Executive Summary
This field study took place at the Imperial Diabetes Center in Abu Dhabi. This facility is part of London’s Imperial College Hospital, and it specializes in diagnosing and treating endocrinological conditions [1]. The focus of the medical professionals is also on the research of diabetes and the promotion of public health initiatives. The purpose is to examine the leadership’s practices used to maintain and improve the quality and safety standards of the facility and, using the observations and scholarly research, offer recommendations for improvement. Under the model developed by Kouzes and Posner [2], there are five practices that CEOs can use to improve the processes and outcomes of their organizations, which are used to formulate the recommendations. The findings of this field study show that the center’s leadership uses tools such as Plan-Do-Study-Act (PSDA), benchmarking, and personnel training to monitor and enhance standards. The recommendations include involving stakeholders in the PDSA process, reviewing benchmarks twice a year, establishing clearer policy communication practices, having regular personnel training, and inspiring a shared vision for the personnel. This report will present the findings of the field study and offer recommendations.
Results
During this field study, the Imperial Diabetes Center in Abu Dhabi was observed, including the personnel and the leadership of this organization. The CEO and the executives of the facility were observed closely to determine what practices they use, both through direct observations and by examining the website and performance reports of this organization. The purpose was to evaluate the efficiency of quality and safety practices and develop recommendations based on evidence. Kouzes and Posner’s [2] model is based on five characteristics of a leader, which suggest that the latter should be the role models and visionaries of the organization. Hence, by observing the executives, one can determine whether the organization approaches the issues of safety and quality with precision or not.
Leaders regularly evaluate the culture of safety and quality using valid and reliable tools
The primary tool used by the Imperial Diabetes Center in Abu Dhabi’s leadership is the PDSA model. Under this approach, each change initiative is planned by preparing an outline consisting of evidence and policies, followed by an implementation. After this, the management monitors the new practice for several weeks or months and gathers data to determine whether any changes are necessary. If there is a need for changes, the PDSA cycle is repeated until the objective of quality and safety is met [3]. PDSA is a simple but comprehensive tool that allows the management to not only implement changes but also ensure that their adjustments allow reaching the goals of this medical center.
Leaders prioritize and implement changes identified by the evaluation
The management of this medical center uses benchmarks and dashboards to set standards and prioritize specific areas of quality and safety. For example, the management communicated the need to reduce readmissions for patients who have diabetes complications such as heart failure and other heart-related comorbidities, among other benchmarks. The management developed a dashboard with key priorities the personnel must pay attention to when working with these patients to ensure that upon being dismissed from the hospital, they are fully recovered and have sufficient information to self-manage their health at home. At the end of the year, the leadership will review the benchmark reports and determine whether the objective was met or not, and set a new priority for the following year.
Leaders provide opportunities for all individuals who work in the hospital to participate in safety and quality initiatives
The leadership of each unit has an open-door policy, which means that any individual working for this medical center can schedule a meeting and discuss their concerns or proposals regarding the existing processes. The open-door policy is a helpful tool in maintaining leader-follower communication [4].
The hospital has a code of conduct that defines acceptable, disruptive, and inappropriate behaviors
The hospital uses the Nursing and Midwifery Code of Conduct developed by the UAE Nursing and Midwifery Council [5]. This document outlines the ethical standards and norms of behavior that are acceptable at the facility and addresses some common problems that nurses may face in their work. Moreover, it is a “non-negotiable ethical standard” that each employee must adhere to work at this facility [5].
Leaders create and implement a process for managing disruptive and inappropriate behaviors
Disruptive and inappropriate behaviors are managed in accordance with the Nursing and Midwifery Code of Conduct [5]. Depending on the specific case of deviant behavior, an employee can receive either a warning or be under the investigation of a supervisory board that will determine whether they can proceed to work at this medical center.
Leaders provide education that focuses on safety and quality for all individuals
All the professionals working for this facility receive preliminary training on the safety and quality standards before beginning their work. Additionally, unit leaders can initiate training sessions n case a medical error or other problem occurred to remind the personnel of these standards.
Leaders establish a team approach among all staff at all levels
There is no clear framework for a team approach at all levels of the medical center, although professionals from different units often cooperate and work with each other on improvements. Hence, the personnel can approach employees or managers from other departments to work on patient cases or quality initiatives.
All individuals who work in the hospital, including staff and licensed independent practitioners, are able to discuss issues of safety and quality openly
There are no restrictions in the domain of discussing safety and quality issues, and nurses are encouraged to approach their supervisors in case they have any concerns. This approach allows ensuring that if an employee notices a practice that may be potentially harmful, they can report it. Moreover, nurses can offer quality and safety improvements by submitting proposals to the management, which must include data supporting the need for change and a brief summary f evidence-based practices that can be implemented to address this problem.
Recommendations
Recommendation 1
The first recommendation is to involve internal and external stakeholders in the PDSA process [3]. Currently, the leadership carries out the preparation of the change initiatives by themselves. However, asking for input from nurses or patients can help foresee potential barriers and address them at this stage [3]. As a result, fewer adjustments will be needed in the future, making the process of implementing new quality and safety standards less time-consuming.
Recommendation 2
The second recommendation is to review the benchmarks for safety and quality standards twice a year instead of once per year. This will help the management make adjustments more quickly in case the medical Center is not meeting the set benchmark after six months [6]. Moreover, adding dashboards for quality and safety monitoring can help the personnel track their work more efficiently. For example, if the medical center implements an initiative targeting dietary changes for patients, the physicians can use dashboards that outline the initial patient education, follow-up sessions, and adjustments to improve this process.
Recommendations 3
According to Manski [7], one issue with implementing safety and quality policies is the lack of clear communication practices that would specifically focus on the areas of the unknown. Hence, with a new dietary training standard, the leadership can openly discuss the areas of the unknown, such as the patient’s perception of this new practice, the ways of addressing non-adherence, and other issues. During this process, the personnel will be able to share their opinions, which can be used to create contingency plans.
Recommendation 4
Personnel training and development should be regular, and employees should be encouraged to participate in professional development training outside the medical facility. Although the medical training offers training focusing on medical errors and potential problems, it is more effective to hold these sessions on a regular basis. For example, a new study found that communication training for nurses that teaches them to handle handovers of patients reduces the number of adverse events [8]. These nurses are trained to ask more questions when interacting with patients and are able to assess their health journey more cohesively. Moreover, safety training can be held online for better efficiency [9]. These sessions should be regular and include all personnel who works in the hospital, not only physicians and nurses, but also managers, administration, assistants, cleaning staff, and other individuals [10].
Recommendation 5
Finally, following Kouzes and Posner’s [2] model, the management should create a unified vision for the safety and quality standards of the hospital and become the role models for this vision. Kouzes and Posner’s [2] approach suggests that the management sets the example for others in the organization and inspires them to act in ways that promote shared values. Hence, the leaders can address the personnel when introducing the benchmarks for the following six months and dedicate some time to explaining the vision and objectives to inspire the nurses and physicians to follow these new practices. This recommendation should help all employees work towards improving the safety and quality standards because they will work towards a common goal.
References
- Imperial College London Diabetes Centre. About us. Abu Dhabi, Imperial College London Diabetes Centre.
- Scouller, J, Chapman, A. What is the five practices of exemplary leadership model? Business Balls. n.d. Web.
- Department of Health. PDSA: Plan-Do-Study-Act. Minnesota, Department of Health. n.d. Web.
- Heathfiled, S. Open door policy. The Balanced Careers. n.d. Web.
- UAE Nursing and Midwifery Council. Nursing and midwifery code of conduct. UAE, UAE Nursing and Midwifery Council, 2013.
- DASON. Data and benchmarking. DASON. n.d. Web.
- Manski, CF. Communicating uncertainty in policy analysis. PNAS, 2019;116(16): 7634-7641.
- Slade, D, Pun, J, Murray, KA, Eggins, S. Benefits of health care communication training for nurses conducting bedside handovers: an Australian hospital case study. CNE, 2018; 10-20.
- United States Department of Labor. Worker safety in hospitals. USDL. n.d. Web.
- OSH Academy. Hospitals. OSH. n.d. Web.