The aim of this essay is to examine and analyse the impact of leadership following the process of implementing IT systems at National Health Service (NHS) hospital. I have chosen to discuss the introduction of handheld computer devices on the general ward where I worked as a support worker. The essay will first describe the project introduction and fulfilment process. I will then explain the leadership style at the hospital and how it impacted on the process. Further to that I will also discuss the response or contribution of staff in health and social care to the implementation of the project. In conclusion the essay will explain some of the challenges that leaders face when implementing a new project. For the purpose of this essay I shall not disclose any particular names of the health organisations or staff for the purpose of maintaining confidentiality.
Lately there has been a revolution in the way health services are provided within England resulting in increase in the need for the care system to make use of best available technologies, (Boostru, Voerrsluis and Vos, 2014). To add on to that, there are new changes on how to collect and share confidential information from health records. This has prompted the National Information Board (NIB, 2014) to unveil a vision under Personalised Health and Care 2020 for the use of data and technology to transform outcomes for patients and citizens as one of the core and immediate priorities of modern digital health and care services. As an example the National Information Board (NIB, 2014) promoted better use of data and technology to lower the administrative obligation for care professionals and to support the development of new therapeutic interventions. Recommendations from the Department of Health (DoH ,2013) which underpinned the guidelines were that all patient's case notes and records are to be paperless by 2020 so that information can be shared where there is medical need to do so.
Of particular interest was the introduction of handheld computer devices for use by staff on the ward in many local hospitals in England and many other working places based on healthcare. All adult patients in hospital emntitled to a clear monitoring plan specifying which Vital warning signs should be recorded, their severity of illness measured using physiological early warning scores(EWS) and a graded response strategy (DoH,2010). Earlier on the paper-based documentation and early warning system was in place for a long period of time and it was the staff's duty to carry all the physiological observations and record them appropriately on the patient record and nursing care plan, (DoH,2013); and on a chart which was always held at the bottom of the patient's bed (Ball,2014& Parkin,2016).However, this sometimes had a limit on the availability of such information to other clinicians involved in the care of the patient such as specialist doctors or the critical care outreach. Parkin, (2016) summed up the process saying, "it was time consuming and widely characterised as incomplete, inaccurate and subjective".
According to Ball, (2014) support workers and other health professionals were mainly dependant on oral communication for exchanging information about patients. In support of the above issues, Clements (2016) highlighted that human factors have a role to play in dictating the ability of the that staff to accurately calculate the early warning scores based on patient care. The VitalPAC provides a structured mechanism for clinical staff to record patients' vital warning signs electronically at the bedside, calculate warning signs (DoH, 2012) and immediately provides instructions to bedside staff on what needs to be done regarding a particular patient's scores. . A patient's health record is easily kept that way. Staff from elsewhere in the hospital can also make an instant access to the charts and data via the internet (DoH, 2012). Doctors can look at all the observation trends from a distance in a clear format and are able to monitor patients even if they are not on the ward (Soumerni & Avery, 2010). Therefore, this means that making use of the VitalPAC provides accurate data and ensures timely communication between healthcare professionals (NIB, 2014).
The System was first rolled out across four pioneering wards at a hospital where I worked. Staff members led by ward manager from the pioneering wards had to work closely with the nominated IT project team. The IT team was outsourced and their role was to make sure that nurses and other clinicians are able to use the devices. The team comprised of three members who had management responsibility and experience and six others who were highly knowledgeable and skilled in IT. The IT project team's responsibility was to assist and educate support workers on both shifts on information and technology mainly how to use the VitalPAC. The managers would oversee the whole implementation process including staff awareness and training.
At the ward they started with five VitalPAC with the hospital software uploaded onto it but went on to order more as staff became more confident to use them. Soumerni and Avery (2010) states that, "the implementation of Information and Computer Technologies remains difficult and involves changes at different levels". That means it requires the involvement of effective and efficient leadership. These views are echoed by Gopee and Galloway (2014 p.231) who states that the concept of change is important to health care leadership therefore it requires an in-depth understanding of the process and the ability to effectively implement the change process as a leader or team member. Thus, a successful implementation of a project will depend on good leadership theories and styles in place within the organisation. Therefore, the hospital where I worked adopted a top-down leadership style.
Turnbull, (2011) states that within a top-down leadership style, operation and management is directed by top management. However, the given form of leadership approach does not fully meet the required democratic qualities and styles where decisions concerning the project vision were made by top management (Northhouse,2012 p.118). Staff were not included in planning and briefing stages of the project but it was the ward manager's responsibility to lead and guide staff on the process. The manager called for a team meeting to introduce the project to staff and brought information booklets for staff to use as guidance to understanding the new devices. Members of the IT were present to assist. Therefore, the project implementation process was more centralised including the direction of the project however induction and training was provided by members of the IT team. The ward manager became more of a transformational leader in adopting the good aspects of the style by overseeing staff awareness and training, performance and promoting the vision (Turnbull, 2011).
According to Northhouse, (2012 p.161) transformational leadership, "is a process that changes and transforms people, it is concerned with emotions, values, ethics, standards and long term goals. It includes assessing followers' motives, satisfying their needs and treating them as human beings." The manager explained during team meeting that they intended to focus on making the process better therefore staff were encouraged to complete a checklist of areas they were not confident in using computers so as to assist in planning for training. The manager also encouraged staff to be more creative and innovative with the project. This is highlighted by Turnbull, (2011) who stated that, "when a leader adopts effective skills of transformation they become at a position to explain everything based on the vision and the purpose for cultivating the personal and professional development in the members of the staff".
As staff , I was inducted on the use of VitalPAC immediately on the ward during handover. The manager checked with me by asking whether I had used the device before and explained the basic clinical concepts. From then on each staff member was given logging details and a website link where they could log in and take up awareness training online after work. The course was assessed online however the manger could check on the results and progress. I received emails regularly from the team manager asking how I was getting on with the awareness training. Working as part of a team, my role was to carryout observation checks on patients and record Vital Warning Signs scores on the observation chart. I could easily approach the manager if I had concerns about observation results because the manager was available and approachable. Decisions pertaining to how information was kept, the type of software used for VitalPac was made by management. Team managers were then closely monitored as they made decisions pertaining to specific wards. This was done through peer reviews and mentorship. This strategy was meant to ensure that the staff members were competent enough with the introduced skills.
Jones and Bennett (2012) mentions that, "within a top down leadership style, a leader or a small number of people take all the decisions on their own but are closely monitored". This is relevant especially when implementing a project such as the IT project on the ward, a leader will at some point adopt a democratic style to make important decisions whilst at the same time consulting the team. However, Northouse (2012 p.116) mentioned that a leader can project intellectual stimulation by recognizing that people have something to say and hence encourages them to come up with suggestions or creative ideas. Such an act is fundamental to a good leadership style. The manager allocated specific staff members the responsibility of ensuring there was always enough devices on the ward, checking on the machine to make sure they are regularly calibrated and to report any problems to the IT department. The manager communicated openly about the project initiative and staff were enthusiastic about the amount of impact the devices were going to have on their workload.
Mckbbin and Walton (2008 p.18) highlights that individuals and teams will follow the person who inspires them. Thus the ward manager supported the staff team and facilitated the process of adapting to the use of the devices. At the same time the manager closely monitored staff nurses to help them see the importance of the project through regular supervision and team meetings. During meetings the manager made sure she was listening to staff needs and ensured that they were well informed and up to date with the policies and procedures of documentation as well as maintaining good conduct with patients. Such form of support provided by management and the quality of this support dictates the quality of the work produced by staff and creates and sustains trust between nurses (Gopee & Galloway, 2014). The manager also addresses the needs of staff (Adair, 1998 p.210) outside of duties to enhance their performance. This was done by making sure that the manager is observing staff most of the time and providing direction on an individual basis as well as checking on whether they have other problems outside of their duties and responsibilities. This could be a potential problem in case there was need to a democratic existence in the institution.
Storey and Holti (2013) states that an effective leadership style assists in maintaining the motivation of staff to produce successful results. The manager also made follow up meetings with every staff member specifically to identify their training needs and to make sure they are up to date with training. Sometimes support was offered during handover...
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