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1. The organisation I work is has a transformational leadership approach to change. The working culture adapts well to significant change, and overtime this ensures that staff change their practice as well. Due to the earthquakes in Christchurch several years ago, the city has had to undergo significant change and manage in situations that are not the norm. The hospital has recently become electronic for medication charts, IV prescriptions, and observation charts. Initially, this was met with resistance like most change but throughout the last six months staff have adapted to the new practice and are now appreciating the positive culture change (plus being able to read doctors handwriting!).

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1. The organisation I work is has a transformational leadership approach to change. The working culture adapts well to significant change, and overtime this ensures that staff change their practice as well. Due to the earthquakes in Christchurch several years ago, the city has had to undergo significant change and manage in situations that are not the norm. The hospital has recently become electronic for medication charts, IV prescriptions, and observation charts. Initially, this was met with resistance like most change but throughout the last six months staff have adapted to the new practice and are now appreciating the positive culture change (plus being able to read doctors handwriting!).

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2. All patient feedback is collated by one person at the hospital and then distributed to the manager of the area responsible for the feedback. In my ward, these are raised at our monthly meeting, where we initiailly look at the positive feedback congratulating the staff involved. If there is generic feedback about how the staff could improve then this is also discussed at an open forum. However, if a particular nurse is involved with a complaint process then this is discussed privately. I don't believe at the organisation I work at that the data is used for audit requirements.
Katie O'Byrne

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1)	I believe that the best change model for my healthcare facility would be the strategic approach.  This ensures all healthcare professionals are involved in the process of quality control and risk management, whilst being held accountable for recognising and reporting potential risks or improvements.  In healthcare, we learn from not only the things that work, but also the things that don’t work (near misses).  This guarantees the ownership of change to everyone, from the clinical microsystem of the hospital (clinical wards) right up to the Macrosystem of the hospital.                                                                                                                                2)	Within the healthcare facility that I work in, the Patient and Family satisfaction surveys are completed bi-annually as a way to identify continual or needed improvements within the organisation.   They used to be completed in the traditional method (pen & paper), yet now we have progressed to online data collection, and the majority of families are alerted via social media (Facebook).  This allows for data to be collated in a more efficient and professional manner, however it restricts the amount of families who can complete the survey, as they have to be linked to the organisations Facebook page &/or have readily available internet facilities.  The health care organisation also has a Consumer Liaison Officer who is integral to the overall strategy and improvement as an in-partial member. While the data collection method of the hospital is excellent, there is minimal evidence to account for changes that have been brought about by the survey’s.  For a consecutive 7 years, families have expressed their biggest concern was the price of food and parking and while the hospital assures the public they will explore methods to reduce the cost, there has been no change to these, only an increase of 15% (Royal Children’s Hospital, 2016).                 Reference                                                                                                                        Royal Children’s Hospital, (2016). RCH Patient and Family Satisfaction Survey results. Retrieved from https://blogs.rch.org.au/news/2014/02/17/rch-patient-and-family-satisfaction-survey-results/

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1)	I believe that the best change model for my healthcare facility would be the strategic approach.  This ensures all healthcare professionals are involved in the process of quality control and risk management, whilst being held accountable for recognising and reporting potential risks or improvements.  In healthcare, we learn from not only the things that work, but also the things that don’t work (near misses).  This guarantees the ownership of change to everyone, from the clinical microsystem of the hospital (clinical wards) right up to the Macrosystem of the hospital.                                                                                                                                2)	Within the healthcare facility that I work in, the Patient and Family satisfaction surveys are completed bi-annually as a way to identify continual or needed improvements within the organisation.   They used to be completed in the traditional method (pen & paper), yet now we have progressed to online data collection, and the majority of families are alerted via social media (Facebook).  This allows for data to be collated in a more efficient and professional manner, however it restricts the amount of families who can complete the survey, as they have to be linked to the organisations Facebook page &/or have readily available internet facilities.  The health care organisation also has a Consumer Liaison Officer who is integral to the overall strategy and improvement as an in-partial member. While the data collection method of the hospital is excellent, there is minimal evidence to account for changes that have been brought about by the survey’s.  For a consecutive 7 years, families have expressed their biggest concern was the price of food and parking and while the hospital assures the public they will explore methods to reduce the cost, there has been no change to these, only an increase of 15% (Royal Children’s Hospital, 2016).                 Reference                                                                                                                        Royal Children’s Hospital, (2016). RCH Patient and Family Satisfaction Survey results. Retrieved from https://blogs.rch.org.au/news/2014/02/17/rch-patient-and-family-satisfaction-survey-results/

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Jessica McKirkle

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I actually agree with all three comments above from Trish, Juanita and Judith.
There needs to be a strategic approach which is governed in a very specific way by the Board as they are accountable at the Executive level but I feel it is the dissemination of information and expectations which can be lacking. In order for an entire organisation to be engaged in the process of Risk Management and Quality improvement processes, there must be a quality and improvement culture. Just because data (audits - QBA, etc) are collected, it doesn't necessarily follow that the interpretation or the translation of benefits of the results are passed on to the staff at the coalface or to the consumer.
Feedback after the QBA for example is passed on to staff at a ward meeting, etc, but that does not mean to say that they are engaged with the process - there is often a lack of connection between high level strategic planning and direct outcomes to the patient or any great transparency about how the results are translated into direct improvement for patient care.

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I would say that transformational leadership is  the most appropriate model of change for my organisation to adopt. I agree with Sollecito & Johnson(2013) who stated that successful implementation of  TQM and CQI is change in culture within the organisation. This is accomplished through transformational leadership where a leader
sets the direction and helps herself and others to do the right thing to move forward. To do this, a leader creates an inspiring vision and then motivates and inspires others to reach that vision. A leader influences her follower...
PATIENT FEEDBACK:
In ED, the NUM informs the staff re patient feedback. In general, compliments are attached to handover book or placed on the board. If a patient complains, information from those involved will be collated and addressed accordingly. If necessary, it will be included in staff meeting and discuss how to resolve the issue.
Hospital wide, the Patient Liaison Officer collects the patient survey and an external agency deals with it.The CEO will then inform the organisation regarding the result of patient survey as part of the yearly report.

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The management where i am currently employed are very focussed on customer feedback. Both good and bad feedback is frequently relayed back to the various wards , and depending on what the negative comments are, occasionally small changes are implemented if required. Good feedback is often rewarded with chocolate or cake by the ward manager which is always appreciated!

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I am working within a private hospital which no doubt has an element of the Top Down approach for a managerial perspective, however it also demonstrates I believe a strong element of strategic management within the organisation as well. Ramsay's management team is very focussed on maintaining a happy working environment for all its members, regularly provides/ offers new learning experiences to its staff, and is very open to new ideas and staff where possible. As a result, this particular hospital has high staff retention, relatively good ward morale despite wards being extremely busy at times, and a large satisfied customer base.

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Good to see that data is being used to effect quality improvement and that compliments are brought to staff attention. This is where management are supporting staff engagement in their work and consolidating staff commitment to the organisation, which has an impact on quality outcomes for patients.  There is a lot of evidence suggesting that lack of engagement in work can have a negative impact on patient outcomes. 

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Good to see that data is being used to effect quality improvement and that compliments are brought to staff attention. This is where management are supporting staff engagement in their work and consolidating staff commitment to the organisation, which has an impact on quality outcomes for patients.  There is a lot of evidence suggesting that lack of engagement in work can have a negative impact on patient outcomes. 

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Good points raised, Juanita. The Queensland Bed Audit is another significant audit that is usually 'well actioned'. Unfortunately, according to the literature, a lot of organisations do only collect the data for 'appearances sake'. Sue

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Good points raised, Juanita. The Queensland Bed Audit is another significant audit that is usually 'well actioned'. Unfortunately, according to the literature, a lot of organisations do only collect the data for 'appearances sake'. Sue

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You two have been busy, forging ahead. Well done ...

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You two have been busy, forging ahead. Well done ...

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I believe a strategic approach to change is a more appropriate change model in healthcare. It seeks to engage all healthcare members and consumers into the change process. It also enables and encourages collective input and feedback that breeds ownership, accountability and promotion of the change within the organisation.
From a clinical perspective, my organisation participates in numerous clinical audits such as the compliance to care and correctness of forms. At the ward level the deficits may be addressed individually or as a group depending on the results and the collated results are often sent out from the Q & S unit showing overall results per ward and specialty. It identifies changing trends, increase in incidence and area requiring improvement which is actioned at the local level.
Patient satisfaction surveys are performed biannually and registers a minimum of 50 reviews at each term. The results are collated and presented to the departmental meeting and concerning issues or patient complaints are addressed immediately from the NUM and involves communication with patient (where possible) and staff. The hospital’s consumer liaison officer also sends through patient compliments and complaints to the NUM for circulation or correction/action to the staff.
Whilst some of the audits seem laborious and excessive, the motivation for collecting data and providing feedback is worthwhile provided it is constructive, evidence-based and improves patient care.

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I believe Strategic approach would be most beneficial as it introduces to staff a new way to feel so that new strategies can be implemented which then leads to things being done in a different manner
I have also just spoken with our Consumer Liason Officer at this hospital and she assures me that all patient complaints are addressed and dealt with. Ward patients are encouraged to fill in patient survey forms which are located at the ward reception areas on each ward,which are collected and any compliments as well as complaints are communicated to the appropriate ward staff.
Patient incidents which involve patient harm are referred to Quality and Safety . A DR is in charge of this area with two Registered Nurses who work alongside her to investigate
.