Delegation refers to the transfer of authority and responsibility from a high authority to a lower ranking position in patient care provision. Delegation occurs when a medical superior or consultant transfers the provision of care for a patient under treatment to a nurse, medical student, a doctor or a health worker for continued treatment. Delegation instructs the named registered and competent individual to perform specific tasks in the specified setting without direct supervision. The delegating medical consultant however retain accountability for the outcome of care given and must therefore ensure that the chosen individual has skills, knowledge and experience to perform the assigned duties safety and effectively.
Benefits from delegation in healthcare
Delegation is a crucial part in healthcare system with various benefits to the organization, employer and employees. Delegation increases productivity and continuity in planning which increase and improve the reputation of the organization. Delegation helps in the formation of reliable teams and help team members to develop and enhance their skills. It helps the employees to build their loyalty to the organization by offering opportunities for career growth (Baron, 2015). Delegation help in the removal of delays and the waiting process enhancing patient care and service delivery. Healthcare benefits from delegation through increased efficiency in the provision of service. By allowing care to be transferred to the next person who has a sufficient skills set to perform the activity, delegation enables the assigned assistant caregivers to contribute to patient outcomes and lower costs of operation. Delegation is critical in health care for development of knowledge, skills and abilities (Gadbois et al., 2015). Delegations help the medical leader to pass on significant skills and abilities to team members encouraging them to grow and attain independence in medical practice through less supervision. Delegating tasks is beneficial in health care to foster empowerment allowing the lower ranking healthcare personnel to gain expertise by completing the assigned responsibilities for ultimate success. From delegation, the healthcare system also benefits from influential and effective leadership. Through the process of delegation, potential leaders can be identified and empowered. Delegation is also crucial in harnessing leadership skills as it ensures that medical leader has more time to focus on the core issues for efficiency and effectiveness while at the same time they propel and enhance proper care.
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Obstacles to delegation with examples
Understanding activities to be delegated
The health care system experiences challenges in the delegation process in determining what can and what cannot be delegated. The determination is crucial due to the unique requirements in conduct and service delivery. For example, before delegation, the medical consultants and superiors or any other qualified personnel in their capacity must be in line with the legal considerations (Baron, 2015). By taking into account the legal perspectives, medical professional must therefore understand which activities can be delegated and adhere to the state regulations on the performance of lower ranking or unlicensed medical professionals. Considering the delegation policy, midwives cannot be allowed to delegate their duties like attending to women in childbirth since it is a statutory midwifery duty.
Delegation also faces an obstacle in variations and inconsistency in practice. Effective delegation requires setting and communicating clear goals defining the right scope for the assistant care provider who performs the delegated tasks (Gadbois et al., 2015). It also requires personal accountability for the outcomes and effective learning on how to train the employees to learn and effectively perform new tasks. It is also essential to recognize and understand the potential displayed by the employees. Failure to keenly observe and meet the delegation requirements will results in variation and inconsistency in practice. For example if proper assessment is not conducted before delegation, the person chosen may fail to have the required skills, knowledge and experience required for the care of the patient. In such cases the results obtained will vary which will raise concerns in the consistency of practice and may as well adversely affect the patient outcomes. Delegation may also be obscured by failing to accomplish the best interests of the person under care due to inconsistent decisions made by the caregiver which may be contrary to the patient consent, beliefs, needs, preferences as they can go beyond their limitations.
Use of delegation for effective and safety in management of care
Delegation can be effectively used to manage care by understanding, practicing and observing all policies of delegation. For effectiveness and safety in the management of care, the health professional with authority to delegate tasks to another should take full responsibility and become accountable in the delegation. They should be in a position to justify the delegation by keeping perfect and precise records of the delegation discussing the need, purpose, results ant outcomes of the delegation. For effective and safe use of delegation in healthcare, the healthcare professionals must be keep to delegate aspects of care to an individual who demonstrates competency with suitable skills knowledge and experience for safety enhancement (Gadbois et al., 2015). They should ensure that the person to whom they delegate understand the nature of the task and the necessary requirements. The professionals should also offer supervision to ensure competency and be prepared to intervene when the delegation is deemed in appropriate and unsafe for the patient in care. The healthcare professional should make sound judgment on delegation of care and make decisions with the knowledge that he or she holds the sole responsibility of the outcomes, safety and effectiveness of the delegation process (Hansten & Jackson, 2009). Safety and effectiveness will be attained whom the healthcare professional trains and educates the person to who tasks are delegated ensuring that they understand their limitation knowing when and when not to proceed and understanding the circumstances of the delegation and the likelihood to change. All legal policies and regulations should be followed to strictly for proper service delivery.
The importance of effective communication skills in delegation
The key to effective delegation is clear communication. There is need for detailed and timely communication between the registered medical personnel and the delegated personnel. Research shows that clear communication improve patients’ outcomes and enhances high quality measures. Failure to establish clear and precise communication leads to negative outcomes such as medication errors treatment and deterioration of health of the patient (Gadbois et al., 2015). Communication issues have also been rated as the most common cause of death. Poor communications in addition to non-specific and infrequent communication causes delays in treatment. Thus effective communication is influential in shaping the quality and patient safety outcomes. Effective communication is influenced by information shared and in most cases transfer of information is subjected to loss misinterpretation and may at times be forgotten (National Council of State Boards of Nursing, 2016). In healthcare specific information is valued for example changes in vital changes should be detailed and discussed for action. Information should also be offered in time to enhance intervention as information presented too late may be found incorrect finding patients conditions having changed drastically. Communicators should ensure that information is interpreted correctly to avoid miscommunication. Effective communication is essential as it enhances patient outcomes. It helps in making patients feel at ease feel in control and valued. Delegation calls for effective communication to increase safety and accuracy (Mackey & Nancarrow, 2005). On the other hand poor communication leads to inadequate monitoring and may result in failure to recognize the deterioration of a patient health.
The legal aspects involved with delegation
Delegation in health care is regulated by statutory guidelines which specify medical personnel regulation offered by the state. The regulations vary from one state to another directed through the Medical Act Practice and Public Health Code. The statues in regard to delegation for example allows physicians to delegate tasks to advanced practice nurses (APRNs), registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants( CNAs) and other unlicensed assistive personnel(UAPs) (National Council of State Boards of Nursing, 2016). Nurses also at as delegates or delegators. Delegation is also influenced by institutional policies which in many cases outline the responsibilities and limitation of professional medical personnel. Delegation is mainly governed by the five rights of delegation which includes the "right" person, the "right" task, the "right" circumstances, the "right" directions and communication and the "right" supervision and evaluation. All states have attained legal scopes of practice. Violation of the practice status laws is witnessed when medical professionals for example nurses perform roles and functions which are beyond above or those not included in the scope of practice which may result in permanent revocation of license. The scope of practice outlines the specific tasks which cannot be delegated to unlicensed and assistant medial personnel. For nurses such tasks may include assessments, nursing diagnosis, and establishment of expected outcomes, evaluating care and other tasks and aspects of care which include hygienic techniques, critical thinking, professional judgment and professional knowledge.
Conclusion
The assignment of are to others involves critical choices made by medical professionals. Appropriate and suitable delegations enable quality care while improper and inappropriate assignments results in poor quality care with disappointing outcomes of care, compromise of client safety, and in extreme cases lead to legal consequences. Thus medical professionals must delegate tasks within the scope of practice as dictated by the state laws and statues.
References
Baron, R. J. (2015). Professional self-regulation in a changing world: old problems need new approaches. Jama , 313 (18), 1807-1808.
Gadbois, E. A., Miller, E. A., Tyler, D., & Intrator, O. (2015). Trends in state regulation of nurse practitioners and physician assistants, 2001 to 2010. Medical Care Research and Review , 72 (2), 200-219.
Hansten, R., & Jackson, M. (2009). Clinical delegation skills: A handbook for professional practice . Jones & Bartlett Publishers.
Mackey, H., & Nancarrow, S. (2005). Assistant practitioners: issues of accountability, delegation and competence. International Journal of therapy and rehabilitation , 12 (8), 331-338.Harris, M. (2017). Delegation by Registered Nurses. Home healthcare now , 35 (9), 523-524.
National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation , 7 (1), 5-14.
Xue, Y., Ye, Z., Brewer, C., & Spetz, J. (2016). Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing outlook , 64 (1), 71-85.
