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Clinical Leadership
Using observations of care to focus risk management and quality improvement activities in the clinical setting
Lorraine Ferguson
Associate Professor, School of Nursing, University of Western Sydney and Sydney West Area Health Service, Sydney NSW
Judy Calvert
Acting Nurse Manager, Blacktown Mt Druitt Health Service, Sydney NSW
Marilyn Davie
Nursing Unit Manager, Lithgow Health Service, Lithgow NSW
Mark Fallon
Clinical Nurse Consultant, Sydney West Area Mental Health Services, Sydney NSW
Nada Fred
Clinical Nurse Educator, Nepean Hospital, Penrith NSW
Vicki Gersbach
Patient Flow Manager, Central Cluster, Sydney West Area Health Service, Sydney NSW
Lynn Sinclair
Acting Clinical Nurse Consultant, Westmead Hospital, Sydney NSW
Abstract
In an era when patient safety and quality of care are a daily concern for health care professionals, it is important for nurse managers and other clinical leaders to have a repertoire of skills and interventions that can be used to motivate and engage clinical teams in risk assessment and continuous quality improvement at the level of patient care delivery.
This paper describes how a cohort of clinical leaders who were undertaking a leadership development program used a relatively simple, patient-focused intervention called the 'observation of care' to help focus the clinical team's attention on areas for improvement within the clinical setting. The main quality and safety themes arising out of the observations that were undertaken by the Clinical Leaders (CLs) were related to the environment, occupational health and safety, communication and team function, clinical practice and patient care. The observations of care also provided the CLs with many opportunities to acknowledge and celebrate exemplary practice as it was observed as a means of enhancing the development of a quality and safety culture within the clinical setting.
The 'observation of care' intervention can be used by Clinical Leader's to engage and motivate clinical teams to focus on continuously improving the safety and quality of their own work environment and the care delivered to patients within that environment.
Keywords
Clinical leadership, leadership development, risk management, quality improvement, observations of care, clinical setting, clinical teams
References
Bolton R (ed) (2005) What is Leadership Development? Purpose & Practice Leadership South West Research Report 2, University of Exeter Centre for Leadership Studies accessed at http://www.leadership-studies.com/lsw/lswreports.htm on 23 July 2006.
Brink PJ and Wood MJ (2001) Basic Steps in Planning, Nursing Research From Question to Proposal 5th edn, Jones and Bartlett,,Boston
Hindle D, Braithwaite J and Iedema R (2005) Patient Safety Research: A review of the technical literature. Clinical Excellence Commission and University of New South Wales, Sydney
Clinical Leadership
Program in Australia (2005) Goal and Objectives, accessed at
http://www.clinicalleadership.com/index.php?option=com_content&
task=blogcategory&id=23&Itemid=37
on 21 July 2006.
Cunningham G and Kitson A (2000a) An evaluation of the RCN clinical leadership development program: part 1, Nursing Standard 15(12): 34-37.
Cunningham G and Kitson A (2000b) An evaluation of the RCN clinical leadership development program: part 2, Nursing Standard 15(13): 34-40.
De Groot HA (2005) Evidence-based leadership: Nursing new mandate, Nurse Leader 3(2): 37-41
Grol R, Baker R and Moss F (2004) Quality improvement research: the science of change in health care, in Grol R, Baker R and Moss F (eds) Quality Improvement Research: Understanding the science of change in health care, BMJ Books, London
Hewison A and Griffiths M (2004) Leadership development in health care: a word of caution, Journal of Health Organization and Management 18(6): 464-473
Institute of Medicine (1999) Keeping Patients Safe: Transforming the Work Environment of Nurses, National Academy Press, Washington DC.
Institute of Medicine (2003) To Err is Human: Building a Safer Health Care System, National Academy Press, Washington (DC).
Mann S (2004) Final Program Report - Clinical Leadership Program in Australia, Royal Adelaide Hospital, Unpublished Report
McGarvey HE, Chambers MGA and Boore RP (1999) Collecting data in the operating department: issues in observational methodology. Intensive and Critical Care Nursing 15: 288-297
Melum M. (2002) Developing High-Performance Leaders, Quality Management in Health Care Fall 2002; 11 (1): 55-68
Mulhall A (2003) In the field: notes on observation in qualitative research, Journal of Advanced Nursing 41(3): 306-313
NHS Institute for Innovation and Improvement (2005) accessed at http://www.wise.nhs.uk/cmsWISE/aboutUs/AboutMA.htl on 21 July 2006.
Palm Consulting (2004) Health Hospitals: Transforming Workplaces for Patient Safety, Workshop Report, Australian Council for Safety and Quality in Health Care, Canberra
Robson C (2002) Real World Research A Resource for Social Scientists and Practitioner-Researchers 2nd edn, Blackwell Publishing, Oxford.
Royal College of Nursing (2004) Clinical Leadership Toolkit. Royal College of Nursing, London
Rubin GL and Leeder SR (2005) Health care safety: what needs to be done? Medical Journal of Australia 183(10): 529-531
Turnock C and Gibson V (2001) Validity in action research: a discussion on theoretical and practice issues encountered whilst using observation to collect data. Journal of Advanced Nursing 36(3): 471-477
Van Der Weyden MB (2005) The Bundaberg hospital scandal: the need to reform in Queensland and beyond (editorial), Medical Journal of Australia 183: 284-285.
Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L and Hamilton JD (1995) The Quality in Australian Health Care Study, Medical Journal of Australia 163: 458-471.
Wilson RM and Van Der Weyden MB (2005) The safety of the Australian healthcare: 10 years after QAHCS, Medical Journal of Australia 182: 260-261.
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