Healthcare Quality Strategy for Scotland

Scotland is a small country comprising of 5.2 million inhabitants, with 22.6% of its population aged 60 or above. Scotland has been distinguished among prosperous western societies for its poor health, with statistics on average more analogous to eastern European countries than with those of Western Europe. Additionally, Scotland has been differentiated within the UK for having a higher degree of mortality than can be justified by its proportion of deprivation. The reasons why Scotland’s health is significantly poorer than other countries is yet to be discovered, however correlations have been made with environmental, financial, behavioural and cultural indicators of population health risks which exist in Scotland (Gordon, Fischer and Stockton 2010).

The health care quality strategy has been inaugurated to improve health and well-being for the Scottish people and it provides a framework to guide the NHS professionals who supply healthcare services to the Scottish people to work with the public toward a collective ambition. The NHS has been critisised as a health care system that is multifarious and fragmented—one in need of enhancement (Finkelman and Kenner 2007).

Incidentally, the challenges that face the future of nursing will also have substantial repercussions for the delivery of sustainable high quality healthcare; this is compounded by the aging demographic often with numerous and long term illnesses, as well as the presence of health inequalities and mounting expectation all in the context of diminishing monetary funds, dictate that we must construct a strategy that focuses on individual patients rather than the collective and combine our efforts to address these challenges and turn them into opportunities (NHS Scotland 2011).

The Quality Strategy endeavours to supply the highest quality healthcare to the Scottish people which will ensure that they highly regard NHS Scotland and consider it to be amongst the finest in the world. The needs and wants prioritised by the Scottish people are the core around which the strategy has been built. The Quality Strategy aspires to steer Scotland toward the provision of world-class health care based on millions of individual care experiences which will are (continually) person centred, clinically effectual and safe.

This essay attempts to explain the multidimensional role played by the individual nurse in ensuring that these goals are accomplished (The Scottish Government 2010). The nurse will encounter complex difficulties and dilemmas in delivering this high quality care in the current economic climate; for this reason it is essential to be responsive and enthusiastic about learning new ways of achieving these goals so that the people of Scotland, NHS employees and the health system can thrive.

Scotland has the potential to develop into a world leader in health-care provision due to millions of individual care experiences that are person-centred, clinically effectual and safe. This has been achieved through collaboration between patients, their families and those delivering healthcare services which honour individual requirements and beliefs and which demonstrate benevolence, empathy, continuity, clear communication and shared decision-making (The Scottish Government 2010).

Shared decision making can be perceived as an occasion for patients to benefit from professional competence by discussing difficulties in the self-management of their condition. If this opportunity is squandered, it may hinder patient’s ability to self-manage their care and negatively influence their prognosis (Zoffmann, Harder and Kirkevold 2008). To this end, the “one-size fits all” approach adopted by the NHS since the post war years has survived for too long (Department of Health 2001).

Enriching the health of Scotland and transforming how healthcare is administered relies upon effectual leadership at all levels of NHS Scotland. Cultivating the leaders of today and tomorrow will be indispensable to the execution of the impressive objectives delineated for the health service (NHS Scotland 2004). Leadership in nursing involves an amalgamation of clinical, academic, executive and political facets. Hence, there is the contingency for nurses to be leaders at the bedside, in universities, in the boardroom and in a political capacity (Gallagher and Tschudin 2010).

The clinical nurse leader position is an emergent dynamism as health care endeavours to cope with the challenges of today’s intricacy and result orientation. (Gerard, Grossman and Godfrey). Nursing leadership is critical for effective practice as nurses emblematise the greatest discipline in health care (Sullivan and Garland 2010). Additionally, leadership in nursing has been established as a cost-effectual approach to enhance patient outcomes in times of constrained monetary reserves, when leaders can administer direction, impel change and embolden others (Murphy 2009).

In order for the health service to achieve the delivery of high quality, safe, effective care; successful leadership will be required at multidisciplinary level throughout the organisation (Health Service Executive 2009). Research on leadership has revealed an optimistic affiliation with improved patient safety results, salubrious work environment (Shirley 2009), job fulfilment (Sellgren et al. 2007), reduced staff resignation rate, professional accountability and clinical excellence (Murphy 2009) and auspicious outcomes for associations, patients and healthcare providers (Wong and Cummings 2007).

In terms of clinical governance, this role expansion brings with it more responsibility and accountability for nurses. While it can be contended that there are currently numerous challenges facing nurse leaders for instance new roles, pecuniary limitations, pronounced emphasis on partaking, ethnic multiplicity and education; it ought to be acknowledged that leadership should not be considered a discretionary role or task for nurses (Sullivan and Garland 2010).

Leadership can be defined as a process by which an individual can induce/compel others to accomplish a shared objective (Northouse 2007). Leadership is a process which is comparable to management in countless ways, however, management necessitates introducing order and consistency whereas leadership is pertaining to establishing flexible and productive change (Daniels, Grendell and Wilkins 2009). Leadership in nursing is dependent upon the nurse to be an enforcer (perpetrator) of change.

The insufficient amount of nurses globally and the emphasis on evolving quality practice in the health care environment has elevated the need for nursing leadership to develop an agenda of change in healthcare associations. The necessity to transform the nursing profession to a leadership profession involves a reconstitution of nursing practice by i ntroducing new models of care, transport, health and well-being to a shattered and over extended workforce (Cummings et al. 2010).

Transformational leadership is predominantly concerned with harnessing human values. It is the idiosyncratic values of these transformational leaders that inspire ambition, perspicacity of situations or tribulations and establish responses. Thyer (2003) intimated that nurse’s behaviour is transformational in nature, primarily in their roles as instruments of change, creative thinkers and acting as a voice for their patients and profession. The attributes of Clinical leadership necessary for the contemporary nurse to fulfil this new role are: clinical expertise, effectual communication, collaboration, coordination and relational intelligence.

Effective leaders will also need the innovation to devise resolutions to problems and have the impartiality to appraise them and ensure they are suitable for the NHS (Howard 2010). Clinical leadership in nursing entails impelling and rousing others to supply clinically effectual care by demonstrating clinical excellence, and offering support, and direction to co-workers through mentorship, management and encouragement (Health Service Executive 2009). Nevertheless, the adoption of a leadership role unaided may not be adequate to ensure efficacy. The leader must be well-informed regarding leadership and be capable of harnessing leadership skills in all aspects of the nursing role.

Heller et al (2004) argue that by and large nurses are insufficiently equipped for the role of leader in the course of their nursing educating programmes. The disparity between sufficient educational training and the demands of the clinical setting can give rise to unproductive leadership in nursing (Curtis, de Vries and Sheerin 2011). Traditional approaches to education and learning may now represent a hindrance to the progression of various objectives by Health Care Organizations including the promotion of the nurse in a leadership role. (Pacini 2005).

There seems to be incongruity between how prominent undergraduate nursing courses train students principally during the shift from education to practice and the suggestion from numerous journals that leadership in nursing is nurtured all through their schooling (Curtis, de Vries, and Sheerin 2011; Bellack et al 2001; Kleinman 2003). Thus, it may be felicitous for leadership to be taught continually at undergraduate level, as such an approach could equip nurses to envision practice as part of leadership, in replacement for the present state of affairs through which leadership is being presented as part of practice (Curtis, de Vries and Sheerin 2011).

Nursing is changing as expeditiously as the circumstances in which it is practiced. Across the NHS nurses are engaging in new leadership roles, by working across boundaries and initiating new services to meet patient requests (NHS Scotland 2011). The government has been dedicated to the empowerment of nurses, perceiving them as a means of spearheading cultural change in the NHS.

This can be seen in various policy proposals which have presented nurses with the chance to boost their professional status via the introduction of improved skill mix and task shifting which challenges the ascendancy of the medical profession (Doherty 2009). Nurses’ careers have changed extensively and as part of the frontline workforce they have an essential role to play in advancing the new NHS. Compared to other NHS employees, nurses are often the group that are closest to patients and thus are central to attaining a patient-centred NHS. The NHS Plan and the Government’s proposal for Nursing entitled Making a Difference 2, accentuated the necessity to phase in new roles and new ways of working for nurses to help enhance services and increase the quality of patient treatment and care.

Nurses are being empowered to assume a more extensive range of clinical tasks including the right to admit and discharge patients, to make and receive referrals, order investigations and diagnostic examinations, operate clinics and prescribe medications (Department of Health 2002). Nurses are adopting a central role in case management and directing education and support schemes through which patients are playing a pro-active role in controlling their illness and consequentially are experiencing healthier lives (Beasley 2005).

Effectual communication is exhibited by having the capacity to enunciate and elucidate information and to motivate and galvanise others (Patrick et al 2011). Nurses habitually act as the leading communication source in health care teams, efficaciously conveying assessment information, and their apprehensions to general practitioners and other health care professionals. Furthermore, the nurse elucidates information for patients and their families to encourage understanding of their ailment and to support decision making. Nurses are also expected to make countless ethical decisions on a regular basis in relation to patient management and care (Linton and Farrell 2009).

This involves nurses having to collaborate with other health care professionals and coordinate the resources of the multidisciplinary team in order to provide timely care. Nurses synchronise health care team procedures, operate as a conduit of information between team members and act as the intercessor between healthcare professionals and patients (Miller & Apker). Interpersonal understanding is displayed by nurses’ self-awareness, observation of others in the health-care setting and ability to empathise with patients (Cook and Leathard 2004).

The current issues affecting healthcare are also considerably transforming the landscape of nursing practice. Nursing care traditionally emphasised reductive thinking, functionalism, one-sided decision-making and a task orientated approach which no longer meets the demands of nursing practice today.

However, this approach has become so entwined in the dynamics of the nursing profession that they have obstructed the inauguration of new nursing practices in the 21st century (O’Grady, Clark and Wiggins 2010). In particular, traditional ways of educating in relation to aims, content and techniques may obstruct the organisational progress. The necessity for change dictates the focus on industrial, linear cogitation towards must shift to integration, results, receptiveness, holism, contingency thinking, flexibility and anticipatory openness to opportunities. (Pacini 2005).

Regardless of these proposed changes, the fundamental role of nurses will remain unchanged, namely, to continue to care for patients who are powerless to care for themselves, endeavouring to support and empower patients with long term conditions to care for themselves, and assisting patients to promote their own health. Nurses’ roles and responsibilities will continuously change in ways that are consistent with the health reforms that are enhancing care for patients. The nursing staff will need to coordinate care around the needs of patients, to ensure that patients have a satisfactory experience of the nursing workforce as reputations of organisations and patient choice will depend on the quality of nursing care received.

This will require nurses to participate in telemedicine, have the ability to practice preventative and health promotion intercessions, have highly developed skills to meet demand, work as leaders and participants of multidisciplinary teams both internally and externally to the hospital setting, and across health and social care teams, work with new forms of physicians such as assistant practitioners and anaesthesia practitioners to supply healthcare which is highly productive and economical.

By assuming new and improved roles and responsibilities, nursing has been influential in carrying out the improvements in patient care of late. Nurses have already played a central role in decreasing waiting times, creating more accessible services and enriching the quality of care (Department of Health 2006). However, some nursing staff encounter difficulties advancing within these new roles due to role uncertainty, paucity of role clarity and constrained support from other health care workers (Bonsall and Cheater 2008).

The need for efficacy and cost efficiency has been a significant influence on alterations to the nursing skill mix adopted by organisations in developed countries. Arguably such skill mix alterations have intensified the already broad and unsure jurisdiction inherent in the nursing profession (Doherty 2009). It is not obligatory for a nurse to be required by an employer to assume new roles or tasks if they do not deem themselves to be competent to do so without contravening the Code of Professional Conduct and being open to an allegation of professional misconduct.

It is imperative that nurses who embrace new roles are conscious of the legal boundaries associated with the role, and that they have adequate training and preparation to make sure that they can execute the role to the required standard. The Code of Professional Conduct also elucidates that the nurse is personally accountable for their actions, as well as being accountable to their employer. Professional accountability cannot be delegated or deferred by the nurse or their employer (Department of Health 2006).

Person-centred care has an extensive alliance with nursing. It focuses on caring for patients as individuals; valuing their rights as a person; creating reciprocated trust and understanding, and establishing relationships which are therapeutic (McCormack and McCance 2010). To accomplish person-centred care nurses ought to treat every patient as an individual irrespective of age, faith, creed, sex or sexual preference (Galloway 2011). A holistic patient assessment is central to ascertaining patient’s requirements, which might need explicit intervention in order to maintain dignity and deliver person-centred care (Parse 2004).

The government embarked on a ‘Dignity in Care’ campaign in 2006 with the purpose of eradicating any remaining indignities in the healthcare services by generating awareness and motivating people to take action (Department of Health 2006). Furthermore, other national campaigns and best practice guides have been launched which emphasize the essentiality of dignity, privacy and respect (Galloway 2011). Nurses should work with others to safeguard and endorse the health and wellbeing of those under their care, their patient’s families and carers and the broader community and uphold the reputation of their vocation (NMC 2008).

Nurses play a crucial role in the protection of susceptible patients, along with the prevention and detection of abuse. The nurse ought to be open and honest, while engaging with and including the individual at every phase of the patient trajectory (Galloway 2011). The nurse must ensure that the individual patient is well informed to enable them to give valid consent for care and treatment. The nurse must treat patients’ personal information confidentially and use judiciousness in the distribution of this information (The International Council of Nurses 2000). Additionally, the nurse should perform the role of advocacy for patients in their care, assisting them to access pertinent health and social care, information and support (NMC 2008).

On the topic of patient centred care it is imperitive that the nurse considers the rights of the patient, taking into consideration the Patients Rights Bill (2011); this bill encompasses many factors relating to the patient including consideration of the patients needs; what would be the most beneficial course of action taking into consideration individual preferences and circumstances of the patient.

The Bill also encourages the involvement of patients in decisions regarding their own care, it also encourages patient feedback and complaints about the care they received where necessary, thus creating transparency and a culture of learning from mistakes and acting on feed back. Thus the competent nurse should be aware of this bill and implement its content (The Scottish Parliament 2011).

Over time societal norms change and nurses need to be aware of generational influences and culture to assist them in delivering care which is tailored to the individual patient’s needs. Cultural competence describes a personal capacity to treat every person with respect, dignity and justice, in a fashion that is equally receptive to dissimilarities and resemblances, and thus helps to construct an inclusive culture. To realise this policy the nurse must be able to scrutinize their personal code of ethics, viewpoints and cultural identity, and recognise prejudice and racial discrimination.

Accordingly, nurses should not be influenced by a patients’ social background and should ensure that stereotypes of a patient’s family or social affiliations are avoided (Galloway 2011). Also, nurses need to be able to acknowledge and improve their roles, skills and tasks and complete cultural assessments and plans; implement and evaluate those plans. This enables the nurse to deliver culturally sensitive care whilst confronting bigotry and inequality. In delivering care which is person-centred it is imperative to attend to the person’s other needs which may include religious, spiritual, physical and psychological.

There is agreement that person-centred care is synonymous with quality care (Innes et al 2006; RCN 2009). It’s essential that the nurse builds a rapport with the patient ensuring that communication methods respect the essence of the person and defend their safety in a manner that preserves person-centred values and continuity of care. By getting to know the patient as a person the nurse can plan their care around patient’s preference, values, beliefs, expectations and holistic health care needs.

To attain person-centred care the nurse will continually require particular knowledge, expertise, methods of working, and an effectual culture in the place of work, organisational support and a communal philosophy that is carried out by the nursing team. Continuous assessments should be undertaken by the nurse to determine whether care and services are still suitable for each person. This encompasses being reassuring, an active listener and acting on feedback from patients. (Manley et al 2011).

It is essential that the nurse imparts knowledge to the patient to allow them to make an informed decision supported by the nurse and other members of the multidisciplinary team thus promoting the patient’s self-sufficiency and independent lifestyle. By equipping the patient with information that is tailored to the individual the nurse will have prepared them to make the best decision based on the most credible evidence available (Manley et al 2011). It is advisable that healthcare professionals encourage the patient who is the possessor of the problem to partake in problem solving and decision making, instead of just expecting the patient to conform to decisions made by the nurse.

Shared decision making might however, frequently be no more than a pretence, as major discrepancies’ have been identified in the clinical practice between the intent to involve patients in their healthcare plan and their actual involvement (Gold, Abelson, and Charles 2005; Hernandez 1995; Paterson 2001). However, we know from widespread research that increased employee engagement with patients is strongly linked to improved organisational performance. We also now recognise that staff experience and wellbeing is reflected in patient experience and patient results.

Nursing as a career tends to span many decades, thus, the process of lifelong learning is imperative to enable the nurse to maintain competence; the importance of this skill is ever present for the nurse as they try to implement the Healthcare Quality Strategy for Scotland; as the nurse has to learn new skills, knowledge and change their working practices in order for the priorities to be met. (The Scottish Government 2012).

The Healthcare Quality Strategy of Scotland emboldens the implementation of Releasing Time to Care (RTC); a government strategy being enforced to enable nurses to spend more time directly caring for patients, firstly, they analyze their everyday activities and identify ways in which they can be more productive and effective, then alter their environments and working practices to free up time to provide direct care to patients.

Furthermore, in releasing time to care there is a major emphasis on ensuring that the nurses and other healthcare professionals working within the NHS Scotland have the ability and capacity to deliver health care to patients that is of high quality and aspires to achieve the six dimensions of quality; that care is effectual, person-centred, timely, efficient, equitable and safe (National Health Service Scotland 2008).

In light of the foregoing, it is imperative to balance our determination for quality, productivity and effectiveness, with support and development for the workforce to feel involved, appreciated and empowered in leading and propelling quality in their communities, services, wards and departments (The Scottish Government 2010). Already, considerable advancement has been made in improving the support system for those living with long term illnesses, by empowering them to self-care, and lessen the possibility of unscheduled hospital admissions.

The NHS has acknowledged the essential role of carers by introducing a new carers’ strategy to assist them in the work they do and include them in the planning process. The quality strategy has already made significant progress towards our Quality Ambition for person-centred healthcare through the launch of certain initiatives which are being commenced across NHS Scotland for patients, carers, staff and the public’s benefit.

Key areas of development incorporate the Living and Dying Well: A nationwide action strategy for palliative and end of life care in Scotland which is decidedly enhancing care for patients at the end of life coupled with revolutionary legislation to establish patient rights and the initiation of new services within Community Pharmacies to enhance services for patients (The Scottish Government 2010).

Better Health, Better Care is a scheme intended to create a corporate NHS in Scotland where the workforce, carers and patients have a comprehensive level of knowledge about their rights and responsibilities, and the kind of care they should expect from their NHS (The Scottish Government 2010). The nurse’s primary professional responsibility is to people requiring nursing care. When delivering care, the nurse ought to promote a setting wherein the human rights, values, customs and spiritual viewpoints of the individual, family and community are appreciated (The International Council of Nurses 2000).

In conclusion, the crucial role that the nurse can play in achieving the priorities set out in the Healthcare Quality Strategy for Scotland has been established. Through a combination of effectual leadership, clear communication, patient education, lifelong learning and delivery of equitable, person–centred, high quality care, these priorities will continue to be achieved for the people of Scotland.

Reference list:
Beasley, C. 2005. Changing times. Nursing Management. 11(10) pp. 12-14. Bellack, J.P. et al. 2001. Developing BSN leaders for the future: the fuld leader initiative for nursing education. Journal of Professional Nursing. 17(1):PP. 23-32. Bonsall, K. and Cheater, F.M. 2008. What is the impact of advanced primary care nursing roles on patients, nurses and their colleagues? A literature review. International Journal of Nursing Studies.45:pp. 1090-1102. Cook M.J. and Leathard, H.L. 2004. Learning for clinical leadership. Journal of Nursing Management. 12:pp. 436-444. Cummings, G. et al. 2010. Leadership styles and outcome patterns for the nursing workforce and work environment. International Journal of Nursing Studies. 47:pp. 363-385. Curtis, E.A., De vries, J. and Sheerin, F.K. 2011. Developing leadership in nursing: exploring core factors. British Journal of Nursing. 20(5):pp. 306-309. Daniels, R., Grendell, R.M. and Wilkins, F.R. 2009. Nursing Fundamentals: Caring & Clinical Decision Making. 2nd ed. USA. Thomson Learning. Department of Health. 2001. National Service Framework for older people. [online]. Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4071283.pdf [Accessed 07 January 13]. Department of Health. 2002. Developing key roles for nurses and midwives a guide for managers. [online]. Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4101739.pdf [Accessed 04 January 2013]. Department of