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A critical analysis of the nursing leadership and management issues that may have influenced the quality of care provided in the Leas Cross nursing home

A critical analysis of the nursing leadership and management issues that may have influenced the quality of care provided in the Leas Cross nursing home

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An essay for the 2012 Undergraduate Awards Competition by manuela cristea. Originally submitted for B. Sc. General Nursing at None, with lecturer Ms. Phil Halligan in the category of Nursing & Midwifery
An essay for the 2012 Undergraduate Awards Competition by manuela cristea. Originally submitted for B. Sc. General Nursing at None, with lecturer Ms. Phil Halligan in the category of Nursing & Midwifery

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Published by: Undergraduate Awards on Aug 30, 2012
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10/27/2013

 
A critical analysis of the nursing leadership and management issuesthat may have influenced the quality of care provided in the LeasCross Nursing Home.
Word count: 4143 words
 
Abstract
The purpose of this assignment was to critically analyze the nursing care issues that emergedfrom one of two published Irish health inquiries drawing on principles of Management,Leadership and Quality Improvement and discuss how they could be better managed incurrent practice. The report selected was O’Neill (2009),
The Commission of Investigation(Leas Cross Nursing Home) Final Report 
. Evidence to support the critical analysis was drawnfrom a wide range of sources – published literature, agencies (An Bord Altranais, HealthInformation Quality Authority, Department of Health and Children, and Health ServiceExecutive), and informed by media discussions (Prime Time Investigates). Three themes wereidentified for further discussion:
Staffing, Documentation
and
Complaints
as key determinantsof poor outcomes arising from within the inquiry. Staffing was shown to be truly inadequatein the skill mix and quantity. Documentation showed that it was also inadequate anddemonstrates the need to carefully document at every point in the delivery of care and finally,how concerns made by patients and families are significant and should be addressed promptlyand can be used as a vital resource in reflecting quality of care.The investigation into the care provided at Leas Cross Nursing Home was the first Irishinquiry to reveal abuse on a systemic scale in care of the older person. In the context of very ‘lose’ nursing homes regulation covering both the public and the private area atthe time, Leas Cross was not a unique once-off incident, rather an example of endemic practices across the sector. The O’Neill Report is, in itself, an outcome of poor regulatory systems, absence of standards and concerted policy failures in addressingand monitoring the needs of the older person and how they are adequately met. Ittherefore epitomizes the absolute failure of a healthcare system devoid of leadershipand inadequately managed from the very top of the structure down to the local/individual level.Arguably, the Leas Cross inquiry is directly linked to the radical overhaul of the healthcaresector that followed the inquiry. It is the end- it was the result of a flawed system- andalso the beginning of a new improved one, an integrated system that is nowaccountable and oriented towards safety, quality and clinical effectiveness. Thestandardization of care and the introduction of HIQA as a regulator and enforcer of quality are clear initial illustrations of transformational leadership with the potential of optimizing care. Clinical governance frameworks are now geared towards minimizingrisks through regular audits, continuous education, evidence based guidelines andincident reporting systems. Person centeredness is being embraced as the ultimatefocus of care delivery, however scope remains in achieving a transparent and a blame-free organizational culture. Health information technology, considered critical to patient safety, is also in the early stages. While current practice has been informed andimproved by the findings of Leas Cross inquiry, enduring leadership combined witheffective management are necessary requirements for engendering long lasting positivesystemic changes.Key words:
 Management, leadership, quality improvement, information management, qualityof care
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Introduction
The findings at Leas Cross Nursing Home (LCNH) uncovered a pattern of institutionalized abuse (O’Neill, 2006), symptomatic of systemic failures at the macrolevel (the Health Services Executive (HSE) and inadequate nursing management andleadership at the micro level (nursing home). However, at system level, theideological vision and values underpinning health care were person centeredness,accountability and quality of care (DoHC, 2001). Their implementation was notrigorously followed by the HSE and thus not translated into clinical practice acrossthe whole health system (public and private). Due to the word limitation of the essay,the following will have a narrow scope of critical analysis, but will attempt to focuson the managerial failures at LCHN, while keeping in sight its interdependence withthe macro system, and address the issues that emerged from an overarching qualityassurance perspective. It will propose that there was a consistent lack of managementand leadership at every step in the structure (staffing), process (documentation) andoutcomes (complaints) triad. The second part of the essay will discuss how the currentclinical practice has been informed and improved by those findings from a qualityimprovement perspective. Firstly, the constructs of management and leadership will be unraveled to assist our understanding, followed by three themes that have beenidentified from the analysis of the published Leas Cross report, which might haveinfluenced the management of care.
The Role of Management and Leadership
Management is a technical approach to getting people to meet specific predetermined goals in an efficient and effective manner, whereas leadershipmanifests as a pull effect connecting people on a more meaningful level towards the broader organizational goals (Halligan, 2010). Management is concerned withoperational planning which is more specific and short range (staffing, controllingresources, daily organizing), while leadership involves strategic planning whereby itsets the direction and vision of organization on a long-term basis (Tomey, 2006).Consequently, effective leadership is of a transformational nature as it aims to bringabout change, unlike management, which uses a transactional style of rewarding
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