by Andrew Thorn

Created on: August 30, 2009   Last Updated: September 03, 2009

In focussing upon current research and experience of nursing service development, a number of factors are involved in ensuring quality HealthCare delivery is provided. One such factor is the organisational commitment to provide time and opportunity for the development of reflective practice. This commitment is of course multi-dimensional and there needs to be 'buy in' from clinical staff and a mutual understanding of how this time is used effectively.

In addition, it is crucial to develop a culture that supports decentralisation and participative management structures. Staff cannot be guaranteed to make good decisions without sufficient information and training and they are unlikely to make suggestions if they feel that this may compromise the stability of their current roles. We need to ensure that the qualities of the current structure are encapsulated and given the opportunity to develop. As an example, there are often multiple projects and initiatives occurring within any health care environment. The common perception is that these are being conducted in a somewhat isolative and non-coherent manner and I feel, this being the case, these projects are not being given the opportunity to realise their full potential in terms of corporate ownership, relevancy, implementation, usefulness to others and, ultimately in Kudos.

No one would question the view that hospital organisation and management matter greatly, in delivering quality HealthCare. Knowledge about the relationship between structures, processes and outcomes within nursing and within healthcare generally, is complex and incomplete and hence it is difficult to recommend ways of organising that actually improve patient care. In defining a quality initiative we need to be mindful of how the organisation and management of care affects outcomes. Naturally, both medical and nursing education tends, quite rightly to concentrate on individual patient care. An awareness of how each clinical encounter is compromised or improved by the system takes many years of clinical experience.

In reflecting on this, it is possible to make judgements on the essential organisational features required for clinical development to occur; these are as an example only, identified within the 'MAGNET' programme:

A relatively flat nursing hierarchy with few supervisors

The chief nurse has a strong position in the management structure of the hospital

Nurses have autonomy to make clinical decisions in their own areas of competence

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