Tom Fulton Clinical Case Analysis Using Fishbone Diagram

pages Pages: 4word Words: 890

Question :

SNPG927: Promoting Clinical Excellence

Task Description

Identify a patient story / narrative related to the quality and/or safety of health care. The patient story / narrative may be based upon your previous experiences or be identified from published literature (including videos, books and journal articles). The patient story / narrative can relate to an identified near miss, an actual breakdown in care or an example of high quality care. Provide a summary of your patient story / narrative and describe the context in which the healthcare experience occurred. Analyse the care the person experienced using The London Protocol or Significant Event Audit (SEA). You should also include a Fishbone Diagram as evidence of your analysis of the patient story /narrative. Using the components of clinical governance (consumer participation, clinical effectiveness, an effective workforce and risk management), discuss how these components can be used to improve the quality of care the patient experienced.

Subject Learning Outcomes Assessed

1. Explore and critically analyse current literature regarding health service design and delivery. 

2. Analyse client/patient narratives and ‘nursing stories’ about care and caring. 

3. Synthesise literature relating to current models of clinical supervision within a selected nursing workplace 

4. Explore principles of risk assessment, surveillance and monitoring; Analyse the concept of clinical reasoning in the context of clinical excellence.

Show More

Answer :

Promoting Clinical Excellence


Today, with increased globalization and with advent of new technologies, it is found that the need the healthcare organizations are deploying new models and frameworks for the purpose of improving the quality of healthcare services delivered to the patients. Today, with introduction of new technologies, it is also found that the patients and their family members have turned aware of the different healthcare issues and are thereby expecting better quality healthcare services in a given environment (Ziebarth, 2014).

The purpose of this paper is to use the Fishbone diagram and thereby analyse the case of Tom Fulton, who is suffering from diabetes. The report will include the narrative of Tom Fulton and will identify the possible causes of the failure of the organization to provide him proper treatments. Also, it will then discuss the role of clinical governance in today's ear and how it can be applied to improve the quality of care services.

Need for Quality Healthcare Service Design and Delivery

Researchers have found that there are challenges in the present delivery model due to which the nursing staff is not able to deliver as per the expectations. The nursing staff also lacks desired knowledge, training, and motivation to perform as per the needs of the organization (Ziebarth, 2014). 

There are no proper leadership models implemented in the organisation due to which the nursing staff will lack coordination, working approach, and confidence in performing their tasks in a given environment. It is thereby important for the senior management to carry out careful planning of these issues and then implement proper plan in a given healthcare organization. 

There is a need to improve the healthcare delivery through - imprison time to diagnosis, improve patient-reported outcomes, overcome practice management issues, improve coordination, ensure that the staff adheres to the compliance, and also train the staff to improve their working practices in a given environment (Simoens et al., 2013). 

The nursing staff needs to consider the aspects of - quality deployment in the different healthcare services, teamwork improvement, value improvement, sustained management, improving thinking from the statistical perspective, and finally, overcome the challenges of the workplace. There is a need of continual improvement through - corrective action plan, patient feedback, auditing of the different practices, analysis of the current practices, and revamping the service delivery model to ensure that the nursing staff is able to deliver as per the needs of the healthcare organization (Simoens et al., 2013).

Patient Narrative

In one of the case scenario, a patient suffering from Diabetes was admitted in the hospital. The healthcare organization had deployed quality management models to ensure that the nursing staff will deliver as per the quality management aspects and principles in a given work environment. 

Mr Tom Fulton is 56-year old living in New Jersey City and has just retired from his job. He was suffering from Diabetes since last five years. He also had consulted the physician earlier after which he was following the prescribed medications and other instructions. 

However, since last week, his health deteriorated and was thereby required to get admitted in the hospital. He was suffering from chest pain as well as felt uncomfortable in living in the present working environment. During the initial screening process, it was found that he not only suffered from diabetes but also faced certain cholesterol level issues. He sometimes became drowsy and hence was required urgent medical attention.

When Mr. Tom Fulton was admitted in the hospital, the nurses and there consulting physician did not record much of the initial medical information of the patient. They even asked for any historical reports to get to know more about the issue of diabetes. Later, when the diabetes specialist entered the room, he explained the situation of diabetes to the family of Mr. Tom Fulton. He even recommended to stay in the hospital for five days so that he can get proper treatment. 

However, this specialist was busy with other cases as well and hence did not provide any other additional information of taking care in a given environment. The rest of the staff did not provide proper support and due to which the condition of Mr. Tom Fulton was deteriorating day-by-day. 

After four days, Mr. Tom Fulton all of a sudden experience a heart stroke and seemed critical. The surgeon and other specialists rushed to the situation and immediacy started provided antibiotics and their medication. He was experiencing shakiness and was feeling drowsy. He was not even able to speak to norm about his situation and other medical needs in a given environment. 

Later, after one day, the situation seemed normal and the consulting physician informed to the family that the conditions were under control and Mr. Tom Fulton will be allowed to get discharged after two days. Fortunately, after two days, the conditions seemed normal and Mr. Tom Fulton was happy to leave the hospital. He arrived back home and decided to take full rest for the next whole week. 

Later, after one day, he again experienced stroke and in an emergency situation he was again admitted to the hospital. It seemed like the medical professionals were not only lacking the desired technical knowledge but also did not provide any type of psychological support to the patient. They lacked experience in handling the given situation, which further deteriorated the situation of Mr. Tom Fulton. 

It is thereby important to follow the principles of clinical governance in a given environment and subsequently provide him all types of support that will assist the patient to get recover soon from the present situation.

The patient also narrated that none of the nursing staff was able to consult him despite the fact that he was in need of a proper medical consultation. Further, the nurses did not arrive for proper clinical supervision on time and due to which sometimes the sugar levels used to increase. However, it was automatically controlled through different medical measures. 

It thereby raised a question on the quality management aspects of the organization. The given healthcare setting did not focus on the issues of - patient satisfaction, process improvement, commitment needs, and other environmental factors of the organization. Hence, considering these aspects it was important for the healthcare organization to improve their healthcare service delivery model in a given environment.

Based on the procedures followed and the type of communication carried out in the organization, it seems that the healthcare organization needs to revise their current strategies. They need to work on - medical errors, reducing delays, overcome coordination issues, and thereby improve the quality of healthcare services in a given environment. There are several issues found in the case of Mr. Tom Fulton and hence, it is necessary for the top-level management to focus on each of these aspects and thereby overcome the failures in a given environment. 

Improving Safety and Quality in Patient Care Through Deploying Clinical Governance Framework

  • Consumer Participation

To improve the quality of care in a given environment, it is important for the nursing staff to overcome the challenges and focus on improving their current practices. Base on the given case, it is first important to analyse the medical history of the patient. Second, the consulting physician needs to improve on his working approach in a given environment. 

He needs to communicate clearly and effectively to gather all the required information for treating the respective patient. He needs to deploy the principles of clinical governance and thereby improve the current work environment. 

The healthcare professionals need to support the family of Mr. Tom Fulton and assure them that he will be alright and will get recovered soon. It is important to remain clear in communication and provide accurate information to the patient and their relatives. For example, communication skills' training will help the medical professionals to overcome such issues and improve their working efficacy in a given environment.

  • Clinical Effectiveness

There are different models deployed for the purpose of improving clinical effectiveness in a given healthcare environment. The first is the self-monitoring model that will help in evaluation the current healthcare services in a given environment. These include - goal setting, case discussions, evolution of the practices, and reviewing the work approach. The second is the APT Model of supervision that can be implemented in the organization (Karlsen, 2012). 

It refers to the attitudes, processes, and tools that will assist the nursing staff in improving their services in a given environment. Attitudes reflect to the confidence levels, evidences provided, motivation, and self-awareness levels of the nursing staff. The processes reflect to - defining focus, training, problem-solving, and decision-making attributes of the staff in the organization. 

And, tools refer to - scaling, making changes, questioning the current practices, and finding exceptions in the organization. There is also another model known as Gibbs Model for Reflection that assist the nursing staff for clinical effectiveness. It includes - description of the problem, identifying the needs of the patients, evaluating the performance of the present strategies, analysing the need of new model, developing the action plan, and implementing it to improve the current practices of the nursing staff in a given healthcare environment (Karlsen, 2012).

  • Effective Workforce

To improve the care-delivery it is important to improve the working approach of the workforce in the organization (Bowblis, 2012). They need to be trained on the aspects of clinical governance and clinical effectiveness to achieve required objectives and also to serve as per the needs of the patients. 

There are several aspects that they need to consider while working in the healthcare organization. These include - healthcare management, remote care monitoring, caregiver scheduling, care tracking, and care providing to the different patients admitted in the hospital. It is further important to deploy the IT tools in a given environment that will improve the consultation, implementation, enablement, support, and customization services in a given healthcare environment. 

Also, the HR department of the organization needs to train the nursing staff on the aspects of Total Quality Management that will focus on - commitment levels, culture, continuous improvement, cooperation, customer focus, and control in a given environment (Bowblis, 2012). It will ensure delivering of standardized and better quality services in a given environment.

  • Risk Management

The different failures of the healthcare institution forced the organization to monitor the current practices, identify the gaps, and thereby improve the safety and quality of patient care in a given clinical environment. It thereby suggests that there is a need to overcome the different risk factors in a given environment. Even in this case, there are issues that include - scheduling problems, unable to meet the expectations of the patients, unable to meet the professional standards of the organization, issues with the Human Resources management, inadequate practices of quality management, lack of professional scope, lack of motivation, and also lack of planning in a given environment (Yankovic & Green, 2011). 

It is thereby important to deploy the practices of nursing surveillance and monitoring to ensure that the nursing standards can be improved in a given work environment. Further, the nurses need to be trained on the aspects of risk management and thereby deploy controls of quality management in a given environment. 

It will thereby help the organization to not only overcome the issues of workplace but will also help the nursing staff to improve their professional working approach in the organization. Further, the nursing staff needs to deploy the practices of Total Quality Management to overcome the quality aspects and other issues of monitoring in the organization. Only then the nursing staff will be able to improve the satisfaction levels of the employees in the organization.


Considering the given case of Mr. Tom Fulton, the nursing staff needs to learn and deploy the aspects of - leadership, governance, culture, patient engagement, provider engagement, performance tracking, and shared vision in a given organization. Also, the top-level management of the organization needs to provide the strategic plan on improving the healthcare practices in the organization. 

The nursing staff in a given work environment needs to consider the needs of the patients as mentioned in the narrative and thereby ensure improving the quality healthcare services in the organization. The top-level management thereby needs to deploy surveillance and monitoring tools to monitor the performance of the nursing and medical staff in a given environment (Seo & Spetz, 2013). 

It will further improve healthcare services from the aspects of - management, leadership, control, monitoring, and surveillance in a given healthcare environment (Dolfman, Insco, & Holden, 2017). Even, the nursing staff needs to learn operating on the technological platforms and thereby ensure better coordination in a given work environment.


Today, with advent of new technologies and with deployment of new frameworks, it is found that the expectations of the patients from the healthcare organizations have increased. It is important to deploy the Deming's Cycle for the purpose of - planning, doing, checking, and acting on the new techniques of quality management to deliver healthcare services as per the expectations of the patients. 

The nurses need to ensure that they overcome the challenges of the workplace as discussed in this report and subsequently provide quality services to the patients (Arling et al., 2011). Further, they need to work on improving the delivery models in the organization and thereby overcome the challenges of the internal and external environment. 

With the help of surveillance tools, the senior management should gather necessary feedback and reviews of the patients; it will help them to work on the gaps and thereby improve the services in a given environment. The nursing staff through their effective nursing supervision should thereby be able to achieve desired excellence in a given environment and accordingly complete the tasks within the given timeframe and as per the needs of the healthcare organization.