Case

Fire the Facilities Manager?

John Faber is the facilities manager employed at a 240-bed nursing home for the past 3 years. Before John, the facility had one supervisor over both housekeeping and laundry and a separate maintenance supervisor. Hiring John to supervise all three departments resulted in an annual savings of $7,000 in labor and materials. Prior to joining this facility, John was the maintenance supervisor at a 120-bed skilled care nursing home. Before that, he was a small business owner of a home cleaning service that employed six people. He sold that business 4 years ago. John’s background also includes ownership of a coin laundromat that he disposed of several years ago.

It is time for the annual performance review for all associates. For department heads, the corporate office has authorized a wage increase of between 0% and 6% based on performance. As the administrator (NHA) mulls over John’s performance during the past year, she is pleased with the ongoing cost savings and on-budget performance in facilities services. However, the NHA thinks that she has to hold John accountable for the citation in housekeeping during the certification survey just 2 months ago (rated as E on the Severity/Scope Grid). Last year also the facility had been cited for housekeeping (rated as H on the Severity/Scope Grid), and a resident who had tripped and fallen over a vacuum cleaner cord had sued the facility. Earlier this year, the corporation had settled the claim for $20,000.

The corporate vice president of operations just called and suggested that John should be fired for his poor performance, but the NHA does not share the same view. Her response to the VP of operations was, “I would like to think it over and get back to you tomorrow.” Now, the day has arrived for the NHA to have a phone conference with the VP of operations and a face-to-face meeting with John.

Questions

1.  How should the NHA resolve the conflict with the VP of operations? Provide adequate details, and incorporate in your response the leadership style you suggest using with John.

2.  The NHA’s decision is to not give John a wage increase, which leads to a disagreement between John and the NHA because he regards it as unfair. How should the NHA handle this conflict in which the objective should be to arrive at a win–win solution? Again, provide adequate details.

Your written assignment for this module should be a 2-3 page paper (not including title page and reference page) that describes the following:

J.D. is a 70-year-old man with a history of prostate cancer, being treated with palliative hormones and radiation. His admitting diagnosis is adenocarcinoma of the prostate with widespread bone metastasis. J.D. is married and has one grown daughter, who often helps with his care. His chief concern is severe back pain for which the physician has ordered intrathecal morphine sulfate and aspirin 650 mg for pain relief. J.D.’s admitting CBC shows a WBC count of 500 and platelet count of 15,000.

For this case study:

1. List the symptoms typically seen in patients with prostate cancer.
2. Identify the risk factors for prostate cancer, including which population is most at risk.
3. Identify the complications J.D. is at risk for and explain the pathophysiology causing those risks.
4. List 3 nursing problems and your goals for J.D.
5. List at least 3 nursing interventions for each problem.

You should include a minimum of 3 references. Include a title page, in-text citations, and a reference page in APA format.

Comment 1

I have never personally been put in this kind of situation but we have education every year about this at our hospital. A scenario, a young child, age 8, is brought into the emergency room twice in one week for “falling” and his arm is hurting again. The first visit’s xray of his arm was normal, no broken bones seen. The child is discharged. The second visit, the xray shows a broken clavicle. The nurse and doctor assess the child and notice bruises all over the child’s body under his clothes. The nurse and doctor know that they must be caution at this point. Start with questions to the child: How did you fall? Do you fall often? Ask where a particular bruise came from. The child shys away and start to hide his face.  The healthcare team then turn to the mother and again are cautious with the way the questions are asked. The mother is reluctant to answer the questions but she does in a hesitant way but does not make eye contact. The healthcare team dismiss themselves stating they would return soon. The nurse and doctor have a private conversation and they both are suspecting child abuse and know that it is their duty to mandatory report their suspicions after their assessment. Our hospital policy for mandating reporting is to follow they chain of command before reporting. The manager must be notified and the administration on call must be notified along with the risk officer. When all has been notified then the local police station and DHR will be notified. This can flow very easily if done properly. The State of Alabama had changes to the mandatory reporting law in 2013. The changes are: 1.) The State of Alabama mandates that the person who assess and has the suspicion on that assessment must be the one to support it to the police and DHR. 2.) Any public or private employer who discharges, suspends, disciplines, or penalizes an employee solely for reporting suspected child abuse or neglect will be guilty of a Class C Misdemeanor (National, 2018).

Comment 2

The State of Texas has a law that mandates anyone who thinks a child, a person 65 years or older, or any adult with disabilities is being abused, neglected or exploited must report it to the department of Family and Protective Services (DFPS). The abuse report can be made by phone 1-800-252-5400 or online at Texas Abuse Hotline 24 hours, seven days a week or call 911 the Local Law enforcement.

A person who reports abuse in good faith is immune from civil or criminal liability. The DFPS keeps the name of the person making report confidential. Anyone who does not report suspected abuse could be held liable for a misdemeanor or felony.

In the State of Texas, nurses and doctors are mandated to report any suspected child or elderly abuse to the department of Family and Protective Services or the Local law enforcement agency. They also document all findings including physical findings in the patient’s chart. Both nurses and doctors are also expected to report the suspected abuse to their immediate supervisors like nurse managers or senior doctors respectively (Texas Department of Family and Protective Services, n.d.).

Scenario

I was working in ER one evening when a 6-year boy was brought in by his parents with complaints of a painful leg secondary from fall. On assessment, the child looked frightened and withdrawn from the environment.  Multiple bruises at healing stages, black eye and swollen left leg was noted. When I asked the parents what could have caused the findings, both mother and father stated “ the boy is” messy” with himself and falls most of the time when playing”. When I asked the boy what happened to his leg and skin, he just stared at me. The doctor ordered an x-ray of the left leg, which reviewed spiral fracture of the femur.

Comment 1

Knowing scientific management theory as defined as supervising by way of focusing on task accomplishments rather than interpersonal relationships (Huber 2014). Some routines in health care that seem to be inefficient in regards to scientific management are the overwhelming focus on tasks, the evaluations based on tasks accomplished, and the pressure to join committees to add more tasks to nurses’ duties. A lot of times nurses have trouble tending to the needs of their patients because they are so focused on getting the tasks done so as to not get in trouble. Many times tasks are added to the nurses’ workload making it hard to complete everything on time. This causes incidental overtime which is also greatly frowned upon. Finally, the committees are supposed to be a good thing, allowing nurses to participate in shared governance. The issue arises when the requirements for the committees capitalize on the time the nurse should be working or decompressing from the stress of daily work. Some examples of participative decision-making at the hospital that I work at are unit forums and shared governance council. The unit forums allow for nurses and aides in the unit to meet and discuss issues to resolve amongst themselves. Shared governance councils allow for nurses to meet with administration to discuss issues at the bedside that can only be fixed by administration.

Comment 2

The scientific management theory states that humans are motivated by money, and there should be a separation between managers and workers. The expected result is a dramatic increase in productivity of the workers and profits for the organization. Some of the routines in the health care setting that are inefficient is nurse-to-patient ratio and staff retention. I feel the nurse-to-patient ratios are unsafe as it overloads the nurse and nursing assistants in carrying for high acuity patients with a higher prevalence of medical errors and oversight. When staffing is is done according to census instead of census it creates an unsafe environment for the patients and the staff. Without adequate staffing, patient care is inadequate and the patients suffer. Which in turns causes patient surveys to report negative feedback giving the hospital low numbers.Staff retention is important to ensure there is adequate staff to meet the demands of an aging population with numerous chronic illnesses. When facilities ignore the concerns of staff or do not provide attempt to implement change that benefits the staff and the patients, morale falls and staff leave. When nurses feel their safety and license are in jeopardy, they will seek out a better work environment they feel safe in. The facility I work for currently does annual retention surveys that allow its employees to voice any concerns and share what they feel the facility is doing well or could improve on. The nurses are asked various questions in regards to the leaders and managers they work directly under and whether their needs are being addressed. The facility offers committees that focus on allowing staff to have voice. Some include unit base council for each unit of the facility, committee for staffing concerns and safety committees that focus on sentinel events. 

Project 2: Promoting Health Care Quality

Section 4: Quality Improvement Strategies

Throughout this course you have been considering the relationship between structure, process, and outcomes as it relates to health care quality. Looking at outcomes, alone, may not tell the “whole story.” For instance, if you are concerned with improving fall rates, evaluating the process—related activities or practices—can help you identify factors that contribute to outcomes and develop strategies for improving them.

For this section of your Course Project, you create a process map to examine a current process related to your quality improvement issue. You will use the results of the process mapping to redesign a process to help minimize or close the performance gap(s). As you proceed, keep in mind the importance of maintaining a patient-centered focus so the patient experience is not negatively affected by any changes in process.

To prepare:

• Review the instructions provided in the Learning Resources for creating a process map.
• With your quality improvement issue in mind, as well as the other work you have completed on your Course Project thus far, think about how creating a process map could help you to better understand your quality improvement issue and redesign an associated process.
• Create a process map using Microsoft Word or PowerPoint.
• Refine the strategies for promoting systems-level change to minimize or close the performance gap(s) that you began to think about in Week 7. As part of this, identify a way to redesign at least one process based on your analysis of the process map that you have created.

To complete:

• Write a 2- to 3-page paper in which you describe quality improvement strategies that you selected related to your quality improvement issue.
• Finalize your process map, which will be submitted along with the paper.

Required Readings

Cookson, D., Read, C., Mukherjee, P., & Cooke, M. (2011). Improving the quality of emergency department care by removing waste using Lean Value Stream mapping. International Journal of Clinical Leadership, 17(1), 25–30.
Retrieved from the Walden Library databases.

This article demonstrates how a process map can be used to identify waste and promote efficiency, particularly in large departments.

Ford, J. H., Wise, M., & Wisdom, J. P. (2010). A peek inside the box: How information flows through substance abuse treatment agencies. Journal of Technology in Human Services, 28(3), 121–143.
Retrieved from the Walden Library databases.

The authors of this article establish the importance of using process maps for improving productivity and information flow.

Abubakker, H. T. (2010). Practical guide to creating better looking process maps. Retrieved from http://www.isixsigma.com/tools-templates/process-mapping/practical-guide-creating-better-looking-process-maps/

iSixSigma’s website offers a practical guide with many tips for creating an easy-to-follow process map.

NHS Institute for Innovation and Improvement. (2010). Quality and service improvement tools: Process mapping—an overview. Retrieved from http://www.miltonkeynesccg.nhs.uk/resources/uploads/files/NHS%20III%20Handbook%20serviceimprove.pdf

The NHS article outlines the importance of process maps and provides a detailed description of how to create a process map.