary C ar Nursing EssayInnovation and alteration be currently seen as an integral part of the NHS, and nurses restrain an increasing responsibility in the delivery of health palm (DOH 2004). With the introduction of clinical constitution many NHS Trusts are examining the standard of care being flagn and are useing unfermented initiatives to bring the care up to standard.This essay bequeath aim to discuss and explore the effectuation of an initiative to remove per phase in a clinical field of study of a primary care setting within an NHS trust. The proposed metamorphose is that of an taste band for new ply. This trans stick outt dirty dog be linked to one aspect of clinical governance, staff and staff management, as it was felt that this was an area that chartered developing.It book explore the reasoning for the replace and the attractorship call that was utilised for to implement a channelize. It allow an alyse the transmit hypothesis real by Kurt Lewin (1951) and how it will influence the carrying into action. draw strategies for effective clinical governance involves effective teamwork, lead, ownership, capableness and, to the highest degree historicly, communication. The additional recurring theme is that the public and patients need to be involved in all aspects of the grooming, governance and environment of care.Since 1999, it has been at the top of the agenda for the NHS (Sale 2005). Scally and Donaldson (1998) define clinical governance as A organization through which NHS organisations are accountable for insistently improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (p61). There are many describe elements in clinical governance these have divided into seven pillars. The pillar that will be focussed on in this particular instance will be pillar 4 Staff and sta ff managing, it has many crucial elements essential to the structure of a trust, specifically work hug planning. Without planning on that point will be a lack of staff skills, knowledge and empowerment which could threaten the supply of quality clinical care (Sale 2005).An orientation pack is vital in any organisation setting. It brook be overwhelming when starting a new enjoyment, and people shadow experience many emotions because on that point call for to be a structure in place to aid with this transition. Ward (2009) explains an orientation pack may impact retention within the breast feeding profession as well as increasing self confidence it will also impact staff with greater productivity and aesthesis of direction in the work group. This is due to new employees getting to know the alignment between their role and the organisation expectations of them (Brown 2000). The primary care trust was having difficulty in retaining their staff, and had been experiencing a high writheover in that respect had also been nigh difficulties in filling the va spatecies. Recruitment is ongoing, and salutely the official cost is 32% of nurses one- course salary, but including the building up of new staff and productivity deficit in the process it can be four measure this (Foster cited by Agnew 2004). He goes on to explain in the first year if the new employee has a sense of belonging by being effectively bonded to the setting thus this significantly reduces turnover. Despite these obvious advantages, it was base that there was only a ecumenical induction to the trust which any employee has within the first three months of their new employment however no formal structure had been highly-developed in the specific clinical area. By not having a formal orientation to the clinical area made it makes it difficult to establish the roles of the already existing team. The team is split into clusters these clusters cover different general practices around the are a, however trying to establish which cluster covered which practice was confusing. There was also set in motion to be a lack of clarity when it came to the caseload, it was difficult to identify client groups and information was limited, this in turn was also putting practical risk to patient care. Furthermore there was no hazard for new staff to identity their objectives and how to develop themselves within their role.When an initiative is being introduced to staff, they need to be aware of the reasons for the performance. To change successful integration into a new work place there needs to be a structured form of induction to alleviate barriers in communication and to enable a smooth transition. The proposed predilection of a staff orientation pack (appendix 1) was the result of think change. Planned change is a contend application of knowledge and skills by a leader, to bring about a change requires the leader to have the skills of problem solving, determination devisi ng and interpersonal and communication skills (Marquis and Huston 2006). Warrilow (2009) and Oliver (2006) both recognise that transformational leadership is focussed on, and embraces change, as it involves both the leaders and followers engaging on a common aim. They also recognise the leader to be a key element of successful strategies for managing change. Transformational leadership would be the most appropriate style to utilise when introducing the orientation pack as the underlying goal of transformational leadership is to bring about some type of change (Grimm, 2010, p76). The leaders who use this style are also regarded as change ingredients. A change factor should be a person skilled in the theory and implementation of mean change to be able to deal appropriately with the very real military personnel emotions, including resistance that planned change can bring about (Marquis and Huston 2006). They can achieve this by using qualities such as charisma to motivate their foll owers to be able to achieve their goals, share visions and empower them (Grimm 2010).Change can be an intricate process which can have barriers which can threaten a successful implementation (McCrery and Pearce 2002). Sullivan and Decker recognise that sop up Leaders must initiate the changes they believe are necessary to strengthen nursing practice, provide quality care, and create a better system (2005, p.217). In an organisation, to implement change they would need to follow a change theory. There are many theorists who have developed processes of change, but Lewins theory is perhaps the one that is most recognised, user friendly and uncomplicated. The aid of a change model can be beneficial in overcoming certain obstacles. His theory of change provides the structure for understanding nurses behaviour during times of change and ways to improve the behaviour when introducing change into the workplace (Bozak 2003 p83). The model encompasses a three streptococcic process this can be found in appendix 2.Lewins normative model of change is found on team participation, including all staff that will be affected by this change. This then increases their boon and implementation of change through a bottom-up method (Murphy 2006), furthermore identifying that achieving durable and efficient change entails the collaboration and involvement of the whole team not isolated individuals.Nevertheless, before any change is considered a plan is required that identifies the need. Baulcomb (2003) suggests guidance from Lewins (1951) force field analysis (FFA) demonstrates the complexities of the change process and how driving and resisting forces were integrated within the planning and implementation phases(p275). It is pertinent that the driving and restraining forces must be analyzed before implementing a planned change. Cork (2005) further explains that when implementing any change there are a number of factors that ease to achieve change, this would be the driving conc ept for role model the aim to improve orientation to the work place. Conversely, a restraining factor could be unwillingness to change or poor staff morale. Change can then only occur when one force outweighs the other, ideally for substantiative change the drivers must outweigh the restraining forces. The FFA for the proposed change can be found in appendix 3.The focus of the unfreeze stage is to change the condition quo of the existing practice. The change agent needs to prepare the staff by identifying and dispute the need for change. The realization is necessary because changing for the sake of changes sake can cause unnecessary stress and the feel of role (Marquis and Huston 2006). Involvement of colleagues from the very beginning empowers staff and makes them feel more valued. Sale (2005) identifies that staff are authorise when an environment has been created which encourages them to be actively involved in the decision making processes. However it is inevitable that t here will be resistance when trying to implement a change especially when involving humans. Emotions can flood high and change can be held as threatening. Conflict can also arise as it is making something different to what was (Sullivan and Decker 2005). To be able to start to overcome resistance the change agent needs to start to utilise their qualities as a leader and focus on valuing creativity and innovation form their staff (Marquis and Huston 2006). Informal discussions took place with different members of staff at various levels to explain problem had been identify and that there was a need for change. This leaded for the change agent to find common ground and start having a sense of connection with the staff (Tyrrell 1994). Staff appeared quite unsatisfied with the current status quo, however it was found that time was a resisting factor due to busy workloads. An come that the change agent could bring to the tutelage of the staff is that the in the current climate worklo ads would not improve if there is low retention in staff, which in turn can be caused by not feeling integrated into the team properly. bug out of this stage may involve making people feel uncomfortable. Another factor that would need to be considered would be a thinkable cost implication and who would carry it, management may feel backward to participate in funding. In the clinical setting the change agent could start to communicate their coveted change via email which all staff have access to. This can give the staff the fortune to convey their opinions on the change, which can then be reinforced with a formal team meeting which will allow the change agent to convey their purpose for change and give the staff a sense of direction, and also allowed for them to be open and honest within the team (Grimm 2010). It can also give the change agent an idea of how change may be perceived by the whole team, and possible resistance. Once the need for change has been perceived by others and the status quo has been disrupted then the change agent can go on to the next stage in the change model (Marquis and Huston 2006).Marquis and Huston (2006) states that In movement, the change agent identifies, plan and implements appropriate strategies, ensuring that driving forces exceed restraining forces (p173). It also allows for problems to be undertaken and for goals and objectives to be set, and opportunity to scope out for alternative solutions. This stage can take time as there are many factors to take into account. In appendix 2 the FFA for the proposed change identifies that restraining forces appear to have an undercurrent of human behaviour. This can be extremely difficult to overcome especially when nurses have always done something in a particular way and are reluctant to make change. As previously mentioned communication is the key to successful change and the change agent needs to keep an open line of communication when implementing the plan. A transformational leader uses effective communication to increase the motivation, morale and performance of their staff members as opposed to the common command and control staff supervision style (Lorraine 2010). Trust is also a key issue it arises from a mutual understanding that the change would not be detrimental to the staff (Hein 1995). Hence the change agent will require the ability to communicate effectively and encourage motivation amongst the staff. According to Clark (2009) a leader needs to develop a high degree of emotional intelligence. This allows for an understanding of the emotions of their staff and manages them in a positive way to achieve the best possible outcome. Hein (2007) then continues and says it enforces the problem solving and decision making skills of the change agent allowing for staff to become more relaxed, less stressed and more open for change. If there is a continuation of motivational struggles and unwillingness to change motivational interviewing would be a per ceptiveness to over overcome this. This looks at encouraging and supporting people in adopting new behaviours. The change agent would support the staff member whom is struggling with ambivalence about change. Encouragement is used so that there is intuition of the alternatives to the status quo (Bundy 2004). However, Bundy (2004) does go on to say this can be seen as quite challenging and can have elements of being confrontational. This process needs to be executed wisely.For a successful implementation education would also be a key factor. The change agent would need to educate staff on the new pack and clarify the expectations of the staff for the pack to continually be used and developed. Spencer (2001) suggests that this will give staff the confidence that they are doing the right thing and that practice is successful and sustainable.Once the plan has been established and implemented into practice, leaders need to ensure that there is maintained equilibrium. By including staff in the change, the change agent has invited them to become more attached to organisation, which leads to greater commitment, willingness and motivation (Hein 1995). Additionally it is imperative that continual support and guidance is given so that acknowledgments that all staff has embrace and understood it. Nevertheless no change should ever be frozen solid there needs to be scope for re-thawing to allow for continual changes to improve practice, however initially stabilization needs to occur for staff to reap the benefits. Refreezing actions include defining standards, documentation, training, processes and so on. The change agent would need to continue to monitor over a catch of time as it can take three to six months for a change to be to be accepted (Marquis and Huston 2006). There will also be the need to make sure that people are not pulled back to the previous stage. Ways of doing this is removing any method by which people can return, so there is nothing to return to (Str aker 2010). The change agent can try to do this is by making it part of everyday practice. Once a norm is developed and there have been significant signs that it has had a positive impact such as greater staff retention then people are more inclined to use it.If the change was found to be successful then a possible scope for victimization would be to start to look on a wider scale and try to implement the pack into other clinical practices within the PCT. Again there will be barriers to overcome, although from the experience that the change agent had encountered in the clinical area, these barriers could seem less daunting. There would have also been greater development in their leadership skills allowing for the growth of confidence in implementing change.Change is an essential dynamic in positive growth and development although some may be resistant to it others may embrace it and feel empowered. A recurrent theme that has appeared through the here may change process is that of c ommunication. Excellent communication skills allow those affected by change to have their say, thus allowing barriers and resistance to be overcome. Although it may not be possible to fully eliminate barriers there may be ways to move the barriers to make them a positive. Saver (2009) also states that constant communication helps new and current staff feel valued (p19).In conclusion nurses in the present working climate have to accept necessary changes with an open head teacher and motivation arms. Not only should they accept changes as they take place, but should also be perpetually reviewing working practices and being proactive in implementing changes as and when necessary. Change is not always welcomed, however it will allow for eradication of stagnation within the working environment (Ootim, 1997).ReferencesAgnew, T (2004) Support for staff reduces cost of recruitment. Nursing Standard. May 2004 18(35) p7 online functional from Ovid URL Accessed 11th November 2010.Baulcomb, J (2003) Management of change through force field analysis. Journal of nursing management. Jul 2003 11(4) 275-80 online available from EBSCO URL Accessed 10th November 2010.Bozak, M (2003) Using Lewins Force line Analysis in Implementing a Nursing Information System. CIN Computers, Informatics, Nursing. 21(2)80-85, Mar-Apr 2003. online Available from Ovid URL Accessed 30 October 2010Brown, J. 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Lewin Push and Pull. online Available from http//www.syque.com/quality_tools/tools/Tools54.htm Accessed 14th November 2010Sullivan, E Decker, P (2005) Effective leadership management in nursing. 6th ed. New Jersey Pearson Prentice Hall.Tyrrell, R (1994) Visioning an important management tool. Nursing economics. Mar-Apr 1994 12(2) 93-94. online. Available from EBSCO URL Accessed on 10th November 2010Unsworth, J (2001). Managing the development of practice, in Spencer, S, Unsworth, J and Burke, W. (eds) Developing community nursing practice. Buckingham Open University Press, pp. 69-92.Ward, CW (2009) Enhancing orientation and retention one units success story. Journal of keep education in nursing. Feb 2009 40(2)87-90 online. Available from EBSCO URL Accessed on 30th October 201 0Warrilow, S. (2009) Transformational Leadership Theory The 4 Key Components in Leading Change Managing Change. online Available from http//ezinearticles.com/?Transformational-Leadership-TheoryThe-4-Key-Components-in-Leading-Change-and-Managing-Changeid=2755277. Accessed on 5th November 2010.Appendix 1ProposedInduction pack guidelinesAppendix 2Kurt Lewins Change theoryUnfreezing reducing those forces which maintain behaviour in its present form, recognition of the need for change and improvement to occurMovement development of new attitudes or behaviour and the implementation of changeRefreeze stabilising change at the new level and reinforcement through supporting mechanisms, for example policies, structures or normsMullins (2007 p736)