Review of the Role of Department of Health-Samples for Students

Question: Discuss about the Major Health care Deficiencies Identified in the Ducketts Review. Answer: Introduction Duckett report 2016 was commissioned in the response to a review of the role of Department of Health and Human Service in detecting and managing critical safety risks and clinical governance in the hospital system. It was due to the occurrence of a cluster of perinatal deaths at Djerriwarrh Health Service in between 2013 to 2014. Duckett in his report clarifies the misconception held by the Victorian population about the high quality healthcare across the system. He highlighted the significant deficiencies in Victorian healthcare system and health care systems defences against the avoidable patient injury. Ducketts work is a review of the hospital acquired diagnoses in the Victorian healthcare system that concludes the existence of complications in the hospital. The report states that around 300,000 patients suffer a complication in the Victorian hospital while receiving healthcare every year and at least 70,000 of them were potentially preventable. He also identifies a lack in monit oring process of the outcome data and it circulation in the hospitals to efficiently deal with similar situations that might occur in the future. Duckett suggested a series of modification in the Victorian Health Service in achieving the high level of clinical governance on safety and quality, monitor and circulate the outcome data and increase the efficiency of response when things go wrong. This essay will primarily identify the healthcare deficiencies mentioned by Duckett and his team in the review and relate them with the standards of National Safety and Quality Health Service 2012. Major Health care Deficiencies Identified in the Ducketts Review Duckett and his team have identified several issues that need attention to eradicate the health care deficiencies prevailing among the Victorian hospitals. The review addresses some of the major deficiencies that are discussed in the following. Isolation in Governance Many of the hospitals in Victoria achieved success in innovation, accountabilities to local communities and even reflect exceptional leadership. However, these successes are limited to the particular hospital. Ducketts (2016) report identifies the principle of devolution and local autonomy among for justifying the inadequacy and inefficiency of the healthcare system in disseminating the innovations achieved by individual hospitals. Implementation of strategies, incentives and cultural development are the keys to achieve the standard quality and safety as identified by Bismark, Walter and Studdert in their work in 2013. Ducketts report (2016) finds significant gap in the legislative requirements for big and small and the private hospitals. This contributes to the variation in adequate skills in both financial and legal sector (Bismark Studdert, 2014). Lack of proper justification leads the community to formulate the idea that these deficiencies are the medical issues that are resulti ng into the low quality of health service and safety. Implementation of strategies and specifying the roles and responsibilities of the board can help the hospitals increasing the quality. Complication of Health Care According to Duckett (2016), the complications that exist in the Victorian hospitals are a frequent case. The total number of the patients suffering from a complication in Victorian hospitals is above 300,000 out of which, around 70,000 were preventable. Moreover, Ducketts calculated a total number of 250 surgical deaths in Victorian Hospitals. The report made from Australian research identifies that one out of ten patients undergo a complication of health care during their treatment that can easily be avoided. The maximum numbers of the complications only have minor impact on the patients; however, some of the affected patients faces permanent disability and death. On the other end, these complications have devastating effect for the patients their families and healthcare system as it significantly increases the cost of the care across the system. Furthermore, these complications arise within the complex, high-pressure environments where mistakes are likely to occur. The hospitals n eed process of minimising the risk and consequences of human error. These complications results into failure of the system. The hospitals definitely need efficient management support that is support from the department to address the health care deficiencies. It might also facilitate the hospitals in taking swift and appropriate decisions during the strenuous situation by releasing the steam. The implementation of efficient manager can also result in strengthening the safety and quality of their care by using their vantage point and economies of scale to coordinate, facilitate and encourage improvement in efforts across the system. Lack of Transparency in Health care System Lee et al. (2015) pointed out the importance of transparency in the health care system is essential for maintaining high quality care. The patients and his family must know all the details related to the patients care and the charges (Christensen, Floyd Maffett, 2016). The lack of transparency and accountability in the health care deliverance is present in the system (Lee et al., 2015). The various events of death at Djerriwarrh Health Services highlighted the deficiency. Duckett (2016) argued for the transparency in the healthcare where the hospital is accountable for investigating the cases, and engage in an open disclosure with the effected families. The health care lack transparency as the process of treatment, chances and other important factors are not properly communicated with the patients. Hence, the patients and their family and friends find it difficult to make decision best suited for their situation. This reduces the efficiency, safety and the overall quality of the pro cess of health care in the Victorian hospitals (Hor et al., 2013; Ledema et al., 2012). The family members and friends of the patients should be informed about the identified risk of the procedure to take proper decision where both the public and private hospitals fail. Not only this Victorian public has no information about the safety standard or the record of the hospital and even if there is any information available it gives public false impression about safety. Flow of information and Data Sharing Issues The department should take responsibility for monitoring the safety and quality in Victorias hospital sector. The essential data are rarely collected or used or made available in an accessible form that limits the clinicians ability to use information to identify opportunities for improvement and strengthen safety and Quality of the care. Sometimes, routine is maintained for data collection on preventable surgical and perinatal deaths; however, it is rarely accessed by the hospital in future cases. Anderson and Kodate (2015) find importance of information in the continuously improving system and related it to the reporting system which can play the role of a useful resource for providing the critical data required for continuous improvement and risk management. Their view was supported by Van Spall, Kassam and Tollefson (2015). The report from the Department of Health (2017) also states about the limitations in monitoring and flow of data in Victorian health sectors. It evidences tha t only one percent of the total of 300,000 adverse cases are properly reported which can be used to support Ducketts findings. The administrative department fails to follow a standard for monitoring and data collection on the patient outcomes. Moreover, the administrative department does not have any idea of the number of complaints against individual practitioners. This disrupted information flow is a result of fragmented custodianship of data across the system combined with underuse of existing data. The data on clinical governance and safety issue is not shared by the department to the AHPRA on a routine basis. It results into failure of AHPRA in risk assessment. It means that the information on the cases related to unsafe and low quality service is not circulated to AHPRA. It reflects significant consequences that can mean that a lack of broader context about a health service can hinder investigation of individual practitioners, which otherwise be warranted. No amount of investi gation and intervention can speed up the process until the data is flows between the hospitals and AHPRA. The issue could only be eradicate if is flows from both sides. Moreover, the report presents the need of increased data collection and analysis and calculation of combined prone score using the pooled data from AHPRA and HCEs. Cultural Issue The workplace culture is one of the essential factors in the health care sector for providing quality care and maintaining safety of the care (Holland, 2017; Jeffreys, 2015). The review evidenced a number of unsafe health care practices that were deliberately continued over years. Duckett evidenced that a number of staff complaints were ignored, discouraged or even dismissed. The internal management did not detect the problem and failed to address the issues. This is the result of a weaker culture of reporting the cases of unsafe and low quality service that took place in the Victorian hospitals. Independent Clinical Expertise The independent incompetence or malice is another complication faced by the healthcare service of Victoria. A number of complex, high-pressure cases arrive where the patients are already frail and at risk of deteriorating. The mistakes easily arise in these types of cases. The hospitals require stronger process for minimising the risk and consequences of human error. The administration also needs to ensure the process of monitoring, reporting, reviewing and addressing these cases to ensure the avoidance of such incidents in the future time. This in turn demands for a strong system manager who can protect the patients from serious failures in the safety and quality. The role of the manager would be to oversee the quality and safety and ensure to take swift and appropriate decisions to address the deficiencies (Buchbinder Shanks, 2016). Relating the issues with National Safety and Quality Health Service Standards (2012) The Australian Commission on Safety and Quality in Health Care (ACSQHC) after consulting with the technical experts, jurisdiction and a wide range of stakeholders including the health professional and patients proposed ten National Safety and Quality Health Service Standards for the hospitals. Maintaining these standards can potentially increase the safety and quality of the health care service provided. The Standards are as follows: Standard 1 Governance for Safety and Quality in Health Service Organization that marks the standard of the quality framework required for health service organizations to implement safe system. Standard 2 Partnering with Customers that narrates the strategies and systems to create a patient-centred health system by including patient in the development and design of quality health care. Standard 3 Preventing and Controlling Healthcare Associated Infections that suggests the way of preventing the infection of the patients within the health care system and to control the infection effectively when they occur to minimise the consequences. Standard 4 Medication Safety highlights the strategies and systems that ensures the clinicians safely prescribe, dispense and administer proper medicines to informed patient. Standard 5 Patient Identification and Procedure Matching defines the process of identification of patients and properly matching their identity with the correct treatment. Standard 6 Clinical Handover states the strategies of effective clinical communication that needs implementation in accountability and responsibility for a patients care. Standard 7 Blood and Blood Products process of strategic management of blood and blood products to ensure the safety and quality of the blood that the patients are receiving. Standard 8 Preventing and Managing Pressure Injuries describes the guideline of preventing the patients from developing the pressure injuries and provide knowledge of the best practice management when pressure injuries occur. Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care explains the process of implementation of required health care effectively by the organization during the deterioration of the patients clinical condition. Standard 10 Preventing Falls and Harm from Falls that marks the strategies to minimise the occasions of patient falls ill and the best practice management if they do fall ill. The identified issues from the review of Victorian health services by Duckett fall under the Governance for Safety and Quality Health Service Organizations standard. It is possible to address the issues with this standard proposed by ACSQHC that describes the quality framework required for health service organizations to implement safe system. However, the issues identified require multilevel attention as they are related to each other. Hence, procedure implemented for the complexity issue might also be useful in addressing the information flow and service monitoring. On the other hand, a single issue might require assistance from a number of actions proposed in the governance standard. Clinical Governance Bringing improvement in the clinical governance requires to setting a governance system in the organization. The role of the system will be to set out policies procedures and protocols achieving the standardized safety and quality. This seeks for a clinical governance framework, identification of risks, collection and reviewing of performance data, implementation of prevention strategies, and analysis of incidents. Following these suggestions will help the organization to address the following issues that falls under clinical governance and increasing the quality and safety of the service. Complication of Health Care This particular deficiency identified in the review needs attention in the managerial ground and also the staff level training. The process of simplifying the complexity in the health care service needs a proper management. Hence, implementation of an appropriate leader for the task is necessary. A multiple level assistance required in resolving the issue. Lack of Transparency in Health care System The issue in the transparency in health care system identified from the report is possible to address with the standard 2 in the NSQHSS that calls for a customer centred health system. It asks the hospitals to include the patients in the development and designing process of quality healthcare. The hospitals needs to implement systems to support partnering with patients, carers and other consumers, clinicians and other family stakeholders in order to improve the safety and quality of care. The guideline 2.2 of the second standard of NSQHSS points out the requirement of forming policies, procedures and protocols for successfully partnering with the above mentioned parties. The hospital needs strategic and operational planning, decision making about safety and quality initiatives and quality improvement activities (safetyandquality.gov.au. 2017; Heyland et al., 2013). Flow of information and Data Sharing Issues The monitoring and data sharing issue faced by the Victorian health care service can be managed using the guidelines proposed under the Governance for Safety and Quality in health Service Organization Standard. Standard 1 make suggestion for establishing an organization with quality management system that monitors and reports on the safety and quality of patient care. It means that the health care organizations with the issue in information collection and data sharing needs to use a management system that will actively monitor the quality and safety standards of the health care being provided to the student. This will help the organizations to track the deficiency in the quality and safeties of the health care provided to the patient and formulate the necessary planning for addressing the particular deficiency. Moreover, it can ensure the flow and accessibility of the data when it is required. These proposed actions have the potential in improving the patient quality. The standard also proposes the hospitals to include the patients in the decision making process about their care including informed consent to treatment. This will enable the patient to make proper decision regarding the service they require. Cultural Issue A separate system is required in the hospitals to manage the complaints both from the staffs and patients as proposed by the Standard 1 of the guideline. This is due to the corrupted culture of the workforce in the Victorian hospital sector. Wachter (2015) calls for a just culture that will balance between the extremes of punishment and no blame for achieving goal for a improved healthcare system. It allows the workforce to recognize and report complaints regarding the quality maintenance in service. The patients will also be allowed to lodge a complaint if they find any complications in understanding or some unsatisfactory service is provided to them. The system will then analyse and implement the improvements required in response to the complaints. This feedbacks and complaints will be reviewed at the highest level of priority. The process must be made transparent to all the stakeholders of the health care service and the feedback will be communicated to them. Last but not the leas t, the patients feedback will be viewed with the highest priority. Independent Clinical Expertise The governance standard identifies the requirement of a training program for implementing the safe and quality health care protocol in the healthcare system. Implementation of this training program will increase the skills of the workforce and develop their information base that is required to fulfil the safety and quality roles and responsibilities (Nelson Staggers, 2016). The standard proposes for an annual mandatory training program that will help meeting these required standards. The training will be competency based training that will ensure the improvement and safety and quality service in the health care system. Conclusion The review conducted by Duckett and his team on the range of Victorian health care organizations has successfully identified several issues in health care quality and safety prevailing in the organizations. The issue is visible in both the private and public organizations of Victoria that needs consideration. The deficiencies that are identified in this essay are clinical governance, flow of information and data sharing issues, independent clinical expertise, lack of transparency, cultural issues and complication of health care. These are the primary reasons working against the Victorian health care organizations in providing high quality health care to their patients, though they are associated with good clinical outcomes. The change in the administration and workplace culture is required ensuring patient safety across the Victorian hospitals. The blaming needs to be changed into learning. The patients still do not receive the safest and high quality health care recommended for them . The workers need to be properly trained and they must have a proper understanding of their roles and responsibilities. It we help them to work accordingly that will lead to real and perceived changes in patient safety. The standards set in National Safety and Quality Health Service Standards (2012) proposes guidelines for managing and performing the operations that are necessary in health care organizing to function properly without disruption. Implementation of these standard guidelines can help Victorian Healthcare Organizations to overcome these issues. Introduction Change is inevitable in the present business scenario for the contemporary business organizations. This is due to the reason that, the current business scenario is much more challenging for the operating organizations than ever (Grant et al., 2014). Moreover, for the health care sectors, the rapid change in the technology and patient service is making more difficult for the health care organizations to operate. Hence, to effectively cope up with the change in the market and business scenario, it is important for the health care organizations to implement the process of change management in their internal management (Hayes, 2014). Moreover, the current business scenario is more oriented towards the customers compared to the organizations. Thus, effective determination of the requirement of the customers and identifying the grievances of the customers is important for enhancing the level of satisfaction and loyalty of the customers (Agrawal, Gaur Narayanan, 2012). In this case, also initiation of the change management will be beneficial for the business organizations. Effective implementation of the change management process will help the organization to offer effective customer service along with considering other aspects of the organizational effectiveness (By, Burnes Oswick, 2012). This essay will discuss about the initiation of different theories of change management and power in improving the internal culture of the organization. Stakeholders involved in the initiation of change management To initiate an effective management of change in the health care organization, it is necessary to indentify the stakeholders who can be involved in the change management. The key stakeholders in the change management will be the upper level management, employees and the patients (Bradley, 2016). Upper level management and the employees will form the internal organization in implementing the change. However, patients will be involved in the process due to the fact that the change management will be designed according to the requirement of them and thus it is important to effectively determine their requirement. Implementation of the change in the existing process It is been previously discussed and observed that, there is an urgent need of initiation of effective communication process in the organization (Shockley-Zalabak, 2014). This is due to the reason that, the existing communication channel is not effective in garnering the feedback from the patients and transmitting it to the upper level management. Thus, it is being recommended that an effective mechanism of communication system should be implemented in the hospital (Sorensen et al., 2012). Moreover, the employees have to be trained in reporting the patient safety issues to their manager. Thus, in initiation of the change management in the communication channel in the hospital, theories of change management will be used in order to create and design an effective plan to improve the internal organizational culture. Initiation of theories of change management Lewin model of change Various authors have given different theories of change management in the business organization. One of the most prominent theories of change management is being stated by Kurt Lewin. According to him, three steps should be maintained by the business organizations in implementing the change in the internal management effectively. Unfreezing The first step is unfreezing the resisting force in the organization (Manchester et al., 2014). This is due to the reason that in initiating change in any existing organizational procedures, resistance will emerge from the side of the employees and other stakeholders along with various infrastructural barriers. Thus, the process of unfreezing will help to resolve the barriers of implementing change. It makes the employees comfortable and aware about the potential benefits of the change. Moreover, the organizational structure is being modified according to the requirement of the change. In the case of this hospital, the upper level management should first aware the employees and other internal stakeholders about the implementation of the new communication channel and methods in the organization. They should be well aware about the benefits of having updated channel of communication. This will help to reduce the influence of the resisting forces. Change The next step in the Lewin model of change management is the implementation of the change. The updated technologies and other required infrastructure will be employed and the change will be effectively implemented (Shirey, 2013). The training process should be initiated and provided to the employees in order to equip them in handling the latest technologies in the communication channel. Moreover, training should also be given in enhancing their skills regarding the handling of patient security and welfare. Refreezing The last step will be the refreezing. In this step, the organizational procedures and structure will be taken back to their existing place after the implementation of the change. The more effective will be the process of refreezing, the more will be success rate of the change. McKinseys 7s model This model is also helpful in designing the organizational structure and other procedures in implementing the change in the internal management. The key advantage of this model is its holistic approach with having covered all the required aspects of change management (Singh, 2013). In the case of the discussed hospital here in this essay, this model will help to design the plan of the change management with considering all the required aspects and stakeholders of the organization. The above-discussed hospital can implement the change management in their management with the help of this model. Strategy According to this model, the first aspects to be considered are the strategy. To implement the change management in the organization, a specific strategy is required, which will act as vision for them in future implementation of the change (Cummings Worley, 2014). Thus, an effective strategy should be initiated in order to implement the culture of reporting the patient safety effectively. The next step in this model is the structure. Having an effective organizational structure is important due to the reason that the more effective will be organizational structure, the more effective will be the mechanism of the reporting in the organization. If the organizational structure can be effectively maintained, then it will be easy for the patient to report their safety issue to the employees and it can be effectively transmitted to the upper level management. Adhering with the health reforms should also be considered during the determination of the strategy. Systems and cultures The next step is the effective initiation of the systems and procedures. The more will be the effective system in the organization, the more will be the engagement level of the employees. Thus, in order to enhance the process of reporting in the hospitals in the Victorian regions, the internal systems of the hospitals should be effectively managed. This will help in increasing the engagement of the employees in the workplace. Thus, the increased level of engagement of the employees will help to effective transmission of the safety report from the patient to the upper level management. Organizational culture also holds an important part in enhancing the effectiveness of the change in the organization (Alvesson Sveningsson, 2015). This is due to the reason that, the effectiveness and flexibility of the organizational culture will determine the extent to which the employees can adhere with the implementation of the change. Thus, in implementing the plan of change the internal culture o f the hospitals of Victorian region, organizational culture should be made flexible and effective. Leadership roles In the process of initiation of implementing change in the organization, role of leadership also plays an important part. Thus, the leadership role in these hospitals should be effective and efficient in order to motivate and create effective vision for the employees. The level of motivation of the employees and their engagement in the workplace is being determined by the effectiveness of the leadership. In the case of the change management, the initiatives should start from the upper level management (Northouse, 2015). The leaders should convey and communicate the effectiveness and benefits of the change to be initiated to the employees. Moreover, the effectiveness of the working environment in the organization is being determined by the effectiveness of the leadership. Thus, in the case of the hospitals in the Victorian region, the style of the leadership should be changed first and transformational along with situational style of leadership should be adopted. It will help the hosp itals to enhance the level of motivation of the employees. In addition, initiation of transformational leadership will help to effectively communicate the organizational vision to the employees. Thus, the change in the taste and preference pattern of the customers will be effectively determined and situational leadership help to train the employees accordingly (Avolio Yammarino, 2013). In the case of the hospitals in the Victorian regions, initiation of effective leadership will help to enhance the level of motivation and job engagement of the employees, which will in turn help to create the suitable organizational culture for reporting the safety concern of the patient. Human resources along with the upper level management also play an important role in effective initiation of the change management. In the case of the hospitals in the Victorian regions, right employees for the right job should be employed. It will help the organizations in having the right expertise for the right job. In the change of the internal culture of the hospitals, having the right employees in the organizations will help to enhance the effectiveness in reporting the patient safety. Moreover, having the right employees for the right job will also help in effectively determining the issues in the reporting and resolving accordingly. Skill set of the employees The last step of this model is the skills that are being possessed by the employees in the organization. If the employees do not possess the right kind and amount of skills for their respective job roles, then the accomplishment of the organizational task will not be possible. Thus, it is required for the organizations and especially the hospitals in the Victorian regions to recruit the employees for the certain job role with having the needed expertise. The more diversified and effective skills being possessed by the employees, the more will be the competencies of the organization in the market (Gallie et al., 2012). Thus, in the case of the hospitals in the Victorian region, existing employees should be provided proper training and skill development courses in order to enhance their skill sets. On the other hand, newly employed employees should also be recruited according to the required skills in the organization along with providing them proper and suitable induction-training pro gram (Breaugh, 2012). This will help them in enhancing their existing skill sets. This will help in enhancing their capability in adhering with the change being implemented in the organization. Moreover, the reporting of the safety concern of the patient will also be more effective due to the enhanced expertise and skills of the employees. The employees with their diversified skill sets will effectively solve the safety concern of the patient. Initiation of theories of power Along with adhering with various theories of change management implementing the change in the internal culture of the hospitals in the Victorian regions, adhering with the theories of power will be also be beneficial for them. This is due to the reason that according to theory being given by French and Raven, without influence or power, the procedures in the organizations will cannot be effectively managed (Lunenburg, 2012). According to them, the effectiveness of the role of the leadership will only be proven if they can effectively utilize power, authority or influence in managing the internal organization. Thus, in the case of the organizations in the Victorian regions, the upper level management should the power according to the situation in order to effectively lead the organization. Power is of five types, which should be initiated according to the generated situation and external environment. However, it should be considered that, initiation of power is not only about negatively managing the employees rather than rewarding and recognizing the effort of the employees are also being included in the theories (De Gieter Hofmans, 2015). Among the various types of power, expert power and reward power will be the most effective for the Victorian hospitals. This is due to the reason that, there are no employees issues that are being generated from these hospitals and thus there is no need of exercising the coercive power. This is in turn will create negativity and lower the morale of the employees. On the other hand, initiation of reward power and expertise power will help the upper level management to motivate the employees along with guiding them in determining the change in the market scenario and work accordingly. With the effective initiation of power by the upper level management in the organizations, the implementation of the change will be more efficient. The leadership qualities will get enhanced further along with effectively controlling the internal management of the organization. In reporting of the patient safety in the hospitals, the initiation of the use of power will motivate the employees in reporting the safety in timely manner and to the responsible stakeholders. Initiation of power will act as the complementary to the initiation of the change management in the organization. Thus, the more effective will be the initiation of the power, the more effective will be the implementation of the change in the organizations. Challenges to change in health care Resistance from the side of the employees is one of the key challenges being faced by the organizations. This is due to the reason that employees will have the fear about the change to be implemented in the health care organization (Payne Askeland, 2016). This is due to the fact that, employees will have the fear of the uncertainty associated with the implementation of the change. Another challenge that may get aroused is the fact that the implemented change may not adhere to the existing culture of the health care organizations, which will further reduce the efficiency of the health care (Mclnnes et al., 2012). Aligning the implemented change may also not adhere with the health reforms. This, it will also difficult task for the health care organizations to effectively adhere to the various health reforms. Planning process Thus, after evaluating the various theories related to change and power, it can be concluded that an effective planning process will be required to counter the safety issues in the ward. In this case, Kotters eight stage model will be the most effective model in designing an effective planning process (Appelbaum et al., 2012). The first step is establishing the sense of urgency in the health care organization. It is being expected that the prime motive if the health care organizations will be to ensure the safety and health of the patients. Thus, the first step is the identification of the crisis or gaps in the existing process. This will help all the internal stakeholders to act accordingly. As discussed earlier, leadership plays an important role in the managing the safety concerns. Thus, leadership role should be played in every organizational structure. For instance, in nursing, leaders should be made, who will provide guidance to others. This will enable more sharing of knowledg e among the peers, which further resolve the issues. Creating and communicating the vision to the subordinates is also important. According to the Ducket (2016), creation of the vision to the employees will help them to adhere to the health standards. As discussed earlier, effective channel of communication is important to communicate the vision to the employees. However, it should be considered that, the communication process should be both ways, which will enable the employees to gain the visionary ideas as well as providing effective feedback. Thus, any type of safety concern will be effectively identified and solved. For ensuring the patient safety, employee empowerment is also important (Guffey Loewy, 2012). This is due to the reason that, if the employees will be provided with enough resources and equipment, then they will effectively meet the safety standards. Rewarding the employees will also be beneficial to ensure the patient safety. This is due to the reason that, employees will be more motivated if they are being rewarded and recognized. Thus, short term targets should be made for the employees, which will be easy for them to accomplish. Continuous process of monitoring and evaluating the change process is important due to the reason that, it will help to determine the effectiveness of the change process in solving the patient sa fety concern (Moore et al., 2015). Accordingly, the strategies should be rectified and modified to enhance their effectiveness. As discussed earlier, shared leadership and visionary leadership will be beneficial for the change process. It will help in continual development of the change process according to the change in the safety concern in the health care organization. Conclusion Thus, in order to implement an effective plan of change in the internal culture of the hospitals in the Victorian regions, an effective initiation of the change theories and power theories should be considered. This will help the hospitals in motivating and engaging their employees in order to implement the change in the organization without having any resistance from their side. Moreover, the initiation of the theories of the change management will help to consider the various aspects of the change management, which will help them to initiate a holistic approach in the change management. On the other hand, the initiation of the theories of the power will help to enhance the leadership qualities in these hospitals. This will in turn will help the hospitals to lead and motivate the employees in effective plan of safety reporting of the patients. 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