Applying Quality Management in Healthcare

This case is adapted from Smith, P.L. & Kelly, D .L. (2017) Applying Quality Management in Healthcare: A Systems Approach.  Washington, D.C.

Dear Chief Nursing Officer,

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Last month, I had surgery at your hospital.  I was supposed to have a short laparoscopic surgery with a discharge by lunch, but it turned into an open surgery with complications.  This led to a four-day stay and discharge with a Foley catheter.  Overall, my hospital stay was OK, but I had a situation when the call bell was broken.  It was during the night, and I was alone.  I needed pain meds, I kept ringing the call bell and no one answered, I used my phone to call the switchboard and no one answered.  I didn’t want to yell.   My IV began beeping (to be honest I kinked the tubing to make it beep), but no one came with that noise either.  Eventually the certified nursing assistant came to routinely check my vitals and she got a nurse for me.  They switched call bells, but apparently there was an electrical problem, and the call bell couldn’t be fixed until the next day, when maintenance was working.  The CNA told me to “holler if I needed anything” as she walked out, closing the door.  I was so mad, but by this time, the IV pain med was working and I was dozing off. I reported the situation again on the day shift and spoke to the Unit Manager. Upon discharge, I included this dangerous and unethical situation on my patient satisfaction survey.  For me, it worked out OK.  All I needed was

This case is adapted from Smith, P.L. & Kelly, D .L. (2017) Applying Quality Management in Healthcare: A Systems Approach.  Washington, D.C.

Dear Chief Nursing Officer,

Last month, I had surgery at your hospital.  I was supposed to have a short laparoscopic surgery with a discharge by lunch, but it turned into an open surgery with complications.  This led to a four-day stay and discharge with a Foley catheter.  Overall, my hospital stay was OK, but I had a situation when the call bell was broken.  It was during the night, and I was alone.  I needed pain meds, I kept ringing the call bell and no one answered, I used my phone to call the switchboard and no one answered.  I didn’t want to yell.   My IV began beeping (to be honest I kinked the tubing to make it beep), but no one came with that noise either.  Eventually the certified nursing assistant came to routinely check my vitals and she got a nurse for me.  They switched call bells, but apparently there was an electrical problem, and the call bell couldn’t be fixed until the next day, when maintenance was working.  The CNA told me to “holler if I needed anything” as she walked out, closing the door.  I was so mad, but by this time, the IV pain med was working and I was dozing off. I reported the situation again on the day shift and spoke to the Unit Manager. Upon discharge, I included this dangerous and unethical situation on my patient satisfaction survey.  For me, it worked out OK.  All I needed was pain medicine, but what if I had needed help for something more serious?  But I have to wonder, when these data are combined with all the other data, if my experience will be minimized.  Depending on the layout of the satisfaction and quality of care survey results, this situation could look very minor.  For all I know, my dissatisfaction was under the heading “dissatisfied with room.”

I am writing to you because I have not heard from anyone about what they have done to fix the problem.  I believe it is important that you hear my complaint so other patients will not have to go through the terrible experience that I did. 

Questions

Discuss the active and latent errors that appear to have contributed to this adverse event (the James Reason’s Swiss Cheese Model)

Identify what type of error they were such as judgment, execution, of omission or commission.

Discuss what are the key patient safety system concepts that appear to have contributed to this adverse event?

Discuss what data sources would be needed to study this event and what analytical method would you use and with what staff?

Discuss what specific nurse sensitive indicators should be reviewed and/or the type of reactive or proactive measures should be develop to evaluate performance. (https://nursingandndnqi.weebly.com/ndnqi-indicators.html)

What would be your response to the patient as the Chief Nursing Officer for this organization?

but what if I had needed help for something more serious?  But I have to wonder, when these data are combined with all the other data, if my experience will be minimized.  Depending on the layout of the satisfaction and quality of care survey results, this situation could look very minor.  For all I know, my dissatisfaction was under the heading “dissatisfied with room.”

I am writing to you because I have not heard from anyone about what they have done to fix the problem.  I believe it is important that you hear my complaint so other patients will not have to go through the terrible experience that I did. 

Questions

Discuss the active and latent errors that appear to have contributed to this adverse event (the James Reason’s Swiss Cheese Model)

Identify what type of error they were such as judgment, execution, of omission or commission.

Discuss what are the key patient safety system concepts that appear to have contributed to this adverse event?

Discuss what data sources would be needed to study this event and what analytical method would you use and with what staff?

Discuss what specific nurse sensitive indicators should be reviewed and/or the type of reactive or proactive measures should be develop to evaluate performance. (https://nursingandndnqi.weebly.com/ndnqi-indicators.html)

What would be your response to the patient as the Chief Nursing Officer for this organization? For more information on Applying Quality Management in Healthcare see this: https://en.wikipedia.org/wiki/Quality_managemen

Applying Quality Management in Healthcare

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