Critical Decision Making for Providers

Overview of the Scenario

The "Critical Decision Making for Providers" scenario relates to two critical issues regarding the management of a hospital. The first issue involves keeping patients safe while the second relates to protecting the hospital from inordinate judicial liability. Mike, a hospital administrative employee notices a spill on the floor at the hospital. The right decision from the perspective of the hospital is to ensure that the spill gets cleaned as soon as possible and also that patients are warned not to step on the spill prior to its getting cleared. The right decision from Mike’s personal perspective is to get signed in as fast as possible to avoid getting fired for tardiness. When Mike decides to ignore the spill, he creates an active safety risk for the hospital due to patient falls. When a patient falls and is injured then Mike becomes involved in handling the patient, he exposes the hospital to even a larger liability whether or not he admits that he knew about the spill but ignored it. 

Consequences of Failure to Report

As indicated above, the consequences of failure to report are twofold as they relate both to patient safety and litigation against the hospital. Based on the scenario in question, the failure to report my Mike not only exposed patients to danger but also make Mike a ticking time bomb for the hospital from the perspective of litigation. The spill that Mike ignored led to the fall of a patient who most probably has a hip injury. The hip injury will not only cost the hospital a lot of money to treat but also lead to a possible litigation for negligence. Unfortunately, Mike is now involved in the investigation of the incident and will thus be reflected in the incident’s paperwork. If the issue ends up in court, most probably Mike will be deposed as part of the hospital team that handled the case. If Mike fails to reveal the part that he played by not reporting the spill and handles the case while he is still feeling guilty about the part that he plays, chances are he will be caught in a lie during deposition. The hospital will be liable for willfully ignoring a spill and trying to cover it up under the concept of vicarious liability (Alert, 2015). Possible damages from such a case can ruin the entire hospital. Mike should not only report his involvement by not reporting the spill immediately but also avoid any contact with the patient as legally speaking, he is now radioactive. 

Impact of Mikes Decision

On Patient Safety 

Patients are highly vulnerable to slip and falls due to their physical and psychological states or the medication administered to them (O’Neil et al., 2015). Further, the propensity for injury from a fall for most patients is higher on average than that of other individuals. A spill on most modern floors would almost guarantee a fall on anyone who steps on it with the risk increasing when a patient steps on it. Leaving a spill on the floor in busy part of the hospital amounts to expressly placing patient safety and even patient’s life at risk. 

Risk of Litigation 

Since the risk of patient falls is well known, it would be reasonable to assume that hospitals have an obligation to avoid spills on their floors. A fall caused by an accidental spill that is cleaned reasonably first but caused a fall anyway can still create a risk of litigation (Sohn, 2013). The risk is exacerbated if the spill took long to clean as this reflects negligence. Further, if it is revealed that the spill was discovered and ignored, the negligence develops an element of reckless endangerment which augments the risk. The worst-case scenario, however, would be if the hospital is accused of a cover-up as it would most likely attract punitive damages. 

Organization's Quality Metrics 

Human is to error hence any hospital floor can have a spill due to a variety of accidents caused by patients or members of staff. However, Mike finds a spill that has not been discovered, that is not marked to warn patients, and that is not being cleaned. The scenario in itself is reflective of lax standards with regard to patient safety. Secondly, finding a spill on the hospital floor should normally have so alarmed Mike that he should have called for help without leaving the scene of the spill to protect any patient that might walk by. The fact that Mike left the scene, even if it is to report the spill reflects lax in safety quality (Alert, 2015). 

The Workload of Hospital Departments

Among the reasons why the safety quality metrics of the hospital are lax as indicated above is due to work overload by departmental staff. According to the scenario, housekeeping takes 3-5 minutes to arrive at a sight even when the issue is as urgent as a spill. Within five minutes on a busy corridor, several patients could already have been injured due to the fall. The housekeeping department’s members of staff are clearly overloaded and understaffed. 

Solution to the Problem

If tasked to solve the instant problem, I would take a threefold approach. The first approach relates to the security department that would be expected to have some form of CCTV network and foot patrols. Since spills are safety and security issues in hospitals, the security team would be advised to be on the lookout for any spills (Alert, 2015). The second approach would relate to an instruction made to all members of staff that any spill found anywhere in the hospital becomes the immediate obligation of the finder. A person who finds a spill will not leave the spill unless it is handed over to another person capable of handling it. The finder will stand next to the spill and ensure no one steps on it until someone else takes over responsibility for the spill. The final approach in the instant scenario entails the increasing of housekeeping members of staff and conducting spill drills until a spill can be cleaned within a minute of discovery.

References

Alert, S. E. (2015) Preventing falls and fall-related injuries in health care facilities. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_55.pdf  

O’Neil, C. A., Krauss, M. J., Bettale, J., Kessels, A., Costantinou, E., Dunagan, W. C., & Fraser, V. J. (2015). Medications and patient characteristics associated with falling in the hospital.  Journal of Patient Safety , 14 (1), 27–33. 

Sohn, D. (2013). Negligence, genuine error, and litigation.  International Journal of General Medicine, 2013 (6), 49-56. doi:10.2147/ijgm.s24256