ASSIGNMENT

OF
Responsible Leadership in Health

Submitted to: Submitted by:

Dr. Matylda Howard Ms. Muskan
 Table of Content
Topic Page No.
1. Introduction 3
2. Background 3-4
3. Problems/Issues 5-7
4. Proposed 7-11
solution/ changes
5. Recommendations 11-15
6. Conclusion 16-17
7. References 18-22
Introduction-
Teamwork refers to working collaboratively to provide
integrated care delivery in health care organizations
(Huber, Thomas, Rodriguez, Hector & Shortell, Stephen,
2020, page 302). As public safety, prevention from risk,
and risk management become a feature of work, so health
care services require the engagement of the public more
closely and regularly (Clarke.J, 2018, Page 93). In
Stafford, there was a lack of all the aspects mentioned
above, due to which patients were suffering and the
hospital was failing in attaining its desired outcome that
was putting the patient first. To unfold the truth, there was
a requirement to conduct a public inquiry.

Background-The given case study reveals about inquiry

happened between the year 2005 to 2009 by the Mid-
Staffordshire NHS foundation trust (Francis, 2013, Page
7). From the year 2005 to 2008 the hospital was overseen
by the board which achieved in leading its trust (Francis,
2013, Page 7). Initially, to achieve the foundation trust
(FT) status, the organization had been investigated by the
higher authorities regulating the health system that
includes Strategic Health Authority, Department of
Health (Francis, 2013, Page 7). The brief investigation
was done by the Health Care Commission (HCC) for the
quality and standards of the hospital (Francis, 2013, Page
4). Despite all the investigation, no systemic failings were
found. Therefore, complaints were made by the patients,
and rise in death rates was also seen, even after so many
investigations, patients were left at risk (Francis, 2013,
Page 4). The most important issue was that these
problems were not visualized by the board, but
complaints were issued by patients that created the need
for conducting a public inquiry (Francis, 2013). Other
problems that also emerged in the hospital were lack of
care, ethics, and leadership which are essential factors to
provide quality care (Francis, 2013). No one from the
hospital staff raised their voice for such misconduct
(Francis, 2013). The reason for this might be they were
unable to see it or ignoring it deliberately. As a result, not
only the Trust’s Board but also the whole system of
hospital failed in protecting the patients (Francis, 2013).
Problems identified:
 Negative Culture refers to leaders who are not capable
of adapting the change & stick to their goals and
strategies (Daft, 2016, page 436). The hospital in
question was only focusing on their financial goals and
not seeking a change even after knowing about the
concerns (Francis, 2013, page 44). Change is the main
factor for effective leadership (Daft 2016, page 5)
which was not adopted by the board members rather
they were focusing on their interests and were
distrusting others (Francis 2013, page 44). Thus, this
irresponsible behavior of the board resulted in loss of
reputation and affected the health of many patients.
 Professional disengagement was seen in the
organization as none of the staff came in front to share
the information about the concerns (Francis 2017, page
44). This all happened due to ineffective
communication between the leaders and the other staff
member (Francis 2013, page 64). There was an absence
of responsibility, openness, transparency among all the
workers and leaders (Francis 2013, page 75). Patients
suffered because the clinicians and other staff members
 did not raise their voices or are unable to speak up due
to fear (Francis 2013, page 44). Hence, organization
faced the poor customer service and less level of
productivity among employees.
 The board of directors did not take the responsibility to
see the issues (Francis 2013, Page 44) as there was a
lack of vision and strategic actions to the concerns. The
board was working as doer without a sense of purpose
and direction, did not serve the organization (daft 2016,
page 397). The board only focused on the good
outcomes and neglected all the concerns that were
important (Francis 2013, page 44). Vision deals with
change (daft 2016, page 405) which was not at all
considered. Hence, it impacted the reputation of
hospital.
 In Stafford, inadequate standards were followed in
some wards. Many incidents occurred due to lack of
skilled staff and poor recruitment (Francis 2013, page
45). Some of the concerns came in front that trainees
were bullied by their senior staff which was totally
unethical practice (Francis 2013, page 59). There were
insufficient staffing policies and training of practice
among employees which led to decline in patient safety
and standards (Francis 2013, page 59). Hence, these
 concerns all in professionalism, and poor standard
(Francis 2013, page 45).
 The board of directors was giving attention to financial
and organizational issues to gain its Foundation Trust
status and ignoring the quality care (Francis 2013, page
45). As for the hospital, patients must be given
protection and safety. But due to the self-centered
behavior of leaders, the organization failed in detecting
the issues & lost their chance to take action (Francis
2013, page 45). The reason for all these happening was
inability to prioritize the things in systematic order to
achieve the desired outcome. This caused compromise
in quality care and lack of satisfaction among patients
which later on had a bad impact on the hospital status.

Proposed solutions from case study:

 To maintain the positive culture director of the

organization should be fully prepared to invite the
new changes and practice on daily basis to regulate
the changes (Rowland 2017, Page 203). Hospital
managers should be assessing all the departments in
the organization to know what new changes they can
bring to provide efficient care and safety to their
 patients. Leaders should be focusing on the issues
and follow the right approach to fulfill the needs and
requirements of patients. They need to bring all the
members together and take their opinions and
concern into considerations regarding new changes
(Rowland 2017, Page 208). These solutions were
chosen due to the rising concerns in the organization
which was not taken into account by the trust
members. Healthcare managers should think about
patients before financial issues (Francis 2013, page
86).
 To make improvements there should be professional
engagement between leaders, staff members, and
patients. The possible solution for this is effective
communication and sharing of the information
between regulators (Francis 2013, page 89). As
patients are the centre of attention of the hospital
they should be engaged in providing feedback and
share their experience about the hospital and its
services to the organization (Braithwaite J, 2019,
Page 171). Not only this, use of information for
effective regulation, information like investigations,
patient risk assessment, complaints, and incidents
which can help in making improvements (Francis
 2013, page 89). These solutions can have a huge
impact on improving patient service and quality care.
 To improve governance leaders should bring change
in themselves. This can only be possible if rules and
principles are made for the directors by the higher
authorities. To implement these changes Care
Quality Commission should make guidelines and
make strict penalties if they breach any of the
regulations (Francis 2013, page 93). There should be
requirements to be fulfilled by directors of all bodies
to get registered by the Care Quality Commission,
and considerations should be given to the proper
fitness for the role of director without the history of
serious misconduct (Francis 2013, page 94).
Moreover, the board should improve its strategic
vision and think about patient resourcefulness and
should be focusing on what is possible & changeable
to get the desired outcome (Thomas, 2013, Page 5).
Staff should be trained with an adequate programme
conducted in the organization (Francis 2013, Page
94). This is how the organization will succeed in
making a good impact on its effective governance.
 To maintain the quality standards there is a need for
monitoring the delivery of standards. To provide
 good standard services to the patient there is a need
for ensuring assessment and enforcement of the
standards which means standard commission should
focus on the essential improvements to maintain the
safety of patients and quality of standards (Francis
2013, page 98). To address workplace bullying
among nurses there is a need for nurses to include
training on legitimate methods of performance
review (Johnson, 2018, Page 1528) and there should
be regular in-place workshops to update the
knowledge of nurses and staff members.
Commission of standard should motivate nurses and
other staff to continue their education to provide
critical care to the patient (Francis 2013, Page 98).
Also, there is a need for nursing leadership to
maintain the nurse-patient ratio to avoid shortage of
nurses. These changes will improve care and safety
of patients.
 To make priorities in systematic order. There is a
need for performance management and strategic
vision (Francis 2013, Page 100) to make the priorities
for patient safety which is much needed for the
hospital. Leaders should adopt a participative
behavior which will help to enhance the team
 performance, application of new ideas, and facilitate
learning (Kathuria 2010, Page 1085). Moreover, the
General Medical Council should also take
responsibility to review and assess its approved
practice settings criteria concerning the recognition
of the priority given to patient safety and the public
(Francis 2013, Page 101). Making priorities for the
patient will help to fulfill the need of the organization
to maintain its reputation and also the quality
standards.

Recommendations:
 The culture of the healthcare, which necessarily
impacted all the aspects of care and services received
by the patients, must develop and change (Mannion,
2018, Page 1). To bring positive culture three levels
of organizational culture should be followed which
includes visible manifestation, shared way of
thinking, and deeper shared assumptions. “Visible
manifestation refers to distributing services and the
roles between service organization”(Mannion, 2018,
page 2).“In shared ways of thinking organization
focuses on patient needs, staff performance and
 evidence for the actions”(Mannion, 2018, page 2).
The organization should conduct culture assessment
tools directed towards patient safety which can
include Safety Attitude Questionnaire (Mannion,
2018, Page 3). Through this, the Board of directors
will be able to assess all the aspects of patient safety
and can implement changes in culture. There is an
interdependent relationship between culture and
facility design due to which organization gets the
opportunity to assess its performance and consider
how to make things better (Hamilton, D. K., 2008,
Page 44). With all these positive cultural shifts there
will be a prominent change in hospital (Mannion,
2018, page 3).
 Employee engagement plays an essential role in the
success of organization which improves workplace
performance (Makoni, 2019, Page 14). The strategy
of motivating the employee for achieving a rewarding
outcome can be very influential (Makoni, 2019, Page
18). The provision of employee engagement
strategies is that healthcare managers should not only
focus on financial inputs but also harness the
knowledge of engaged employees (Makoni, 2019,
Page 27). To engage the employees in workplace
 efficiently fiscal remuneration and rewards can be
helpful (Makoni, 2019, page 37)). Training and
educating the employees to make them feel
competent can improve the level of performance
(Makoni, 2019, Page 38). Patient & family
engagement in the hospital is also required to monitor
the care given to the patient including consuming
information about their health and treatment from
doctors (Holden, 2013, Page 1677).
 To accomplish good governance health care
managers must adopt an innovative approach to
promote investigation and obtain a legal framework
against corruption (Hunter, 2020, Page 2). There
must be a strict observation against the person who
breaches the rules of the organization irrespective of
their position in the hospital. To implement
communication and consultation between
stakeholders to ensure transparency (Hunter 2020,
Page 5). There should be functioning legal system so
if any from the public raises the voice, there should
be likelihood of investigation, prosecution, and
conviction (Hunter 2020, Page 6). To improve public
official accountability, strategy of conducting
specific elections to board in intermediate health
 services bodies can be implemented by the
government (Stewart, 2016, page 69). These
strategies will help in improved decision making and
increase public engagement (Stewart, 2016, Page 70).
 An initiative should be taken by the board of
directors to focus on effective leadership in
maintaining nursing standards. The Nursing
supervisor should monitor the roles of staff and
activities performed by them to increase quality care
(Havig, 2011, Page 1). The Nursing supervisor
should maintain the ratio of registered nurses and
unlicensed nurses, and clarify their roles about
quality care (Havig, 2011, Page 3). The use of health
information system should be implemented (Means,
T.L.B, 2015, Page 2). The board members should
make sure there is in-place learning to prepare nurses
to possess adequate technology competencies
((Means, T.L.B, 2015, Page 7). By using these
strategies, prominent change can be seen in
performance of nursing which will lead to quality
care.
 To make right priorities for the health care
organization. Health care managers should have
specific insight and priorities for patients (Taylor,
2014, Page 9). To accomplish that health care
managers should create customer-centered
organization and focus on process improvement
(Taylor, 2014, Page 9). There must be a
transformational change made by the leaders which
should be aimed at creating a new culture which can
be beneficial for the patients (Taylor, 2014, Page 9).
There should be improvement in the process of
collecting the information from patients which should
be well documented (Pine, 2015, Page 1301). Health
care managers should assess the effectiveness of
various health care interventions and monitor risk-
assessment of patient ((Pine, 2015, Page 1302) which
will improve patient safety.
Conclusion:-
The Mid-Staffordshire reports consider some major
issues of dissatisfaction among patients, diminished
quality care, upsurge in mortality rates, Poor
performance, and lacking standards, which was the
result of the unsatisfactory management and
inadequate leadership. The factors that affected the
leadership in healthcare organization were
ineffective communication, blindness towards
concerns, lack of care, compassion, and humanity
among the healthcare workers. The NHS system put
many efforts which include checks and balances but
failed in preventing systemic failure. No one from
the scrutiny groups or other investigation department
was able to prevail the truth. Afterward, failures
were detected by the public inquiry. After knowing
about the failures everyone got shocked why these
failings were not discovered earlier. In the case
study, to resolve the issues certain possible solutions
were prescribed. All the solutions recommended
changes to leadership which is the main component
to run an organization, in which changes in culture,
employee engagement, patient engagement, and
high-quality standards should be adopted. These
aspects can have a positive impact on the patient care
and reputation of the organization. To imply these
changes there is need of strategic action to be taken
by the directors which will help them to implement
these changes into organization. Strategy of
collecting information or feedback from the patient,
maintaining nurse-patient ratio, and training of staff
about new technology. These strategies can make the
organization successful & should be adopted in
every organization that no hospital should suffer
from this kind of crisis.
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