According to Piccolo & Colquitt (2004)

      Transformational leaders have the ability to raise follower task performance while also encouraging organizational citizenship behavior-those “extra-role” behaviors that are not discretionary and not directly recognized by an organization’s formal reward system and that help improve organizational functioning (p. 1).

      As a transformational leader, if the employee is able to relate to the mission and vision of an organization, the employee will play a large part in the positive efforts toward building the organization and be personally rewarded for its success.

Performance Measurement

      Hall, Doran, & Pink (2004), suggested that “valid indicators of hospital quality are based on outcomes of care experienced by the patient, the nursing staff and the hospital system” (p. 1). One effort in question is the measure of performance of the nursing staff who utilizes nurse indicators. These indicators are specifically designated for the surgical unit of any hospital that has an operating room.  The focus for this essay will be the Washington, DC Veterans Affairs Medical Center (VAMC), the unit of interest will be 2D General Surgery.

Quality Control

      According to Marquis & Huston (2009), “quality control, a specific type of controlling refers to activities that are used to evaluate, monitor, or regulate services rendered to consumers” (p. 538). The quality control relevant to the surgical unit requires a plan for ongoing monitoring, auditing, and evaluating of findings that will provide a basis for performance improvement. The Agency for Healthcare Research and Quality (2005) stated “the Surgical Care Improvement Project (SCIP) is designed to provide hospitals with effective strategies to reduce four common surgical complications-surgical wound infections, blood clots, perioperative heart attack, and ventilator-associated pneumonia” (p. 1). The interventions used to combat these surgical complications are evidence based practices and as time goes on changes will occur to improve the outcomes of surgical patients.

Indicators

      Surgical complications can take a measurable toll on a patient’s health and safety causing prolonged treatment and increased lengths of hospital stays. To prevent these complications specific measures are performed that will aid in the recovery of the patient. Two performance measures that will be focused on include appropriated antibiotic usage and venous thromboembolism prophylaxis (VTE). These two measures were chosen because the nursing staff plays a crucial role in the compliance and the effectiveness of both antibiotic and VTE prophylaxis usage. 
 

Benchmarking

      To have performance excellence with the two previously stated measures there must be a reason to look at them. Hall, Doran, & Pink (2004) also suggested that “The outcomes of nursing care should demonstrate three characteristics: (1) they should be measurable by efficient, valid, and reliable methods; (2) they should be relevant to the patient, healthcare setting, and or government; and (3) they should be represent the intended or unintended effects of hospital nursing care” (p. 1). If the data shows that the performance is less than perfect than there is room for improvement. If the data shows perfect performance then there is no reason to routinely look at this measure, random monitoring will therefore be required. Next, a benchmark is performed. Marquis & Huston (2009) defines benchmarking as “the process of measuring products, practices, and services against best performing organizations” (p. 540). When benchmarking the SCIP performance will be reviewed. The review will assess how well or how bad they are doing and then goals will be set to reach and surpass the other organization’s performance. Surpassing the benchmark will require the VAMC to set their SCIP performance numbers higher than that of the benchmark.

Auditing, Processes and Tool

      The process is initiated with an audit tool which was specifically designed to meet the needs of the quality control. The tool has information that is relevant to the data that is being collected such as the patient’s name, type of surgery, date of surgery, diagnosis, antibiotic order, antibiotic order followed, VTE ordered, VTE order followed and comments. The bottom of each column will be totaled once the sheet is completely filled out. The information used to complete the audit sheets is obtained from different sources. The majority of information is obtained from the Computerized Patient Record System (CPRS). The CPRS contains physician orders, operative notes, nurse’s notes and medications, all of which are needed to complete the auditing process. Once the orders of new admissions are reviewed the patients are physically assessed to ensure that the orders have been accurately carried out by visualizing that the patient is wearing TED hose and SCD pumps.

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