1. Refer to the EQUIP 6 Standards and Criteria to identify 3 criteria/standards that were not met and negatively impacted the care of Naomi Williams.
2. Discuss the interrelationship between clinical leadership and clinical governance in ensuring safe, quality patient care in the case study; then using the Swiss Cheese Model of Accident Causation, identify the systems and processes that resulted in the errors that led to the death of Naomi Williams.
3. Review the coroner’s recommendations and identify areas for change. Using Kotter’s 8-step change management model, justify how you would put the changes into practice.
case study in the link below:
https://coroners.nsw.gov.au/coroners-court/download.html/documents/findings/2019/Naomi%20Williams%20findings.pdf
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