Discussion
Innovation leadership is a technique that combines different leadership styles to effectively influence employees for producing creative ideas, products and services (Saleh, et. al., 2018). It can be analysed that innovative behaviours are effectively related to superior’s leadership style because leads are the key entities to establish organizational goals, apply new ways to commence the job and they motivate employees to make new move in the effective way. On the other hand, change management is a systematic approach which deal with the transition or transformation of an organization’s goals and to bring new changes in the existing system of the company (Kiwanuka, Nanyonga, Sak?Dankosky, Muwanguzi & Kvist, 2021). Moreover, selected topic for this report is “implementation of bedside handover”. As, bedside handover is a patient-centred care process in which patients participate in communicating relevant and timely information for the process of care planning. Although patient input reduces care fragmentation, miscommunication-related adverse events and it helps in providing enhances patient satisfaction with continuity of care. In this report, there will be discussion about the issue of the selected topic as per the WHO, PESTLE analysis, possible implication of the change, importance of leadership in implementing the change, selected leadership theory, etc.
As per the World Health Organization (WHO), during bedside handover the communication between patients between different units among care teams may not be included all essential information or information can be mis-understood. As, gaps in communication can cause serious break-down in the continuity of care, it can cause potential harm to the patient and inappropriate treatment. The problem of bedside hand-over is link with the unsafe care of the patients. In the year 2021, WHO launched its global patient safety action plan for the year 2021 to 2030 (WHO.int, 2022). WHO mentioned in this report that 134 million adverse events occur due to unsafe care in hospitals specifically in low and middle-income countries. Among 134 million adverse events around 2.6 million deaths recorded every year. Apart from this, it is also mention in the WHO report that associated social cost of overall patient harm is valued up-to $2trillion (Who.int, 2022). Here, it is important to understand that this report of WHO (action plan for the year 2021 to 2030) focus on the all the patient harm activities not just only on bedside patient handover. In the case of patient handover issue, it is important to understand that technological transformation with an effective leadership can leads towards the patient handover (Panidou & Antoniou, 2022).
Selected Nursing Practice of Bedside Hand-Over
In the above section, it is suggested that the use of technological transformation methods such as: cloud computing, artificial intelligence, robotics, electric health records and centralized command centre can help the hospitals to overcome the issue of patient handover in the effective way. In the below section, there will be discussion about the PESTLE analysis:
The political risk in Singapore is extremely low due to the democratic country and stable government operations. Singapore citizens and permanent residents are effectively entitled to avail subsidised healthcare services through government healthcare facilities (Guidemesingapore.com. 2022). The government of Singapore created a program for the patients under “Central Providence Fund (CPF)” scheme. Under this scheme, employers are required to contribute a specific amount for covering health care needs for their own and their dependents. Moreover, Singapore government has created an overall health coverage system through a mixed financing system method (Earn, 2020). Apart from this, for nurses and healthcare practitioner the government of Singapore has created the “Singapore Nursing Board (SNB)” (Healthprofessionals.gov.sg, 2022). SNB is the regulatory authority which effectively creates new guidelines for the nurses and health practitioner. Moreover, the Ministry of Health Singapore created various schemes with the government partnership such as: MediShield Life, Care-Shield Life, MediSave, CHAS and ElderShield (Moh.gov.sg, 2022).
The economy of Singapore is a vibrant free-market economy and the country stands at the 7th position in the World Index of Health Care Innovation (Girvan and Roy, 2020). Apart from this, as per the World Bank, Singapore is classified into a high-income economy with per capita income of $54,530 in the year 2017 (Worldbank.org, 2022). Although, according to the report of the “Index of Economic Freedom” Singapore’s economy managed to gain a freedom score of 84.4 points (Heritage.org, 2022). WorldBank showcase that GDP of the Singapore in the year 2020 was USD$339.99 billion (33,999.85 crores) (Datatopics.worldbank.org, 2022). Although, the government of Singapore conducted expenditure of $13.2billion in the year 2020 and it is expected that by the year 2029 the government of Singapore will increase their expenses by $36billion (Trade.go, 2022). Apart from this, in the year 2021, there was a shortage for nurses and healthcare practitioner in Singapore which leads towards high demand for nurses at the global level (PTI, 2021).
In the year 2019, the average life expectancy in Singapore was calculated 83.5years (Datacommons.org, 2022). Singapore is the small-east country in the South-East Asia but it is known for best places to live in Asia with a high quality of life measurement (Guidemesingapore.com, 2022). In the year 2018 as per the report of World Happiness Report, Singapore is marked as the “Happiest country in South East Asia” (Guidemesingapore.com, 2022). The people of the Singapore focus on adopting a healthy lifestyle habit so that they can reduce probability for indulging into diseases. Here, it is important to understand that the diet of the Singapore people incorporate following diet such as: meat, seafood, rice, noodles, etc.
Innovation in the Healthcare: PESTLE Analysis
The healthcare sector of the country is moving towards incorporation of the advance technology to provide effective patience care and to reduce work load from the healthcare practitioner. There are three award winning innovations in Singapore which are effectively revolutionised Singapore’s healthcare system in the effective way, such as:
- Remote rehabilitation and IoT measures: remote rehabilitation work through the mobile application which connects patients who are at home with their careers who are at the hospital. For example: heart-tracking application effectively help the patients who are dealing with the cardiac attacks utilizes wearable devices (Nolan, 2021).
- Analysing scans by incorporating the use of Artificial intelligence-based operations: In Singapore, Tan Tock Seng Hospital has designed an AI based system which utilizes for identifying sings of pneumonia in chest scans (Nolan, 2021).
- Lean training to the hospital staff to improve their day-to-day inefficiencies in the effective way.
Private Hospitals and Medical Clinic Act 1980 effectively govern the controlling process and licensing of the private hospitals, medical clinics and the healthcare establishment. Apart from this, the Healthcare Services Bill (HS Bill) was passed in the Singapore parliament in the year 2020. This bill will be implemented into three phrases such as: from late 2021 to early 2023 (Lexology.com, 2021).
Healthcare institutions in Singapore are effectively trying to reduce their carbon footprints from the environment. For example: many hospitals have completely discouraged the use of papers and adopted the digitalization process in the effective way. All these actions resultant in promoting sustainability which helps in improving the efficiency and reducing cost of operations. Although, in order to reduce carbon footprints hospitals in Singapore installed water dispensers, solar panels and other measures to reduce their average carbon emission rate in the effective way.
Technological transformation and appropriate leadership can be helpful in overcome the issue of patient handover. Here, it is important to understand that there are certain key issues which arises during patient handover such as: inadequate documentation, difficult in tracking changes, insufficient system knowledge and lack of domain knowledge. For example: suppose Tan Tock Seng Hospital is suffering from the issue of patient handover and it is reported that inadequate communication among nurses is the primary reason for arising patient dis-satisfaction. In order to minimize this situation, the hospital staff decided to adopt technological transformations methods such as: use of cloud computing, tele-health application, electronic health records and centralized command centres. This technological transformation method can help the hospital in overcoming the issue of beside handover (Moey & Hashi, 2018).
In the issue of bedside handover, a critical leadership skill in nursing is the ability to help in overcoming the issue. In reality, nursing leader’s faces various uncertainty of both their day-to-day rapidly changing landscape. Apart from this, the leadership style of nursing staff plays a key role in the issue of bedside handover. Below are the key points which are specifically related with the issue of leadership in bedside handover, such as:
- Leadership requirement in the bedside handover for staff and patient allocation.
- Leadership for communicating with the patients or their family members during patient’s admission.
- For analysing the patient’s handover sheet with the team members.
- For offering patient-centred approach (Moey & Hashi, 2018).
Apart from this, there are two foremost leadership theories which can help in overcoming the issue of patient handover communication, such as: situational leadership theory and theory of the autocratic leadership. Situational leadership theory effectively stresses towards the use of situational variables and it enable the leader to take an appropriate action on the bases of situation’s demand rather than staying rigid to their specific leadership style. It can be evaluated that the use of situational leadership theory states that it is entirely up-to a leader that which leadership style he/she thinks will bring the best outcome as per the given situation. US Professor. Paul Hersey states that situational leadership theory focuses towards the two primary elements such as: the leadership style and the maturity level of the subordinates or the team members (Simplilearn.com, 2022). According to this hypothesis, it is clear that different situations require to monitor about the variables which can effectively help the leader to reach on an appropriate decision-making. For the bedside handover, the utilization of situational leadership theory can be highly beneficial because in majority of the cases leaders who take use of situation leaders can beat ambiguity and uncertainty. As, situational leaders are able to use a specific leadership style as per the given situation (Alqahtani, et. al., 2021).
Suggest Change to Overcome the Issue of Patient Hand-Overs
Another suggested leadership style is an autocratic leadership theory. As per this leadership theory, an individual effectively controls over all decision and he/she incorporate a little input from the team members. Autocratic leaders can make their choices on the bases of their own ideas and judgement rather then taking any decision after consulting with their team members. The reason for suggesting to implement autocratic leadership is that at the initial level of any programs or technological changes it becomes necessary that only specific persons who have expertise in the field should take key decisions rather then including all the team members into the operations. Moreover, an autocratic leadership styles effectively enable quick decision-making because leaders or management are no longer require to include team members into the decision-making which eventually resultant in faster decision-making process in the effective way. So, in the case of any new implementation or any new program when a leader takes use of an autocratic leader style then it immediately speed-up the decision-making process of the project. Although, this theory of leadership (autocratic) is completely different from the democratic leadership style.
It is suggested that technological transformation and effective leadership style can be used as an appropriate measure to overcome the issue of patient hand-over activities. It is important to understand that the reason behind selecting technological transformation methods for the issue of bedside handover is that healthcare care at the global and domestic level is already experiencing different technological transformation. So, these technological transformations can be effectively applied for the improvement for the nursing practices with appropriate leadership style. Moreover, focusing towards the system re-designing of care delivery can be most effective approach in handling patient hand-over communication methods. In the below, there will be a step-by-step implementation of the process which can be used for the patient transformation (Kanninen, Häggman?Laitila, Tervo?Heikkinen & Kvist, 2021).
Step 1: designing a policy to place standardizes approach for handing over the communication between staff change of shift and between different patient care.
Step 2: ensure that a responsible provider has updated information regarding the patient’s status, medications, treatment plans and bringing significant status changers.
Step 3: taking use of leadership approach and standardized method to minimize confusion among nursing experts (Yusuf & Irwan, 2021).
Change agents the skill and power to stimulate and coordinate the change efforts. As, change agents develop their skills in changing situations and they (change agent) it creates a strong sense of identity, joint ownership, high-performing mindset, to manage resistance, etc. In the nursing practice of bedside handover, change agent play a critical role in the lean transformation (Davidson, et. al., 2018). In the above section, it is suggested that the use of technological transformations methods (such as: artificial intelligence, machine learning, cloud computing, digital record keeping techniques, etc) can help the nursing staff members to create ease of operations and it can also help them in conducting effective communication practices. However, for local community-based hospitals a major issue can arises that they may not have skilled workforce which incorporate knowledge regarding the technological changes. Another issue can arise that nursing staff may refuse to take use of advance technological methods like artificial intelligence and machine learning due to involve complexity in the operations (Labrague, Al Hamdan & McEnroe?Petitte, 2018).
Below are the three change theories which can be applied in the selected nursing practice: the Kotter’s model of change, Nudge theory of change and Lewin’s three stage change model. Both of these models can be applied to implement the suggested technological and leadership change in the bedside handover. As, Kotter’s model of change focuses towards the critical step which can be used to implement the change. This model first states to focus on increasing urgency in the operations. For example: the hospital management can state to the nursing staff that now they should focus on the advance technological information handover because it will help them to become more productivity and it will also resultant in delivering better patient satisfaction. Then, they need to focus on building guiding team with the specific change leaders who are capable to bring the transformation and who are capable to convivence staff members about the importance of the project in the effective way. Another step is to focus towards the developing the vison by explaining about the key expectations with the associated changes. Then to focus towards empowering action and creating short-team wins. The reason behind creating short-term wins is linked with an aim to increase motivation level of the team members. Here, the change leaders can also utilize different motivations theories. Apart from this, another step is to anchoring change in the organizational culture. Anchoring change can only be possible then all the nursing staff will become satisfied with the continuous change results (Kirkham, 2020).
This theory of change focuses towards implementing “nudging change” rather then implementing any change strictly. In the hospitals, nurses are the main change agents. Nudge theory helps the employees to effectively observe the need for a specific change. The nudge theory is based on the below principles such as:
Figure 1: rrslide.com, 2022
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Steps |
Description |
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Step 1: Define changes: |
Before the implementation of any change, an institute or a company is required to define the need of change and its significance. For example: that the management of the Tan Tock Seng Hospital in Singapore decided to implement digital screens and all the screens will be connected with the cloud computing network. As per the hospital management, this change will help effectively in solving the issue of bedside handover from nurses-to-nurses and it will reduce paper wastage in the hospital. |
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Step 2: Considering viewpoint of the employees |
Once the management define change to the employees then the employer is required to consider the viewpoint of the employees as well. For example: (in the continuation of the above example in step 1) nurses said that it will not be possible for them to put each entry into the digital screens because it will take more time as compare to writing about patient’s detail into papers. So, in this case, it is expected from the management that they should understand employee’s perspective also rather then blindly implementing any change. |
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Step 3: Providing evidence to the employees for showcasing them best available options: |
The management is required to showcase different options to the workforce so that they can decide about which option can be best suited for generating for changing the operations. For example: the management of Tan Tock Sen Hospital can showcase to the employees that they can opt for digital screens with cloud computing, Artificial Intelligence (AI), etc. |
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Step 4: Presenting change as a choice: |
After showcasing different options to the workforce now they can present a selected option as a choice to the employees. The management need to explain in detail about specific strength and significance of the plan details and other aspects in the effective way. For example: the management can state to the employees that incorporating the suggest idea (in the above point) will help in removing human errors, it will be enabled through Artificial Intelligence (AI), etc. |
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Step 5: Listening carefully to the employee feedback: |
Before the implementation of any program or changes, the management should always consider the feedback shared by the employees in order to make sure that new programs will make the workforce more productive. For example: the management of Tan Tock Seng Hospital in Singapore can conduct a brainstorming session by including their nursing staff and healthcare practitioner to get detailed feedback from the staff members. Although, after getting the feedback the company is required to implement the feedback of the employees in possible areas. When the employees will observe that the management respected their feedback then it will create a better satisfaction level among the workforce. |
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Step 6: Limiting obstacles: |
Limiting obstacles will effectively help in creating a positive interaction of the employees with new changes or new programmes. |
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Step 7: Solidifying changes with short-term wins: |
Once the changes are implemented then the management is required to show to all nursing staff and healthcare practitioner about the key benefits which are occurring after introduction of new changes in the system. |
Apart from this, Lewin’s three stage change model incorporate discussion about the three stage of changes such as: unfreezing, changing and refreezing.
Stage 1: The stage of unfreezing focus on evaluating existing state of current practices. As, in this stage it becomes necessary to make sure about the current practices which are being involved in the process to handle the patient-information handover. In this stage, change leader can communicate about the importance of implementing the change in the process and the reason for implementing. For example: change leaders can explain and need to convenience nursing staff members about the importance to utilize advance technologies (such as: acritical intelligence, cloud computing, etc) in the process of patient-information handover.
Stage 2: In this stage, change leaders explain team members about the changes which are bringing in the process. Once team members will experience the change then they will start showing their positive approach towards it.
Stage 3: After implementing the change, it becomes necessary for the refreeze the change and to develop the key performance indicators for monitoring the process.
Conclusion
It is concluded that the gap in the communication process and information can be mis-understood due to the bedside handover process. As, the selected nursing practice of bedside handover is effectively link with the unsafe care of the patients. However, this report effectively focusses on the issue of bedtime handover rather then focusing on all the activities which are linked with patient information handover. For example: the issue of patient information handover arises at different levels such as: change of nursing shifts, continuum of care, etc. Apart from this, it is suggested that adaptation of advance technological transformations and leadership style can help in overcoming the issue of bedtime patient handover. For example: hospitals can implement the use of advance technological such as: artificial intelligence, machine learning, cloud-based computing practices to keep a track on the patient’s information, electronic digital record systems, etc. Apart from this, two leadership theories are suggested in this report such as: use of situational leadership theory and the use of an autocratic leadership theory. The utilization of situational leadership theory can enable the team leader to change his/her leadership style as per the situation rather then striking around a specific leadership style. On the other hand, the use of an autocratic leadership style can also be suited at the initial level.
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