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

By Ferguson, Lorraine; Calvert, Judy et al. | Contemporary Nurse : a Journal for the Australian Nursing Profession, April 1, 2007 | Go to article overview

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


Ferguson, Lorraine, Calvert, Judy, Davie, Marilyn, Fallon, Mark, et al., Contemporary Nurse : a Journal for the Australian Nursing Profession


INTRODUCTION

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. The 'safety defences' recommended by the report include the need for leadership and management practices that are 'transformational' and evidence-based; the provision of an adequate number of nursing staff that have appropriate knowledge and skills to provide safe and coordinated care in collaboration with the interdisciplinary team; the redesign of nursing structures, processes and work spaces to decrease the likelihood of error and the creation of an organisational culture that focuses on safety and engages and supports the workforce in their efforts to take action in dangerous situations to prevent harm and promote patient safety (De Groot 2005; IOM 2003).

Throughout the quality and safety literature there are continuing calls for 'leadership' from senior executive management through to senior clinicians, clinical teams and individual clinicians at the bedside to take action to improve the safety of health care provision. The National Health Service (NHS) in the United Kingdom (UK) as part of its reform agenda has focused on clinical governance, service improvement and leadership development as means of'modernising health care services and improving the experience and outcomes of patients' (NHS Institute 2005). While in the 1980's and 1990's the UK NHS had an emphasis on improving health services management, in the 2000's it has leadership and leadership development as the central tenets of its reform and modernisation policies (Hewison & Griffiths 2004). …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

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

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.