Relevant Stakeholders and Values
A clinical department manager is promoted to administrator in one of the departments in a multisite hospital. The manager successfully transformed her previous department from failing to a successful enterprise. There was considerable improvement in the bottom line, patient volume, nurse and physician satisfaction, and patient and family satisfaction. At the new department, she notices that the new division could benefit from the changes that were made in the previous department. However, she faces a new problem; the staff and physicians in the new department are resistant to change and insist that the processes are working fine. Their motto is, “If it ain’t broke, don’t fix it” (Filerman, Mills & Schyve, 2014). She is faced with a dilemma on how to start transforming the department. On one hand, the wants to establish a culture of quality improvement (QI) and change the motto to “If it’s working OK, let’s make it better.” On the other hand, she would not want the highly competent people that compose the department.
Relevant Stakeholders and Values
It is crucial to take into consideration the various perspectives of stakeholders. Usually, QI projects involve interdisciplinary teams with representatives from different fields, such as medicine, administration, and nursing. In this case, physicians will be medicine representatives. Physician engagement is an integral component of QI projects. In QI, the people at the front line who do the work need to be one to change the work (Johnson & Sollecito, 2018). Although healthcare professionals have experience working in teams, it requires stakeholder mapping to come up with the right composition of a QI team. Stakeholder mapping helps identify supporters and resistors of change. Including resistors is an effective strategy to avoid conflict and administrative delays in the course of implementing a QI project. It is essential to pay more attention to physicians during stakeholder analysis to identify motivations that may facilitate or obstruct the project. Physicians should be engaged in a customized manner to involve them in the change team and thus overcome their resistance. Also, the insights provided by patients and caregivers should be considered.
QI programs need to engage all stakeholders for them to understand the importance of achieving efficiency and decreasing adverse events. Team leaders in each discipline play a crucial role as they can promote working relationships that facilitate team success. The teams need dedicated leaders who can put sufficient time in the project (Hughes, 2008). Also, the type and ability of team leaders need to be considered as it affects outcomes and visibility of the change initiative. Furthermore, diversity in the composition of a team minimizes group biases and enables the team to concentrate on meeting the selected goals. Physicians recruited in the team need to include those that can influence others by informing them about the importance of changes in improving the quality of care and patient outcomes and satisfaction.
Effective communication that allows smooth information sharing with physicians and staff is critical as it ensures that the purpose and strategy of the QI program are specified (Hughes, 2008). There is a need to have open communication channels across all staff and levels of leadership that allow the provision of feedback, concerns, and observations in the course of the change process. Also, concerns of patients and their families need to be included in the program as they form a critical part of the QI program. Every stakeholder, no matter the role they play, need to feel their part of the change to make the program successful. However, keeping everyone in the loop is a challenging process as some staff and physicians may have difficulties accepting system changes effected by the program.
Role of Administrator
The administrator needs to select an appropriate improvement framework that builds upon the success of the previous program. Six Sigma is a common change process commonly applied in healthcare systems (Johnson & Sollecito, 2018). It is an approach that focuses on understanding and controlling the change process with quantitative tools by reducing unwanted variability. It has five major steps: define, measure, analyze, improve, and control (DMAIC). The administrator needs to understand that the numerous steps involved in a QI program present multiple opportunities for error. Therefore, the team structure should allow members to take charge of the steps from their discipline (Hughes, 2008).
Despite strong leadership, it is common for some people within a healthcare organization to be hesitant in participating in quality improvement efforts. Negative and unpredictable reaction by individuals is often as a result of a sense of loss evoked by change. Such individuals, no matter how few they are, may cause a disruption. But when resistance comes from a disaffected workforce or professional group, the chances are that the QI project will fail if the resistance is not adequately addressed (Johnson & Sollecito, 2018). The implication is that the group of employees needs to be engaged in a culture change to ensure that the initiative succeeds. Physicians may be concerned about the dysfunctional consequences of change, such as increasing emphasis on performance targets.
The success of the QI program also depends on how motivated and empowered teams are. Evidence shows that there more benefits in basing the work of QI strategies on the teamwork of the multidisciplinary team that reviews data and leads change (Hughes, 2008). The team needs to have the right composition that includes physicians, nurses, administration, and patient representatives. The administrator should pay more attention to physicians and nurses in the team as they are in the frontline and actually make the change. The two groups should be encouraged to lead in solving problems within their departments. Since implementing changes proposed by the QI program requires significant changes in the physicians’ daily work, their attitudes and willingness to adapt to the changes need to be taken into special consideration.
Ethical Principles Illustrated
The ethical principle of autonomy is often an emerging issue in QI programs. Autonomy is the obligation to respect the rights of people to make independent choices. It involves enabling people to make decisions, fostering their decision-making, and avoiding the assumption of controlling influence on their decisions (Jennings, 2007). Delegating critical responsibilities to team leaders after extensive consultations with other members of the interdisciplinary team enables each group to reach a resolution that also respects not only their values but also the values and integrity of the administrator.
Beneficence is an ethical principle that guides QI where healthcare providers have a duty to provide patient care that is consistent with good practice (Jennings, 2007). Innovation to improve the quality of care is a central promise in modern medicine. Studies show that gaps exist between existing scientific knowledge and its application in practice and that physicians do not optimally use their innovation tools. Physicians play a central role in QI programs, yet, many seem to be reluctant to embrace change at the level of delivery (Jennings, 2007). In fact, in various cases such as this, they are seen as obstacles to QI projects. Physician resistance is inconsistent with their ethical obligations to provide the best possible care and seek opportunities to improve care. The Code of Medical Ethics lays great emphasis on beneficence.
Summary of Learning
Healthcare managers with previous success in quality improvement projects often get promoted to lead similar projects in roles with additional responsibilities. Usually, QI projects involve interdisciplinary improvement. It is essential to take into account the various points of view of stakeholders. In QI, the people at the front line who do the work need to be one to change the work. Physician engagement is an integral component in QI projects, and Physicians should take responsibility for making changes in their discipline. The administrator needs to select an appropriate improvement framework that builds upon the success of the previous program. Effective communication that allows smooth information sharing with physicians and staff is critical. Team leaders in each discipline play a crucial role as they can emphasize on improving working relationships that ensure team success. Open communication channels across all staff and levels of leadership that allows the provision of feedback, concerns, and observations in the course of the change process. Ethical principles of autonomy and beneficence often arise in QI programs.