Explore how understaffing across NHS services drives delays, safety incidents, and burnout, and uses quality‑improvement frameworks to design practical, evidence‑based strategies for safer, higher‑quality patient care.
Understanding how staff shortages affect the quality of healthcare delivery in the NHS is a common topic for students who seek help with assignment uk, especially in nursing and healthcare management courses. This introduction outlines the context of the NHS workforce crisis, explains why understaffing leads to longer waiting times, reduced patient safety, and increased burnout, and highlights the need for evidence‑based improvement strategies. It also sets the stage for applying quality management theories and practical frameworks to propose realistic solutions that can support both patients and healthcare professionals.
The purpose of this report is to provide suggestions related to service improvement for the NHS in terms of addressing its current challenges of staff shortage which leads to longer waiting time, poor healthcare facilities, patient dissatisfaction, and workforce burnout. This study has implemented multiple theories such as total quality management, Herzberg’s two factors theory and Maslow’s hierarchy of needs to provide a theoretical underpinning of what is the issue, why it is occurring and is a cause of concern and things that can be done to improve the overall quality of healthcare service provided by NHS. Furthermore, this report has also provided short term and long-term recommendations to the NHS, which can help the organisation to reduce the impact of its current issues.
Background of the Issue
The National Health Service or NHS is one of the most important systems of a fundamental human right in the United Kingdom which offers free treatment to the natives of the country without respect to their capability to pay for the services. NHS is one of the biggest single payer health systems all across the globe and holds the significant role of root for UK’s national health (Aked, 2013). However, in the recent past, the National Health Service has had some drawbacks in the provision of adequate health care due to the mismanagement of its employees besides experiencing a shortage of staff. From the existing literature, it is imperative to establish that NHS has experienced declining staff numbers in terms of workforce, and there is shortage especially in the doctor, nurse, social care and other positions, among others (Khan, 2023). This has in effect resulted in additional burden on the existing workforce in the health facilities and a non-reducing number of open positions. It has also posed a serious threat to the quality of care that is given to patients, because of the many vacancies that have resulted in long hours of wait and strain in the current healthcare professionals to deal with the numerous demands of healthcare delivery for patients in the United Kingdom.
7 Years | MSc
The rise of staff deficit in the NHS is a crucial threat within the British health-care system, which influences the availability of services, quality and outcomes of care, and employees’ morale and productivity. However, as one of the biggest single-payer systems of healthcare in the world, the NHS is in trouble to meet the demand of patients due to lack of staff especially doctors, nurses and social care workers (Khan, 2023). This has resulted into overworking of available human resources hence burnout, low job satisfaction, high turnover rates,. Consequently, longer wait times for patients have been realized, and compromise of the delivery of health care services is seen with concerns to the safety of patients and its sustainability.
The idea for this research originates from the current scarcity of the workforce in the treatment settings in the UK NHS resulting in a disastrous impact on healthcare. To this effect, it is appreciable that one must identify the fundamental reasons as to why there is high turnover of staff and low funding for the staff, weak policies on staffing among others. Furthermore, knowledge about the impact of staffing shortage on patient care and organizational outcomes will help in making policies that could rectify the problem regarding recruitment and retention of the workforce in the healthcare facilities. It is arguably important to address these issues in as much that it can help to make sure that the desired mandate of the NHS continues to prevail to the effect that healthcare for all residents in the United Kingdom is effectively availed.
Risk identification and DMAIC Framework
Six Sigma methodology’s five phases which include Define, Measure, Analyze, Improve, and Control are very useful when it comes to risk management in hospitals. Cabrera’s case shows that Six Sigma could address the system process issues related to failure in storing and administering medicine.
Define
This phase involves specifying the cause factors that take part in sexual exploitation in healthcare facilities. The workplace violence policies of the hospitals should define unacceptable conduct or actions, roles and responsibilities of various staff, and reporting process (Janssens et al. 2022). Thus, the risk, including insufficient background check, unsupervised employees, and not reporting incidents, can be set goals for enhancement by organizations.
Measure
In this phase, organizations acquire information concerning the number of reported cases of different incidents, complaints from the patients and staff, and also existing security features. Likewise, calculation of risk factors associated with sexuality takes bearings on ways of appreciating the proportion of the problem similar to how drug storage risks were analyzed after the incidences of Cabrera.
Analyse
Risk factor analysis is used in order to determine its causes. As with Cabrera, in which investigators found that inadequate drug storage contributed to the employee’s demise, an RCA of patient sexual misconduct may only uncover missed policy and enforcement or organisational culture.
Improve
This report found that there are measures that may be taken to enhance patient safety such as stringent background checking on potential employees, sexual harassment prevention trainings for the workers and patient safety policies. In this case, better medication management systems were implemented throughout Cabrera hospital, showcasing that such successes can be achieved to avoid such deaths in future.
Control
Therefore, the definition of long-term monitoring is to maintain implemented changes over the long haul. Sexual harm prevention policies and procedures also need regular reviews, audits, and promotion of accountability among the hospitals.
Six sigma tools used for minimizing risks
This proactive tool evaluates which processes in the hospital are vulnerable to failure and likely to produce sexual harms. Like any other analysis related to medication, FMEA can identify risks such as lack of supervision of staff, absence of reporting systems, and hazards to the patients. According to Six Sigma, there are sundry tools aimed at admitting, evaluating, and managing risks within healthcare facilities.
Analysis of FMEA
Root cause Analysis
RCA is always employed to establish the root causes of adverse events that happen within a hospital. In Cabrera’s scenario RCA played a very useful role in establishing that; Wrong storage of drugs contributed to the fatal Medication error. RCA may be utilised to discover if there were systemic breakdowns that enabled the misconduct to occur. it could ascertain if, for example, the negligence stem from insufficient training of workers or liberalism within disciplinary measures. The recipe might include Safety measures such as mandatory reportFMEA is a risk assessment model that is used in hospitals to ascertain that the process involves scrutinizing the different stages in a process that may lead to a failure in delivering good results or harm to the patient (Felderer, and Ramler, 2021). FMEA, for instance, would identify risks that are related to medication administration, for instance, wrong labeling or storage of medicine that actually caused the death of Cabrera. Lack of Staff Supervision, which means that poor supervision means that there are many openings for unbecoming behavior. Other routes include inadequate reporting procedures where individuals might be depressed to report cases of abuse, or witness because there is no action that will be taken. Possible threats include unprotected zones for patients, which may lead to patient privacy violation, increase in incidence of theft or cases of assault as these areas are likely to lack close security monitoring.
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Statistical process control
SPC is primarily employed for tracking and identifying trends in data over a period so as to get an enhanced vantage point to intervene before the risks have become unmanageable. SPC can be used in monitoring reports of misconduct and revealing trends in a particular section or period in order to prevent sexual harm (Piggott et al. 2021). This is required in assessing the outcomes of measures put in practice in regard to safety. The use of predictive analysis in relation to risk, so as to be able to respond before something occurs, based on assessment derived from affected history.
Root cause analysis is very important in problem solving and an effective and powerful tool that can be used for the purpose is known as fishbone Model or Ishikawa diagram. Whereas, the following section analyses the Fishbone Model, also known as stable travelling Ishikawa Diagram to determine potential causes of Mayra Cabrera’s fatal medication error in Great Western Hospital NHS Trust.
Figure: Fishbone Diagram
(Source: Self-Created)
Human error
Reduced compliance of upholding professional standards is also another cause that led to this incident: the midwife did not check the medication she was to administer to the patient. It was established that, instead of administering a Saline solution or blood volume expander, a 500ml bag of bupivacaine, a strong epidural anaesthetic, was connected to Cabrera’s IV line. Though the midwife conflicted that she gave the wrong drug to the patient, the above evidence suggests negligence in checking the label before administering the drug, which shows that there were a gap in the hospital's practices a s far as patient safety is concerned.
Failure to observe working standard safety measures including the “Five Rights” of medication administration was one of the main causes of the error. The calling of three separate administrative charges instead of ensuring the three different verifications could have prevented the fatal administration.
Storage and labeling issues
The other notable root cause was related to storage and labeling of high-risk medication. This made it possible for Bupivacaine to be stored in a way that may easily be confused with intravenous fluids causing some professionals to administer wrong doses of the drug.
It is common knowledge that healthcare facilities must have standard guidelines when it comes to disbursement and storage of high risk medications to reduce the confusion that may arise.
Training and protocols
This case also revealed the weaknesses in training of the human resources and failure to adhere to the standardized procedures. Before identifying some implications of the given event, it is important to acknowledge that although hospitals have measures in place regarding medication safety:
Thus, correct and intense training, as well as enforced safety culture, may help to avert the fatal error (Karam et al. 2021). To address such risks, the hospitals should embrace the ongoing education of practitioners, competency tests, and prerequisite procedures when dealing with the high-risk medications.
Communication failures
However, one of the worst aspects that could be cited was the general lack of openness after the event. Cabrera’s husband was early told that she died from an embolism (blood clot), and not due to any medication mistake. This only learned after a year, and it established the following:
There are 20 good reasons that are pivotal to the understanding of patient safety and trust in hospitals (Timbi et al. 2022). When the error was made the hospital ought to have admitted their mistake and communicated this to the family honestly, then undertake remedial action to ensure that such error was not repeated again.
Systematic weakness
Finally, the case highlights system-wide weaknesses in patient safety measures. Unfortunately, it seems that no measures were taken to establish precautions against such an erroneous decision in advance, or a method to identify the mistake before it caused fatal incidents. Key failures included:
Better quality assurance protocols, additional technology, better double check policies and enhanced safety climate would have pre-empted the error before it caused harm to the patient.
Given the case brought up by Mayra Cabrera, the company organizational structure and human error fishbone analysis shows that the issues are caused by human error, storage, lack of adequate training, poor communication, and structural flaws.
Why did the medication error occur?
The medication that caused Mayra Cabrera to die was given bupivacaine, a strong epidural anesthetic, instead of saline or blood volume expander through an I.V drip. This mistake was however to prove fatal because the woman developed a fatal cardiac arrest, an event that led to her death just two hours after giving birth. Although people were involved in this mistake, one should examine ways in which the system supported this error. The ‘guilty’ components should be sought in such questions as derivation of staff’s inadequate training, failure to enforce procedures, and lack of protective measures.
Why was the wrong drug administered?
Essentially, the midwife who administered the drug got a bag of bupivacaine and thinking that she was putting an intravenous fluid, connected it to the victim’s IV line (Frechen, and Rostami, 2022). This error is committed when there is a discrepancy in the verification process that precedes the administration of medication to the patient. In health care, the Right Patient, Right Drug, Right Dose, Right Route, Right Time veritable principles or what is commonly referred to as the ‘Five Rights’ are basic safety precautions that are meant to avoid such errors.
Why was the drug mistaken?
Among the possible causes of the medication error, the failure of the nursing staff to observe proper storage and labeling systems in the hospital. The bupivacaine was placed near the shelf with intravenous fluids that made it easy for it to be prescribed mistakenly. Some elements of safe medication administration include high-risk labelled different from IV fluids so as to ensure that they are not confused.
Why was the storage system poor?
The hospital did not follow a proper system of isolation of amber and red zone products among IV fluids. In most healthcare organizations, the anesthetic drug bupivacaine is placed in a tightly locked compartment that is different from that of regular parenteral fluids. Also, warning signs of color and restricted areas also contribute to the limitation of access to those categories of personnel with special privileges. In the case of Great Western Hospital, such measures were not implemented which have exposed the hospital to precarious conditions where dangerous drugs were easily procured without supervision.
Why was there no segregation ?
The root of the problem was the absence of standard measures aimed at ensuring safety in the working process of the hospital. These areas of deficiency were the absence of a drug separation policy as well as failure to develop and implement comprehensive standard operating procedures regarding the storage of the medicinal products, and poor performance by the management in supervising medication safety measures (Liu et al. 2023). Such oversights created gaps where fatal mistakes that led to Cabrera’s death could be made. As for this event, the hospital changed the procedures regarding medication storage, which in turn modified the national guidelines in 2007.
Strengths
This hospital has sober human resources of competent qualified midwives and nurses who are qualified in managing the medical complications that may arise when delivering babies. It can be seen that their experience proved valuable in delivering optimal quality care to the patients. Further, after Mayra Cabrera’s death in this hospital, multiple policies were adopted most of which related to the handling of medicine including storage and management (Kirwan et al. 2022).
Figure 2: SWOT Analysis
(Source: https://www.bni.com/the-latest/blog-news/3-easy-steps-to-conduct-a-swot-analysis/)
Weaknesses
A major drawback was the inadequate labelling and storage of the drugs were fatal confusion of high-risk drugs was experienced by the hospital. This is because epidural anesthetics were not separated clearly from routine IV fluids hence leading to high probability of medication mistakes. Also, the hospital had not implemented a double check on these specific and high-risk medications through barcode scanning or through having another person verify before administering the drug or medication.
Opportunities
The hospital can use a number of modern technologies, for instance, an electronic medication administration system and barcode scanning system to minimize human errors. These can also offer automation in terms of having a method that will prove that the right medicine has been given to the right patient (Pansara, 2023).
Threats
These improvement measures only go up-to a certain level, there is likelihood of medication errors to recur in the future if aggressive continuity improvement activities are not practiced. Thus, if certain measures are not followed, one can only come across similar calamities again. However, failure in safety also had its legal and financial implications as well as the consequences of the resultant damage to the hospital’s reputation and possible litigations.
Recommendation
Improving drug storage and labeling
Invest in “high-risk” high alert labels: Combination of high-risk products such as bupivacaine and the normal IV fluids should not be put close to each other or in similar containers to avoid confusion. In addition, color differentiation and differentiation topical classification to prevent and possibly minimize cases of dangerous drug administration.
Mandatory barcode and scanning
Barcode scanning system: Implement the use of barcode scanning for all the medications. This will help to make the right drug to be given to the right patient by scanning the patient’s wristband as well as scanning the barcode of the medication to be given to the patient in compliance with medication administration.
Regular staff training
Continuous education: Ensure every staff member has structured annual, or more frequent retraining based on their position, on the subject of drug safety, correct handling, and non-occurrence of errors. This will enable its staff to be conversant with current safer handling of medication practices and ensure competency in handling of incidents.
Double-check procedures automated alerts and digital safeguards
Verification process: Pharmacological check with the actual drug, dosage and patient are to be verified independently by two registered and qualified staff. From this, it will be easier to prevent human error from influencing the overall results of the system.
Management of Alerts and Safety Measures in View of Patient Record Systems
Some of the barriers reported include Electronic health records and alerts and Safeguards which should display messages or pop up on the patient record systems when any health care provider prescribes an incorrect or wrong dosage of medicine or high risk medicines (Zipfel et al. 2023).
Conclusion
Therefore, it can be stated that the theories of quality assurance, such as Six-Sigma, have a pervasive presence and can significantly reduce risks of medication errors in order to enhance the overall quality of the entire healthcare system. Using Six Sigma methodologies, we would be in a position to seek out the problems and deviations associated with administering drugs to patients, thereby eliminating possibilities of errors. A safety culture in a healthcare setting entails developing a culture within the institutions that will help in enhancing staff compliance, reporting of adverse events, and patient safety.
The long-term plan should be the establishment of a medication administration system that does not involve any form of error. This can be done through the use of modern techniques of handling, staff training, and exercise of precautions at workplaces.
Implementation plan
Short-term (0-6 months)
Specific Intervention: First and foremost, provide mandatory staff and drug safety education to different healthcare workers with special regards on medication safety with academic facility on the best practices on drug administration, how to avoid medication errors, and the five rights of medication administration.
Storage of Drugs and fluids: For safer storage of the drugs in health stoke, there is a proposal of redesigning storage systems, where high risk medication must be stocked separately from the common IV fluids and there should also be unique labeling to avoid confusion.
Long term (12+ months)
Barcode implementation: Implement and fully utilize the barcode scanning system on the drugs to provide medication confirmation on the drug administration point. This system will be useful in ensuring that the right drug is given to the patient and in the right dose to avoid further complicating the patient’s condition.
Policies: An organization should ensure they develop regular safety audit checklists and compliance checklists as well as ongoing compliance assessments to determine whether conformity is in order or not hypothesis.
Reference List
Journals
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