Answer the following question in 800 words essay form after reading the case study below. Use online sources and cite them harvard style (intext). 1 source per paragraph minimum.

Question:Drawing on your knowledge from weeks 7AND8, what factors have contributed to the effective team work demonstrated in the Accident and Emergency Department? Advise the manager of any risks associated with this strong team approach.

Appendix A: Assessment Case Study

Middleton NHS Trust

Middleton is one of the largest NHS Trusts in the UK. With an annual budget of over 970 million and around 13,000 clinical and support staff, it provides medical services to a population of over one million patients per year and recently received a rating of 'Good' from the Quality Care Commission. The Trust Board of Executive Directors and Officers are responsible for setting the strategic direction of the Trust lead by the Chief Executive Officer (CEO). Its vision of providing "Exceptional Care Together" is supported by clinical, quality, people and finance strategies that aim to: put patients first; get things right first time; invest resources wisely and develop and nurture staff.

Departments are organised into four clinical divisions: medicine; surgery; cancer diagnostics and clinical support;women's and children's services, each lead by a Director of Services and General Manager. There are also six non clinical departments in the structure: operations; finance, performance and IT; workforce management; strategy improvement; corporate affairs and governance; patient experience and facilities management, each run by a non-medical Director.

Within each division/department there is a traditional hierarchy of medical and administrative staff, paid according to a rigid national pay band structure. In July 2022, the government announced NHS staff, including nurses, paramedics and midwives, porters and cleaners, would receive a pay increase of up to 9.3%, Doctors and Dentists, 4.5%. With high inflation this represents a pay cut in 'real terms'. However, staff also receive 27 days annual leave (rising to 33 days after 10 years service) and access to a generous NHS pension scheme. A package of childcare services and vouchers, occupational health care and counselling services, work related training and development, as well as a range of discounted products and services for NHS employees are also available as well as long service awards.

The Trust has recently faced its most challenging period in the 73 year history of the NHS, managing its five hospitals through the COVID pandemic. Amazingly, during this period they have completed a significant change project. This has included the extension of the treatment centre into a state-of-the-art building, the largest investment in the Trust for over a decade. Despite this success, The Trust is under pressure. In particular it is struggling to recruit and retain enough staff to operate its services within safe operational standards. A recent report from the Health and Social Care Committee estimated a shortage of 50,000 nurses and midwives and 12,000 hospital doctors in England alone (Ford, 2022). With accompanying concerns about staff wellbeing, an environment of chronic stress, and burnout, the British Medical Association (BMA) has compared the retention problems in the NHS to a 'leaky bucket' caused by understaffing, increased workload and bureaucracy. In August 2022, The Nursing Times reported 1/3^rd of healthcare workers 'feel overwhelmed at least once a week,' almost half are considering a job change and nearly a fifth plan to leave the care sector all together. Similarly, in September 2021, 43% of respondents to a BMA survey said they planned to retire early and 50% said they planned to work fewer hours after the pandemic.

Surgery Division

The Trust has one of the largest planned surgical programmes in the country with the third highest number of elective (planned) operations. The expansion of the treatment centre increased the number of patients who can have surgery but the pandemic called for a reallocation of resources so that critical care for COVID-19 patients was available. This exacerbated an already large backlog of surgical cases and has resulted in huge pressure from the Board to reduce waiting lists as quickly as possible. The department has failed to meet the government's target to reduce the wait for elective cases to less than two years by July 2022 (www.england.nhs.uk). By April 2023 this should be down to less than 18 months!

Despite a well-run recruitment campaign to staff the new unit, the department is experiencing some significant staffing problems and some staff have been working for 12 days in a row without a break. Sickness rates in the theatre department's team of porters, responsible for moving patients around the department and between the theatre and the hospital wards, is also well above the hospital average with significant impacts on the speed at which patients move through the department. The late arrival of patients for their theatre slots has resulted in medical staff standing around waiting for patients to arrive and theatre sessions regularly running late. While many of the theatre nurses have been happy to work during these over runs for free in the past, this has now become so regular that they are asking for overtime payments to be made and staff have made complaints to their Trade Union representative.

Patient Experience and Facilities Management Department

In the Medical Records Department changes have been implemented to bring all of The Trusts records and appointment services into one central department to reduce costs. Staff have relocated from two community hospital record departments to a new purpose built administration and records library. In the community hospitals, records staff covered all jobs in the department, preparing medical records for clinics, sending out appointments, setting up new clinics on the computer system, filing, and answering telephone queries from hospital staff and patients. In the new department, these functions have been separated out so each employee can specialise in one area and build their expertise. Detailed procedures have been drawn up for each function to help improve consistency of service, for example when dealing with patient enquiries staff now follow a script on the computer to ensure they cover all the necessary information. Staff have been carefully briefed on the procedures relating to their own jobs and trained on the new computer and telephone system. The records manager also holds daily team briefing sessions with staff to cascade information to them about the department's performance. She appears to be in firm control of the department giving clear directions about what needs to be done each day, allocating each task to a member of staff. She has also completed all the staff appraisals and set every team member the same performance objectives to meet the departments key performance targets (KPT).

However, this department has also experienced some difficulties. One of the biggest complaints from the clinics has been the loss of patient records. Clinics have been held up and some patients have had to have medical tests repeated as a result. This has led to a lot of 'in fighting' in the team with divides appearing between staff from the old hospitals. When the records manager investigated she found a number of the missing files had been withheld by the doctors and consultants themselves revealing a problem with the overall process rather than with the ability of any of the team members. She is working on designing a new process to tackle this but her discovery has done little to heal the rift in the team. Two of her best staff have left the hospital to take jobs elsewhere and remaining staff have been reluctant to move their shifts around to cover the service. Friday afternoons and 'out of hours' (evenings and weekends) are particularly difficult to cover so staff who do work those shifts come under considerable pressure to keep up with answering queries and dealing with problems.

Medicine Division

Staff relationships appear to be better in the Accident and Emergency Department despite increased levels in the number of patients attending the Royal George A&E department to nearly 1,000 patients a day, as a result of limited GP capacity. The average waiting time in the department is currently 8 hours and 20 minutes, breaching the target of 4 hours from arrival to admission, transfer or discharge. Staff prioritise patients with the most severe injuries but the long waiting times are increasing customer complaints. They may even be behind higher-than-average reports of staff personally experiencing physical violence from patients in the department. At 1 in 5 this is the highest level reported in the Trust.

The new Clinical Manager has spent a lot of time in the department talking to patients and staff and observing its day-to-day operations. She set up a number of action teams and asked them to look at developing and putting in place solutions to a number of the key problems including speeding up the patient booking in service, the treatment and discharge of minor injuries and the completion and return of results from blood and radiological tests. Each team consisted of a mix of staff including doctors, nurses, administrative staff, and porters and was asked to spend 15 minutes, twice a week working on their solutions. These have been popular in the department and are now moving on to examine problems around wellbeing in response to staff suggestions. The manager told the staff she thinks this is a great idea and has offered to help the team by talking to the other Clinical Managers to see if they would be willing for the A&E teams to visit and talk to their staff to identify any examples of good practice which they could use