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. Nursing Leadership And Management Essay
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. Nursing Leadership And Management Essay
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. Nursing Leadership And Management Essay
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). Nursing Leadership And Management Essay
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 profe
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