Enhancing Healthcare Quality Integrating Team Development

THE CAUSES AND IMPACTS OF NURSE BURNOUT IN DEMENTIA SETTINGS

Introduction

In healthcare, quality management is important because it helps in reducing error and enhancing the care of the patients to ensure them better health outcome and well-being. The effectiveness and safety are the two key measures to be followed for maintaining quality in healthcare. In this study, the team development theories are to be discussed to inform the role and performance to be played by teams in promoting quality healthcare. Moreover, two continuous quality improvement tools are to be assessed to present the way they influence quality in healthcare. Further, a relevant motivation theory is to be assessed to critically analyse the need of achieving person-centred care for social care by the service providers.

Question 1:

In healthcare, effective teamwork is essential as it helps in sharing expertise and role to create better safe care environment for the patient where adversities are minimised that are otherwise caused by miscommunication due to lack of collaboration between carers and misunderstanding of their roles (Rosen et al., 2018). One of the key theoretical consideration regarding team building followed in healthcare is Tuckman’s Team Development model. The Tuckman’s Team Development Model consist of five stages that are forming, storming, norming, performing and adjourning. The forming stage indicates establishing clarified objectives to create a team charter and help the team members develop and set personal goals so that the team members are able to judge how they fit with the team as a bigger picture. At this stage, the people to be in the team get to understand and known one another (van Geffen, 2020). Thus, this stage promotes development of understanding between individuals to be in the team, in turn, supporting formation of initial collaboration to later promote rights and fulfil responsibilities of care for the service users in together manner. In comparison, the storming stage is the phase in which the team members are able to identify and determine the idiosyncrasies in the character and ability of one another which makes them involve in conflict with one another. In this phase, due to conflicting thoughts the team members are seen to show lack of trust toward one another and involve in clashing working styles to perform their roles and responsibilities (Jones, 2019). Thus, this stage helps the team members to identify the conflicting skill and actions present in the team among one another that could be responsible in non-collaboration to systematically follow care responsibilities and delivery care through promotion of rights and diversity of the service users. In contrast, the next stage of team building that is the norming stage consist of the phase where the team members have accepted each are faults in character to move past their quarrel and conflict to show recognition and value towards strengths of the teammates (Peralta et al., 2018). Thus, this stage leads the team to gradually perform in collaborative manner to accomplish care delivery as their conflicts are resolved. Moreover, it leads to enhanced promotion of rights and diversity in care of the service users as the team members work collaboratively without quarrelling to share their responsibilities and expertise to meet the various needs and demands of the patients by following different legislative procedures and policies of care appropriately. The performing stage is referred as the happiest phase in which the team performance level is high. This is because in this phase all the team members are self-reliant and confident of the problem-solving skills that they are able to function effectively without help from leader and conflicting with others in reaching the same goal (Ryan, 2017). Thus, at this phase, the team members are well-aware of their roles along with their strength and way weakness to be managed. It makes the team members personally efficient in structuring own work nature to show enhanced performance by abiding with the work policies that supports them in promoting rights and diversity of care for the service users. This is because the team members in the phase knows what actions they are to take so that diversity in care is maintained for the service users and they understand how the responsibilities are to be shared and they are to work independently in abiding with the rights of care for the patient. However, the adjourning phase is the stage where the team members are seen to have accomplished their mission and the team get dissolved. Moreover, it is seen that a close bond in formed with the team members by the end of the team developed (Fernando and Hughes, 2019). Thus, this stage indicates that it is the phase by which the team members have accomplished their role and responsibilities in effectively structuring work nature to promote the right and diversity of care for the service users. In contrast to the Tuckman' theory where the way team building is executed is informed, it is seen that Belbin's theory mentions the nine key roles been players by team members. It mentions the roles to be present in developing an effective team that support enhanced structuring to promote the rights and diversity of care for the service users (van Diggele et al., 2020). The nine key roles mentioned in the Belbin’s team role theory are shaper, implementer, complete finisher, coordinator, team workers, resource investigator, plant, monitor-evaluator and specialist (van Diggele et al., 2020). The shaper performs the role to challenge the team members towards making improvement by encouraging them to overcome potential weakness and avoid quitting to accomplish the goal of the team (Khalil and Yasmeen, 2017). Thus, this role of the team member makes them motivate other team members in acting appropriately to overcome challenges related to maintaining diversity in care for the service users. This is because the shaper alters the things that are creating hindrance in meeting the care diversity and rights of the patients care to make sure all the possibilities are present for the team to act effectively in meeting the rights and diversity of care for the service users (Hernandez and McCray, 2017). The weakness of the shaper is that they are argumentative and offend the feelings of the people (Khalil and Yasmeen, 2017). Thus, they may involve in unnecessary argument with team members regarding their opinion to be unable to fulfil any care diversity or rights of the patients. This, in turn, may offend the team members who may show lack of responsibilities in delivering quality care out of lack of value and respect while performing in a team (Sinha, 2017). The importance of the shaper is that they help in accomplishing the structured design of care under any condition by motivating the team members to work accordingly (Sweet et al., 2017). In contrast, the implementer plays the role of getting the things in the group to be done which in turn mentions that they are responsible for turning the idea and concept in the team into practical plans and actions (Porter et al., 2018). Thus, the implementer plays the role of establishing care diversity by following and institutionalising ideas and concepts of care rule and policy that in turn help to promote right and quality of care for the service users. In comparison, the complete-finisher play the role of going through the entire project and are responsible in completing the projects effectively by avoiding any errors in the project to ruin it (van Diggele et al., 2020). Thus, the complete-finisher helps in ensure deadlines are meet and effectively each of task for care delivery in accomplished without error in maintaining systems and structures described for promoting rights, diversity and responsibility of care delivery for service users. This is important because the role help to avoid gaps or error in the structure of care to be established that may disrupt the accomplishment of structured design of care (Griseri, 2017). However, the coordinator plays the role of guiding the team regarding the way to accomplish the objectives and they are responsible in delegating task as per the ability and skill of the team members (Hernandez and McCray, 2017). They are important in maintaining and promoting designed care system for service users as coordinators realise the value of each member in the team and how they can be involved effectively so that they can assist in accomplishing the care goal (Hernandez and McCray, 2017). In contrast, the team workers play the role of offering support to the people in the team and they are the ones who act as negotiators to ensure flexible working nature to meet the care goals (Gander et al., 2020). They help in maintaining and promoting diversity in care and rights of service users as they negotiate to work according to the care policies and plan that fulfil care diversity and patient’s rights effectively (Lynch et al., 2018). The resource-investigator play the role of arranging and negotiating resources on behalf of the team so that they can use them in fulling the goals (Bednár and Ljudvigová, 2020). In accomplishing care diversity and responsibilities of care, the presence of adequate resources in maintaining them are required to be present as without resources no achievements can be made (Lynch et al., 2018). Thus, the resource-investigators have key people-oriented role in the care designing and management. However, the plant has the role to act as creative innovator who is responsible in developing new ideas and approaches in continuing the work and achieving the goal irrespective of the barriers being faced in the tasks (Krawczyk-Bryłka, 2020). Thus, they have an important role to be played in supporting structured design and system of promoting rights and diversity of care of the service users. This is because the plant is the one who acts as creator in overcoming issues in structure of care so that the ultimate goal of care is achieved (Bednár and Ljudvigová, 2020). The monitor-evaluator has the role to analyse and evaluate idea and actions in the work implemented by plants. This is because they are one that are responsible in presenting the pro and cons of the ideas to help other decide of it is effective to implement such approaches and to what extent they would be able to maintain and managed determine system of care designed for the service users (Bednár and Ljudvigová, 2020). Thus, the monitor evaluators act as critical thinkers in managing system and structures of care design. This is important to avoid drastic implementation of any ideas that may instead disrupt the care system instead of managing it that would otherwise lead to hindered care delivery to service users (Ayinde and Oke, 2017). In contrast, the specialist is seen to play the role of presenting specialised knowledge and ideas that are required in the work so that the intricate and complex issue at work are resolved (Bednár and Ljudvigová, 2020). They play an essential role in maintaining system and structure of promoting care diversity and patient’s rights. This is because they provide specialised opinions regarding the way the team members are to commit themselves in accomplishing the care diversity goals and promote the rights of the patients by overcoming obstacles (Krawczyk-Bryłka, 2020).

Question 2

In the healthcare, continuous quality improvement is important because with the progressing years the need and demand of the patient regarding care are changing and to meet those needs it is required that continuous changes in quality of care is made. This is because it is the only way in which skills, actions, knolwdege and ability to delivery the changed care is achieved leading to delivery quality care support (Antonacci et al., 2018). Moreover, continuous quality important is necessary to reduce cost, enhance reliability and efficiency of delivered care for the patients (Yapa et al., 2020). The two key continuous quality improvement (CQI) tools being used in healthcare are PDSA (Plan-Do-Study-Action) cycle and fishbone diagram. The fishbone diagram is a quality improvement tool that mimics the shape of a face and acts as cause-effect diagram to determine the reason for imperfections and variation along with the mentioned alteration is going to act in resolving the issue (Dumenco et al., 2018). The benefit of using fishbone diagram in making quality improvement in healthcare is that it helps in thinking through the cause of any problem or need of any change for quality including the root causes that are indicating such change or raising the problem. Since by identifying the key cause of the problem any issue can be resolved permanently, therefore, the mentioned tool act as potential assistance in enhancing care quality by resolving problem or support identification of required change (Luca et al., 2017). In contrast, the cause-effect aspect of the fishbone diagram may create disadvantages at times toward its use because they may lead to identity irrelevant causes that are not required to be focussed in quality improvement for care. Thus, this aspect of the tool leads to create waste of time and develop irrelevant confusion to hinder the follow of continuous quality improvement in care (Raphael et al., 2019). However, the other benefit of using fishbone diagram for CQI is that it facilitates joint brainstorming of ideas in making appropriate improvement. This is essential because joint collaboration of different team members in discussing potential ideas of quality improvement helps to share and judge diverse and broader approaches and plans. This in turn allows the best suitable quality improvement approach to be determined for use that ensure greater efficiency in achieving improvement of quality in care (Coughlin and Posencheg, 2019). Moreover, it helps in avoiding limited thinking patterns for quality improvement which often leads the team members making the quality improvement get stuck in deciding right approach for improving continuously (Raphael et al., 2019). The use of fishbone diagram is beneficial in CQI as it helps in prioritising relevant causes that are to be resolved first so that smooth improve in quality is achieved without delay (Colvin et al., 2021). In contrast, the limitation of using fishbone diagram is that it leads to develop complex multiple factorial diagram which can cause challenge that is too much difficult to be effectively displayed in the diagram (Rogers, 2018). Thus, it would lead to hinder the development of an effective cause-effect framework to plan the quality improvement actions accordingly. The other limitation of using fishbone diagram for CQI is that it gathers ideas and decision of making quality improvement on the basis of the opinion of the people rather than the analysing the evidence itself (Swamy et al., 2018). Thus, it indicates there is lack of proof to mention the quality improvement aspects identified are true. The PDSA cycle helps to test the changes required for improvement in care quality in healthcare by allowing building the cycle on the basis of the structured learning (Christoff, 2018). The benefit of using PDSA cycle it truly allow establishment of continuous quality improvement. This is because the PDSA cycle is designed to be rapid, short and frequent due to which result of one cycle to be used is found to be used to inform enhanced idea that is to be tested in another new cycle. This process is repeated till a successful and suitable improvement is achieved (McNicholas et al., 2019). The other benefit of PDSA cycle for CQI in healthcare is that it allows to test quality improvement ideas on a small scale first before its actual implementation in the broader field. This helps to support cost-effectiveness, create ease in avoid bad ideas to be implemented that may hinder quality improvement, allows better reception of improvement by the staffs to work accordingly and creates less disruption among the patient through the CQI brought by following the cycle (Leis and Shojania, 2017). The other benefit of using PDSA cycle for CQI is that it empowers the frontline staffs involved in making improvement have direct ability in solving any raised problem. This makes the staffs to be remain proactive and have the ability to make best decision possible that could effectively bring the change in continuous and steady manner (Crowfoot and Prasad, 2017). Moreover, the benefit of using PDSA cycle is that creates a cohesive culture where ideas for improvement are easily interchanged and a culture of change is developed. It is considered to be most effective way in making the resistant team towards making change by getting them accustomed in making change (Coury et al., 2017). The quality improvement done through PDSA cycle is seen to be standardised in nature as the use of the cycle makes measuring and drawing of comparison between change ideas and project to be easier (Chartier et al., 2018). Thus, the PDSA cycle promotes standardised improvement in continuous manner. The benefit of using PDSA cycle for CQI is that it allows creating a greater focus on the project by approving thorough planning at different stages to identify how gradual and relevant changes are to be in continuous manner to achieve quality improvement in cyclic way (Chartier et al., 2018). The limitation of using PDSA cycle for CQI is that it is often avoided to be repeated which eventually leads to the failure of making quality improvement in continuous manner. This is evident from the study of Taylor et al. (2014) where it was mentioned that on documenting 73 cases of PDSA cycle use for quality improvement it was seen that only in 20% cases it was repeated to resolve the mistakes and ensure quality improvement. The limitation of using PDA cycle in making CQI is that it led to mix-up the steps due to error in making improvement in created and continuous change as determined in not appropriately achieved (Knudsen et al., 2019). This is evident from the study of Taylor et al. (2014) where it was mentioned that one of the healthcare facilities used PDSA cycle without following the steps and implemented the full quality improvement plan by avoiding using it as a trail run. The other disadvantage of using PDSA cycle in making CQI is that it requires the changes to be planned over longer time and does not allow the ability to make immediate changes (Knudsen et al., 2019). Thus, it cannot be used in making short-term improvement in quality required during the mid of continuous quality improvement in healthcare services. Question 3 The motivational theory indicates the understanding of the fact that may drive a person to work towards a particular outcome or goal. One of the motivational theories commonly used in healthcare for promoting patient’s health condition and person-centred care is Maslow Hierarchy of Need. The Maslow Hierarchy of Needs is the theory of motivation that states the five key features of human needs which dictates positive and enthusiastic individual behaviour (Hopper, 2019). According to Maslow’s theory, the physiological and safety needs are the basics needs of the people and their fulfilment help the person to get motivated in leading a safe life with enhanced physical ability in executing activities of daily living (Hopper, 2019). In this context, the social care organisations and teams are required to achieve person-centred care for the patients. This is because in person-centred care, the individual physiological needs of the patients are specifically identified by the carers to develop care arrangement with due permission from the patients to enhance their physical ability to live. It leads them to get physical motivated to live better life because the physical obstacles faced by them are resolved through the person-centred care plan and additional support is provided to the patients to executing their physical activities of daily living (Nilsson et al., 2019). However, if person-centred care is not established for the patient, then it leads the care staffs to deliver holistic care but not focusing on the individual physical needs of the patient. This would make the patients in care feel neglect and demotivated in showing compliance in accepting care or show hindrance in motivation towards achieving enhanced health outcome (van der Meer et al., 2018). The safety in care motivates the carer to deliver less risky, harmful and errored care services for the patients. Moreover, it motivates the patients to feel secured and avoid fear of harm or abuse from the society which in turn helps them to develop positive intention to live and achieve enhance well-being (Hale et al., 2019). The safety of the patients can be easily achieved through person-centred care. This is because in person-centred care individual risk analysis of each patient are performed to determine specific risk unique to each of the patients and accordingly develops risk management process to resolve them (Nilsson et al., 2019). Since safety is one of the basic motivational needs of people in life as mentioned by the Maslow’ theory and it being able to be achieve through person-centred care. Thus, the social care organisation and teams are required to focus towards delivering effective person-centred care for motivating patients to live a healthy life. However, failure to achieve safety by not providing person-centred care would lead the patient to be demotivated in living life. This is because they would feel stressed to cope with adversities each day with no adequate support in care (Nydahl et al., 2017). The Maslow’s theory mentions that presence of belonginess and love along with self-esteem needs are psychological needs which on fulfilment psychological motivates the person lead life (Evans et al., 2017). In person-centred care, it is seen that an effective belonging and love relationship grows between the nurse and the patient with the support from the nurses. This is evident as person-centred care are always seen to be delivered by coordinating with the patient by the nurses to understand the patient’s personal needs and demand regarding care. The nurses are seen to record patient’s needs and accordingly plans their care and share it with other caregivers to ensure the specific care is received by the individual at all times (Santana et al., 2019). It leads to create a trustful and friendly relationship between the patients and the nurses, where all needs of the patients are listened with calm and compassionate nature along with fulfilled effectively (Kuluski et al., 2019). Thus, the social care team and organisations are to achieve person-centred care for the patients as it the way through which belonging and love towards the patients can be shown to motivate them psychologically to live and accept care. In person-centred care, it is seen that patients are provided absolute independence to decide and chose their care in an informative way. This is because the nurses in person-centred care are seen to inform the patients regarding all the care available to be used by them as per their health condition along with the pros and cons regarding each care. It leads the patient have individual opportunity to personally analyse and decide which care they wish to be received. This in turn makes them feel free and avoided to be forced to take care decision (Nydahl et al., 2017). It eventually leads the patient to feel their rights to take decision are respected which makes them feel dignified (Nydahl et al., 2017). According to Maslow’s theory, the presence of feeling of prestige and accomplishment is required as it promotes self-esteem of the person to be increased which act as psychological motivation for them to perform task and accept care in leading a healthy life (Velmurugan and Sankar, 2017). Thus, social care organisations are required to focus on delivering person-centred care to service users as through it they are able to show self-esteem which acts as psychological motivation for the patient to accept care and develop well-being. However, the lack of person-centred care does not provide opportunity to the patients have greater self-esteem as dignified and respected care with independency is not achieved. This is because in general care all the patients are holistically treated with no specific delivery of care as per their needs (Nilsson et al., 2019). Therefore, social care organisations are required to deliver effective person-centred care for psychological motivation of the patients. The Maslow’s hierarch of needs mentioned that self-actualisation that is allowing an individual to achieve full potential in performing actions such as creative activities, self-care and others act as self-fulfilment needs and it motivates the person to live independently with efficiency (Velmurugan and Sankar, 2017). In person-centred care, it is seen that strength and weakness of the service users are recognised individually. On the basis of the facts, the care plan is frame so that the patients have the ability to take creative actions and be empowered to take own care with the use of their strength and by overcoming their weakness (Nilsson et al., 2019). Since person-centred care lead individuals to reach self-actualisation, thus the social care organisations are required to achieve it for the service users. This is because it is through person-centred care that the patient can be holistically motivated accept care, live independently and show greater well-being.

Conclusion

The above discussion mentions that Tuckman’s theory informs the way team are to be gradually framed and managed so that the they are able to maintain systematic and structural design of care for the service users. However, the Belbin’s theory mentions about the nine key roles to be played by the team members so that they can actively support in managing the care diversity and responsibilities of care for the service users in the healthcare. The fishbone diagram and PDSA cycle are the key continuous quality improvement tools being used to maintain quality healthcare. The person-centred care is to be achieved by the social care organisation as it meets the basic, self-fulfilment and psychological needs of the patients as mentioned in the Maslow’s theory that motivates a person to live with enthusiasm and develop well-being.

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