The Location and Size
The Cleveland Clinic is an academic hospital which covers multispecialty and is based in Cleveland, Ohio. The clinic is operated and owned by a nonprofit corporation of the Cleveland Clinic foundation established in 1921. Besides its flagship clinic in Cleveland, the clinic operates other affiliated facilities in the States of Nevada and Florida as well as internationally in the United Arab Emirates and Canada. The main campus of the Cleveland clinic has 45 buildings on a 65 ha land near the University Circle (Patrnchak, 2016). The hospital operates eighteen ambulatory surgery and family health centers in the neighboring communities, a hospital in Florida and an outside patient clinic in Toronto. The hospital also has got branches in Las Vegas and Abu Dhabi.
Services Provided
The Cleveland clinic put up new operating rooms to enhance the growth of cardiac surgery. The hospital has since then been recognized for specializing in cardiac surgery. The number of patients has gradually increased since then. Health experts have spearheaded several development strategies to help accommodate the growing number of patients. This has included put up buildings called the century project.
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Patients’ Demographics and the Type of Personnel
It is estimated that the clinic accommodates an estimated figure of 7.6 million total visits annually with nearly 229, 132 admissions and 207, 354 surgical cases (Patrnchak, 2016). The clinic has got roughly 52, 083 caregivers out of which 3676 are scientist and physicians and 11, 889 are nurses (Patrnchak, 2016). The clinic has got 27 institutes giving care in 140 subspecialties and receiving patients from 50 states and roughly 180 countries from all over the world (Patrnchak, 2016).
Research and Education
The clinic has 1965 fellows and residents training and 107 training programs with a total of 227 million dollars funding including 108 million dollars in federal funding (Patrnchak, 2016). The hospital serves the community by giving uncompensated care to the needy engaging in a broad coverage of medical research, community health initiatives, education, and training programs. The contribution of the clinic summed up to 693 million dollars in 2016 (Patrnchak, 2016).
Quality Improvement Proposal
This paper suggests the use of the three hinge approach to implement safety program which focuses on the use of safe surgery checklist in ambulatory surgery centers. The three hinges are the agents of change, and they include team cohesiveness, RN with a doctorate in nursing practice and continuous quality monitoring. Surgical errors lead to serious consequences and sometimes death. According to Hawn et al. (2011), surgical errors continue to happen in the medical field at a high rate. Recent studies suggest that the causes of surgical errors include OR interruptions, human factors, error reporting trends, as well as staffing issues (Hawn et al., 2011). Many big hospitals including the Cleveland clinic continue to experience the problem of surgical errors.
The three hinge approach enables the caregivers to focus on interventions including appropriate hair removal, proper use of prophylactic antibiotics, maintenance of post-op normothermia and post-op glucose control. The team should also focus on intervention with a particular type of surgery instead of performing all surgical procedures.
The health caregivers should ensure that the documents, equipment, and related information are:
Available before the beginning of the surgical procedure.
Correctly identified, labeled and matched with the identifiers of the patient.
Properly reviewed and are confirmed to be consistent with the expectations of the patient. and with the caregivers' understanding of the patient, site, and procedure.
The team should consider addressing discrepancies or missing information before starting the surgical procedure.
Marking the Site of Operative
Procedures which need marking of the insertion or incision site are those which involve many possible locations for the procedure or those that would negatively affect the safety and quality of the procedure (Greenberg et al., 2007). Only the appropriate site should be marked. “No” or “X” should not be used to mean wrong sites.
Conducting a timeout before the Procedure
The team carrying out operation should do a final assessment to ascertain correct site, patient, and procedure before starting the procedure.
Pros and Cons of the Quality Improvement Program
Pros
Prevention of stress and fatigue for caregivers
The three hinge approach helps in ensuring that the caregivers avoid excessive stress and fatigue. According to Jones, Brown & Opelka (2005), disrupted patterns and insufficient sleep may lead to fatigue and hinder cognitive performances and as a result, increase the risk of surgical errors. The human error which arises from fatigue may have dangerous consequences in safety vital environments. The three hinge approach ensures that there is enough staffing to avoid straining and fatigue amongst the limited staff.
Prevention of medication errors
The surgical environment should have heightened security and vigilance to avoid medication errors since medication is usually given verbally instead of writing making the orders vulnerable to misapplication or misinterpretation (Jones, Brown & Opelka, 2005). Increased confusion and stress during emergency situations in the operating room can increase the probability of error in administering, prescribing or even monitoring medications. Staff cohesiveness allows for the surgical team to discuss and agree on protocols that can enable proper administration of treatment and medications as well as implementation. Effective and timely communication between the anesthesia team and the surgical team during the procedure would help in avoiding surgical errors which could result from miscommunication or misunderstanding amongst the team members.
Prevention of retained foreign objects
The suggested approach helps in preventing foreign objects which may remain in the patient during the procedure. Monitoring the quality of the process helps in ensuring that the process is standardized and there is documentation of surgical accounts as well as the actions which are taken in cases where discrepancies occur (Greenberg et al., 2007).
Cons
The suggested approach would not work during emergencies which need quick decisions.
Justification of the Program
The program is necessary to teach the surgical residents, obstetric-gynecologic residents, nursing students, operating room technicians as well as the anesthesiology residents. It is also essential to educate the caregivers who are already in the medical profession through sharing of knowledge amongst themselves on how to prevent the surgical errors which result from lack of knowledge and experience (Greenberg et al., 2007). It is a fundamental principle that all the surgical specialists should be vigilant when performing surgical procedures (Jones, Brown & Opelka, 2005). This can only be achieved through teaching programs for each one of them to properly master their roles during the procedure. Since the patient safety depends on the team cohesiveness as well as effective communication amongst the team members, it is essential that they master and understand all the relevant terminologies used during the surgical procedure.
The program is also necessary to teach the surgical team to avoid distractions during the procedure such as calls, radios, and other nonessential distractions in the surgical environment. The program teaches all team members in the operating room to postpone nonessential activities until the procedure is finished. Also, the program emphasizes the need to keep off the non-essential personnel outside the operating room.
Communication Plan
A proper communication plan is essential to enable the surgical team to get the best out of the program. An open discussion forum for the caregivers would provide an excellent platform for free discussions and share amongst the medical practitioners on how best to deal with the ever-recurring problem of the surgical errors. The more experienced surgeons get to educate the recruits who are getting into the surgical field for the first time.
Legal and Ethical Issues
Regarding ethical and legal considerations, the program aims at providing the participants with an opportunity to acquire a more systematic and in-depth understanding of the legal and ethical issues regarding surgery. The program also enables the participants to explore the moral issues which they face during their practice, recognizing the problems which raise potential legal liability and to understand the surgery practice in its ethical and legal aspect. The program would also focus on the health insurance portability, accountability and the patient bill of rights. The program aims at teaching the ability of the surgeons to analyze the implications of legal and moral theories especially those dealing with justice for both the individual and society. The participants also get to know the appropriate framework which is needed to analyze claims based on expert knowledge critically.
In summary, the program is conducted for the Cleveland clinic surgery department to train on ways to prevent surgical errors during procedures. The program should be attended by both the experienced and the recruits who are getting into the surgery department in medicine. The program purposes to enhance the surgeons' capacity to analyze, reflect upon and critically articulate and evaluate their ethical position in their practice. The program creates awareness on how ethical issues in health care relates to healthcare in different contexts. The three hinge approach ensures that they deal with the most common causes of surgical errors.
References
Greenberg, C. C., Regenbogen, S. E., Studdert, D. M., Lipsitz, S. R., Rogers, S. O., Zinner, M. J., & Gawande, A. A. (2007). Patterns of communication breakdowns resulting in injury to surgical patients. Journal of the American College of Surgeons , 204 (4), 533-540.
Hawn, M. T., Vick, C. C., Richman, J., Holman, W., Deierhoi, R. J., Graham, L. A., ... & Itani, K. M. (2011). Surgical site infection prevention: time to move beyond the surgical care improvement program. Annals of surgery , 254 (3), 494-501.
Jones, R. S., Brown, C., & Opelka, F. (2005). Surgeon compensation:“Pay for performance,” the American College of Surgeons National Surgical Quality Improvement Program, the Surgical Care Improvement Program, and other considerations. Surgery , 138 (5), 829-836.
Patrnchak, J. M. (2016). Implementing servant leadership at cleveland clinic: A case study in organizational change. Servant Leadership: Theory & Practice , 2 (1), 3.
