The aim of this assignment is to demonstrate my ability to select an aspect of nursing of care management, identify relevant organisational factors. Critically analyse relevant literature, research and practice experience. Appraise organisational and managerial factors influencing the safe and effective delivery of quality care and evaluate the organisation and management of an aspect of nursing care.

Discharge planning can be defined as the assessment of inpatients medical conditions for the purpose of arranging appropriate care upon leaving the facility, within this planning it includes how long the patient will be in the hospital, the expected outcomes and whether there are special needs or requirements on discharge Watts and Garner, (2005). According to Goodman, (2010) a recent audit has identified that 16% of patients did not feel involved in their discharge arrangements.

Rose and Haugen, (2010) identify a recent audit at a tertiary hospital showed that percentages of patients whose discharge needs were assessed within 24 hours varied between 100-50%. The Royal College of Nursing, (2010) state poor discharge planning is considered harmful to patients health as it could lead to the increase in readmissions to hospital due to patients not being able to manage, or not having relevant support put into place prior to discharge.

Although it has been identified effective discharge planning is important according to Fader and Phillips, (2012) nursing staff are still not carrying out discharge planning effectively leading to delayed discharges, increased length of stays, and readmissions. This factor however is often beyond a nurse control and can be related to the organisation factors and managerial factors within a workplace. Organizational factors are boundaries, which effect the establishment of care and cannot be changed, such as the environment of the ward, budgets and resources, local and government policies and staff skills mix.

These factors often impact the ability of the nurse to carry out the discharge process effectively. Levels of staff and skills mix can an impact on the management of discharge planning. Forrester (2009) identifies that staffing issues are a regular concern within healthcare, which can lead to care being given ineffectively, due to lack of staff or lack of skills mix. However Drucker, (1999) states that delegation of care is important in staff and task management, and with appropriate delegation care should be unaffected.

McNichol and Hamer, (2006) identified that the availability of resources can be a potential barrier in implementing high standards of care. According to Fyfle, Mccubbery and Reid, (2008) organisational factors have a major impact on the ability to facilitate effective discharges, however emphasis on improvement towards organisational aspects can lead to effectiveness of care and patient satisfaction. The practice area I will be discussing is a stroke unit, therefore a long stay ward where the discharges will be complex to meet the needs of the patient.

There are a number of ways in which discharge planning can be managed, often depending on the area and type of discharges taking place, the main two being Nurse-initiated, or that with use of a discharge coordinator. The approach I have selected for my practice area will be nurse initiated rather than having a discharge co-ordinator. However if the ward gets to the stage where they will have a lot of discharges a nurse will be delegated the discharge planning as an allocated role for that shift.

Huang and Liang, (2005) identify that as nurses are the direct caregivers with the most consistence presence and knowledge of patients, this will enable them to play a critical role in preparing the patient and their families for the transition from hospital to home. Cesta, (2011) identifies that individual nurses recognise that planning for patients discharge throughout the inpatient stay sets the stage for successful self-care management when patient’s return home.

Whereas employing a discharge co-ordinator to pragmatically get the job done according to Chandler, Wyatt and Roberts, (2010) can risk deskilling the nursing ward staff in relation to discharge planning, due to staff solely relying of the discharge co-ordinator to manage the discharges. According to Lee, (2010) a discharge co-ordinator can be a disadvantage to the ward as it is an isolated role that can be detrimental to patient care, especially at times of annual leave or sickness when no one else on the team possesses the knowledge and skills to effectively discharge patients, causing a potential halt to discharge within that area.

Therefore due to discharge planning been a fundamental part of nursing the approach chosen will provide a continuity of care to patients, with all nurses able to carry out the discharge process, clearly aware of patient needs and able to work with the patients to provide and safe and effective discharge.

Perez, (2012) supports this stating, having nurse initiated discharge process ensures patients’ needs are effective met prior to discharge, with nurses assessing patients daily on how they can manage with the ability to implement the right support and help for patients when need identified, with a clear up to date knowledge of what they can and can’t do. However to ensure this approach is effective the appropriate managerial and leadership factors need to be present to ensure an effective discharge process is achieved. Managerial factors act as a vital role within the discharge process, which interlinks with the leadership style adopted.

According to Rainmond, (1991) a manager needs to guide staff to achieve goals, which motivates and empowers individuals. Stordeur, Vandenberghe and D’hoore, (2000) identifies to be an effective manager you need to be aware of leadership styles, identifying there are three main leadership styles: authoritarian, democratic and liassez –faire. According to Hill (2003) Leadership skills are very important due to them been necessary for team building at the organisational level, ensuring successful recruitment, retaining consistent nursing staff and maintaining a high quality practice depends on successful team building.

The leadership style which I feel will best manage discharge planning is democratic, which according to Marquis and Huston (2006) is characterised by moderate control and motivation, using economic and ego awards direction via suggestions and guidance, with interactive communication, group decision making and constructive criticism. Therefore as nursing involves working with people and as part of a team, this type of leadership style will be effective when co-operation and coordination between groups is necessary.

Whereas the authoritarian approach identified by Snow, (2003) is characterized by the manager having strong control over the group, applying coercion, commands, downward communication, single decision making, emphasising on status and punitive criticism. Therefore this leadership style would not be effective in managing discharge planning as Dinham, (2007) identifies that authoritative leadership involves the failure to recognise whereas the democratic leader according to Daniels, (2004) promotes empowerment of team members, facilitating communication, increased creativity and autonomy.

Whereas the Laissez-faire leadership style is characterised by minimal control, motivation occurring rarely and only when requested by a group. There is little direction or interactive communication with dispersed decision-making leading to a lack of criticism, Barr and Bowding (2008). According to Zhang, Ilies and Arvey, (2009) the laissez-faire leadership style has a high risk of failure, which may lead to staff apathy and disinterest. Therefore the best leadership style the manage discharge planning is democratic, Sherring (2012) identifies this style encourages increased co-operation and teamwork, leading to active participation in tasks.

Overall due to democratic leadership style being based on the belief that every team member should have input into development of goals and problem solving, this will help lead to discharges being managed effectively. To ensure that discharges are carried out effectively auditing will be undertaken; these audits can then be used to assess the quality and effectiveness of the discharge process, and as a manager will enable me to make decisions about current practice and identify the need for further improvement.

Walshe and Smith, (2006) identifies that audits add to the managerial effectiveness to the values of prudence and procedural effectiveness of the discharge process. When carrying out the audits it is important everyone who becomes involved in the auditor needs an understanding of an audit in general, and the objective to be achieved from doing the audit.

According to Edwards, Kusel and Oxner, (2008) audits are quality assessment tools, which address quality issues systematically and explicitly, therefore providing reliable information, it can confirm the quality of clinical services and highlight the need for improvement. The National Institute for Innovation and Improvement (2008) discuss that audits are very beneficial, as they provide a fundamental principle to everyone who is involved within the nursing care. It’s beneficial to the nursing staff because it offers the opportunity to concentrate on areas of care where their skills and efforts can have positive outcomes, also identifying greater sense of achievement, autonomy and responsibility, providing the means for self-improvement.

However there are some limitations to auditing Holdaway, Kogan and Caines, (2000) argue that auditing can be very time consuming and the carrying out of audits can affect patient care due the use of the resources and time needed to carry out the task. Overall auditing is seen to be an effective tool to assess current practice against national standards, being able to identify where they is a need for improvement to providing effective and safe patient care, Black and Nossiter, (2011).

From doing these audits on the discharging process, colleagues will be made aware of the of the audit and aware of the results, which will be displayed on a notice board so that as a nursing team staff are aware of how well they are achieving. According to Evans, (2012) displaying results provides encouragement to staff as it lets them know of their achievements and areas, which need to be improved. All nursing staff on the ward will be educated and trained about the discharge process.

There is an on-going need for healthcare professionals to continually update their knowledge and skills to enhance clinical practice, which can be done through training and education, Gresty, Skirton and Evendon, (2007). To enable staff to carry out the discharge process effectively there will be appropriate training about the properties of the discharge process. This will be taught in a number of ways to ensure that individual’s different ways of learning are covered.

According to Well and Dellinger, (2011) understanding teaching and learning theories allows managers to structure training and use teaching techniques to change employee behaviour and improve competence which is the goal for all staff development. The department of health (2010) have identified ten steps to the discharge process, so to achieve effective discharge planning these will be implemented within then training.

Due to staff been trained on this process it will aim to promote effective care meeting the needs of the patient prior to discharge, having a positive impact, therefore preventing delayed discharges, Rooney and Packard (2011) An electronic learning (e-learning) package is going to be set up so staff can develop their knowledge on the discharge process, for example the types of discharges, the services which are available and ways these services can be accessed are just some examples.

There will also be patient scenarios to determine the implementations the nurse would put into place the plan the discharge process. The e-learning strategy will focus on improving staff awareness to supplement than replace other teaching methods. As Kowalzysyki, (2011) identifies that different education methods are effective in assisting individuals to learn, therefore staff knowledge levels and capabilities are major factors in determining the achievement of goals.

Davies and Handscombe, (2002) identify that e-learning can access to education and training, offering a flexible asynchronous mode of teaching and learning, which enables individuals to work at their chosen pace which is a good advantage due to shift patterns within the work place. According to Glen, (2005) most staff exhibit positive attitudes towards the pedagogical value of technology in teaching and learning, although Gill, (2007) identifies that some individuals remained hesitant or lacked confidence to embark on the e-learning development or delivery.

However Pawlyn (2012) identifies the overall impression of the use of e-learning is seen to be effective in facilitating individuals learning, therefore this will be effective in increasing knowledge on discharge planning. Staff will be made aware of the discharge documentation and the discharge checklist which is completed for every patient prior to discharge; this ensures that the multi-disciplinary team is made aware of the stage which the patient in at in the discharge process. This will be taught to the staff by group work or individually on effectively documenting and understanding the checklist.

According to Faber, (2011) group work is beneficial way of educating due to individuals having different knowledge and skills on a topic helps to aids peoples understanding on a topic. According to Grimmer, Dryden, Puntimetakul, Young and Moss, (2006) the use of a checklist allows effective guidance and helps to aid staff through a process. Therefore the use of the discharge checklist will enable staff to effectively and will be aware of components, which need to be addressed in the discharge process.

However there are barriers to educating staff due to the lack of time, lack of resources due to financial issues and sessions having to be cancelled due the shortages of staff or the workload on the ward which has to take priority Newton, Billett, Jolly and Ockerby, (2009), However having nurses undergo this training to manage and implement effective discharge planning according to Hutfield and Dixon, (2009) identifies that as a nursing professional it is essential that we keep and skills and knowledge up to date as they enable tasks to be carried out effectively and enables goals to be met within an organisation.

This training on discharge planning will be mandatory for all nurse involved in the discharge process and will need to be updated yearly, as according to Dimitropouilos and Doyle, (2009) a healthcare professionals we engage in lifelong learning which leads to having a positive effect on achieve goals and patient satisfaction. Communication is the process of creating, transmitting and interpreting ideas, facts, opinions and feelings Cole, (2004).

Effective communication ensures what we say and what we mean; it also enables individuals to set an expectation so they know what they want from a manager. Using a range of communication channels enables clear and consistency when discussing a topic Salmon and Young, (2011). According to Pettinger, (2007) good communication channels underline good relations and enhance general quality of the care provided where as bad or inadequate communication channels lead to frustration and enhance feelings of alienation and lack of unity.

According to Karuppan, (2010) effective management and leadership come from effective communication in ways, which influence the team to keep motivated to achieve goals and outcomes to provide patient centred care. To communicate effectively within the multidisciplinary team and to effectively manage the discharge there will be a ward notice boards on discharge planning and a folder where there is to be copies of any telephone numbers and members of the multidisciplinary team who may need to be contacted to facilitate the discharge process.

This will also include discharge polies, procedures and pathways which staff get refer back to implement the discharge process. Having this information staff will be able to effectively contact members of the multi-disciplinary team and will be aware of where this information is kept on the ward. Helton, (2009) identifies the use of notice boards are an effective way in allowing staff to independently assess information to carry out a task effectively. It has been identified by Weaver, (2012) that the most effective form of communication is face to face, as this allows for discussions and questions on a topic.

Therefore there will be regular meetings on how well staff are achieving within the discharge process, prior to these meeting an email will go out to the nursing staff for any concerns or changes they would like to make to the discharge process which would make it more effective or any concerns staff have about the discharge process. According to Beebe (2012) emailing is an effective communication channel as it enables and fast and rapid response to individuals. However according to Kelly, (2012) the use of emailing can often be misconstrued and individuals can use emails to address issues ineffectively.

Cleary and Freeman (2005) however proclaim emailing is an effective way of communication with a large group and people to get rapid feedback on a certain topic, for that reason emails will be used sensitively to get information from staff regarding the discharge planning process. Group discussions are an appropriate method of communication, according to costa, Rensburg and Rushton, (2007) as they allow active listening between a team and enables people to discuss and improve ideas on a topic effectively.

However according to Lake, (2001) due to groups members having strong personally not all individuals speak up and voice their opinions. Therefore by having the use of email as well should effectively allow communication on the discharge process. Communication channels among staff should always be used to promote safe and effective discharge planning, good communication and co-ordination within the multidisciplinary team allows effective discharge planning to be implemented.

Management of discharging in healthcare isn’t a simple process, which is affected by organisational and managerial factors. Approaches to discharge planning can determine the effectiveness of how discharge planning is managed. There are organisational factors, which cannot be changed, and you have to find ways around these to manage discharge planning effectively. By engaging within managerial factors such as education, communication channels and auditing help to implement and manage safe and effective care.

Recognition of the organisation, managerial and leadership styles has an effective implementation on the discharge process in achieving set goals and work well within the nursing team. For a long stay ward its effective to have nurse initiated discharge due to the relationship nurses develop with patients which allows the needs of the individuals to be met prior to been discharge. From doing this assignment I have become more familiar aspects which underpin the management of discharge planning.