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In healthcare, Quality Improvement (QI) is the combined effort and unceasing activity by all the individuals and professionals in the care environment to make an enhanced change in the care (Mannion and Davies, 2018). In order to achieve QI, the presence of efficient leadership approach is required. The leadership approach is referred to the act of influencing group of people to maximise their efforts to achieve a common goal (Tretiakov et al., 2017). In this study, the leadership approach to be used for promoting and quality improvement of sleep hygiene in paediatric hospital for patients is to be explained critically analysed. Thereafter, the way the leadership approach and QI project would improve patient care in paediatric hospital is to be critically discussed. Further, the importance of service-user involvement and coproduction in the success of the QI project in healthcare is also to be explained. In explaining the QI, confidentiality is to be ensured as per the rules mentioned in the NMC Code under the "Prioritise people” section.
Critical Analysis of Leadership Approach
The transformation leader plays the role of sharing and collecting ideas and consciousness of making the change from different members of the team involved in change or quality improvement of care (Gifford et al., 2017). This is important as it helps to gather diverse ideas and build collaborative environment where each idea is to be analysed from others to reach the best idea to be implemented for the success in making the change (Seidel et al., 2019). Thus, the transformational leadership approach is used in making the current QI so that most effective idea or strategy from the diverse ideas shared by different nurses and healthcare professionals in the change team of making the change in promoting sleep hygiene among children can be determined and implemented. The role of the transformational leader is to encourage the team in making the change by guiding them about the need of the change along with inspiring and motivating them to accomplish it (Musinguzi et al., 2018). Therefore, the transformation leadership is to be used in making the current change so that the healthcare staffs in the paediatric hospital understand the need for sleep hygiene promotion in children along with feel motivated to support the change out of guidance and support directly from the leader.
The advantage of using transformational leadership approach in this QI is that it helps in achieving a common cause in united manner (Krepia et al., 2018). This is evident as disturbed sleep schedule is common among children in paediatric hospital due to their health issues, presence of insomnia and hindered screen time habits which makes sleep hygiene management a common issue. Thus, the transformation leader by working along the healthcare staffs in collaborative way would be able to accomplish the actions to be taken for sleep hygiene improvement. The transformational leadership approach is beneficial as it allows the leader to show increased engagement in assisting and directing staffs to make the change by acting with them (Musinguzi et al., 2018). Thus, the approach is to be used as it helps in avoiding high turnover cost of employees who may leave the project out of lack of support or training from leaders in achieving the mention goals.
The disadvantage of transformation leadership approach is that they require their followers to agree with them which is time-taking because all the members of the team may not approve of following the same strategy of change at a time (Giddens, 2018). Thus, the accomplishment of sleep hygiene in paediatric hospital may be time-taking which may result in deterioration of sleep schedule of the children to be present for longer time. Moreover, the other disadvantage to be faced with the leadership is that it may not be detail-oriented as such leaders in the QI become fixated more on the prize in the end rather than determining details for achieving the goal (Musinguzi et al., 2018). Thus, the transformational leaders may not lead to develop details regarding the way to achieve sleep hygiene in the paediatric hospital. However, the issue is not to be faced as being a leader, detailed idea to be followed in making the QI is framed and shared with the team.
The enabler for change of promoting sleep hygiene in the paediatric hospital is that all the nurses and health professionals consider sleep issue to be faced by most of the service users and it is adversely affecting the health improvement of the children (van Schaik et al., 2020). Thus, healthcare workers are found to be aware of the issue and is personally inclined to accomplish the change. However, the barrier to be faced in promoting sleep hygiene is lack of support from the children in reducing screen time and performing actions in regular manner to minimise insomnia (Golem et al., 2019). The other barrier is that unwillingness of children to avoid spending extended time in beds in the paediatric hospital as they feel mentally depressed and stressed with the current deteriorated health condition for which they are hospitalised (Golem et al., 2019). The use of certain medicine for the children may also act as barrier in helping them to maintain sleep hygiene as they create insomniac effect (Berger and Kudchadkar, 2021).
Way the project support improvement
The current QI project aims to implement sleep hygiene by reducing screen time among paediatric patients who are children. This would help in patient care improvement as lowering screen time would make the children to be least exposed to the high-energy blue light emitted from the TV, mobile and other screens that promote melatonin release which is the key hormone that support healthy sleeping (Calvo-Sanz and Tapia-Ayuga, 2020). As argued by Mortazavi et al (2018), melatonin is released from the pineal gland in the dark that indicate the body to feel tired and go to sleep. However, the presence of blue light from TV and other screen creates light sources that minimise melatonin production in the lack of dark. It would create hindered sleeping tendency that would cause increased stress, forgetfulness, low motivation and others in children (Barrau et al., 2017). Thus, the current action of reducing screen time as taken in the project would limit the sleep hindrance and promote better healthcare for patients.
The QI project also aims to implement sleep hygiene by promoting management of insomnia in children by making them learn and execute relaxing techniques like muscle relaxation, visual imagery and diaphragmatic breathing. These actions taken in the project would improve patient care as it is going to help in accomplishing sleep hygiene among the children by avoid insomnia, in turn, limiting the adversities to be faced by children due to adverse sleep schedule (Gupta et al., 2019). It is argued by Short et al (2019), insomnia in children are mainly raised due to stress out of medical health issue, deteriorated mental perception, stress and others. Thus, taking actions in limiting the cause of insomnia would promote better healthcare of the children in the paediatric hospital.
The current transformational leadership approach would also help in improved patient care and service in regard to sleep hygiene at the paediatric hospital. This is because it promotes direct communication between leader and team members to create better understanding of strategies of the change in care to be followed and access support in overcoming problem at work to achieve the change (Andriani et al., 2018). As argued by Thibault et al (2019), lack of communication or superficial interaction between leader and followers in making change creates hindrance to accomplish the quality improvement. This is because the follower or team members lack proper guidance regarding the way to achieve the goal of change. The transformational leadership would also support improving better healthcare and enhance change because it avoids coercion which makes team members have freedom to execute changed activities with encouragement and without domination from other (Seljemo et al., 2020). However, coercive environment would limit improve patient care to be delivered through change as the staffs involved in delivering the care are intended to work under threat or forced beyond their willingness which lowers their performance in delivering enhanced care (Andriani et al., 2018).
Importance of service-user involvement and co-production in care
The importance of service-user involvement and coproduction in healthcare is that it allows to create an acceptable healthcare environment (Mazzei et al., 2020). This is because service-users involvement such as in this project the children in understanding importance of sleep hygiene would make them accept the selected care without objection as they feel and recognise through evidence out of involvement in care that it is for their better health condition (Beresford, 2019). The importance of coproduction and involvement of service users is that it allows the service users to inform their key needs and act along with the nurses to decide the best specific care to be provided to them (Williams et al., 2020). Thus, service-user involvement is required in current project as it ensures greater quality clinically and personally relevant care to be provided to patient.
The transformational leadership approach is used in the QI improvement project for sleep hygiene promotion in patient in the paediatric hospital. This is because such leaders work together with the team to inspire and motivate them for making the required change in the care environment rather than overshadowing them by playing superficial role of only directing them to make the change. Moreover, the current project improves patient care and service as it implements reduced screen time and relaxation techniques to reduce insomnia and sleep disturbance in patient. This meets the NMC Code of Practise guidance that mentions care is to be provided by acting in best interest of the patients by identifying their key needs as seen in this project where screen time and insomnia are factors of sleep disturbance in children at the hospital.
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