Improvement of safety and quality of health care service by change in the organizational culture of Sri Lankan Government Hospitals
Improvement of safety and quality of health care service by change in the organizational culture of Sri Lankan Government Hospitals
The Government hospitals would be considered as a primary health care delivering organization to the Sri Lankan community. The experience of the health care service is a reflection of the output of the organization of hospital staff of different hierarchy of competence and skill level.
The command and control approach
The framework of the Sri Lankan government health care is obviously a pluralist perspective. It is composed of few categories health care professionals and workers of different interests and goals.The medical specialist of the unit would essentially commands on the patient management and make prescriptions and recommendations of various treatment protocols. The next level is the resident doctors and they carry out the decisions taken by their consultant. They would elaborate the treatment protocols to best of their knowledge and skills to get the nurses involved in the protocol of treatment fully or partly. The nurses are also considered as an “Officer” category as they command the ward non clinical minor staff.
The rate of the conflicts is very high in this organizational culture as the trade union activity is high targeting the welfare of the health care worker rather than the improvement in the practice. The traditional unit runs according to the wish the consultant incharge for the unit.
The change of the organizational culture
The regulating authorities should be concerned to introduce unitarist perspective to health care system so that the each category is working for the improvement of the safety and standard rather than being concerned about the benefits gained by the other category.
Recognition of different categories of different competence as an important person in the unit for the delivery of health care. The traditional approach of command and control by medical specialist or consultants of the unit should be shifted to enforced self regulation and voluntarism in the unit (Healey and Braithwaite, 2006) to achieve the common goal of best practices of safety and standard.
Recognition of different categories of different competence as an important person in the unit for the delivery of health care. The traditional approach of command and control by medical specialist or consultants of the unit should be shifted to enforced self regulation and voluntarism in the unit (Healey and Braithwaite, 2006) to achieve the common goal of best practices of safety and standard.
The health care workers should participate in Continuous Medical Education for Knowledge update and delivering current guidelines for the patients. The continuous education and training is a fundamental of the current clinical governance concepts in maintaining standard of care (Davis, 1998)
Clinical Audit with a view to continuously improve the standard of care should be carried out with the participation of health care team members. The Audit is a key thing in the evaluation of the organizational effectiveness in delivering the health care service and it should be practiced with the participation of all the categories. The audit cycle should be completed to bring about the change to best practice ( Stacey, 2003).
4. The Introduction of concept of inter-professional collaborative practice and relational coordination concepts to the health care system. The traditional organizational framework of the health care system is vertical and there is no collaboration or communication between the different professional categories delivering the services in the same unit. With this novel concept of learning from each other with mutual respect is very effective in improving the novel organizational culture. It also leads to integrated health policy making and planning for a better health care( Gilbert et al.,2010)
References
- Healy J and Braithwaite J,(2006), Designing Safer health care through responsive regulation, Medical journal of Australia (184), pp 57- 59.
- Davis D. (1998), Continuing medical education, Global health, global learning , British Medical Journal (316), pp 385-389.
- Starchy N (2003).What Is Clinical Governance?, 1(12), pp 1-9, Availble online http://www.ssu.ac.ir, Accessed 15/102019.
- Gilbertt et al. (2001), A WHO Report: Frame work for Action on Inter-professional education and collaborative practice, Journal of Allied Health 39, pp 196-197
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