The parkway health care has 220 facilities in the southwestern United States, with an average of 115 beds per facility and a total of nearly 30,000 employees. In addition to health care facilities, it also provides skilled in-home nursing care. Parkway is seen as one of the best care facilities in the region, and it has won numerous awards for its achievements in the field.
Parkway’s clinical programs are founded on a reputation for quality outcomes and service excellence. There are more than 1,200 accredited medical specialists in heart and vascular, neuroscience, oncology, musculoskeletal, transplant and cellular therapy, women’s and children’s chronic disease management and surgery to support these clinical programs.
Holistic perspective on matters related to health are important and relevant, with so many perspectives interrelated and interdependent. This approach helps to identify priorities, where resources are limited, in tackling the basic causes of stress and preventing unnecessary damage. It makes for better team work and helps individuals to feel more confident.
The purpose of this assignment is finding a problems identified in parkway health care, the proposed changes resistances as well as a stress management plan aimed at developing a conductive environment for parkway to pursue its long term growth objectives.
There are a many types of resistances are effected to the parkway and also effected on long term progress of the company, also there are main problem of stress in employ and staff which can be resistance of the progress of our company.
The data on employee injuries, incidents, absences and turnover are shows that all of the data increased every year step by step these described that’s not good for company.
Injuries per staff member are slowly increases at year 2000 to 2007 as a 3.32% to 5.62% but quickly increases. these ratio in 2007-08 as a 5.62% to 7.12% and also near about same in 2009 as a 6.95% and incidents per patients ratio are also increase in last 10 years step by step as a 4.98% to 9.34%. It’s very high data of injuries to staff occur mostly because of back strains from lifting patients.
The incidents per patient are increases 4.98% to 9.34% at year 2000 to 2010. These data ratio are also high and up every year so it described that more incidents reflects injuries due to slips, falls, medication errors or other accidents.
The certified absences per staff increases every year step by step increases between 2000 to 2009 its increase 4.55% to 6.11% and also other absences per staff continuously increases every year between 2000 to 2009 as a 3.14% to 4.28% .
The certified absences and other absences per staff are also very high increases every year. Certified absences are days off work due to medically verified illness or injuries. Other absences are days missed are days missed that are not due to injuries or illnesses.
Number of Patients Ratio
The number of patient are increases continue every year in between 2000 to 2009 its increases 21200 to 25300, increases of patients its good for company but all categories shown decline.
The survey results indicate that many problems have developed while the organization was focusing on achieving its growth and profit objective.
The parkway nursing care have the pressure for growth is one significant challenge. Now the company have making some changes based on AI process and most changes efforts are associated with resistance.
There are some points which effect most of this company is as under will be needed to change for the growth for the company.
The company wants to use such organizational development methods as (Appreciative inquiry) AI process to create and re energize its sense of mission. AI procedures systematically collect employee input and then use this information to create a change message everyone can support.
1] Staffing Problem
2] Physical Demands
4] Focus on filling the bed
 Staffing Problem:
The staffing problem is a main problem identify after the survey result there are no enough staff in to parkway health care. In the parkway there are a major job stress in most of the employers because of less staff then required in parkway that’s why job pressure is effect to all staff in work every step.
There are a many patients handle by each staff member because of no enough staff that’s why some time employ tired to handle these, some time also working in a night time or long hours working problem cause of these reason.
These reasons are more effecting on patients and high per tension on employ so employ can’t gives enough time to patients and work ruff cause of more patients are waiting so incidents ratio are increases every year.
This is looking like a small problem but its effect very high for the company reputation and long time company profit and growth.
There are needed a implication like that some job placement of employ and add some new staff to solve these problem and request to organization is that don’t focus on money because if you increase staff so customer will be satisfied sure and that’s why long time profit of the company.
 Physical demands:
In the parkway health care there are a physical demands also needed because of no latest equipment they are used.
Parkway is a big nursing care but they have no latest equipment that’s why use of staff instead of equipment so incidents and injuries ratio are increases every year.
Mostly its needed for patient transfers, bed mobility, supine to sit, bed to wheel chair, sitting to standing, floor transfers, and wheel chair mobility, now days they can’t use all of these but used human instead of machine.
When patients are heavy then normal body, it’s difficult to transfer without equipments and also these difficult for lady nurses.
2.1 Patient Transfers
Direct patient care involves assisting the patient into various positions and functions. The transfers can be divided into a few categories: bed mobility, sitting, standing, wheelchair, floor, and walking.
2.2 Physical Demands–Ability to bend, squat, twist, lift, pull, push, as well as guiding/standing by in case assistance is needed. Varied assistance is required depending on the ability of the patient. Lifting forces vary with patient weight and level of ability to assist in the movement. Generally no more than 30% of the patient body weight is required. Pediatric nursing often requires the child to be lifted, or positioned independently; these forces would be up to 50 lbs. Draw sheets, transfer boards, lifts and other transfer equipment may be used.
2.3Bed Mobility–A two-person lift to move the 240lbs. patient up in bed with no assistance requires 28 lbs. force from each nurse.
Rolling the patient on to the side requires an approximate force of 10% of the patient’s body weight. Trunk flexion of up to 50 degrees with a return to an upright posture occurs during positioning. Static holding of the patient with one upper extremity while manipulating/tucking sheets against the patient may be required during sheet changing, or bed baths. The process of rolling, holding the patient, and pulling the sheets across the bed would be required to complete the process.
2.4 Supine to Sit–Assisting a 251 lbs. patient from lying supine to sitting with Moderate assistance (50% help) requires 26 lbs. of force, and movement from trunk flexion to an upright posture during load. Dynamic standing with 16 pounds of force is required to assist the patient in a sustained sitting posture.
2.5 Bed to Wheelchair–In the sitting position, the nurse can sit or stand to assist the patient in a bed to wheelchair transfer with standing pivot transfer as described below, or a sitting pivot transfer, including the use of a sliding board. The use of the sliding board requires the use of one upper extremity to stabilize the patient and shift the body weight to one side, while using the contralateral upper extremity to place the board under the patient’s hip. Minimal force is then exerted to slide the patient from one surface to another.
2.6 Sitting to Standing–Assisting a 251 lbs. patient from Sitting to standing with Moderate assistance (50% help) requires 26 lbs. of force, and movement from trunk flexion to upright standing during the dynamic lift. Dynamic standing with 16 pounds of force is required to assist the patient in a sustained standing posture.
2.7 Standing Pivot- A standing pivot transfer to the wheel chair is accomplished with full body rotation and controlling the patient to sitting. The nurse will end with approximately 50 degrees of trunk flexion, although squatting during the patient descent will minimize the trunk flexion.
2.8 Floor Transfers–Floor transfers are accomplished with a minimum two person lift, and generally occur only when a patient has fallen. The patient may be lifted directly, placed on a backboard, or pulled into a chair. Trunk flexion to 40°, full knee flexion, and hip flexion of 90°-120°may be required for a floor lift. Arms are in an extended elbow position. Assistance is sought as the need dictates. This transfer would be rare in occurrence.
2.9 Wheelchair Mobility–Wheelchairs are generally pushed or pulled, and require 20 to 30 pounds of pulling force on industrial grade carpet, 15 pounds force for turning, and 5 pounds force pushing on tile. Minimal trunk flexion is required, generally to lock or unlock brakes. Squatting or kneeling may be required to manipulate the footrests. Tight or confined spaces such as bathrooms may be encountered, and require flexibility of the torso, and extremities.
There are needed implications like that buy all equipment like above and finished physical demands because it must be use for nursing care for patient care and patient safety.
Documentation its most useful part of the patients care but in parkway healthcare they can’t used of these process that’s requirement of government also now days these must be use in hospital.
Documentation is the basis for communication between health professionals that informs of the care provided, the treatment and care planned and the outcome of that care as a continuous and contemporaneous record and it’s a record of the care and the clinical assessment, professional judgement and critical thinking used by a health professional in the provision of that care.
Clinical Documentation Chart
Documentation includes all forms of documentation by a doctor, nurse or allied health professional recorded in a professional capacity in relation to the provision of patient care and record keeping is a fundamental part of clinical practice. It demonstrates the clinician’s accountability and records their professional practice.
Documentation should be clear, concise, consecutive, correct, contemporaneous, complete, comprehensive, collaborative, patient-centred and confidential, it must be patient focused and based on professional observation and assessment that does not have any basis in unfounded conclusions or personal judgements.
Clinical staff must able to competently communicate effectively with individuals and groups using formal and informal channels of communication and ensuring documentation is accurate and maintains confidentiality.
Documentation is often used to evaluate professional practice as a part of quality assurance mechanisms such as performance reviews, audits and accreditation processes, legislated inspections and critical incident reviews.
Documentation systems should promote appropriate sharing of information amongst the multidisciplinary and teams, Accurate and comprehensive documentation is a valuable source of data for data coding, health research and a valuable source of evidence and rationale for funding and resource management.
Documentation should record both the actions taken by clinical staff and the patient’s needs and their response to illness and the care they receive. Clinical staff has legislative, professional and ethical obligations to protect patient confidentiality; this includes maintaining confidential documentation and patient records. Precautions must be taken to ensure that clinicians are fully informed of appropriate, safe and secure use of electronic information systems and the potential risks involved in using such systems in ensuring and maintain confidentiality.
All above reasons shows that’s implications must be require for the documentation process and otherwise can’t improve the patient care so it’s needed to implications.
 Focus on filling beds:
There are in a parkway one reason of focus on filling bed mostly here increased patients every year step by step but aim is filling bed, because no enough staff and equipment requirement also they can’t gives good careful services
Now day patients care is more important than filling bed but here organization have interest only in profit so focus on filling bed is also aim of marketing division because of their own profit they play with patients.
The patient focus of Quality is related to service, products available, and sharing of information to both internal and external patients of an institution. Customer service has become a common buzzword.
Determining whether one’s external customers received the Quality they valued is a powerful tool for an organization to use. In the past, most facilities believed that if they tracked the number of problems or occurrences and they remained within an acceptable level, then the
Organization was providing quality customer service. More recently, the technique of asking the consumers about their expectations of quality Care was found to be much more telling random assumptions as to what the customer needed or considered as quality care.
Patient care surveys are now widely used in all types of settings as successful tools for quality care assessment and improvement.
Change management Strategy:
There are a many resistance effected to the change of the strategy this can be described as below
Staffing problem is needed to change but some resistance like the organization can’t be happy to change, because of if they placement the new staff then they will be pay to more salary and all benefits to provide the new staff.
Physical demands also resistance by organization because it’s more expensive equipment and also provide some special training to their staff for handle the equipment so it’s resistance by organization.
Documentation is also the expensive than local procedure and also its difficult to maintain everyday and every hours so it’s resistance by organization and staff and employers also.
Focus on filling bed is resistance of the marketing division and organization because their focus is earning money. That’s why its resistance by both of them.
There are a many problem observed in survey results that’s shows that some requirement for implementation needed to solve the problem like injuries, incidents, absences ratio are increases every year step by step that’s why the basic reason which can be affected on the above data and like staffing problem, physical demands, documentation and focus on fiiling beds, All of these problem will be needed to change step by step for long progress of the parkway health care.
There are a some other reason effect to the employer its stress because there are a no enough staff here in the hospital that’s why when employer want to take a rest they can’t taken that’s why stress problem increased so needed to some job placement for new staff and provide them to some training so they can able to handle patients when the experienced person have on a off .
In today’s highly complicated, technological, and competitive healthcare arena, the public’s outcry is for administrators, physicians, and other health care professionals to provide high quality care at a lower cost. Health care managers must therefore find ways to get excellent results from more limited recourses.
There are a needed of implementing in to the some points which can be found in the survey results ratio like incidents and injuries will be surely decreased if some changes can be done.
Encouragement of clinical staff to be involved in decision making in relation to selecting, implementing and evaluating documentation systems, Implementing quality improvement processes related to effective documentation, Promotion of documentation as an integral and core part of practice and professional responsibility.
Nurses are viewed as a part of the solution, not the problem. If nurses were allowed to use their skill, the public believe they would significantly enhance quality and reduce costs. One survey (ANA,1993 a) asked consumers about receptivity to nurses having expanded responsibilities. Respondents supported prescriptive authority.
Job Stress in Parkway:
What is stress?
There are many ways of defining stress. What is generally described as “stress” is an inevitable and essential component of normal living. A certain amount of stress is essential to all areas of life and type of activity (Montague 1979). Living involves adapting to circumstances surrounding us every day, in ordinary, everyday events as well as moments of crisis. It is process which is essentially creative, but when stimulus and response do not balance there can be damaging effects on the individual, especially when this builds up over a long period.
Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury. The concept of job stress is often confused with challenge, but these concepts are not the same. Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work. The importance of challenge in our work lives is probably what people are referring to when they say “a little bit of stress is good for you.”
The damaging effects of this unbalanced response to stress are well known ( Cooper 1988; Hingley & Marks 1991; NASS 1992a). In addition to physical or emotional damage to the individual,( Cox et al.1990) notes a number of ‘ organizational effects’ as he outlines the damages to an organization in terms of poor productivity and industrial relations and increased absenteeism.
Source of Stress:
Employees who consistently have too much or too little to do create a lot of stress, Some employees are highly stressed because they simply have too many responsibilities. Others work around the clock, not necessarily on the clock, but throughout the day and at home. These are generally the employees who have too much to do and too many responsibilities.
In the parkway health care there are not a enough staff that’s why it’s a major source of stress because small staff and many work so needed overtime work and also over load work everyday. Individually one staff member handle many patient at one time it’s a bitter truth of parkway So when staff member want to holiday for them personal life can’t possible for them so mostly staffs are in stress.
Some nurse’s have small kids at home but can’t time for the kids that’s why nurses staff member are under stress in the job, also the lady nurses are fulfill them both life so very difficult to handle at home, kid’s with their busy jobs. So they want to rest but can’t get rest.
Most of the stress on this job comes because employee can not take time off when they need it. The LPNs [licensed practical nurses, who do much of the care] and orderlies can not take time off when they need to. The person who takes time off feels guilty, and there can be fights over taking time off. If employee had some way of covering these emergency absences, they had all be a lot happier.
In the staff most of the doctors are experience so mostly they can’t take an enough rest, Sometimes they have their own emergency work but can’t finished their work because of busy hospital schedule so they fell stress.
The major source of stress is the incomplete staff in hospital industries in parkway health care there are no enough staff for hospital that’s why many patients handle by every nurse so its must be that if solve of these problem so use of placement and add some new staff in the hospital
Also buy some equipment like lifting is must be needed for hospital some it’s a reason of stress for lady doctors that’s why this action also can be needed for stress.
There are a many experienced doctors are in the parkway so they can’t take enough rest so give to rest them and use of new staff for the instead of them for providing good training.
There are a hired some yoga trainer for hospital staff and gives time for the employers for use of these services it’s useful for stress and some exercise is also be good for stress.
So all of the above action must be use of the decreased the stress of employers.
Stress Management Plan:
There are some point of review which can be help to decreased the stress of staffing of healthcare industry, These can be described as shown below.
About empowering and enabling individuals to care more effectively for themselves and for others.
Not only to be reactive but proactive
Genuine care at all levels, which encourages those in great and small posts of responsibility to feel equally important
Enabling people to be fully and creatively present in the work they do
A collection of safety nets by which providers of services can feel held, regards and valued
Mechanisms that help to create an environment of care where by individuals are enabled or empowered to receive and give care.
About an organisation having mechanisms in place to help staff who may be experiencing unwanted stress.
Providing the same sort of health service for staff as one would for patients.
About caring for staff that understanding of staff’s needs and being available on the spot.listing problem of staff.
sharing in problems and try to solve.
ensuring people know where they can find and use services which can help in the longer term and ensuring those services are available.
In Parkway healthcare after survey result conclusion that there are a injuries, incidents and absences data increases every year also to gather the patients graph also increase every year its shows that the reputation of the company is a good and its useful for their future growth and profit.
But some reason have effected of the progress of company like staff, and demands of new equipment are needed for the company for and documentation also needed for government rules and patient instant care and data.
That’s why company needed some implementation for the company progress and its requirement for the good future of the company.
Also the reason of stress is also the weak point of the company that’s the reason depends on staffing problem so if solve only the staffing problem so stress can be decreased automatically in future so job placement its must be requirement of the our company.
Also some problem of organization and marketing division because both of them can’t compromise with their profit and they focus only for feeling the bed in the hospital without thinking of good care of the patients. That’s why needed to change their strategy of filling beds to change on focus of patients care because of that’s the good for long term of the company and now days patients care is more important than filling beds.