Improving the Assessment and Triage of Patients with Mental Illness ...

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senior management level were slow to let go of the ‘old’ ways of doing things. Armstrong (2001) expresses the belief that the shock of the ‘new’ way may cause insecurities in people who are afraid to lose their sense of familiarity and belonging. In contrast frontline staff embraced the new changes enthusiastically and with vigour. They were aware of the need to change from a patient safety and efficiencies point of view. The staff took ownership of the project and in essence became leaders themselves in the process. Staff articulated that much of their enthusiasm for the project was due to their involvement from the initiation phase of the project. They considered the regular communication and educational sessions alongside the focus group discussions as key components in their acceptance of the project. Michie and West (2004) articulate that if individuals are managed effectively it will impact on their performance and behaviour. Furthermore, Shirey (2011) places emphasis on teamwork, regular reviews and feedback mechanisms as elements for successful implementation. The introduction of the elements of the change project over a three week period was done in an effort to reduce the pressures on staff. They were consulted on each element at regular intervals and were requested to put forward their ideas and thoughts. Oreg (2003) advises that staff should not be overloaded with too much information about the change. It is suggested that this could lead to resistance of the change effort. The change teams were also supported throughout the change process and it was made certain that they understood what was required to make the change a success. Senior nursing management and the ED consultants received regular updates on the progress of the implementation phase. Although frontline staff including clinical nurse managers had ‘bought in’ to the change effort there were some individuals at more senior level displaying consistent resistance to the change effort. These individuals gave the impression that the change management project wasn’t worth the investment of time and energy. Murphy (2005) expresses the fact that managers may become so entrenched in ‘day to day crises’ that they don’t involve themselves with the empowerment of staff. McAuliffe and Van Vaerenbergh (2006) suggest that without the implicit support of senior management, it is likely the project will end in failure. 30
Nevertheless as a change agent and leader of the project I was determined to overcome these obstacles. Conger (1998:93) states that ‘you must show your commitment to a goal is not just in your mind but in your heart and gut as well. Without this demonstration of feeling people may wonder if you actually believe in the position you’re championing’. Communication and negotiating efforts were improved to counteract resistance including representations made by frontline clinical nurse managers regarding the benefits of the change project they had experienced to date and the positive effect it was having on nursing staff. Sustaining momentum. Anchoring new practice in a culture can be a difficult undertaking one which Kotter (1996) considers as one of the greatest barriers to sustaining momentum. The importance of involving key stakeholders from the outset of the change process cannot be underestimated and for this reason the ongoing influence of leaders and their ability to engage and empower stakeholders at all levels of the spectrum is crucial. In order to successfully influence those involved, the leader must themselves be motivated which will help to enhance the effectiveness, growth and expansion of the change project (Coghlan and McAuliffe, 2003). In sustaining momentum there must be an indication from those leading the change that it will improve things. Focus group discussions were continued following the implementation of all the elements of the change project. Face to face communication with staff and key stakeholders at regular intervals was necessary to continually monitor the progress. Negotiations with senior level management were ongoing. There continued to be levels of conflict among a certain number of senior managers especially in relation to the nursing documentation. The requirement for the documentation was regularly questioned. There was also the insinuation that this project was only authorised for the purpose of completion of a Masters Programme and therefore would be withdrawn once it was evaluated. Despite this aversion and negativity towards the process I as change agent with the assistance of the change team and with the support of other senior management, continued to communicate to the frontline staff /key stakeholders the progress of the project. 31
Page 1 and 2: Royal College of Surgeons in Irelan
Page 3 and 4: Improving the Assessment and Triage
Page 5 and 6: Abstract Since the amalgamation of
Page 7 and 8: Table of Contents Abstract Acknowle
Page 9 and 10: Chapter 1 Introduction 1.1 Introduc
Page 11 and 12: However there are a large number of
Page 13 and 14: Chapter 2 The Literature Review 2.1
Page 15 and 16: with mental health issues, who pres
Page 17 and 18: Australia. The data was collected b
Page 19 and 20: Following implementation of the Nat
Page 21 and 22: Consequently the subsequent chapter
Page 23 and 24: must analyse their surroundings and
Page 25 and 26: After consideration of the aforemen
Page 27 and 28: questioning the patient about their
Page 29 and 30: The benefits of successful implemen
Page 31 and 32: Establishing trust was significant
Page 33 and 34: Group One: Nursing documentation- C
Page 35 and 36: Developing the implementation plan.
Page 37: Communication As discussed in relat
Page 41 and 42: crucial. The change agent or change
Page 43 and 44: The observational audit carried out
Page 45 and 46: Limitations arise as the project wa
Page 47 and 48: 5.5 Conclusion Improving the triage
Page 49 and 50: Cartwright, T., Baldwin, D. (2007)
Page 51 and 52: Happell, B., Summers, M., Pinikahan
Page 53 and 54: McAuliffe, E., Van Vaerenbergh, C.
Page 55 and 56: National Institute for Clinical Exc
Page 57 and 58: Wand, T. (2004) Mental Health Liais
Page 59 and 60: Appendices Appendix A Mental Illnes
Page 61 and 62: Appendix A Mental Illness Nursing A
Page 63 and 64: Appendix C Recommendations in World
Page 65 and 66: Appendix E Manchester Triage Algori
Page 67 and 68: Appendix G Health Service Executive
Page 69 and 70: Appendix I Change Management Projec
Page 71 and 72: Appendix K Mental Illness Triage To
Page 73 and 74: Appendix M Force Field Analysis Dri
Page 75 and 76: Appendix O Questionnaire results re
Page 77: Appendix Q 16 Triage Category alloc

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