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CPH 562 Health Services Administration

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CPH 562 Health Services Administration

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CPH 562 Health Services Administration

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Course Code: CPH562
University: The University Of Arizona

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Country: United States

Question:
Describe the problems and concerns of the current process) and the new process with your intervention (make sure you adequately describe the improvements and the intervention of the new process)

Answer:
Introduction
Every year at least 50% o the people in the United States suffer from mental disorder (Weaver, Dy & Rosen, 2014). The recent advancement in the number of diagnoses available in the American Psychiatric Association (2013) has contributed to more than 75 million additional people requiring treatment in the next 5 years. However, only one third of the people suffering from the mental health complications in the US get access to the specialist mental health staffs and thus generating a huge need for psychologically-informed practice across the mental healthcare system and creates a burden on a wide range of mental healthcare professionals to develop the required skills (Visser et al., 2014).
Important techniques for the psychologically informed practice are diverse and recommendations to improve the process of care mainly involve improvement of the communicational skills, interpersonal interactions and cultural sensitivity. In additional to these requirements, the exponentially expanding healthcare system is also creates an urgent requirement of evidence-based practice among the healthcare professionals (Reeves et al., 2013). Garzonis et al. (2015) is of the opinion that proper education and exposure to the recent advancement in the domain of metal health will help the healthcare professionals to skillfully adopt the concept of the evidence-based practice in mental healthcare and thereby helping to improve the overall quality of care and patient outcome.
The following assignment is based on analysis of the current process of staffs skills and their training needs in the X- mental health organization in US and recommendation of the new interventions based on the PDSA framework and SWOT analysis. The required development of plan for staffs training will help to analyze the overall impact on the improved patient’s outcome. At the end, the assignment provide a brief reflection from the author’s point of view in the domain of importance of staffs training for gaining improved mental health outcomes among the patients.
SWOT analysis of the staffs training
Strength of staff training
The main strength of staff training for the overall improvement of the quality of the procured mental health care in X-mental health organization in US is increase in the number of highly educated staffs which help in the observance of the evidence based practice in mental health care. Other strength of the staff training include good relationship between the staff members generated during the course of training and renovation of the certain facilities which are highlighted by the trainee staffs during  training session. The improvement of the certain facilities as per the requirement or the feedbacks given by the trainee staffs helped to improvement of the care facility as well (Terzic-Supic et al., 2015).
Weakness of staff training
The main weakness of the staff training include lack of proper funding and lack of proper electrical equipments. The process of staff training demands certain amount of funding along with proper availability of the resources in order to execute the training process in a proper manner. For example, training of the proper communicational skills and interpersonal training demands a trained professional for the execution of the overall process along with the presence of equipments like overhead projectors and audio-visual clips to procure the training sessions (Terzic-Supic et al., 2015). Availability of funding and the proper resources will hamper the quality of training. Other weakness of the staff training includes lack of motivation among the employees. The staffs training are mainly executed after the duty hours and this might induce lack of staff motivation due to over work or over exhaustion leading to decrease in the level of patient satisfaction (Terzic-Supic et al., 2015).
Opportunities of staff training
The main opportunities of staff training includes increase in the team bonding among the healthcare staffs which will in turn help to improve the overall process of patient care during the rush hours in the hospital. Other opportunities, which are associated with the medical staffs training in the mental healthcare hospital, include participation in the international projects, which will help to increase the overall exposure of the staff’s members (Terzic-Supic et al., 2015). Support from the local community and NGOs in staff training can also be regarded as another opportunity this is because it helps to generate finding towards making renovation in the process of care procurement (Terzic-Supic et al., 2015).
Threats of staff training
The main threats of staff training include lack of effective gate-keeper function in the primary module of healthcare (Terzic-Supic et al., 2015). According to Ruotsalainen et al. (2015), training plus duty time, increase the level of burnout among the mental health professionals. Burnout is defined a process of persistent negative yet work-related state of mind among the normal individuals which is characterized by exhaustion, distress and sense of decreased effectiveness in work. All this cumulates into lack of proper motivation in work along with dysfunctional attitudes and behaviors. This psychological attitude creates work-related mistakes leading to drop in overall quality of care and decreased patient health-related outcomes.
Problems and concerns
Problems and concerns of the current process in the mental health care (x-mental health care organization)
The current problems and concerns of the mental health care professionals in the X-mental healthcare organization is lack of effective communication skills, intrapersonal skills and cultural sensitivity. According to Norouzinia et al. (2016), communication is multi-dimensional phenomenon and is a dynamic process which is inherently related to the environment in which an individual experiences are shared. Effective communication and right intrapersonal skills is essential in the domain of mental healthcare in order to improve nurse patient relation-ships and thereby improving the treatment outcomes.  Moreover, effective communication and proper intrapersonal skills as executed by the nursing processionals helps to decrease patients’ anxiety, guilt, pain and disease symptoms, which further aids to improved mental outcomes. Moreover, X-mental health hospital also lacks in the domain of cultural sensory especially while handling the indigenous group of population. According to Betancourt et al, (2016), racial and ethnic disparities are well-described in the healthcare sectors of the U.S. The domain of cultural competence has evolved as one of the effective strategy to address this alarming rate of disparity. Lack of proper awareness in cultural sensitivity among the mental health-nursing professionals, lead to the generation of high rate of mental health disparity. This disparity is extremely pronounced in the domain of indigenous group of population.  Betancourt et al, (2016) stated that lack of cultural sensitivity creates a gap in knowledge in handling patients from different cultural background this in turn decrease the overall patients outcomes. 
New process of intervention
The new process of intervention will mainly encompass effective training of the health care professionals in the domain of effective communicational skills and intrapersonal skills along with proper education in the domain of the cultural sensitivity. The main target of the overalls staff training process will be the mental health-nursing professionals. This is because, Lin et al. (2013) have rightly stated that the nursing professionals spent majority of their time with the patients. Thus, it is the duty of the nursing professionals to interact effectively with the patients in order to extract out their exact mental health concerns and thereby helping the mental health physicians to draft out interventions accordingly. The other interventions will mainly deal with the proper training of the nursing professionals in cultural sensitivity. This will be done via giving proper education in the concerns, the way of approach associated with the individuals from different community, and this will in turn will help to frame culturally effective interventions to treat the mental health complications of the indigenous group of populations (Barrera et al., 2013).  
PDSA cycle
Objective: to test the appropriateness of the interventions taken for improving the staff training in mental health care.
Plan
I plan to conduct a survey involving the patients and their families to evaluate any deterioration or progress brought about in the patients after being admitted in the institutions.
Questions & Proposed outcome

Will there be a 25 % reduction of the medical errors especially while dealing with medicines or identification of the patients?
Will there be less occurrence of the sentinel events such as the acts of violence or agitation among the patients.
Can the health care staffs communicate efficiently within themselves or the patients; family?

Plan for collecting the data
25 patients will be selected for the survey followed by 25 registered nurses. A questionnaire will be containing a list of questions that would be helpful in obtaining the feedback.
Steps to execute
We will be preparing a questionnaire consisting of 10 open-ended questions and a checklist for marking the standards. 
Do
A one-on-on-one interview can be conducted with each of the patients accompanied by family members.
Data collection:

All the data was collected electronically and the checklist was ticked against each response.
It was found that in most of the cases the caregivers failed to communicate with the caregivers. According to some family member “we did not even get to know about any mishap occurring and hence always have to visit the hospital every now and then to check our patient.”
Some of the mental patients showed dissatisfaction when asked about their caregivers.
Most of the staffs have shown cultural sensitivity while referring to each of the patients. 

Study
Prediction: we thought that the occurrence of violence and agitation would decrease.
Results:  There were reports of aggressive behavior by the clients, which means the health care staffs were unable to manage them.
Prediction: We predicted that most of the patients would not be able to answer the questions.
Results: they were successful in filling up the checklist.
Prediction: There would be good nurse patient rapport
Results: Many of the nurses showed concerns while approaching the psychotic patients due to mental stigma or fear of being harmed.
Act
It can be concluded from the cycle that there was lack of communication skills among the nurses, in many cases the nurses cannot comprehend the needs of the patients, and often used restraints while making them consume food. The family member present during the interview also expressed dissatisfaction while discussing about communication skills.
Planning for the next cycle
It has to be noted from the PDSA cycle that communication skills, interpersonal skills and the cultural sensitiveness are to be enhanced for a safe care delivery. A robust training is required or improving the communication skills. Proper peer coaching and expert coaching can be helpful. Clinical competency training and peer presentations given by the qualified professionals should be my next phase of training. 
Recommendations
Training develops a work force that is competent enough in delivering a person – centered care, and to ensure that the needs of the mental health patients are met. Well-trained staffs can develop the satisfaction, morale and motivate the workforce that can improve the retention of the staffs, increases the quality of care, the ward efficiency and the productivity (Lyon et al., 2011). Investing in training of the staffs can be helpful in meeting the requirements of the care quality commission. Furthermore, it has also been notices that a will-trained workforce is proportional to less medication errors, lower rate of readmissions and improved mental health conditions in the patient (Garzonis et al., 2012). All these reasons provides the rationale for choosing the training of the health workforce to be important in health care. With time, more people are being presented with health care problems and mental health has become a matter of all the health care professionals that require a cross-disciplinary approach (Gongora-Ortega et al., 2013). Although there are several ways to define the concept of skills and training, training means the systematic development of the knowledge, attitudes, behavior patterns and the skills (Department of Health. 2013).
Already it has been stated that the X- mental health organization lacked proper communication skills among the health care staffs. Jansink et al., (2013), has stated that the group training can be useful in teaching the communication skills to the nurses, hospitals and the general practitioners and the hospital doctors. Shirazi et al., (2013), have stated that group training can also help in improving the diagnostic skills and supervision skills in the health care staffs.  Individual or one-on –one training should be done in order to the provide training regarding specific skills, such as training to mental car staffs for dealing with patients particularly those  suffering from delirium or psyco-sexual disorders (Jansink et al., 2013). Whereas those staffs in charge of the pediatric patients should be trained in a different way. According to Jansink et al., (2013), individual training can be helpful in short-term enhancement of the skills, greater self-efficacy among the staffs and passion for work. Web enabled video training can be done to allow a synchronous communication between the persons who are not present in the single physical space.
Further recommendations includes minimization of the contradictions in practice by provision of a clear guidance for practice, professional standards and learning outcomes (Shirazi et al., 2013). The training should include individual feedback, structured learning and regular training. Work should be allocated for the staffs that is appropriate to their level of the skills in order to prevent medical errors. Supervisors should be approachable to the trainees.
Cultural sensitiveness can be improved by sharing and understanding the culture of the staff nurses and innovative ideas such as celebration of the special days of each culture or arranging cuisines from different culture may help in the development of cultural assimilation (Amerson 2012).
Special training programs for the health care staffs can cause cost burden and hence cost effective strategies should be taken. In case of short term training cost effective information handouts can be given to the staffs containing the information regarding the training (Nilsen 2011). Training can be provided by the senior nurse of that organization instead of hiring people from outside.
Conclusion
Proper work force in health care, especially in mental health care is not only important for the health and the wellbeing of the patient, but is also important for enhancing the professional standards of the health care professionals and the reputation of the health care organization. In order to develop a competent work force, extensive training of the health care staffs are required. Well-trained staffs are confident and are better prepared for providing support to the patients and their families. It can be said that proper group training, clinical competency training and use of the digital equipment can be helpful in providing education regarding the development of the interpersonal, communication skills and cultural sensitivity. A proper plan to do cycle can be effective in measuring the effectiveness of our interventions. 
References 
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Amerson R. (2012). The influence of international service-learning on transcultural self-efficacy in baccalaureate nursing graduates and their subsequent practice. International Journal of Teaching and Learning in Higher Education, 24(1), 6–15. Retrieved from https://www.isetl.org/ijtlhe/pdf/IJTLHE1102.pdf
Barrera Jr, M., Castro, F. G., Strycker, L. A., & Toobert, D. J. (2013). Cultural adaptations of behavioral health interventions: A progress report. Journal of consulting and clinical psychology, 81(2), 196.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.
Department of Health. (2013). Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values. Retrieved from https://hee.nhs.uk/wp-content/uploads/sites/321/2013/05/29257_2900971_Delivering_Accessible.pdf
Garzonis, K., Mann, E., Wyrzykowska, A., & Kanellakis, P. (2015). Improving patient outcomes: effectively training healthcare staff in psychological practice skills: a mixed systematic literature review. Europe’s journal of psychology, 11(3), 535.
Garzonis, K., Mann, E., Wyrzykowska, A., & Kanellakis, P. (2015). Improving Patient Outcomes: Effectively Training Healthcare Staff in Psychological Practice Skills: A Mixed Systematic Literature Review. Europe’s Journal of Psychology, 11(3), 535–556. https://doi.org/10.5964/ejop.v11i3.923
Gongora-Ortega J., Segovia-Bernal Y., Valdivia-Martinez J. J., Galaviz-deAnda J. M., Prado-Aguilar C. A. (2012). Educational interventions to improve the effectiveness in clinical competence of general practitioners: Problem-based versus critical reading-based learning. BMC Medical Education, 12(1),
Jansink R., Braspenning J., Laurant M., Keizer E., Elwyn G., van der Weijden T., Grol R. (2013). Minimal improvement of nurses’ motivational interviewing skills in routine diabetes care one year after training: A cluster randomized trial. BMC Family Practice, 14, . 10.1186/1471-2296-14-44
Lin, E. C. L., Chen, S. L., Chao, S. Y., & Chen, Y. C. (2013). Using standardized patient with immediate feedback and group discussion to teach interpersonal and communication skills to advanced practice nursing students. Nurse education today, 33(6), 677-683.
Lyon, A. R., Stirman, S. W., Kerns, S. E. U., & Bruns, E. J. (2011). Developing the Mental Health Workforce: Review and Application of Training Approaches from Multiple Disciplines. Administration and Policy in Mental Health, 38(4), 238–253. https://doi.org/10.1007/s10488-010-0331-y
Nilsen L. L. (2011). Workplace learning among general practitioners and specialists: The use of videoconferencing as a tool. Journal of Workplace Learning, 23(8), 501–517. 10.1108/13665621111174861
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2016). Communication barriers perceived by nurses and patients. Global journal of health science, 8(6), 65.
Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev, 3(3).
Ricketts, T. C., & Fraher, E. P. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. Health Affairs, 32(11), 1874-1880.
Robson, D., Haddad, M., Gray, R., & Gournay, K. (2013). Mental health nursing and physical health care: A cross?sectional study of nurses’ attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness. International Journal of Mental Health Nursing, 22(5), 409-417.
Ruotsalainen, J. H., Verbeek, J. H., Mariné, A., & Serra, C. (2015). Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev, 4.
Shirazi M., Lonka K., Parikh S. V., Ristner G., Alaeddini F., Sadeghi M., Wahlstrom R. (2013). A tailored educational intervention improves doctor’s performance in managing depression: A randomized controlled trial. Journal of Evaluation in Clinical Practice, 19, 16–24. 10.1111/j.1365-2753.2011.01761.x
Terzic-Supic, Z., Bjegovic-Mikanovic, V., Vukovic, D., Santric-Milicevic, M., Marinkovic, J., Vasic, V., & Laaser, U. (2015). Training hospital managers for strategic planning and management: a prospective study. BMC medical education, 15(1), 25.
Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., … & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34-46.
Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf, 23(5), 359-372.

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