Operating Risks
Executive Summary
Our hospital is facing a 15% loss of trained healthcare provider staff, and is considering the closure of two out of its five clinics. The clinics in operation include a walk-in orthopedic clinic, a radiology department, a labor-and-delivery suite with neonatology, a wound care center with hyperbaric equipment, and an in-patient pediatric psychiatric facility.
15% less staff poses risks of missing new opportunities and optimum patient care. Each clinic offers essential services, so closure could be a problem in terms of servicing all patients. Transferring nurses between clinics would mean the need for retraining and possibly losing specialized knowledge. Changes in staff roles can harm morale. It can lead to knowledge gaps, and also operational inefficiencies. The hospital should also be on guard for entrained thinking, complacency about sudden unforeseen challenges, and communication breakdowns.
Based on the risk assessment, it is recommended to close the Walk-in Orthopedic Clinic and the Wound Care Center with Hyperbaric Equipment. However, closing these clinics will have its own risk, such as patient backlash and operational hiccups.
The Cynefin framework was used to help in forming this decision. It is a framework that focuses on the value of adaptability, vigilance, and open-mindedness, especially in difficult situations like this one.
Introduction
The hospital is facing the potential challenge of closing 2 of 5 clinics. Which 2 should be closed is a key question. This paper discusses the risks of closing and continuing the clinics and provides recommendations.
Risks of Continuing to Offer the Services with 15% Less Staff
There is a potential for missing opportunities that arise unexpectedly from this decision. For example, when 3M allowed its researchers to spend 15% of their time on any project, it led to the creation of the Post-it Note (Snowden & Boone, 2007). In other words, reducing staff means possibly missing out on innovative ideas being produced. Thus, operating with a reduced staff can present significant challenges, especially in a healthcare setting. The potential for missing opportunities, as illustrated by the 3M example, shows that a reduced workforce might not be able to innovate or adapt to unexpected changes in the environment. In the context of the hospital, this could mean missed opportunities for improved patient care or the introduction of new medical procedures.
Another risk is that leaders need to avoid micromanaging and stay connected to what is happening so that they understanding what is going on both at macro and micro levels. Otherwise, there is a risk of becoming complacent, which leads to potential failures (Snowden & Boone, 2007). Leadership should be vigilant against complacency. With fewer staff members, there might happen that existing processes become strained, and oversights or errors occur in patient services. This could be very harmful in areas like the labor-and-delivery suite or the in-patient pediatric psychiatric facility, where patient well-being could be directly at risk.
Benefits of Continuing to Offer the Services of Each Clinic
In the context of the hospital, the same ideas can be translated, as each clinic provides specialized services for specific patient needs. Continuing these services, even with reduced staff, can have its advantages.
The walk-in orthopedic clinic provides immediate care for patients with bone and joint issues. Its continued operation would mean that patients get to continue to receive timely treatment, thus potentially preventing the risk of complications.
Advanced imaging services like MRI and ultrasound are important and so keeping radiology department running helps with making diagnoses that can help with immediate intervention.
Also for consideration is that childbirth is unpredictable, and complications can arise without warning. Thus, the presence of neonatology means that newborns with health issues receive immediate care.
Specialized treatment for wounds can speed up recovery and prevent infections. Thus, patients with diabetes or other conditions that slow wound healing would benefit from the Wound Care Center remaining open.
Finally, mental health is as important as physical health. The in-patient psychiatric facility gives care for children with psychiatric issues, and is also important in holistic care.
Risks of Transferring Non-Physician Personnel and Training Challenges:
Transferring staff from one clinic to another poses significant risk. First, each clinic has specific needs. For example, staff from the orthopedic clinic might not be familiar with the equipment in...
…burned out at some point. Managers should try to promote appointment scheduling and make use of temporary staff if available.Implementation Timeline
Week 1-2
Announce the decision to close the two clinics. Give early notice to staff and patients. Hold meetings to answer questions and address concerns.
Week 3-4
Begin staff retraining and transfers. Prepare staff for new roles or clinics. Pair new staff with experienced mentors. Monitor their progress.
Week 5-6
Communicate with patients. Offer referrals and alternatives. Help patients transition smoothly. Set up a helpline for patient queries. Monitor feedback.
Week 7-8
Optimize appointment scheduling in remaining clinics. Prepare for increased patient load. Hire temporary staff if needed. Adjust workflows.
Week 9-10
Close the Walk-in Orthopedic Clinic and Wound Care Center. Implement the decision. Ensure all patients have been informed and referred.
Week 11-12
Monitor the operations of the remaining clinics. Check for any issues or problems. Make necessary adjustments based on feedback.
Week 13-14
Review the entire process. Gather feedback from staff and patients. Understand what went well and what needs improvement. Address any lingering issues or concerns.
Week 15 onwards
Keep monitoring and making adjustments as needed. Ensure smooth operations in the long run. Stay open to feedback. Make changes as needed.
Assessment of the Cynefin System for Clinic Closure Process
The Cynefin framework is a tool that helps leaders understand their challenges and decide how to act. It sorts issues into five contexts based on cause and effect: simple, complicated, complex, chaotic, and disorder (Page 3). For our hospital's situation, the Cynefin system can guide us.
Our decision to close two clinics is a complex problem. In complex contexts, cause and effect are not clear. We can only see them in hindsight (Page 4). This means we cannot predict everything. But we can watch for patterns and learn from them.
In the Cynefin framework, leaders are warned about "entrained thinking" (Page 3). This is when old ways of thinking stop us from seeing new solutions. We must be careful. We should not just use old solutions for our new problems.
The Cynefin system also tells us that when things seem calm, problems can suddenly appear (Page 3). We must be ready. Closing…
References
Galehdar, N., Kamran, A., Toulabi, T., & Heydari, H. (2020). Exploring nurses’ experiences ofpsychological distress during care of patients with COVID-19: A qualitative study. BMC psychiatry, 20(1), 1-9.
Sanders, K. B. (2020). British government communication during the 2020 COVID-19pandemic: learning from high reliability organizations. Church, Communication and Culture, 5(3), 356-377.
Snowden, D. & Boone, M. (2007). A leader’s framework for decision making. Harvard BusinessReview.
Stefaniak, M., & Dmoch-Gajzlerska, E. (2020). Mentoring in the clinical training of midwiferystudents-a focus study of the experiences and opinions of midwifery students at the Medical University of Warsaw participating in a mentoring program. BMC medical education, 20, 1-9.
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