¶ … Manage identification planning This chapter discusses the management and planning of change process within the clinical setting. Change management plan is very critical to the success of any healthcare unit. Change may be threatening to organizations, however, successful implementation of changes is very crucial for the success of an health organization. Failing to make a change move could lead to the consistence of medical errors among the medical staff and this may damage the reputation of the organization. Typically, medical errors are among the serious issues that many medical institutions are facing, and these are among the setbacks to the implementation of quality healthcare delivery. (Mills, 2008). Identification of the critical issues that may hamper the quality healthcare delivery is very important to address the number of preventable medical errors. With analysis of the current system, several areas need to be changed before the hospital could become a vibrant organization.

Area that Needs Changing

Based on the analysis of the current system, there are areas that need changing within the hospital. First, there is need to make changes to induce learning within the system. Typically, the current system in the Hospital does facilitate effective learning among the member of the staff. There is lack of learning culture across the whole hospital. To meet the challenges posed by the rapid changes in the environment, an organization must implement effective learning culture to induce growth. Learning organization is an organization that must create and assimilate new knowledge to improve organizational development. (Singh, 2010).

Moreover, analysis of the current system within the hospital reveals that there is no standard approach to investigate serious incident. To cultivate an environment that promotes health and minimize risks, a hospital needs to promote the safety of well-being. To facilitate changes within the hospital setting, the Hospital needs to inculcate incident management. Typically, incident management is a part robust risk management that promotes quality and safety of patients. (NHS Foundation Trust.2011). Moreover, changes is also essential induce collaboration of other units to handle medical errors. Analysis of the current situation reveals that there is non-collaboration of the other units to handle medical errors. Increase in the occurrence of medical errors could jeopardize the integrity of the hospital, and this may reduce patients' patronage. To minimize the medical errors within the hospital, a health organization needs to formulate policy and procedures to prevent medical errors. Development of policy and procedure to involve multiple units within the hospital is essential to prevent medical errors. Thus, the hospital should collaborate with other units to prevent the medical errors. (American Society of Health-System Pharmacists 2011).

Further change that the hospital needs to implement is its method of record keeping. Currently, the hospital is still using the manual method recording. The use of free handwritten is still in use. The problem of using this method is that the handwritten and free text report was difficult to read and interpret. Moreover, there is lack of key data elements to aid the decision-making. In a modern healthcare environment, Electronic Heath Record systems are the foundation of high quality healthcare delivery. (National Health Service, 2011). To enhance quality healthcare delivery, the hospital should be ready to implement Electronic record systems to achieve effective data storage and retrieval. The hospital also needs to implement changes to develop staff knowledge. Analysis of the current system, there is no concrete program to develop staff knowledge. Kingston, Evans, Smith et al., (2004) argues that lack of knowledge constitutes incidents that lead to many medical errors. Ongoing education about what constitutes incidents is essential to enhance the knowledge of medical staff on the incident report.

The culture of blame is also rampant in the hospital. Culture of blame, if not prevented, it can create a setback to the growth of a clinical setting. Harber and Ball (2003) points out that a new era has come where a medical institution needs to move beyond the era of "blame game" to the culture of best practice to deliver high quality healthcare. The dissertation also identifies that there is no structured system to monitor quality. Prevention of future errors is also lacking, and this issue has led the healthcare staff to keep repeating the same errors. (University of South Wales, 2006). To improve the well-being of the patients, a medical institution should adopt a policy to prevent medical errors. Between 44,000 and 98,000 American dies yearly due to preventable medical errors. The occurrence of medical errors is also linked with lack of structured monitoring of quality within the hospital. (Vantage Professional Education, 2009) . The cumulative problems identified in the clinical environment are leading to the poor quality healthcare delivery. To accelerate the quality of healthcare delivery within the hospital, there...

The strategies to use in implementing changes should be both discontinuous and incremental in nature. Discontinuous changes are evolutionary or radical changes to enhance the quality of service. The incremental changes focus on the strategy to induce changes bit-by-bit to meet the changing environment. (Abrahamson, 2004). To enhance changes within the clinical settings, the hospital management should draw a vision that would become its guiding principle. The vision should focus on the improvement of health and well-being of adults and children. Moreover, the hospital should draw the mission to guide its operation. The mission is to deliver the quality health services to adult and children especially those requiring the specialist treatment. The vision and mission will be the guiding principles of the hospital. Meeting these objectives will require the integration of learning culture within the clinical environment. The strategy to meet this objective requires radical changes to inculcate learning culture within the organization. Typically, the success of any health institutions is its ability to create new knowledge. Since employees are considered critical assets of any organization, ability to create new knowledge for the workforce is very critical to enhance high performance within the hospital. (Gorman, and Panadit, 2007). The strategy to implement these changes is to introduce an education orientation to develop knowledge of the staff. (Kemp, Moerman, and Prieto, 2001). An education orientation is a powerful tool to educate medical staff about the hospital policies and procedures. Education orientation process is also used to evaluate the individual ability to perform a specific job.
To implement this change, the hospital should draw the policies and procedure that would guide the conduct of all staff with the organization. The education at orientation should also include topics such as:

Vision, mission and values guiding the hospital

Performance improvement program to enhance staff efficiencies.

Issues about environment of care

Patients safety and procedures

Description of key functions in the hospital

Job safety issues.

Education of use of specific health equipments.

Staff benefits.(Joint Commission on Accreditation of Healthcare Organizations, 2002).

"This strategy provides innovative learning and development approaches which enhances the accessibility and value of learning experiences. It is a rich mix of 'visionary' and 'stretch' objectives as well as many practical operational elements." (Darbey, Gregory, Dempsey, et al. 2009 P. 3).

As part of the program to initiate changes in the hospital, there is need to implement workforce learning and Development to strengthening the hospital's position as an excellent healthcare delivery. As part of learning and development program for the workforce, the hospital should support ongoing education with the use of case studies to highlight events related to medical issues.

Moule & Goodman (2008) argues that knowledge in the clinical setting could be drawn from multifaceted base. Learning could be derived from the experience gained in practice, and personal learning. Carper (1978) discusses four fundamental patterns of knowing: empirical, ethical, personal, and aesthetic. This can be used to acknowledge the importance of knowledge developed through personal, experience, understanding, and moral and ethical reasoning.

Carper's Fundamental Pattern of Knowing -- Empirical, Ethical Personal and Aesthetic

As being revealed in Fig 1, Carper's fundamental pattern of knowing is a useful tool to describe the importance of knowledge in the clinical practices. Ethics knowing in the clinical practice guides the conduct of nurses. Ethical knowing obliged the nursing practitioners to have the knowledge of ethical reasoning and social values. Ethical knowing is also to enhance greater understanding of health personnel on their obligation and responsibility. To inculcate the Carper's theory to enhance knowledge in the clinical setting, the hospital should impact the knowledge of the ethical codes and professional standard in the clinical settings.The strategic to induce changes will also be to inculcate the philosophy of Carper's personal knowing that involves the development of self-awareness through interpersonal relationship of medical staff. The openness, listening and reflection should be encouraged. Typically, personal knowing needs to be integrated with professional responsibilities to develop therapeutic use of staff and patients relationship.

The hospital should also impact the knowledge of aesthetic knowing to all medical staff. All staff should have greater understanding on the behavior of individual patient. This includes the ability to develop intuition and be able to respond to patients' needs with…