Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Clinical Leadership: Using Observations of Care to Focus Risk Management and Quality Improvement Activities in the Clinical Setting

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Clinical Leadership: Using Observations of Care to Focus Risk Management and Quality Improvement Activities in the Clinical Setting

Article excerpt


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 Junction, 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.

Received 3 September 2006 Accepted 30 January 2007


clinical leadership; leadership development; risk management; quality improvement; observations of care; clinical setting; clinical teams


The pace of change and reform in health care continues to accelerate and with that change and reform there is increasing concern from health care providers, consumers and regulators about the quality and safety of the care delivered. The Safety and Quality in Australian Health Care Study (Wilson et al. 1995) identified the extent of patient safety issues in the Australian health care system in the 1990's and since that time a number of task forces and expert panels have been established to make recommendations to improve the safety and quality of patient care (Rubin & Leeder 2005). Many of the recommendations (the development of evidence-based standards for care, monitoring, investigation and reporting of incidents, adverse events and near misses and ongoing professional development and accreditation of health personnel to improve the safety of care) have been, or are being implemented, but to date there is little evidence to suggest that health care is any safer in Australia than it was in the 1990's (Wilson & Van Der Weyden 2005; Rubin & Leeder 2005;Van Der Weyden 2005).

The Institute of Medicine (IOM) in the United States of America went through a similar process of studying the quality of health care in America, establishing expert panels, publishing a number of reports and making recommendations for building a safer health care system.The recommendations were related to creating a national focus on leadership, research, tools and protocols for systems improvement, and raising performance standards and expectations for improvements in safety through regulatory mechanisms, professional groups, health care funding agencies and consumers themselves (Institute of Medicine 1999).

A more recent report by the IOM (2003) which focused on how transforming the work environment of nurses contributes to patient safety identified four major threats to patient safety and four safety defences that health care leaders, particularly nurse leaders, need to address in order to improve the safety and quality of health care. Whilst this IOM report acknowledged the critical role that nurses have in relation to patient safety it also concluded that the working environment of nurses posed many serious threats to patient safety (De Groot 2005).

According to De Groot (2005: 37) the safety threats include 'poor management practices, unsafe workforce deployment, unsafe work and workspace design', along with organisational cultures of blame that hindered reporting and learning from errors. …

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