Mergers illustrate the focus on organisational restructuring as the key lever for change as indicated by the ninety nine health care provider mergers in England between 1996 and 2001. (Fulop, Protsopsaltis, King, Allen, Hutchings, and Normand, 2004) However, in many cases, mergers have unexpected consequences and drawbacks including problems in integrating staff, services, systems and working practices, clashing organisational cultures and poor leadership capacity.

This essay considers leadership and management in the context of a problematic merger of services from two hospitals onto one site. The essay focuses on the change management process within one department to highlight key leadership, team, and cultural issues that negatively affected the newly merged department. The microcosm of the department mirrors similar occurrences across the two merged hospitals. The essay concludes with a comment on the organisational consequences if a macro intervention is not implemented.

Confidentiality has been preserved by anonymising the identity of the hospitals and departments concerned.

BACKGROUND

This essay explores a recent change process involving the creation of a psychiatric liaison team based in a NHS hospital Accident and Emergency Department. (A & E) in January 2004.

The change occurred because of the merger of two hospitals that resulted in a number of structural changes, including the amalgamation of a traditionally split emergency service into a one site A & E department. The liaison team replaced the existing deliberate self-harm service which had operated in the one hospital for two decades.

The new liaison team consisted of eight newly appointed G-grade mental health nurses, a team leader, and a consultant psychiatrist who had both previously worked in the deliberate self-harm service. The hours of operation initially were 08:00 to 22:00 and there were two nurses on duty on early and late shifts.

During a four week induction period, the team participated in team building and training exercises and developed into a cohesive, effective group. The team created clear key performance indicators specific to the psychiatric liaison team, established an action plan to achieve the set objectives, and planned to carry out six-monthly reviews. The team developed a shared vision to provide high quality, person centred care to the A & E department without breaching government’s four hour targets (DOH, 2001). The team leader’s leadership style was democratic, and she fostered collaboration and involvement within the team (Walton, 1999). The team members considered her an expert in the field, and respected her for it.

In July 2004, the service manager attended a monthly team meeting. At the meeting she was informed that a major change was expected to the hours of operation. The service would be extended to a 24-hour service starting in September 2004. In order for the liaison team to cover a 24-hour roster there was initially be a reduction in the number of nurses on duty, however, more staff would be recruited if necessary after a six month service review. An exact date for the review was not given. The change had not been communicated as part of the strategy for the greater merger.

The Department of Health (DOH) modernisation agenda for the NHS, (DOH, 2002) sets out to modernise services in the NHS, and introduced a three star rating scale against which each NHS Trust’s performance is compared against benchmark standards. Funding in turn is dependant on the star rating achieved. One such standard relates to delays in A & E departments, and stipulates that mental health patients should have 24 hour access to services, and that patients should be assessed and treated within four hours of arrival. (DOH, 2001) The underlying rationale for the change was therefore that the psychiatric liaison service had to provide a 24-hour service in order for the hospital to comply with the benchmark. Management of the merged hospitals did not consider staff shortages or how the four hour target might affect the quality of service provision, particularly when staff are under constant pressure to discharge patients before they exceed the benchmark standard. (RCP, 2004) In the service described above, reaching the necessary 98 % four hour target proved impossible, because the staff numbers did not match the requirements of the service.

The service was therefore to be expanded without additional staff, implying not only changes in hours and shifts, but also changes in work patterns. The team members reacted negatively to how the change process was introduced. Concerns were expressed about the reduction in staff numbers and questions were raised as to how the staff would be able to cope. The sense of security and continuity were put at risk. (Walton, 1999) The service manager was not available to address the concerns due to an increased scope of responsibility because of the merger that was beyond her normal remit. Lack of two way communication between the manager and the employees meant that the manager lost a valuable opportunity to resolve the negative reactions, and laid the foundation for resistance to change (Johnson, Scholes, and Whittington, 2005).

Within a month of the announcement, the team leader had resigned. A new team leader was appointed and was tasked to lead the team through the change. The team started gradually becoming fragmented, staff sickness rates soared, and morale plummeted. The situation reached a crisis point by December 2005, by which time two more staff members had resigned. The majority of staff had taken sick leave, and the psychiatric liaison service was left uncovered for several days. A number of mental health patients in A & E waited for hours, sometimes all night, to be seen by a mental health professional. The A & E department laid a formal complaint about the liaison team’s performance.

In March 2005, following discussion with a union representative, the team took out a grievance against the team leader. The key issues of concern were the way the change process had been introduced, lack of two-way communication and the team leader’s unsuitable task-oriented, directive leadership style. The team leader was suspended and the Trust commenced a lengthy investigation into the change process. The investigation continues to date.

ANALYSIS

Cameron and Green (2004) suggest McKinsey’s 7S model as a diagnostic tool to identify interconnected and related aspects of organisational change. The model is problem rather than solution focussed, and hence useful for pointing out retrospectively why change did not work. The weakness of the model is that it does not explicit identify drivers from the external environment and accordingly key forces have been described by way of explanation. According to Burke and Litwin (1992), the external environment is any outside condition or situation that influences the performance of the organisation.

Systems, Staff and Strategy

Systems refer to standardised policies and mechanisms that facilitate work, primarily manifested in the organisation’s reward systems, management information systems, and in such control systems as performance appraisal, goal and budget development, and human resource allocation. (Burke and Litwin, 1992) Systems are the mechanisms through which strategy is achieved. Strategy is how the organisation intends to achieve a purpose over an extended time scale. Johnson, Scholes, and Whittington (2005) link it directly to environment (industry structure), organisational structure, and corporate culture. Leaders are the executives and managers providing overall organisational direction and serving as behavioural role models for all employees. (Burke and Litwin, 1992)

The systems that the service had in place to support the staff prior to the merger had functioned efficiently. The psychiatric liaison team had monthly team meetings, weekly ward rounds and supervision, and twice daily handovers to ensure high quality service.

Teams in this context mean a group who share a common health goal and common objectives, determined by community needs, to the achievement of which each member of the team contributes, in accordance with his or her competencies and skill and in co-ordination with the functions of others. (WHO, 1984) Under the previous team leader’s management, the team had achieved a mature and productive level of performance that fell within Tuckman’s model of team development of a performing team. (Mullins, 2002) The leader demonstrated characteristics of an effective team leader (e.g. good communication) and ensured that the team members’ views were passed on to the management. (Marquis and Huston, 2003)

The team also developed team specific performance indicators to fit the Trust’s strategy, such as the goal to provide high quality care within four hours of service users presenting to the A & E department. However, the new management of the merged hospitals did not take into account that the reduction in staff numbers would make it difficult for staff to find time to attend ward rounds and to supervise care. Lack of supervision had a negative impact on the quality of care provided, and staff shortages meant that the team did not reach the four-hour targets in A & E department. The change process indicated a lack of sincere stakeholder consultation which would have alleviated the crisis in the department. (Iles and Sutherland, 2001)

Structure and Style

Structure is the arrangement of functions and people into specific areas and levels of responsibility, decision-making authority, communication, and relationships to assure effective implementation of the organisation’s mission and strategy. (Burke and Litwin, 1992) The NHS Leadership Qualities Framework (DOH, 2002, p34) suggests leading change through people with effective and strategic influencing is essential in a merger environment. This is supported by Johnson, Scholes and Whittington (2005) who suggest that strategic, transformational leadership is a key element within an organisation staffed by professionals and that a collaborative style is required to achieve transformational, lasting change. However, the new team leader’s leadership style was autocratic and the team members were no longer consulted about matters concerning it, which was inappropriate in team nursing approach associated with collaborative patient centric care.

Marquis and Huston (2003) suggest that a democratic leadership style works best with a mature experienced team with shared responsibility and accountability. The change in leadership style meant that the team felt disempowered and uninvolved in decision making which did not allow ownership of the change process to emerge. Furthermore, the flow of information to the team slowed down and the team’s concerns about the change did not reach top management implying that communication channels in the new organisational structure were not functioning efficiently.

Management style equally affects culture. Johnson, Scholes and Whittington (2005) state that culture is the taken for granted assumptions that are accepted by an organisation or team. These work routines are not explicit, but are essential for effective performance. Ignoring these as the new team leader did, reduces motivation and performance, and stiffens resistance to change.

Skills

Skills are the distinctive capabilities of key people. (Cameron and Green, 2003) The nature of the team membership implied a range of key skills interdependent on the other for effective performance. A problem area in the skills portfolio was information technology skills. The Trust managing the merged hospitals had introduced a Trust wide electronic patient record system in accordance with NHS requirements. (DOH, 2003) This was implemented simultaneously with the decision to extend the working hours. The change aimed to improve the service user experience by allowing staff a 24-hour access to service user’s care and crisis plans. (DOH, 2003) The staff shortage meant that team members did not receive appropriate training on the system and the use of the electronic patient record system became a source of frustration and confusion. Lack of computer skills contributed to staff’s frustration and negative attitudes with the change process.

Superordinate goals

Superordinate goals are the longer term vision of the organisation and the shared values and guiding principles that that shape the future of the organisation and motivation achievement of strategy. (Cameron and Green, 2003) The team’s superordinate goals were initially created during the four-week team building period and aligned with those of the larger organisation. The team’s vision was to provide high quality, service user centred care. The team also considered change as a natural part of organisational development. However, the team became increasingly resistant to change when it felt that the organisation did not really care about its employees, their concerns, and the ultimate reason for the organisation’s purpose, being the patient.

DISCUSSION OF CHANGE PROCESS

Change management is art of influencing people and organisations in a desired direction to achieve an agreed future state to the benefit of that organisation and its stakeholders. (Cameron and Green, 2003)

A number of models can be used to model a change management process. A popular model is Kurt Lewin’s forcefield analysis. A forcefield analysis is a useful tool to understand the driving and resisting forces in a change situation as a basis for change management. This technique identifies forces that might work for the change process, and forces that are against the change. Lewin’s model suggests that once these conflicting forces are identified, it becomes easier to build on forces that work for the change and reduce forces that are against the change (Cameron and Green, 2003). The difficulty is the assessment of strength or duration of a force, partlicularly when the human dimension is considered. The key resisting force in the change process was a lack of staff and poor leadership.

The change process under discussion was largely motivated by external factors. However, due to poor project planning, Trust management failed to consider the internal factors that had a major impact on the change. In particular, the management failed to involve the necessary stakeholders at a local level to increase ownership of the change thus failed to consider the human dimension (Walton, 1999 and DOH, 2004). The new team leader’s autocratic leadership style did not fit the requirements of the task, or the culture of the team and thus sowed the seeds of resistance to change. (Hogg and Vaughan, 2002). The poorly managed change process became costly to the Trust due to the loss of human resources, reduced staff morale and lowered the credibility of the management. The change left the psychiatric liaison team feeling betrayed, and individual team members traumatised.

As the change process progressed, it became evident that a thorough analysis of current resources and various dimensions of organisational change had not been carried out (Johnson, Scholes and Whittington, 2005). The management had not prepared a clear plan for launching and executing the change at a local level.

The NHS Modernisation Agency Improvement Leaders’ Guide (DOH, 2004) stresses the importance of taking into consideration the human aspect when planning a change project. Similarly, Walton (1999) argues that change initiatives should be thought through and planned as far as possible taking into account the psychological bonds that staff form with their work groups and their organisation as a whole.

It follows then that no precautions had been taken to address resistance to change. Johnson, Scholes and Whittington, (2005) state that there should be a clear communication plan to state how information about the change project will be communicated inside and outside the organisation. The team members were not given an opportunity to challenge and test the change proposal, or clarify what aspects of the change they could or could not influence. (Walton, 1995)

Fulop, Protsopsaltis et al, (2004) suggest that change project should be presented as an opportunity to improve the quality of performance and that clinicians should should be involved on a consultative basis. Team members were aware of the consequences of extending the hours of operation without increasing the resources, however, there were no systems in place to communicate these views to the Trust management, a key aspect of the change process. The lack of key stakeholder involvement in the change meant that the management did not have access to the psychiatric liaison team’s valuable experience on the immediate and wider implications of cutting down resources. (Henderson, 2002)

The team members felt that their concerns about the lack of resources had not been taken seriously, and this inevitably led to a feeling that the Trust did not care about it’s employees or their views. Strong emotions such as anger and frustration were expressed by the team members. The lack of formal communication channels, meant that the team members took them out on each other. Johnson, Scholes and Whittington, (2005) confirm that at times of change, rumours, gossip and storytelling increases in importance and that team members engage in countercommunication, thus unconsiously spreading distrust, suspicion and negativity which leads to lowered staff morale and job satisfaction.

Although the rationale for change was clear to everyone, the change was executed at such short notice that the team members did not have time to develop strategies to deal with it. The NHS Improvement Leaders Guide to Managing the Human Dimension of Change (DOH, 2004) suggests that clinicians go through phases of shock, denial, anger, betrayal, conformance and understanding before they finally develop comitment to the change. The team members were left in a state of shock after the service manager’s initial announcement of the impending change in July 2004 and then moved into a state of denial. The general opinion was that the management would sooner or later realise that the change could not be executed without increasing the resources and accordingly delayed the change process until more staff would be employed. When there was no indication of this in the weeks that followed, the team members became demotivated. The team failed to move on to the next stages in their reactions to change, and commitment to the change process did not develop.

The team leader’s task-oriented leadership style did not suit the context of the change process, and partly contributed to it’s failing. Cameron and Green (2003) suggest that leadership will be most effective when the leader’s leadership style, the subordinates’ preferred leadership style and the requirements of the task fit together. A directive leadership style therefore is ineffective if the subordinates’ preferred leadership style is democratic, even though the task is well defined within tight parameters. In addition, Hogg and Vaughan (2002) argued that the most effective leaders are those who are able to combine task and socio-emotional leadership styles, and organise team members to work towards achieving goals at the same time promoting harmonious relationships. The new team leader paid no attention to the team culture and failed to communicate to management about the impending issue.

Johnson, Scholes and Whittington (2005) suggest that power is a key element in a change process. Power is the ability of individuals to persuade or coerce others into following a course of action. The new team leader’s source of power was based on his hierarchal position in the Trust rather than on expertise or knowledge as shown by the previous team leader. The team members did not consider that the new team leader possessed appropriate expertise or personal characteristics. The team leader exercised coercion which was met with resistance by the team and for this reason the team members lacked respect for him. He was seen as an executor of decisions made by the management.

The new team leader appeared to be more concerned about a successful completion of the change, was target driven and lacked sensitivity to employees feelings and concerns. The team leader used his positional power in a negative way, filtered information and gave the management a distorted view of how the staff were coping with the change process.

The relationship between the team leader and the staff members eventually deteriorated to a point where communication broke down. Two staff members went on a long term sick leave, and two other staff members resigned. Following a meeting with a union representative in March 2005 the team members, including those who had resigned, made a decision to take grievance out against the teamleader. The key issues brought up in the meeting were the way the change had been introduced, poor project management and the team leader’s autocratic management style (Walton, 1999).

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Essay Examples

CONCLUSION

In conclusion, lack of stakeholder involvement, poor project planning and the teamleader’s unsuitable leadership style lead to the psychiatric liaison team becomimg fragmented, and resistant to change. No systems were put in place to ensure two-way communication with the employees. Lack of communication reduced the staff’s commitment to, and ownership of the change, and lead to a lower quality service provision and increased long waits in A & E. The poorly managed change process became costly to the Trust due to loss of trained human resources, staff morale and credibility of the management. Similar incidents occurred in other areas of the hospital indicating that the change processes associated with the merger had created organisational wide problems that were indicative of failure at a top management and strategic level.

Strategic leadership is a key element of the change process. A successful merger will only be achieved with consistent communication and the establishment of a vision that percolates throughout an organisation as a basis for effective change to realise the stated benefits of all stakeholders.

References

Brooks, I. (2002) The Role of Ritualistic Ceremonial in Removing Barriers between Subcultures in the NHS. Journal of Advanced Nursing. Volume 38, 4.

Burke, W. W. and Litwin, G H. (1992) A Causal Model of Organisational Performance and Change. Journal of Management. Volume 18, 3.

Cameron, E. and Green, M. (2004) Making Sense of Change Management. Kogan Page.

Carr, D. K., Hard, K. J. and Trahant, W. J. (1996) Managing The Change Process: A Field Book For Change Agents, Consultants, Team Members And Re-Engineering Managers. McGraw-Hill.

Crawford D., Rutter M. Thelwall, S. (2003) User Involvement In Change Management: A Review Of The Literature. National Co-ordinating Centre for NHS Service Delivery and Organisation.

Davies H. T. O., Nutley, S. M. and Mannion, R. (2000.) Organisational Culture and Quality of Health Care. Quality in Health Care. Volume 9.

DOH (1998) A First Class Service: Quality in the New NHS. Department of Health. The Stationery Office

DOH (2000) The NHS Plan. Department of Health. The Stationery Office

DOH (2001) National Service Framework for Mental Health. Department of Health. The Stationery Office.

DOH (2002) NHS Leadership Qualities Framework.

www.nhsleadershipqualities.nhs.uk Accessed 4 July 2005.

DOH (2002) Star Ratings System for Hospital Performance Has Improved Services For Patients. NHS Modernisation Agency. www.dh.gov.uk. Accessed 4 July 2005.

DOH (2003) National Programme for IT Announces Further Contracts to Run NHS Care Record Services. www.dh.gov.uk. Accessed 4 July 2005.

DOH (2004) NHS Modernisation Agency Improvement Leaders’ Guide. www.modern.nhs.uk. Accessed 4 July 2005.

ESHT. (2000) Safeguarding Hospitals in East Sussex: Consultation Document. www.esht.nhs.uk. Accessed 4 July 2005.

ESHT. (2002) Merger of Hastings and Rother NHS Trust and Eastbourne Hospitals NHS Trust. www.esht.nhs.uk. Accessed 4 July 2005.

Fulop, N., Protopsaltis, G. King, A. Allen, P. Hutchings, A. and Normand, C. (2002) Process and Impact of Mergers of NHS Trusts: Multicentre Case Study and Management Cost Analysis. British Medical Journal. Volume 325.

Fulop, N., Protopsaltis, G. King, A. Allen, P. Hutchings, A. and Normand, C. (2004) Changing Organisations: Study of the context and Processes of Mergers of Healthcare Providers in England. Elsevier Ltd.

Garside P. (1999) Evidence Based Mergers? British Medical Journal. Volume 318.

Henderson, E. (2002) Communication and Managerial Effectiveness. Nursing Management. Volume 9, 9.

Higgs, M. and Rowland, D. (2000) Building Change Leadership Capability: The Quest for Change Competence. Journal of Change Management. Volume 1 Number 2.

Heron, J. (1999) The Complete Facilitator’s Handbook. Kogan Page Limited.

Hogg, M. and Vaughan, G. (2002) Social Psychology. Prentice Hall.

Iles, V. and Sutherland, K. (2001) Managing Change in the NHS: Organisational Change. NHS Service Delivery and Organisation.

Johnson, G., Scholes, K. and Whittington, R. (2005) Exploring Corporate Strategy. Text and Cases. Seventh Edition. Prentice Hall.

Marquis, B. L. and Huston, C. J. (2003) Leadership Roles and Management Functions in Nursing. Lippincott, Williams and Wilkins.

Miller, D. (2002) Successful Change Leaders: What Makes Them? What Do They Do That Is Different? Journal of Change Management. Volume 2, 4.

Mullins, L. J. (2002) Management and Organisational Behaviour. Pitman Publishing.

Stock, J. (2002) Case Study: Hastings and Rother NHS Trust. NHS Modernisation Agency. www.modern.nhs.uk. Accessed 4 July 2005.

RCP. (2004) Psychiatric Services To Accident And Emergency Departments. Royal College of Psychiatrists Council Report CR118. London.

Stroebe, W. and Diehl, M. (1994) Why Groups Are Less Effective Than Their Members: On Productivity Losses In Idea-Generating Groups. European Review of Social Psychology, Volume 5.

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Thomas, N. (2004) The John Adair Handbook of Leadership and Management. Thorogood Publishing.

UHCW. (2005). Coventry City Centre A&E Department is Being Relocated to Walsgrave Hospital from Saturday 15th Jan. www.uhcw.nhs.uk. Accessed 4 July 2005.

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Webster, R. (2001) An Assessment of the Substance Misuse Treatment Needs of

WHO (1984) Glossary of Terms Used in the ‘Health for All’. World Health Organisation Series No. 1 – 8.

• 
  DIANE PARSONS
  

SAFETY AND HEALTH AT WORK

DIANE PARSONS 1/05/15

TABLE OF CONTENTS

1.

Explore the role of communications & training in the promotion & provision of health & safety in the workplace.

Page


2

2.

Outline the principles & procedures of good house-keeping in the workplace.

Page


3

3.

Noise, dust and fumes are hazards which are commonly found in workplaces. For one of these hazards outline the risk associated with exposure to this hazard and control measures which might be used in the workplace. Identify at least 3 hazards which are commonly encountered in your workplace and briefly describe how these are controlled.

Page 4&5

4.

Explain the typical contents of a first-aid kit & their appropriate uses.

Page


6

5.

Explain the risks associated with the following hazards work environment, work practices, medication, alcohol, drugs and outline for each, steps which an employer might take to control these risks (please provide at least 2 controls per hazard).

Page 7&8

6

. Outline risk factors in relation to health, to include stress/ lifestyle/ diet/ illness.

Page 9&10

References

Page 11

1. EXPLORE THE ROLE OF COMMUNICATIONS & TRAINING IN THE PROMOTION & PROVISION OF HEALTH & SAFETY IN THE WORKPLACE.

The role of communications and training in the work place is important in any job. In Healthcare there is no exception to this. Under the

Safety, Health and Welfare at Work Act 2005

(

SHWWA 2005

) all employers must specify the training essential to ensuring the health and safety of their employees. The training provided will help staff achieve the essential skills, knowledge and attitudes needed to ensure that they are competent in the health and safety features of their work. In healthcare the Conformity European (

CE

) mark is important and a lot of employers train their staff to look out for this. Communication in the workplace is essential as is training and the Health Service Executive (

HSE

), Health Service Authority (

HSA

) and

Health Information Quality


Authority

(

HIQA

) are there to ensure that the

SHWWA 2005

and the

General Application Regulations 2007 (GAR 2007

) are in place in the workplace. It is important from management to staff that communication is enforced in the workplace for health & safety. For instance if there was a spillage in a nursing home in the corridor and there was a sign put in place to warn others of this the management could rest in ease knowing that their staff are aware and capable of ensuring health & safety practices in the workplace. That is just one way of communicating there are many more ways I have listed a few below.

(Course Notes 2015)

• Verbal – speaking, face to face
• Listening
• Non Verbal – texting, email, notice board, fax, registered mail, skype
• Demo/Training
• Focus group
• Conference call
• Emergency procedures

www.google.com


/images

2. OUTLINE THE PRINCIPLES & PROCEDURES OF GOOD HOUSE-KEEPING IN THE WORKPLACE.

The importance of good house-keeping is so important Healthcare and in particular Nursing Homes and Hospitals which are all about health and the well-being of patients. If a workplace practises bad house-keeping it can become unsafe and even hazardous for the staff and patients. Cluttered and untidy areas, spills and leaks and broken and damaged equipment are all signs of poor house- keeping.

An example of bad house-keeping could be a fire exit left blocked and a fire breaking out in the work place, this bad house-keeping endangers everybody in the work place and it is up to the employers and employees to avoid incidents like this.

Work places need to outline the principles & procedures of good house-keeping to all employers and employees. The workplace needs to be actively monitoring the process of house-keeping within the workplace.

HIQA

and

HSA

have certain standards on house-keeping and have an inspection system in place.

Some benefits of good house-keeping are:

• Good housekeeping prevents accidents such as slips, trips and falls
• Make the workplace happy, enjoyable and safe
• Improve and maintain your company’s image (good housekeeping echoes a well-run company) order and routine will impress visitors, employees and clients etc.
• Reduce the risk of accidents or harmful materials i.e. dust, vapours
• Help your company make the most and benefit the best out of its work space.

In house-keeping there are 5S, this is a method of work organised in 5 stages with the goal of considerably improving the order and cleanliness in the workplace. This is known as the Heidelberg Model.

These 5S are:

• 
  SORT-
  
  removing anything unnecessary and disposing of it properly
• 
  STRAIGHT-
  
  set things in order, easy to find
• 
  SHINE-
  
  keep work place clean and safe
• 
  STANDARD-
  
  maintain high standards in house-keeping and maintain orderliness
• 
  SUSTAIN-
  
  to keep in working order, to perform regular audits

(

www.hsa.ie

)

3. NOISE, DUST AND FUMES ARE HAZARDS WHICH ARE COMMONLY FOUND IN WORKPLACES. FOR ONE OF THESE HAZARDS OUTLINE THE RISK ASSOCIATED WITH EXPOSURE TO THIS HAZARD AND CONTROL MEASURES WHICH MIGHT BE USED IN THE WORKPLACE. IDENTIFY AT LEAST 3 HAZARDS WHICH ARE COMMONLY ENCOUNTERED IN YOUR WORKPLACE AND BRIEFLY DESCRIBE HOW THESE ARE CONTROLLED.

A hazard is anything that has the potential to cause you or others harm. In the workplace there are many hazards. There are 5 categories of hazards

Physical, Mechanical, Biological, Chemical and physosocial.

(Course Notes 2015)

Fumes

would be a major hazard, the risks associated with this are life threatening. They would be physical and chemical hazards. The risks of fumes can come from gas leaks, chemical fumes etc. Some of the risks associated with fumes are they can cause serious illness, death, over exposure can lead to long term health problems, gas leaks can cause explosions. The control measures for this hazard would be storing chemicals away in proper storage areas, a carbon dioxide alarm and when handling dangerous substances always wear your Personal Protective Equipment

(PPE)

. Making sure all chemicals are Classification, labelling and packaging

(CLP)

and a Material Safety Data Sheet

(MSDS)

is available and up to date.

(



www.google.com/image)

In healthcare hazards are all too common but they must be identified and control measures must be put in place. Employers need to refer to the hierarchy of control measures which are

:

Remove, Replace, Reduce, Restriction, training and PPE to ensure safety.

3 HAZARDS COMMON IN THE WORKPLACE

HAZARD	RISK	CONTROL
Manual Handling	Lifting heavy items or people Lack of or not having the correct equipment Unexpected movement of a resident Lack of training	Using and having proper equipment Training yearly PHYSICAL & MECHANICAL HAZARD
Spills, Trips & Falls	Slippery floor, tiles lifting & tripping over objects Wires & cables exposed	Ensuring spills are cleaned & proper signage used Tiles, carpets all in good working order Objects all stored away correctly PHYSICAL & CHEMICAL HAZARD
Infection	Mould & dirt Sharp objects not disposed of correctly Failure to use standard provisions i.e. washing hands, wearing PPE	Ensuring good house-keeping procedures Proper management of waste Using PPE And good cleaning standards BIOLOGICAL & PHYSICAL HAZARDS

4. EXPLAIN THE TYPICAL CONTENTS OF A FIRST-AID KIT & THEIR APPROPRIATE USES.

First aid is the first or immediate help given to a patient before the arrival of a paramedic or doctor. The first aid kit is there to offer an appropriate point of care, everything in the first-aid kit is put together based on the knowledge and experience on those putting it together. Included in it is PPE which is one of the employer’s duties in the workplace to have to maintain health and safety at work.

	Contents of first aid box	No.ppl 26-50	Uses
	Medium sterile dressings	6	To Protect wounds from infection
	Large sterile dressings	2	To protect would from infection
	Adhesive plasters in assorted sizes	20	To cover scratches & grazes to avoid infections
	Sterile eye pad	2	To treat wounds to the eye area to avoid infections
	Safety pins	6	To hold bandages closed
	Disposable gloves	10	For protection from blood & bodily fluids when examining casualties
	Triangular bandages	6	Can be used to treat broken arms, dislocated jaw, broken ribs or punctured lung, head wound, hand wound or minor burn
	Roller bandages	2	To apply pressure to a wound & reduce the risk of infection
	Paramedic Shears	1	Cut clothes to get at wounds, examine body, ensure clothing isn’t too tight
	Alcohol free wipes	40	To clean wounded area to avoid infection
Pocket mask/Face shield	1	For protection when giving CPR

Adhesive tape	1	To hold bandages in place
Water based burns dressing Large	1	To be used on 2 nd & 3 rd degree burns
Water based burns dressing Small	1	To be used on 2 nd & 3 rd degree burns
Foil Wrap	1	To treat shock, stop casualty becoming too cold
Sterile Water where there is no clear running water	2x 500 mls	Clean infected area. For chemicals & burns
Water gel	1	To apply to a burn, after treating with cool running water

(



www.hsa.ie



)

5. EXPLAIN THE RISKS ASSOCIATED WITH THE FOLLOWING HAZARDS WORK ENVIRONMENT, WORK PRACTICES, MEDICATION, ALCOHOL, DRUGS AND OUTLINE FOR EACH, STEPS WHICH THE EMPLOYER MIGHT TAKE TO CONTROL THESE RISKS

In the workplace there are many risks, some include hazards work environment, work practices, medication, alcohol and drugs. Under the SHWWA 2005 one of the employer’s duties to employees is to provide a safe place to work so therefore the employer may have steps in place to control these risks. Every year it costs the state 3.6billion in accidents, 70% of accidents can be prevented by good health & safety morals.

(Course Notes 2015)

There would usually be a risk assessment carried out which would:

1. Identify the hazard
   
   b)
   
   assess the risk
   
   c)
   
   put controlled measures in place

HAZARDS	RISKS	STEPS MADE TO CONTROL RISK
WORK ENVIRONMENT	Injury to staff/patient	Have employees read and signed the safety statement Ensuring employees wear their PPE
WORK PRACTICES	Lack of motivation Stress Injury to staff/patient	Proper training and communication between employers and employees Making sure staff are up to date in their training i.e. manual handling
HAZARDS	RISKS	STEPS MADE TO CONTROL RISK
MEDICATION	Accidents Adverse reaction Fatigue	Only accessible to authorised personnel Need to be labelled properly and stored correctly
ALCOHOL	Accidents Unprofessional manner Unreliable/Unfocused	Keeping a log of all incidents Monitoring staffs progress
DRUGS	Violent Unfocused Time off/Sick days	Information and help given on drug abuse being made available Drug tests

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6. OUTLINE RISK FACTORS IN RELATION TO HEALTH, TO INCLUDE STRESS/LIFESTYLE/DIET/ILLNESS

The risk factors in relation to health in the workplace are huge because stress, lifestyle, diet and illness all fall under health. In healthcare it is important that the staff promote good health and wellbeing, they do this through putting into practice of workplace policies and health promotion activities. For employers the risk factors can lead to loss of business and damage the company name, performance impairment, absenteeism and the loss of competitive edge.

STRESS

is a major risk to the health of an employee. Stress can be caused by many different reasons and have many different effects. Some effects of stress:

• Can be physical or mental
• Interfere with your ability to perform
• Increase cholesterol & blood pressure
• Cause depression, break downs etc.

All these can have a bad effect on the employees work and performance.

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LIFESTYLE

can have risk factors in relation to an employee’s health. A hectic or busy lifestyle can take its toll on someone’s health. If a person had a busy social lifestyle and were out parting every night it would eventually have an effect on their work due to tiredness or maybe coming into work with alcohol still in their system, the same would go for drugs. Drugs can be part of someone’s lifestyle too and have a devastating impact on it.

ILLNESS

can also have a lot of risk factors in relation to health. In the workplace it can lead to cross contamination staff and patients. It can lead to poor work performance, judgement and unpredictable moods. Lack of good time keeping and an increase of absenteeism.

DIET

can play a major role in the growth, repair and maintenance of a body. A well balanced diet and exercise are essential to good health. A bad diet, lack of water and no exercise can result in tiredness, stress, illnesses and depression which in return can influence someone’s ability to work.

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REFERENCES

(Course Notes 2015)


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(Course Notes 2015)


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(Course Notes 2015)


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page 10

1

The problem being researched in the article is significant in nursing since it identifies the process, stressors and adjustment strategies of a novice nurse transforming into an expert nurse. This research could assist in developing new policies on institutional level to allow new graduates adjustment in their roles. The author has linked the significance of the research to increased turnover of new graduates in the hospitals in the general world. No specific turnover rates have been mentioned, however, the author has linked the transition difficulty faced by the novice nurses as the main idea behind the research. The author of this article has explicitly explained the purpose of the study as “the transitional experiences from a student to a staff nurse…..and generate theory”. The problem statement or the research statement is written as ” the study established the needs of the new graduates and identified strategies to facilitate the process of the role transition’ (pg E1). The theory which has been generated from this research could be used as a framework by institutes to plan out strategies of retention and growth of their new employees. The limitations have been stated in the discussion part last paragraph as forgotten experiences of the participants and feeling of social constraints. The assumptions have not been listed however, it could be inferred that all the participants were present throughout the study and data saturation was also achieved.

Review of the Literature

The literature review is significant and relevant to the study been conducted. An extensive literature search has been done for categories that have been formulated during the research. The citations documented in the literature review are clear, complete and current as greater part of the references have been taken between the years 1974 – 2001. It can be deduced that the literature review is not within the last five years, however, it can be considered that there was a long time gap between the year of research conduction and the publication of the article. On the contrary, no literature review of previous researches of the same topic and gap analysis has been mentioned in the article. The literature is logical, relevant but the comprehensiveness is lacking. The author has, on many instances, linked the study categories with the previous literature categories, for example, the author has linked the first theme of “Getting on Board” with the a previous research theme by Evans (2001) of “period of uncertainty”. The literature has been paraphrased and no quotes have been mentioned.

The literature review has posed many research questions: what are the coping strategies employed by novice nurses to deal with the transition phase; the strategies are employed by institutions to help new recruits adjustment. Along with this, the author has also mentioned a research aspect of impact of nurse spirituality on patient care in the article.

Theoretical/Conceptual framework

The article does not mention any usage of a theoretical framework for the research. Theory and research have a reciprocal role towards each other, theory forms the baseline to conduct a research and research is useful to test a theory in different contexts (Polit & Beck, 2001 pg 145). Multiple nursing theoretical frameworks are available; however, the most suitable for this research is the theory of Patricia Benner – which identifies the qualities of nurse undergoing the stages from novice to competent (article). It also recognizes the difficulties that a nurse has to undergo in order to progress from one stage to another; this theory would have been helpful in analyzing the data and identifying the core categories and themes.

Population and Sampling

The target population has been described as the recent graduates from the diploma program of the private hospital with a job experience between 6 – 12 months working in ICU, medical and surgical ward (pg E1). The sampling size has not been mentioned explicitly mentioned in the article, however, in one of the quotes the author mentions ‘Six of the seven staff nurses’ (pg E3), it can be deduced that the study sample size was seven. According to Polit & Beck, a sample size of 20 to 30 participants is required to conduct a grounded theory (pg 358). The author does not significantly mentions the variations in the participants such as age, biological gender, and it does not mention the number of participants selected from each area of the hospital. No method of sample selection has been mentioned but according to Polit and Beck (2001), Glaser (1976) has identified theoretical sampling as a suitable method specifically for grounded theory (pg 356). This sampling technique selects participants on an ongoing basis as the researcher understands the area of interest and develops categories and themes (pg 356 -357). The sampling size could have been increased by including participants from emergency department, oncology ward and clinic areas. The demand characteristics of participants’ namely good participant, the negative participant, faithful participant and apprehensive participant have not been mentioned. Along with this no information of Hawthorne effect which defines the effect on dependant variables due to the participants knowledge of being under study has not been mentioned (Polit & Beck pg 755). The article does not specify the negative or discrepant participant of the study.

Research Design

A grounded theory approach has been used as a research design for this study. A grounded theory is the evolution of a theory from the data collected and analyzed (polit & beck, 2001). It has indeed played a significant role in developing many nursing theories which are nowadays acting as a framework for many researches. It was developed by Glasser and Strauss in 1960 and functions with the development of categories and themes which are substantive from the original data collected (Polit & Beck, pg 230). The grounded theory approach is appropriate for this study design, however, phenomenological approach could also be used as this study explores the human life experiences and their relation to the environment (Polit & Beck, pg 227). The author has provided immense information in the form of categories and themes for the study replication but no specific permission has been provided.

Data Collection

Formal unstructured interviews of 50 to 90 minutes have been tape recorded and transcribed as a method of data collection. Moreover, separate notes have also been used to record the expressions and behavioral changes of the participants. No rationale have been provided for data collection strategies but in grounded theory, according to Polit & Beck (2001) in depth interviews and observation are important data collection strategies (pg 230) along with documents and other data sources. These methods are congruent with the research question.

Protection of Human Rights

There is no mention of the study undergoing a ethical review board or committee, however, the article signifies the usage of informed consent (Polit & Beck, pg 176) from the participants. The participation has been based on voluntary basis which denotes the use of the principle of self determination (Polit & Beck pg 171). The author also fails to provide evidence of deception from the participation. Furthermore, there is no mention of appropriate time given by participants for the study data collection. The researcher has provided codes to maintain confidentiality and privacy (Polit & Beck, pg 174) of the participants. The article does not explicitly mentions the implementation of the principal of beneficence (Polit & Beck, pg 170) but it could be assumed that has been minimum risk to the participants.

Analysis

Data according to the article has been analyzed using comparative analysis which denotes the comparison of one interview with other interviews to identify commonalities (Polit & Beck, pg 523). The researcher has utilized the Glasserian grounded theory approach where the data is conceptualized in substantive codes which are interlinked via theoretical codes (Polit & Beck, pg 523). The author via open coding (Polit & Beck, pg 523) has identified the core category of ‘sailing forward’ as the central concept which has dominated all the themes. Selective coding is the second step where the researcher establishes relationships between the main core category and the sub-categories (Polit & Beck, pg 527). Theoretical codes as per Polit & Beck are very powerful because they provide a lot of abstract meaning – necessary for grounded theory approach (pg 523). According to the article, the separate notes were verified from the participants for the clarification of the meaning. The data analysis strategy utilized by the researcher fits the research problem as it develops a core category which is surrounded by themes or sub-categories. The categories established have been supported by raw data which has been written in the form of quotations in the article – further emphasizing the themes formulated. The explanations provided are reasonable and coherent with the quotes thus increasing the authenticity of the study.

Rigor

The data collected in the research has been audio taped and individual codes have been provided to each interview. Moreover, separate notes were also used as a strategy for the data collection strategy. Rigor in a qualitative research is based on 4 criterias: credibility, transferability, dependability and neutrality (Krefting, 1990). Though the researcher does not mention that a prolonged time has been spent with the participants but the study participants were re-approached for verification of observation notes and transcribed material indicating that the author has spent a lot of time with the participants – increasing the credibility (Krefting, 1990) of the study. The article has two authors but there has been no mention of the method of division of the data analysis; which denotes that a combined effort was made without any interruptions. The article does not specify authors’ efforts to control the discrepant material and participant thus it could be assumed that the study has the element of neutrality and does not have biasness or socially affected perspectives of the participants and researcher (Krefting, 1990). The researcher does not mention her own perspective which can be taken positively as an aspect to reduce biasness and increase the trustworthiness of the study. The consistency of the study has been strengthened by the narration of quotes and literature support of the emerging themes which clearly shows that if the study is replicated then similar themes would appear.

Conclusion and Recommendations

The author has identified the state of confusion, anxiety and happiness as initial emotions of the new graduates; guidance as the need of the new recruits and use of senior observations, CNI facilitation and peer aid as the major support systems in their initial adjustment phase. Thus the author has been able to analyze the data in accordance to the research question. The conclusions drawn from the study themes are in connection with the results of the study but the conclusion paragraph of the article mostly includes future recommendations for the nursing practice. The recommendations include increasing post conference timings of the students, ongoing assessments of employees via CBOs and ongoing classes for the employees. The results assist these recommendations as they indicate increased need for a strong support system for the preparation of new recruits. This study is transferable is all settings of Pakistan where new graduates are been hired as new recruits in the institution thus this study has increase transferability.