Term Paper: Risk Management: Improving Communication Amongst Health Care

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Risk Management: Improving Communication Amongst Health Care Providers

Communication is one of the keys to Risk Management, particularly in a hospital setting. The 2004 JCAHO National Patient Safety Goal Number Two clearly states that to improve the effectiveness of communication among caregivers should and must become the priority of every hospital. The JCAHO recognizes that more pressured the environment, the easier it is for mistakes and miscommunications to occur, even in environments with seasoned healthcare workers, much less at teaching hospitals such as UCLA, New York Presbyterian, and Robert Wood Johnson. Also, many doctors, nurses, and health care professionals are not fluent in the language of effectively communicating who and what is at risk during a procedure to the patient's loved ones and to others -- yet increasingly it is one of their central tasks when deciding on a course of treatment and determining the support structure open to the patient after treatment. The involved health care practitioners must be able to know what is the risk of the available methods of treatment amongst themselves, and when necessary, provide the ability of the patient and his or her caregivers to make the best choice of the available, humane, and workable options -- all within the necessary window of time!

Thus all health care providers, even those providers in purely laboratory-based disciplines and the political, public health field have to communicate risk levels to laypeople, to doctors and nurses who might be working outside of their usual field of expertise, and to clarify who and what is at risk with particular heath-related issues. (Smith, 2003) This poses a considerable challenge of communication as well as requires a careful strategy of risk management. To mitigate such potential risks that might occur, the University of California at Lost Angeles teaching hospital has instituted certain standard operating procedures and chains of command, such as demanding all patient's data is entered under a name, social security or patient number, to ensure that records do not become confused during the hectic pace of the day. There is also a clear administrative chain of command for all staff, and within the different levels of expertise of the administrative and nursing staff to ensure that individuals with the necessary experience properly vet all procedures. (UCLA Official Website, 2005)

The slogan of UCLA is "two times, every time" -- identity, procedures, and all standard operating procedures and chains of command during a patient's course of treatment must be confirmed at least twice before the procedure is performed in the hospital, and when a course of treatment is administered to a patient. In other words, if a patient takes insulin, the patient's blood sugar levels must be verified twice before the dosage to correct a low or a high reading is administered. (UCLA Official Website, 2005)

But is checking something twice enough, if miscommunications and misinformation are simply transmuted twice, rather than rectified? Teamwork, dialogue, and contact may be the cores of risk management, but how should this teamwork and dialogue occur at such points of contact, to meet the stated goals of risk mitigation, and patient safety and satisfaction? (UCLA Official Website, 2005) Not all institutions have the check twice policy written in stone, rather the stated risk management procedures of New York Presbyterian, the teaching hospital of both Cornell and Columbia Universities, similarly proclaims "safety" and "service" to its workers and patient populations. ("Mission," Official Website, 2005) and requires all health care providers submit a risk management worksheet when conducting research or administering extensive procedures, to make sure consent was given on a paper trail. When clearance is given for a procedure, such as a dosage of insulin, it can be verified that the necessary signatures were obtained by using the paperwork standardized by the intuition, specifically designed for risk management. The advantage is that research and patient care have different worksheets, specific to the procedure, unlike the UCLA check twice policy, but the disadvantage is that in the large, bureaucratic environment of the hospital, that things are not always checked twice.

In contrast to both UCLA and New York Presbyterian, the teaching hospital of the New Jersey Medical and Dental School, the Robert Wood Johnson Hospital states that it makes patient safety a "priority" on the front page of its website. It notes that Robert Wood Johnson University Hospital meets all seven of the JCHSO goals, delineated in the 2005 National Patient Safety Goals publication. These goals, including improving the accuracy of patient identification, improving the effectiveness of communication among caregivers, improving the safety of using medications, improving the safety of using infusion pumps, reducing the risk of health care associated infections, accurately and completely reconcile medications across the continuum of care, and educe the risk of patient harm resulting from falls," are all met with the same methods. But how can communication, the human element of care, be met with the same technical efforts required to meet the other stated goals. (RWJ Official Website, 2005)

Thus Robert Wood in its own publications and communications between providers and to the public is short on specifics, other than urging patients not to smoke in non-designated areas and to secure their valuables, and urging caregivers to be mindful about communicating with one another regarding patient data. "Improvement" is the goal, rather than solidifying standard operating procedures, and although Robert Wood may have statistics that show improvement, statistics can lie -- and be manipulated, and there is no evidence of how such statistics can be verified. (RWJ Official Website, 2005)

The other two teaching institutions, New York and Robert Wood, lack the stress of UCLA on verifying things 'twice,' with more of a stress upon confirmation. UCLA's stress on patient care and identification numbers seems more patient directed than either New York Presbyterian or Robert Wood Johnson, as the Presbyterian 'paper trail' might be more useful to the hospital, should there be litigation afterwards, to prove that hospital standard operating procedures were followed, and the stress upon improving available data might make for good publicity for Robert Wood. But still, Robert Wood does not require any specific additional paperwork or effort or modified standard operating procedures that can become routine and followed on a regular basis.

UCLA is admirable in its goals of ensuring no mistakes are made, but because it seems to stress verification of data, rather than real understanding of the data communicated between healthcare providers, and between providers and patients, things could still go awry. Although better than New York Presbyterian and Robert Wood Johnson, more risk management review may still need to be done refining the methods and means by which communication takes place. One could even say, moreover, such a mere stress on twice verifying patient identification alone is not enough, because of the changing nature of modern medicine.

Consider the evolving nature of the doctor-patient relationship and the nurse and doctor relationship. When healthcare make decisions for patients -- as many still do -- the must communicate risk to the patients and to one another in a way that the levels of potential risks of different treatments make sense. (Smith, 2003) First of all, the patient, even when treatment plans are being determined, must become a more critical part of the treatment decision making process and the risk management equation, as today, most medical procedures must be approved by a patient's insurance company, and deemed necessary by other providers than the patient and his or her immediate family. The doctor of the past might have the luxury of deciding on a treatment and then help the patient feel good about it, perhaps -- with good intentions -- "slightly exaggerating the benefits and playing down the risks," but no more. (Smith, 2003)

Now, even a patient with dementia may have caregivers that demand to become involved -- as the populace becomes more educated, as they take more personal and financial responsibility for navigating the health care bureaucracies, and choosing between different but non-complementary treatments, numbers in explaining risk levels must become involved. Furthermore, nurses, technicians, and other workers, even researchers are becoming increasingly involved in patient care, as a diversity of treatments become more available to wider populations for formerly terminal illnesses such as cancer and AIDS. (Smith, 2003)

From a patient's perspective, although the calculation of the risk benefit ratio cannot be internalized from experience as it can with a doctor, it cannot always be assumed that the doctor's experience with new treatments will tell him or what to do, if he or she is unfamiliar with the patient's emotional as well as physical history. The nurse, doctor, and patient, as well as other members of the research and treatment staff may all need to convene, and speak the various languages of the research, the side effects of the treatment, and the goals of treatment of the patient, as well as merely to double check data -- and the various competing interests of say, the oncologist eager to try out a new procedure vs.… [END OF PREVIEW]

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