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With the changing world of health care rules and reimbursement, reengineering of the system was bound to happen eventually. “Reengineering is defined as the process of fundamental rethinking and radical redesign of process to achieve dramatic improvements in critical, contemporary measures of performance, such as cost, quality, service, and speed. Reengineering is the design of a completely new process, whereas variations on reengineering can deliver enhancement or improvement in an existing process or a response to an external stressor” (Edens, 2005

The nurse managers and leaders in the organization have important role in this reengineering, they are responsible for staff compliance, any conflicts that may be caused, and aid in the transition with good communication. Change can be a frightening thing for some people, and the nurse manager/leaders should be there to help with this process. Allowing for open communication, and honesty can put staffs minds at ease. Manager must also maintain a positive attitude toward the reengineering process, and any negativity can cause wide spread changes in morale. “Leaderships role is to tame the change, control the conflict, and manage the communication” (Grand Canyon University, 2011).

Edens, P. (2005). Workplace reengineering, reorganization, and redesign for nursing management:Principles, and practice. Retrieved from 2


Grand Canyon University. (2011). Reengineering healthcare. [Lecture notes]. Retrieved from


Nurse managers and leaders need to not only be a major part of the changes in health care but they also need to be the one who involves others in the change process.  “Leadership’s role is to tame the change, control the conflict, and manage the communication” (GCU, 2011).  Nurse managers need to be the role model for accepting change and also need to ensure the process that facilitates these changes.  Staff generally look to the managers to guide them as children do to parents.  As we once looked up to our parents to see if their facial expression translated into comfort, we look to our nurse managers to see if they have accepted the change and will support the bedside nurse in the process. Change is not easily accepted by the bedside nurse as we have our own way of doing things that has been tweaked over the years to become the perfect process that is efficient, safe and effective in ensuring our patients get the best care and that our day goes well.  When change is suggested it concerns us that our process will be disrupted and we will lose control of our day.  If change is to be accepted, the nurse leader needs to ensure that those whom the changes effect are present for the formation of the change.  For instance, if the change is in relation to VAP prevention then not only should RT being involved but also infection control and the bedside nurse.  The bedside nurse can provide a great insight into the process for the change in that they can see aspects of the process that may not be effective or may cause other problems during the change.  The nurse leaders and managers need to ensure the voice of the bedside nurse is heard and taken into consideration.



GCU. (2011). Reengineering Health Care. Retrieved from Grand Canyon Loud Cloud:


Definition of reengineering;

“Systematic starting over and reinventing the way a firm, or a business process, gets its work done,” (Hammer, M., &Champy, J., 1993).

“Senior nurses must acknowledge the importance of their role, recognising that junior staff rely on their leadership in developing their own professional skills. These nurses must use their leadership behaviour to positively influence organisational outcomes and need to appreciate the inter-relationship between developing nursing practice, improving quality of care and optimising patient outcomes. Healthcare organisations need nurse leaders who can develop nursing care, are an advocate for the nursing profession and have a positive effect on healthcare through leadership,”(Frankel, A.,).

There are always times within a work environment that things have to change, not everyone will be happy or on board with change, but ultimately it has to occur, because it is the only way that industry can stay on top and competing. The same goes for the health care field. Administrators have to be on top of the game to keep up with the new innovations that make the patient care outcomes the best. If we fail to keep up with new technology example, “Robotic surgery which is less invasive, and the patients spend less time in hospital, sometimes may even be in and out as a day patient, which is much better for the patient, and also higher income for hospitals.” We will lose to other facilities that provide these new innovations, and ultimately could go out of business. Healthcare like any other industry has to pay it’s way or it does not survive with the completion that is out there today.

It is therefore up to the leaders to provide the necessary education, staff, resources At the forefront of this is a leader that is capable of motivating her staff to accomplish this change, while possibly having to achieve ways of cutting costs, but not taking away from patient care, and staff satisfaction.

“Better outcomes for Patient care ultimately, a goal of any healthcare organisation should be to influence the quality of patient care through good nursing leadership. Good leaders should encourage junior staff to gain a better understanding of patients and their needs and values. Overall, these strategies will lead to increased patient satisfaction, more effective nurse-patient relationships and quicker recovery times. Empowered nurses are eager to implement evidence-based practice. They are highly motivated, well informed and committed to organisational goals, and thus deliver patient care with greater effectiveness (Kuokkanen and Leino-Kilpi, 2000). Good leadership could produce better patient outcomes by promoting greater nursing expertise through increased staff ability and competence. Aiken et al (2001) argued the hospital practice environment has a significant effect on patient outcomes. Junior nurses should be encouraged to seek maximum rather than minimum standards, and be expected to achieve and maintain high-quality benchmarks” (Frankel, A.,).


Frankel, Andrew. What leadership styles should senior nurses develop? Nursing Times; 104: 35, 23-24.

(Hammer, M., &Champy, J., 1993 Retrieved from




Reengineering in health care is a potentially powerful approach to improving health care functions. Reengineering means to engineer again, to go back to square one and start over as though there was nothing already in place. The ultimate goal is to reduce cost, improve quality of care, greater patient satisfaction and employee satisfaction. Reengineering include abandoning obsolete systems, involving departments in cross functional teams, amalgamating jobs, introducing new technologies and creating new principles that suit the needs of the time.
Successful reengineering requires a leadership style that features participative management, delegations, employee empowerment and self directed teams. The nurse leaders and managers have a great role in reengineering health care. It is the leaders or managers who should establish an integrated vision, mission and values, management philosophy, and strategic direction upfront. Integrating operational accountability into the work-redesign effort is important responsibility of leaders. When introducing new techniques and principles, it is necessary to get the support and approval of other members of the organisation otherwise the programs cannot be implemented successfully. So the members should be informed and their opinions are to be sought from time to time. It will help to get more new and effective ideas.
Decter, M, B., Norris, J., & Kramer, S. (1997). Reengineering and integrating healthcare delivery: What have we learned in the 1990s.Healthcare Quarterly.Vol.1 (1).Retrieved from
Wood, D. (2012).Providers re-engineering healthcare for greater efficiency. Retrieved from


Continues quality improvement is the process that employs rapid cycles of improvement to ensure programs systematically and intentionally improve services while increasing positive outcomes for patients, families and the communities they serve. CQI collects data used to make positive changes, even when things are going well, it focus its attention to improve a situation rather than waiting to fix it when something goes wrong (Huber 2010).

As nurse leader one important area that requires CQI and education is the simple act of hand washing.  Hand washing is the single most important step in the fight against infectious pathogens such as MRSA; hand washing only takes thirty seconds to a minute in most instances (CDC) (2012).

In January 2013, at my place of work (VA) we receive an e-mail from the Chief of Nursing congratulating the nursing staff for the decrease in new MRSA cases, this can be attribute to the constant teaching and monitoring not only of nurses but also medical and residents, sadly doctors are the worst enemies when it comes to either using gloves when examining patients or washing their hands right after performing this task.

We also teach our patients to wash their hands before leaving their room and using the hand sanitizers placed throughout the hospital at any time. I have to add up that up to the present time the number of MRSA cases continues at its lowest rate in part again to the continues education of all involved.


Centers for Disease and Control and Prevention (CDC) (2012) Protocol for Hand Hygiene and Glove Use Observations. Retrieve from

Huber, D. (2010). Leadership and Nursing Care Management. Retrieved from




Continuous quality improvement is defined by as “philosophy and attitude for analyzing capabilities and processes and improving them repeatedly to achieve customer satisfaction’ (ASQ, 2007) Today’s health care industry is facing many challenges and continuous quality improvement is the only way, organizations can survive by maintaining patients’ safety and   also customers’ satisfaction. There are certain models of standards to measure quality and it can be grouped into structure, process and outcome. Donabedian’s structure, process and outcome model has been widely by the professional nurses to develop quality management programs.

Continuous quality improvement is process involving all levels of organization to ensure customer’s safety and satisfaction with the participation of everyone in the organization. The staff nurse is accountable to assess the patient’s status health care services provided and nurse manager must develop the work setting to facilitate the primary nurse’s ability to undertake constructive action for improving care. There will be quality improvement coordinators to assist the department with other tools such as documentation and also demonstrate how the requirements of external regulatory agencies (AHRQ, IHI, and JCAHO) and professional standards are met. The nurse executives provide vision and secure the necessary resources to ensure the quality. Some organizations have risk managers in their multidisciplinary team.

I work in labor and delivery. For the last three years we have noticed that, infant fall rate is higher in our department on nights, when the father of the baby drops the baby accidentally. So our manager created a special committee to investigate the problem with the involvement of risk manager and a social worker. We used Plan, do, check and act model to manage this issue. The plan phase explained in different steps   with the help of flow chart when the fall was occurred. Then the members of the team listed all the problems associated with the fall. Then the team categorized all these factors. After categorization the team used cause and effect diagram, and the potential factors are identified and considered as the root of the problem. It was very interesting to know about this mystery baby falls. The root causes were, extreme tiredness because of prolonged labor, in-adequate safety check on babies, the couches in the patient’s rooms were way too comfortable for a visitor so they were falling asleep. Lack of listening ability due to extreme tiredness, when the nurses were teaching the parents about safe sleep practice. First time parents if they are very young are high risk for the incidents. The involvement social worker helped tremendously to resolve this problem. We removed those couches from the room. The primary nurse did a detailed screening and teaching about the baby safety, while parents were awake. Actually the prenatal clinic even gave written instructions about patient safety. So we are making progress.

Reference: Huber, D.(2010). Leadership and Nursing Care Management, 4th Edition. Maryland Heights, MO: Saunders Elsevier

Moran,M&Johnson,J.(1992)   Quality improvement  :The nurses role. Retrieved from

Continuous Quality Improvement strategies to optimize your practice (2013): Retrieved from


an offer to help you as well, you never know what new opportunities could result from that next conversation.




Benton, D. (1999). Networking. Nursing Standard13 (31), 21-27. Retrieved from

Nichol, H., & Tracey, C. (2007).Networking for nurses. Nursing Management13 (9), 26-29. Retrieved from

Peterson, D. (2012). What is networking? Retrieved from




CQI is essential to patient care.  It is based on and works hand in hand with evidenced based practices at the bedside.  If it were not for EBP and CQI then protocols to prevent infections such as VAPs and CAUTIs would not exist and thus there would be an increase in patient deaths in the ICU.  CQI requires the bedside nurse to stay up to date on their skills and knowledge of recent EBP.  CAUTI prevention is the product of EBP prevention methods that are always under CQI assessments for further prevention methods.  The bedside nurse needs to not only stay abreast of new information but also needs to be committed to putting this EBP into work at the bedside.

In my practice, EBP is the difference between life and death.  The standard trauma patient does not present with any infections.  Therefore, the infections that they form are usually a side effect of our treatment such as use of the mechanical ventilator or a urinary catheter.  Trauma patients carry a high mortality already, when an infection is added to the mix of issues that mortality rate increases dramatically. It is my responsibility as the bedside nurse to stay update on the most recent evidenced based practices that prevent these infections.   “Because so much information is available, no one could ever have sufficient capacity to acquire all the knowledge he or she will need. Thus, the focus has shifted from possession to access” (GCU, 2011).  It is also my responsibility to utilize those practices to ensure the process is working.  If all staff are using the protocols for infection prevention and infections from ventilators or urinary catheters continue to occur then it is likely that the process needs CQI to determine what other processes need to be put into place to prevent the infection.


GCU. (2011). Reengineering Health Care. Retrieved from Grand Canyon Loud Cloud:


Continuous quality improvement (CQI) is a quality management process that encourages all health care team members to continuously ask, “How are we doing?” and “can we do better?”  (Edwards, 2008).  In establishing an effective strategy for CQI one must book at the structure, process, and outcome of the current situation and determine the changes necessary for improvement.


The lean process was implemented at a facility I previously worked at.  The purpose of the lean committee was to assess the workflow of the units and determine areas the needed restructuring.  The goal was to maximize quality patient care while minimizing areas of waste.  The committee gathered input from staff on the current workflow process.  They determined that the nurses were spending a lot of time searching for supplies needed to perform patient care.  They also found that nurses were unable to complete their charting in a timely manner.  This was hurting the facility financially due to the amount of overtime incurred and creating nurse dissatisfaction.  Once the committee identified the issues they gathered input from the staff on how to improve the process.  With approval from upper management, they were able to place locked supply cabinets in each patient room and install bedside computers.  The committee also organized the supply areas on the unit, giving each item a “home”.  This made it easier to find supplies when needed.  They did a follow up survey six months after the changes had been made, to determine if they were helpful.  They found increased patient and staff satisfaction and a decrease in the amount of overtime used.



Edwards PJ, Maximizing your investment in EHR: Utilizing EHRs to inform continuous quality improvement. JHIM 2008; 22(1): 32-7.


Huber, D. (2010). Quality improvement and healthcare safety. Leadership and Nursing Care Management. Retrieved from



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