Description of the Department
The subsystem selected is the emergency department. This is the department that is concerned with handling casualties, a subunit that deals with handling the patients who need urgent care and attention. This subunit works for 24 hours and is equipped with all required equipment and staff to deal with all the emergencies. According to the nursing service delivery theory, an organization is an open system made up of subsystems and constitutes of an input-output system. The emergency department at UCLA Medical Center located in Los Angeles has inputs, throughput, output, and negative feedback. This organization depends on the environment for its inputs to ensure that there are sustainability and continued operations. As a system of interrelated parts, the organization’s emergency department requires the inputs from the environment. Input is the inflow of energy and information from the external environment to the system ( Meyer & O’Brien ‐ Pallas , 2010). The inputs at the emergency department include the hospital staff, emergency equipment, information, and resources. The emergency department requires enough staff to help handle a large number of emergency cases.
Also, the emergency unit at UCLA Medical Center has throughput. The throughput is defined as the energies inside the system that is transformed through the reorganization of the outputs ( Meyer & O’Brien ‐ Pallas , 2010). The emergency department requires nursing services such as first aid, surgery, and other nursing interventions to make it operate effectively. These nursing services are the throughput in the emergency department at UCLA Medical Center. The goal of any healthcare organization is to provide quality services to the patients, increase the positive health outcome and to increase customer satisfaction. The output in this department is the volume of patients, the number of satisfied patients and the number of readmissions. The output is the products that are exported to the external environment, which in this case is the number of patients treated, the level of their satisfaction and the reduction in the number of readmissions.
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The negative feedback is the internal information about the functioning of the system as a corrective mechanism used to make adjustments. The negative feedback in the emergency department of this healthcare organization is the feedback on the level of satisfaction of customers and customer complaints ( Meyer & O’Brien ‐ Pallas , 2010). The organization has a system where it receives information from the patients about their level of satisfaction with the kinds of services offered. With the reports on the performance indicators, it becomes easy for the organization to align its goal and work towards these goals as it makes improvements.
Problem Identification
The problem identified within the emergency department of the organization is the scarcity of staff to handle the increasing number of cases of emergencies effectively. According to the American Nurses Association (ANA), the required nurse to patient ratio is 1:4 for the emergency department ( Pilcher & Odell , 2013). The right number of nurse patients must be maintained as this ensures that there is effective service delivery to the customers. Having an appropriate nursing staff ensures that there is enhanced patients satisfaction, reduced medical errors due to fatigue and improved safety. Currently, the nurse-patient ratio at the emergency department of UCLA Medical Center is one nurse for every ten patients. This makes the nurses to overwork as they handle a large number of patients thus increased chances of medical error, reduced satisfaction, and reduced safety. The emergency department requires an urgent response from the patients. If one nurse is handling ten patients, a problem arises when a large number of patients are brought to the healthcare facility at the same time ( Shang, Stone & Larson, 2015 ). It means that some patients who require urgent care will have to wait while the nurses attend for other patients. Such a situation could lead to loss of life that could have been save with urgent care and thus a reduction in the patients’ satisfaction rate.
Within the system theory model, the problem exists within the input. Nurse staff is the human resource, an inflow of energy from the external environment to the organization’s subsystem ( Backhaus et al., 2014 ). The shortage of nursing staff is, therefore, a reduction in the energy input into the system to produce the desired output. With the large nurse-patient ration, the nurses are unable to meet the desired goals and objectives of the organization. With the mission of UCLA Medical Center being to provide quality services, to increase their health outcome and to increase their level of satisfaction, these goals, which are the desired output in the system theory model, will not be attained. With limited output, the organization is facing a challenge of putting insufficient energy required to produce the required output. While the problem of understaffing falls within the input, it affects output. The output of the system depends on the input, the energy that is pumped into the subsystem.
Solution to the problem
The desired outcome for UCLA Medical Center’s department of emergency is to increase the positive health outcome of the patients brought to the facility, increase patients’ satisfaction and attract more patients to the facility. The organization’s outcome is, therefore, more patients to the facility by increasing their level of satisfaction. With that outcome, the organization would be in the right direction towards creating an effective organization that meets the needs of the patients.
The primary goals and objectives that facilitate high customer satisfaction and attract more customers are the quality focus, efficiency, and innovation. The first goal of the organization’s emergency department is to emerge as the leading healthcare facility in offering quality services. The mission statement is to offer quality care and services that set the community standards exceeds patients expectations and provide a caring, convenient and cost-effective environment and in an accessible manner. With the quality care as the goal of the department, it puts the organization in the line to work towards meeting the quality goal. To provide the quality care that meets the standards of the community, the organization will have to realign itself and reform its structure and culture in a way that moves the organization towards these goals. At the same time, the goal of the department is to meet and exceed the expectations of the patients. This goal will also make the department to make policies aimed at meeting that goal. The department can also make a goal of setting the target number of customers to serve in a day and to reduce the waiting hours that the patients have to wait before they get services. This goal can also push the company to work into policies and procedures that will facilitate the achievement of these goals.
Based on the goals and objectives described above, the first policy that the department can make is on setting the quality requirements that the department must meet. The quality requirement policies can involve; no patient should wait for more than ten minutes before receiving services. Another policy that the organization that the department can make is to set a low on the minimum nurse/patient ratio. The relevant professional standards that can be included include the need for every nurse to be held accountable as they provide services to the employee. Another standard can be set on the recruitment by setting the required qualification and experience for those serving in the emergency departments to ensure quality services. The organization can review its staffing and recruitment and make the right mix that will ensure there are flexibility and efficiency in the department.
The mission of the organization is “to improve the health of those we serve with a commitment to excellence in all that we do.” The goal is to offer quality care and services that set community standards exceeds patients’ expectations and are provided in a caring, convenient, cost-effective and accessible manner. The first proposed resolution is to set the minimum nurse/patient ration. This move will ensure that the department has enough staff to handle the patients. The quality of the care, as well as the level of satisfaction of the patients heavily, relies on the staffs’ input with the right number of nurses to handle the patients. Waiting time will be reduced, medical errors due to fatigue will be minimized, and this will subsequently lead to an increase in the patients’ satisfaction as well as the quality of the care. Setting quality standards will also ensure that all employees have a culture of quality as part of the organization and to always work towards meeting this goal. This will support the organizations’ mission of providing quality services to the patients in a way that exceeds the expectations.
References
Pilcher, T., & Odell, M. (2013). Position statement on nurse-patient ratios in critical care. Nursing Standard (through 2013) , 15 (12), 38.
Meyer, R. M., & O’Brien ‐ Pallas, L. L. (2010). Nursing services delivery theory: an open system approach. Journal of Advanced Nursing , 66 (12), 2828-2838.
Backhaus, R., Verbeek, H., van Rossum, E., Capezuti, E., & Hamers, J. P. (2014). Nurse staffing impact on quality of care in nursing homes: a systematic review of longitudinal studies. Journal of the American Medical Directors Association , 15 (6), 383-393.
Shang, J., Stone, P., & Larson, E. (2015). Studies on nurse staffing and health care–associated infection: methodologic challenges and potential solutions. American journal of infection control , 43 (6), 581-588.
