Post 4.1-LDRS 501

“Crafting a realistic vision and gaining employee-buy in is just a first step “(Lepsinger, 2010, p.6)

Background

An organization that understands customer value and focuses on its purpose and the process works towards achieving those values as “an organization’s cultural commitment to applying the scientific method to designing, performing, and continuously improving the work delivered by teams of people, leading to a measurably better value for patients and other stakeholders” (Toussaint and Berry (2013). The importance of evidence-based medicine (EBM) (Price, 2012) and point-of-care testing is to improve the safety, quality, and efficiency of care. The principal objective of EBM as suggested by Glasziou and colleagues was trying to improve the quality of the information on which decisions are based and outcomes. Point of Care Testing (POCT) (Leeds pathology, 2014) is clinical laboratory testing conducted close to the site of patient care, typically by patients or clinical personnel whose primary training is not in the clinical laboratory sciences. POCT refers to any testing performed outside of the traditional, core or central laboratory. While POCT represents an important advance in patient care and providing decision support interventions; thereby, healthcare providers must use it discerningly and back up its use with evidence-based data through electronic health record as a tool to achieve a learning health system. Therefore, affords the opportunity to build decision support within the workflow of the nurses, physician and laboratory staff.

Switching from conventional laboratory testing to POCT shortens the time to decision-making about further testing (Junker, Schlebusch, Luppa, 2010) and treatment, therefore, delays are no longer caused by specimen transport and preparation, and the results are rapidly available at the point of care as better medical outcomes and lower costs may ensue. The POCT is a patient-centric strategy when implemented successfully; it is essential that there should be suitable management structures (Galbraith; Hughes, Beatty, Dinwoodie, 2014) with clearly defined areas of responsibilities. Managing all the POCT activities through a computer network of the instrument in the decentralized use with a central information system (laboratory information system) allow reliable documentation of the results, optimizing the quality assurance and service performance, and provide a proper calculation of cost-effectiveness. “Systems cannot be fully perceived with one set of eyes,”(Senge’s law, 2006) and visioning the benefits of POCT require the clinicians, laboratorians and healthcare administrators to have guidance in the effective utilization of POCT, exploit the therapeutic potential and avoid waste. Hospitals systems, wanting faster turnaround time of laboratory results to move patients faster through the system, and POCT as rapid clinical decision-making can provide faster results[outcomes] and earlier therapeutic interventions. There is also a tendency for physicians to equate new technology with better patient care. Thus, it is essential that each laboratory or testing site research new test requests to determine clinical utility and cost-effectiveness, as well as management and reimbursement issues. The implication of implementing the POCT systems into medical practice is patients’ satisfaction, quality assurance, and compliance.

Lean Thinking and implementing the change                                                                       

Based on the background, some area in an organization needs improvements. Strategic renewal is “the process of change and the outcome of adjustment in a strategic direction that has the potential to determine the long-term competitiveness of a firm” (Bonnici & McGee, 2015). Using lean thinking principles by Toussaint and Berry (2013) to determine actions would make the better change.

Areas to focus on

Considering the objective of the strategic renewal is to provide “a strategic fit between a firm’s internal capabilities and shifts in the external environment involving technology, markets, industries, and the economy that require a change in the status quo of conducting business” (Bonnici & McGee, 2015)

• Considering the available analytical spectrum without facilitating the networking of POCT system made it difficult to develop the new approaches of using POCT into clinical decision-making. Therefore, lack of communication and transferring the laboratory service, regarding POCT, to the providers to shorten the turn around time. Which means, the computer- networking of the instruments in decentralized use with a central information system [Hospital or Laboratory information system].
• Lacking reliable documentation of the results may affect the optimization of quality assurance and accreditation, patient care and safety. When considering the errors as most commonly due to a) operator incompetence [nonlaboratorian clinical staff, whose primary job is the delivery of patient care rather than the analysis of fluid body samples];  b)nonadherence to test procedures due to the pressure of a busy clinical environment might result in a violation of the performance of POCT; c) and the use of uncontrolled reagents and testing equipment as necessary in POCT. It is easy to speculate that such errors may be symptomatic of a lack of accountability of the individuals performing POCT. Therefore, “lack of accountability creates and reinforces a culture of blame” which, in turns, generates other problems (Lepsinger, 2010). Given that, POCT is often carried out by individuals not previously accustomed to POCT; these individuals may often view the need for performing instrument maintenance, instrument calibration, or external quality assurance (EQA) testing as being the responsibility of someone else.
• Suitable management structure to defined areas of responsibilities (Galbraith, 2014). Thus, Insufficient information on cost-effectiveness hinders the successful implementation of POCT instruments when screened with the fixed costs in the laboratory. Junker et al., 2010. Additionally, overuse or incorrect utilization of POCT could potentially increase the cost of care or delay treatment. 

Challenge and new direction

Three steps necessary to shift to a new direction; lean thinking presents six principles that constitute the essential dynamic of Lean management: the attitude of continuous improvement, value creation, the unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation.  Based on the background provided above;

–    I would suggest embracing a new economy of productivity, quality and continuous improvement (Ungerer, Ungerer & Herlodt, 2016). Identifying the organizational performance standards and expectations and focus greater attention on patient safety; whereby, implementing the meaningful of patient safety programs with defined executive responsibility (Kohan, Corrigan, Donaldson, 2000). The public and private purchaser should provide incentives to healthcare organizations for continuous improvements in patient safety. (Kohan, Corrigan, Donaldson, 2000).

–    I would advocate commitments and hold myself and others accountable. Adding more emphasis on accountability, Blagescu & de Las Casas (2005), Bovens, (2007), and O’Dwyer & Unerman (2007), they referred as” relationship based on commitments of some people to demonstrate, review, and take responsibility for performance, both the results achieved in light of agreed expectations and the means used”(as cited in Abd Aziza, Ab Rahman, Alam, Said, J., 2015, p.164). It includes moral and rights as well.  Through a collaborative process with others in collective efforts and responsibilities (Hughes et al., 2014); Implement periodic examinations, relicensing, accreditation and training sessions to doctors, nurses and key providers to improve performance and reduce errors (national academic press, 2000). Training and education are the principal mechanisms for cultural change with relationship to quality improvements. The need for interdisciplinary training since there is a team involvement with different backgrounds.

–    The importance to set up a POCT coordination office managed by the central laboratory. The role of this office is fulfilling the requirements of quality management. Another condition for successful [fruitful] POCT system is the computer networking[connectivity] of the instruments in decentralized use with the central information system [Hospital or Laboratory information system]. The reliable documentation of the results, optimization of the quality assurance, in regard, providing proper control of cost-effectiveness.

Promoting the threes

The positive renewal (Create-continue-promote)

1. Create the supportive environment and encourage healthcare providers in an organization and make them comfortable with trying a new approach when taking on challenges (Lepsinger, 2010), which in regard, increase chances of innovation, quality improvement, and safe patient care.
2. Continue to follow the organization’ mission, vision, and values. Hughes, Beatty, and Dinwoodie, (2014) noted MVV helps employees understand and make sense of the organization’s purpose, goals and culture, that, promote patient safety.
3. Promote and welcome innovation and acknowledge “the systems can’t perceive with one set of eyes” (Senge’s law, 2006). Therefore, a new connection leading to new insights (Ungere et al., 2016) and create a visible value to support evidence-based medicine and therapeutic intervention, which in regard, support patient safety.

The contrary practice [Three negatives]

1. Ignoring the negative pressure that may affect the networking of the POCT system, then, developing the new approach of using it. Hindering the communication and transferring the laboratory service, regarding POCT, may affect the practice and patient safety.
2. Ignoring the cultural norm and the possibility of making errors (Hughes et al., 2014) and learn from these errors and contribute to success as opposed to apportioning blame.
3. Ignoring the use of suitable management structure (Galbraith, 2014) in defining the areas of responsibilities, which in regards, affect the performers. Not changing that sap energy will cumulatively and negatively reflect on developing capabilities and values (Hughes et al., 2014), that is, crucial to any healthcare organization.

Corrective Action

1. Strategic influence in gendering Commitments to on continuing improving resulting in improved performance; the powerful dynamic starts when your expectation translated into behaviors” (Lepsinger, 2010).
2. Continue to develop the best performance and transform perspectives that encompasses many facets and dimensions of the leadership process (Northhouse, 2013) When all conditions come together we can create a team of high performers; a team can execute care effectively than ever before. (Lepsinger, 2010)
3. Challenge the process (Northhouse, 2013) and willingness to challenge the status quo and to be willing to innovate, grow and improve. Building trust with others and promote collaboration. Encourages the heart and support others attentively, take an active and keen interest in providing quality service to patients; therefore, they resonate with their surroundings (Mukonoweshuro & Sanangura, 2016) toward success.

Conclusion

The underlying goal of Lean is to improve the quality and efficiency of patient care while controlling the cost in the provision of the best ideal patient care. Successful lean transition requires a systematic and systemic change, leaders at all levels and servant leaders to engage their staff in identifying and solving problems based on continuous improvement attitude; therefore, change the culture.  The medical or organizational advantages of POCT is to provide the preliminary screening of patient results; thus, leverage a clinically significant strength in decision-making.

References

Abd Aziza, M., Ab Rahman, H., Alam, M., Said, J.(2015). Enhancement of the Accountability of Public Sectors through Integrity System, Internal Control System, and Leadership Practices: A Review Study. Procedia Economics and Finance,28, 163-169. doi.org/10.1016/S2212-5671(15)01096-5

Bonnici, S., T., & McGee, J. (2015, January). Strategic renewal. Wiley Encyclopedia of Management, (12). Retrieved from: https://www.researchgate.net/publication/280248400_Strategic_Renewal

Christopher, P., Price (2012). Evidence-based laboratory medicine: is it working in practice?. The Clinical biochemist. Reviews, 33(1), 13-19. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284339/#b13-cbr_33_1_13

Galbraith, J. R. (2014). Designing Organization: strategy, structure, and process at the business unit and enterprise level. San Francisco: Jossey-Bass. ISBN:978-1-118-40995-4

Glasziou P, Del Mar C, Salisbury J. Evidence-Based Practice Workbook. 2nd ed. Oxford, UK: Blackwell Publishing, BMJ Books; 2007. pp. 1–202. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284339/#b13-cbr_33_1_13

Hughes, R. L., Beatty, Collarelli-Beatty, K., & Dinwoodie, D. L. (2014). Becoming a strategic leader: Your role in your organization’s enduring success. San Francisco, CA: Jossey-Bass

John S. Toussaint, Leonard L. Berry (2013). The Promise of Lean in Health Care. Mayo Clinic Proceeding, 88 (1), 74 – 82. doi.org/10.1016/j.mayocp.2012.07.025

Junker, R., Schlebusch, H., & Luppa, P. B. (2010). Point-of-care testing in hospitals and primary care. Deutsches Arzteblatt international, 107(33), 561-7.

Kohan, L., T., Corrigan, J., M., Donaldson, M., S. (2000). To Err is Human: Building a safer Health System. Institute of Medicine (US) Committee on Quality of Health Care in America; Washington (DC): National Academies Press (US). Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK225181/

Leeds Pathology. (20104, November). Introduction to Point of Care. Retrieved from: http://www.pathology.leedsth.nhs.uk/pathology/Departments/BloodSciences/ClinicalBiochemistry/PointofCareTesting.aspx

Lepsinger, R. (2010). Closing the execution gap: How great leaders and their companies get results. San Francisco, CA: Jossey-Bass

Mukonoweshuro, Jeskinus & Sanangura, Cleopas. (2016). The role of servant leadership and emotional intelligence in managerial performance in a commercial banking sector in Zimbabwe. Banks and Bank Systems. 11. 94-108. doi10.21511/bbs.11(3).2016.10. Retrieved from https://www.researchgate.net/publication/309141829_The_role_of_servant_leadership_and_emotional_intelligence_in_managerial_performance_in_a_commercial_banking_sector_in_Zimbabwe

Northouse, P. G. (2016). Leadership: Theory and practice, Seventh Edition. Thousand Oaks, CA: Sage Publications. ISBN 971452203409

Senge, P. (2006). The fifth discipline. New York: Doubleday. Retrieved from: https://create.twu.ca/ldrs501/unit-3-learning-activities/

Ungerer, M., Ungerer, G., & Herholdt, J. (2016). Navigate strategic possibilities: strategy formulation and execution practices to flourish. Randburg: KR Publishing. ISBN 978-1-869-22623-7. Retrieved from http://ezproxy.student.twu.ca:2956/eds/ebookviewer/ebook/ZTAwMHhuYV9fMTQyNzAyOF9fQU41?sid=978ecd5d-68db-489c-9ecb-1f013269a988@sessionmgr4010&vid=2&hid=/&format=EB