Introduction In the first part of this assignment

In the first part of this assignment, a description of the resource’s base used as part of the strategy in orthopaedic wards two is given. A brief literature review to establish the best practice of good governance and effective management from top management to the most junior staff is presented.

The strategy, structure, processes, rewards, and people (STAR model) are used in different sections of this assignment. The strategy is used as a guidance to map value propositions over time and make strategic choices to achieve the whole organizational goals. The structure and processes (STAR model) help in the identification of some of the key processes that are deployed within the structure used in this ward. The resource base (input and output) within the ward being human, physical, equipment and stock must be kept adequately full. Motivational initiatives are essential in identifying ways that work to keep the staff motivated. By utilizing the rewards, and people (STAR model) recommendations for maintaining adequate resources and motivational enhancements must be given.

1. Map out the resource base of your chosen Unit. You will need to decode the strategic asset base by way of human, physical and organizational resources. Issues such as causal ambiguity, uncertain imitability and asset specificity all come into play.

Orthopaedic Ward Staff and Main Deliverables

This orthopaedic care speciality ward which caters for Maltese and foreign patients’ needs elective surgeries such as knee or hip replacements. It is the only ward that provides pre and post- operative care to patients with scoliosis (asset specificity). Spinal injuries and patients with chronic or other bone conditions ranging from Paget’s disease, back pains to bone tumours are admitted in this ward.

Orthopaedic ward 2 is an elective twenty-four bedded and caters for both males and females. Six consultants give their service to the patients. Three to five physios and two occupational therapists offer their service daily. The orthopaedic outreach team also has their office in this ward.

The main deliverables in this orthopaedic ward include, general nursing care, pre and post-operative nursing care, using technology, consultant’s and geriatrician ward rounds, multi-disciplinary team rehabilitation services, patient education and discharge planning. Nursing aides and care workers help nurses in providing care to the patients. Cleaners do their job to keep the ward environment clean. Furthermore, the ward clerk does receptionist work, delivers general administrative, clerical, and support services such as ensure that all patient’s records are available and properly maintained. The medical logistic section staff are responsible for supplying the consumables and all other disposable items to orthopaedic ward. However, good communication is essential with ward staff to ensure any specific items that needs to be ordered will be available in time.

Demographic Ward Staff Human Resources Information

Staff Age – Range Experience Nationality and Gender Language Adaptabity
Charge Nurse
40 to 50 years 20 years in A and E departement and one year in Orthopaedics Maltese Female Maltese, English and Italian
Deputy Charge Nurse 40 to 50 years 10 years (Surgical), 9 years in orthopaedics Maltese Female Maltese, English and Italian
Two day Nurses 40 to 50 years 10 years Maltese and Bosnia
Maltese, English and Italian
Nurses in Shifts 20 to 25 years
25- 35 years 1 year
2-6 years Maltese and Bulgarian
Five Maltese, one Spanish and Italian man Maltese, English and Italian
Nursing Aide 45 years 20 years in orthopaedics Maltese Male Maltese and English
Four Care Workers 25 to50 years 2 years 1 Maltese 2 Indians and 1 from Nigeria Two females and two Males English
Three Cleaners 25 to 50 years 1 year Phillipines Females English
27 years 5 years Maltese Male Maltese, English and Italian

Strategic Asset and Resource Base Evaluation

Local managers of healthcare are facing unique challenges in the ward’s environment to manage the healthcare service’s most valuable assets that include its human resources, physical asset capital, consumables and other resources, such as technology management in healthcare (World Health Organization 2000) (WHO). The organization chart based on Barney ‘s (1991) definition of human, physical and organizational resources explains the strategic and non-strategic resources available in orthopaedic ward 2.

Ketchen et al (2014) explained that strategic resources are assets that are valuable, rare, difficult to imitate, and non-substitutable. Rizzo (2018) stressed the point that if the available resources give some form of sustainable competitive advantage, then they are strategic in nature. Thus, a strategic plan is necessary that should be focused on the orthopaedic setting strategic resources and capabilities. Therefore, strategy should include the tangible and intangible resources and capabilities available in this orthopaedic ward.

Ketchen et al (2014) mentioned that capabilities are needed to bundle, manage, and otherwise exploit resources in a manner that provides value added to patients and creates advantages over competitors. On the other hand, Helfat and Winter (2011) define capabilities as the capacity to perform an activity in a reliable/satisfactory manner. One’s view point is that capabilities are vital because they are how organizations capture the potential value of the organizational resources, experience, learning, and practice.

Leadership and staff tacit know-how capabilities are essential in maintaining synergy in the organization by building and sustaining strong trusting relationships to achieve the best care outcomes for their patients. Teece (2000), Johnson and Scholes (1999) stress the point that human capabilities are the most difficult to be copied because of the possession of highest levels of causal ambiguity. Casual ambiguity in this ward can also be identified and sustained because most of the nursing staff had no formal training in the orthopaedic speciality. They learnt and developed new skills by studying and by working with their nursing colleagues. Learning in practice to achieve core competencies occurred through demonstration of the procedure, observation, reflective skills and role modelling. Thus, one can argue that it is very difficult to be copied by other organizations due to the uncertain ambiguity and asset specificity present.

2. Through a brief literature review, establish what is deemed to be best practice by way of good governance (as well as effective governance by way of setting direction) from management senior to the Unit. Argue if this holds for your chosen Unit. Recommend any possible enhancements.

Good Governance Best Practices Literature Review
Efficient governance of hospital wards involves the accountable and effective use of funds, professional management and competent governing structures Ditzel et al (2006). Flynn (2002) mentioned the importance of good hospital’s governance and defined it as a process of monitoring the whole functioning and ensure effective performance by defining the hospital’s mission, setting its objectives, supporting and monitoring their realization at the operational level. Leadership is necessary for managers to realise the importance of their mission and strategies to achieve the overall goals of the organization. Governance implies a series of actions to achieve result that needs to be discussed, planned, communicated, implemented, and monitored (Debono 2018).

In Mater Dei hospital, the top people within the governance structure include the Chief Executive Officer (CEO), Medical Director and the Director of Nursing and Midwifery services that are responsible and accountable people for the overall operation of this acute hospital. Nevertheless, good governance in healthcare is considered as a collective process of top-level organizational leadership, policy and decision-making, non-excitative board that represents the owner (government), chief, executive officer (CEO) decision-making process, senior management and clinical leaders (Patience Aseweh Abor 2015).

Governance entails the way that top management dissemination of power and how they behave among themselves (Rizzo 2018). Team relationships, unity in direction and command, accountability, ownership needs, self-improvement, clear flow of information and understanding governance costs are all essential capabilities top management should practice. One can argue that where good governance is practiced top-down and bottom- up approaches are implemented in practice where new ideas are taking into consideration, continuous feedback is generation, for decision making process. Feedback can influence decision-making and the need for adjustments in policies and standard operational procedures (SOP’s). generating an environment that top-management is open to ideas from employees and patients can favourable leads better governance in MDH hospital (Rizzo 2018).

Taking into consideration that the workforce in orthopaedic ward 2 consists of a well-mixed Maltese and foreign workers. One’s opinion is that to achieve the objectives of the organisation functional governance by working within an ethical and cultural framework is essential. One’s leadership knowledge and being morally obligated to a wide range of follower including staff and patients is essential in maintaining good governance practices (Ciulla, 2005). This is helping the charge nurse to work effectively towards good governance in ward orthopaedic 2.

Brown et al (2005) portray being ethically knowledgably and demonstrate good working ethics, ward leadership creates favourable working environment that can result in increased professional dedication, problems reporting and job satisfaction. However, to deliver efficient services the written governance and ethical standards, must be followed which can encourages high performance from all public providers (Lewis and Pettersson 2009).

Corporate Governance
Working as a team in the organisation is imperative and to gain its advantages, individuals must feel engaged altogether within the organisation to transform inputs into outputs effectively. This can be achieved by a good corporate governance, which entails everyone to take the decisions which are based on a continuing relationship governed by responsibility and empowerment both formal (by following rules and SOP’s) and informal that includes the people’s cultural, norms, beliefs and values (Debono, 2018). Governance also defines a sense of ownership of being part of the system, belonging, proud of being part of something and leadership of your responsible resources (shared governance).

Improving Governance
Shared governance at ward level involving leadership participation and frontline staff in decision-making process empowered the nursing staff to improve their practice environment and works more towards attaining the healthcare mission (Brandt et al 2012). However, to achieve good governance employee must have the skills, commitment and aspirations and collaborate to works towards achieving the larger goals of the organization. According to the World Health Organization (2010) collaborating, practice occurs when various health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers and communities to deliver the highest quality of patient-centred care across settings. Shared decision making, and relationship-building initiatives can determine what matter most to the patient in having patient centric care.

The Agency for Healthcare Research and Quality (2016) established an effective model that
provides guidance on the training, tools and the application of a shared approach (SHARE) framework in the clinical practice. These include:

1 Seek the patient’s participation
2 Help your patient explore and compare treatment options
3 Assess your patient’s values and preferences
4 Reach a decision with your patient.
5 Evaluate your patient’s decision.

Taking a shared-governance approach to leadership ensures staff of all levels are involved in having a say and managing the environment in which they work. Without well applied strategies good governance cannot be implemented effectively in healthcare.

3. Choose one strategy model that you are conversant with (strategy as an action, a process, a pattern, a position), and use this model to map out the strategic intent of your Unit. You should be able to establish the environmental forces external to the Unit, the key strategic goals of the Unit, as well as significant actions and initiatives being taken within the Unit to achieve these goals.
Strategy is defining goals and adopts a course of actions to reach them. There are various strategies and pathways to reach our goals. Jonson et al (2009) defines strategy as the chosen directions and scope of an organization over the long term, which achieves competitive advantages in a changing environment through its configuration, human and other resources. Tension between the internal and external needs is increasing in local orthopaedic hospital wards. Strategic leaders are essential to work in ways that affect the direction and momentum of the whole organization (Hughes and Beatty 2005).
A holistic evaluation of the micro and macro environment in ward O2 can reveal information to develop a robust strategy that could improve the decision-making process in this unit. Strategy model and different analysis establishing the environmental internal and external forces and guide a sense of directions to take the necessary actions needed to achieve and maintain the strategic goals. A strategic process model is necessary as a guidance to implement effectively strategic phases of planning in orthopaedic ward 2. Jurevicius (2013) presents a strategy process. However, the World Meteorological Organization (2016) presents a clear structured process of planning to support the implementation of the strategy process.
Jurevicius (2013) World Meteorological Organization (2016)
Initial Assessment Preparatory phase: establishing the strategic planning process that involves the justification, pre-planning course of actions
Situation Analysis Assessment and analysis phase: These include SWOT, PESTEL and Porter’s five forces of competition to provide the information required to design a strategic plan
Strategy Formulation Design/define phase: Strategic plan development; defining or updating the organization’s vision, mission and values statements, identifying organizational goals, strategies and expected results.
Strategy Implementation Implementation phase: making the strategic plan a reality develops action or operational plans
Strategy Monitoring Performance measurement phase and Review and modify phase that includes performance measures and adjustment of the plan as necessary to remains relevant

World Meteorological Organization (2016)

Assessment and Analysis Phase
The Strengths, Weaknesses, Opportunities and Treats (SWOT) analysis is performed to analyse the internal environment. Political, economic, social, technological, environmental and legal environment (PESTEL) framework which monitors the external environment is utilized. Porter (1990) five forces model of competition is discussed to explain the competitive forces in the orthopaedic healthcare industry.