For this specific case, the issues that have been discussed are dynamics and leadership, lack of assertiveness, communication errors, and patient safety concerns. Alternatives and recommended solutions for this case will include an evaluation of performance strategy and a comparison of performance to expectations.$$

The first step of this evaluation is introducing a model to help collaborate on the common issues in this healthcare system. The improvement model that can best help and reintroduce procedures and time management is the Lean improvement model. The Lean improvement model eliminates adverse inefficiencies that affect performance outcomes. The goal is to minimize waste and in this case, the waste is a lack of assertiveness and communication. In a systematic literature review the Lean improvement model was tested and used to eliminate poor qualities in certain healthcare fields regarding communication and lack of readiness. By using the Lean improvement model they step by step increased the healthcare environment and ultimately gained experience $($Ramori$,2019).$

The Lean improvement model is a model composed of eight steps. The first step is identifying the performance problem which is mainly a lack of assertiveness and communication errors within the staff of the hospital. Step two is evaluating current work processes which in this case according to the case study during the case handoff at shift change there was insufficient communication for the deteriorating heart rate of the baby and mother. Therefore the attending resident leaving the unit without letting the team know about the recent medical discovery further worsened the patient's outcome.$$

Step three is identifying potential areas for better opportunities. This could include better handoff from shift to shift teams, making sure there is time between each shift to allow attendings and the team to go over each patient's conditions, and staffing enough people so they are allowed this time.$$

The next step is finding the root causes for which the problems occurred which went over as the attending resident not having enough time or assertiveness to allow the new team coming in be caught up on the current condition of the patients in the unit. This underlying issue could be understating at the hospital or poor time management guidelines that have been set.$$

The fifth and sixth steps go together in designing a better way to be working and creating an implementation plan. Healthcare is now one of the largest and most complex industries in the United States involving employees and patients. Healthcare expends more than eleven percent of gross national product and costs. Healthcare problems in the hospital are worldwide known. In this book by Jeffery Pfeffer, he explains that time management and assertiveness are constantly an issue in healthcare systems. Designing a better way to be working is nearly impossible because healthcare is constantly changing and advancing. The three major steps provided that could be implemented in this case would fix the short staffing. This could be done by adding incentives for picking up shifts more often or hiring overflow staff at all times. The second step would be shift times allowing at least thirty minutes at the end of each shift change to allow communication to be handled effectively within the different teams. The third and final step would be allowing breaks into the shifts so that the workers are allowed stress relief time because as Pefreffer states there is no time for mistakes in healthcare $($Pefeffer$,2003).$

The next step of the Lean improvement model is to identify expected improvements. These improvements could be better communication about patients' needs and conditions. This also can open the door to allow assertiveness to be a top contender to allow the patients who are worsening to be checked on more frequently and not left alone.$$

The final step in this process would be measuring the good and changing things for the bad outcomes that occur. To allow changes to come in there will be bad outcomes. The healthcare community is changing constantly and implementing this improvement model will allow patients to feel safe and taken care of so that a case like this will eventually never have to happen again.

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