Facts of the case
There are several facts about the case. First, the hospital is experiencing increased cases related to substance abuse that has shifted regular expectations that can be handled by the hospital in terms of capacity and available facilities. Secondly, the good relationships between Greenville Community Hospital (GCH) and the large psychiatric hospital adjacent to it started long before the present challenge that is experienced currently that has caused sharing and cooperation between the two hospitals. Thirdly, the cost-of drug rehabilitation facilities and service in the area is very expensive for most patients. Some patients struggle financially, and the expenses are beyond their reach discouraging the private pay and, hence, many patients with drug rehabilitation needs and services have opted for the Medicaid supported services resulting to overbooking and, thus, delays that strains the GHC and the adjacent hospital services and facilities. Fourthly, placing the psychiatrically challenged patients alongside routine medical-surgical patients increased the risks and vulnerabilities of possible negative consequences that breached security and safety measures as noted in the Rosemary (the nurse) case. Fifthly, the GCH, and the nearby hospital despite the good relationship and objective to help both patients by sharing the facilities, failed to take up pro-active measures that would deter possible negative consequences from their actions such as a threat to security bearing in mind that drug substance abusers have higher chances of behavioral challenges. Finally, the case shows that drug addiction psychiatric patients have multiple health issues secondary to substance addiction and, thus, require special attention and care by the concerned health practitioners.
The management implications of this case and what the management ought to do to protect their employees
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The management is implied negatively in the case. It indicates poor management skills and failure to plan and adjusts to the changes not only related to facilities and the provision of hospital services that need to be taken, but also other fields and organizations that enhance safety and security to their employees and also the clients or customers as well. The management, in this case, failed to put up measures that could be commensurate with the abrupt changes that the hospital at GCH realized. When the two hospitals are adjacent to each other (GCH and the large Psychiatric Hospital) geographically does not justify the action taken by the two hospitals of merging the admission departments by the two hospitals especially on the emergency cases. It is because the two hospitals meet different patients that have diverse needs and risks. Therefore, it indicates that the management failed to provide leadership and adhere to the ethical and moral concerns guiding such hospitals and the practice of healthcare and also, showed negligence and unprofessional management conduct that fell below the minimum standards set in the management and administration aspects.
The management has a great responsibility to protect their employees as well as the facilities and patients (clients) that visit their premises (O'Connor, Ward, Newton & Warby, 2013). Management first and foremost has to ensure that there exist safety and security in the hospital environment that they operate to all the people that include patients, employees and visitors. They ought to have provided safety and security measures including physical means such as barriers and security guards that would ensure the safety of their employees. For instance, in the case where they knew that most of the emergency admitted patients suffered from substance abuse psychiatric challenges and the related behavioral concerns. They could have achieved this by putting barriers and if possible guards to protect the employees and facilities from damage.
The managements have to establish the right infrastructure such as building special rooms and provide special facilities that would enhance safety and increase security to the employees as well as visitors and patients (Zubko, 2011). The management should also ensure the employees get insured against such possible eventualities related to safety and security thus encourages them to give their best as a far as work issues is concerned. It (management) should provide them with assurance of security and compensation in the eventuality that they get injured either directly or indirectly from the environment that they work under as noted in the case.
The responsible if Rosemary had been injured, if the visitor attacked another patient as well as the legal and ethical obligations GCH has to its employees and to its patients and how they apply to the case
If Rosemary (the Nurse) in the case had been injured, it would bring more complications and show many loopholes related to the management failures to protect its employees as well as clients and the facilities. The hospital administration and leadership would have been responsible if the nurse was injured. The person causing the injury had a mental and behavioral challenge as he was suffering from substance abuse psychiatric healthcare concerns. Since the hospital management and leadership is concerned and responsible for decision-making, including the cooperation established between the two hospitals that agreed to share the facilities and consequently overstretching the facilities, they would be responsible for Rosemary’s injury if it happened.
If the visitor attacked another patient, the blame would squarely lie with the management as it failed to protect its patients or clients as is required by law and also among the core needs related to management of providing safety and security as a priority before other services offered. The administration ought to provide controlled access to the facilities that would ensure visitors actions is monitored and restricted. They also would have established specific times that visitors would be allowed to access the premises under security escort.
The legal and ethical obligations that GCH has to its employees and patients is to provide a working environment that enhances service delivery allowing services provided without any threat to both employees and patients resulting from insecure environments. The legal and ethical obligations apply to this case whether the employee got injured or not. Employees have a right to work in a secure place and, hence, they can take any legal action such as to sue the leadership of the hospital as a result of failure to adhere to both the legal and ethical requirements of healthcare services provisions. It also applies to management that shields the employees and patients from threats (Toebes, 2013).
The optimum physical space for these patients, the cost to install a panic alarm in the patients’ rooms, At the nurse’s station, A safe room and the costs of doing nothing
The optimum physical space for the substance abuse psychiatric patients and those of routine medical, surgical patients not only between the two nearly placed geographically hospitals should be slightly far from each other. Also, the psychiatric patients have to be placed in a secure-unit even in the hospital unlike the situation in the case. The costs for installing a panic alarm in the patient’s room would be affordable and manageable to the hospital management. It is because the alarm would enhance quick response and provide a sense of security to patients especially when they feel threatened or in danger. A panic alarm should also be installed at the nurse station that can enhance quick response if the nurse might require the help of any nature not only related to matters and issues of security. Installing a safe room would also increase safety and security especially in cases that deal with psychiatric challenges as noted in the case where mostly they exhibit behavioral problems among other symptoms and secondary health care challenges. The costs of doing ‘nothing’ are more expensive than doing the mentioned actions above. It is imperative to note that prevention is better than cure. The cost and negative impacts that can result from failure to do nothing as noted in the example can be severe for the hospital that it cannot manage to handle. Thus, the management should learn from the case and immediately institute actions that can restore the legal and ethical expectations from such a healthcare facility noting that cheap is always expensive, and enhance professionalism (Cohen, Foglia, Kivong, Pearlman & Fox, 2015).
An emergency plan for the staff in this unit while they await administration’s decision on renovations
The emergency plan for the unit as they await the management decisions on renovations include separating the patients of psychiatric concerns from others by taking measures such as putting them on different floors and rooms (Hollander, Tahtalian, Young & Kulkarni, 2012). Provide security escorts to all visitors especially to those with sychiatric challenges. They should immediately install alarms, in particular to the unit personnel to rise danger such as an in the noted case. They should also increase the number of unit personnel working and assessing the patients at any time to at least two so that they can help each other as well as the patients in case of an emergency before the administration makes decisions on renovations.
References
Cohen, J. H., Foglia, M. B., Kivong, K., Pearlman, R., & Fox, E. (2015). How Do Healthcare Employees Rate the Ethics of Their Organization? An Analysis Based on VA IntegratedEthics® Staff Survey Data. Journal of Healthcare Management , 60(3): 169-184.
Hollander, Y., Lee, S. J., Tahtalian, S., Young, D., & Kulkarni, J. (2012). Challenges Relating to the Interface Between Crisis Mental Health Clinicians and Police When Engaging with People with a Mental Illness. Psychiatry, Psychology & Law , 19(3): 402-411
O'Connor, N., Ward, D., Newton, L., & Warby, M. (2013). Enabling clinicians to become the quality leaders in a mental health service. Australasian Psychiatry , 13(4): 357-361
Toebes, B. (2013). Healthcare on the Battlefield In Search of a Legal and Ethical Framework. Journal Of International Humanitarian Legal Studies , 4(2): 197-219.
Zubko, N. (2011). Incentivizing risk management. Behavioral Healthcare , 31(6): 28.
