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Rocket clouds

1. What are people doing that indicate they need to change?

1.1. Not unusual to see patients lying alone on stretchers

1.2. Patient care technicians and nurses gather in nursing stations while patient call lights go unanswered, and soiled linens dropped on the floor.

1.3. Families can be seen caring for family members because there is no one else who seems to care.

1.4. Many medications are misplaced on the shelves, there is a backlog of prescriptions to fill, and there is no system for managing unit dosing for patient safety

1.5. Outdated sterile equipment and often inadequate supplies when requested by the units.

1.6. The dietary department provides adequate meals for patients but is known to confuse patient diets.

1.7. The laboratory lacks adequate qualified staff to manage the required laboratory tests. Inspection of the blood bank shows that normal blood banking procedures are lacking, refrigeration is inadequate, and labeling is inadequate. Equipment is outdated.

1.8. Spilled blood and other bodily fluids are observed on lab tables. Samples are lying about the lab, some labeled and some without.

1.9. Sentinel events occur often.

1.10. Poor systems of insurance billing and coding.

2. What are people doing that suggest they might have an innovative attitude?

2.1. No actions were displayed in the case study that suggest that anyone has new and innovative ideas. In my opinion, Mercy needs to be completely restructured starting with the highest positions and then work on retraining and restructuring a complete new team. They need a complete system overhaul.

3. When we speak of a “hostile environment” what does that mean and how is Mercy an example?

3.1. Staff morale, which is at an all time low, does not seem to be a concern to the department. Staff benefits have not changed in the last 15 years, with few, if any, raises, no increases in healthcare benefits, and limited contributions to retirement accounts.

3.2. Nursing Director has also been with the hospital for over 25 years and demonstrates little leadership skills, and has made no attempt to improve nursing conditions or professional development for almost as long. She has an authoritarian management style and tends to manage from a position of fear.

3.3. The nurses who have stayed have become complacent and “just put in their time.”

3.4. Salaries have not been raised in years and while staff is often required to work overtime, no additional pay beyond the usual salary is provided.

3.5. , the Nursing Director appears a fixture at Mercy andrules with an iron fist. This leaves no room for nursing staff involvement in governance or any incentive to engage in evidence based practice

4. What does the work space look like?

4.1. Old Building- Established in 1895

4.2. 143 bed hospital in a small community

4.3. located on a small hill in the center of the town surrounded by upper and upper-middle class homes on the hill and low-income neighborhoods at the base of the hill and surrounding a main street of shops, restaurants, and services

4.4. dingy green halls are lined with long windows overlooking the lawns

4.5. Few changes have occurred to renovate the hospital in the last twenty years

4.6. patient rooms hold four patients each.

4.7. small pediatric unit and small maternity unit, both appear to be stuck in the 1950’s.

4.8. no security devices

5. What attitudes are currently displayed? Is there a team spirit?

5.1. The patient care technicians appear to resent the position of the RN and do little to work as a team.

5.2. When the nurses do not agree with doctors’ orders, they do not question them but rather simply refuse to carry the orders out.

5.3. There is very little teamwork displayed.

5.4. , the Nursing Director appears a fixture at Mercy andrules with an iron fist. This leaves no room for nursing staff involvement in governance or any incentive to engage in evidence based practice

6. What has leadership done that would contribute to the current corporate culture?

6.1. Since coming to Mercy, the Chief of Medicine has been met with continual barriers from staff, the board of directors, and even patients. Services are limited and outdated, patient safety and quality is poor, staff is ineffective, and morale is at an all time low. He is faced with patient care technicians playing cards while patients gouncared for, supplies that are often in short supply because of theft, and systems that do not exist in any part of the hospital.

6.2. Leadership has not done much at all to change the culture - seems overwhelmed.

6.3. No new service lines have been added in recent years. Technology based services such as CTs, specialized sonography, and technology based diagnostics and surgery are not available