Managing Complaints: Improving Service in a 15-Bed Emergency Room
As chief operating officer, you are responsible for a 15-bed Emergency Room (ER), which has received many complaints within the last year regarding inadequate patient care, poor ER management, long wait times, and patients being sent away due to lack of space, staff or physicians to provide appropriate care.
Diagnoses: Root Causes of Clinic Complaints
The complaints at hand in viewing the lack of success in the ER at hand can be largely traced back to poor internal management within the ER. Employees operating within the ER have long been confused about the standards and protocols that the hospital has implemented which poorly effects the running of the ER from the time a new patient enters the facility. Many of the complaints lodged toward the ER make mention of an incompetent and insensitive ER staff who have led patients to leave the ER before being seen to go elsewhere. Further, many complaints deal with the inadequacy of the ER itself and its poor physical condition. Patients note long wait times, poor waiting space, small areas and poor facilities.
These complaints can all be traced back to the office of the chief operating officer, from whose office all of the ER's standards, regulations and rules come from. In viewing these complaints closely, it appears that the root of the overall problem can be traced back to poor staff training and an inability of hospital and ER executives to firmly transfer the hospital and ER's mission statement regarding excellence into the minds of its staff. In order to begin remedying the situation at hand, the office of the chief operating officer must set forth a strategic plan for the redevelopment and reassessment of the ER in order to turn the problem around and set the ER on the path for positive patient opinion and return patient care.
Strategic Plan for Overcoming ER Problems
In order to begin fixing the deficiencies of the ER that have been brought to light by patient complaints, the ER must work from the ground-up in order to successfully implement changes. In order to make sure that the whole of the institution is improved with ER improvements, all changes must be made in a cohesive way. Small changes must be implemented and allowed to begin working in order for the ER to take the next steps in bringing about new changes. The ER must change as a whole and must do so with the whole of its staff working towards change.
Anyone who works in a hospital understands that they are complex, high-stress systems that require significant cross-departmental and cross-role coordination at all times (Carrus, Corbett and Khandelwal, 2010, pp.1). As such, the only way to make sure that the ER can run smoothly under its new operational plan, the entire hospital must be on board to aid in these changes. The basis of an emergency room is to handle patient care as needed and to pass these patients on to specialists and departments that are better suited to deal with their respective health issue or injury. The focus of the ER, then, is to maintain an outward flow with patients and emergencies moving from the confines of the ER and into the greater confines of the hospital for specified treatment.
These changes can only be implemented if each and every employee in the ER is on board with these changes. Further, these changes can only be truly effective if each and every employee within the ER realizes that they have played a part in a failing system. Denial and accusation will do nothing to further this ER into an institution that works the way it was designed to and cares for and respects each and every patient that comes through its doors. Patients moving in and out of the ER must never be viewed as numbers to fill a quota, but rather as the different people who they are. It is with this sense of complacency and a focus on a "numbers game" that any ER, including this one, can fall into a state of uncertainty and disrepair. In implementing this new plan for change, the staff within the ER must be grateful that the problem was caught early enough to be remedied.
Effects of the "Good Samaritan Law"
Nearly every institution that works within the medical field will be effected by the Good Samaritan Law and its many outcomes. In the medical sense, the Good Samaritan is a medical care professional who volunteers to help someone tho is in need of emergency care and this act must be done without there being any duty to care for the patient and without any expectation of compensation (LSU, 2012, pp.1). Many emergency rooms across the world operate with a general fear of the Good Samaritan law, fearing that doctors or medical personnel or staff may be sued should a poor outcome result from their helping a stranger in need. However, it must be remembered that no physician has ever lost a suit over a Good Samaritan act, and care must always be given to those who need it, as the alternative can be far worse.
Prioritizing ER Levels: Basic, Intermediate, Transfer and Trauma
In order for the ER to function at its highest capacity, a high priority level must be placed at each level of care including: basic, intermediate, transfer and trauma. In beginning to prioritize the care that comes from the ER, one must always remember that communication will always be the key to understanding which patients need care and when they do. This communication will come largely from triage, which is a nursing assessment made to determine the level of urgency of the patients' need for medical intervention, which is basically an assessment of who can wait for care in the waiting room, whose conditions will worsen if not treated, and who may die if not cared for immediately.
In the ER, patients have all kinds of problems, with all kinds of severity, stemming from all kinds of accidents or incidents. Nurses and doctors working in the ER are often under unreasonable amounts of stress and are capable of suffering from exhaustion when there are more patients than can be safely handled at any one time (Sharon, 2010, pp. 1). It is because of this capacity for problems and stress that communication is truly key and triage must be handled with the utmost care and a clear distinction must be made as to who belongs in basic, intermediate, transfer and trauma care.
Adults, Minors, Emancipated Minors, Incompetent Adults and Treatment Refusal
No one working in an ER is unqualified to be there, and as such, each and every employee working within that unit has the capacity to make medical decisions when those decisions are essential to the care of an individual. Just like the Good Samaritan Law, no ethical medical professional could witness someone in need of care and not do anything about it for fear of facing legal repercussions. As such, treatment for adults, minors, emancipated minors and incompetent adults within this new ER should essentially be treated the same. Despite differences in mental health or competency, each human being is created equal and every human being who is injured or ill requires the same standard of care that would be provided to another individual. As such, an ER cannot function under the threat of providing needed treatment with repercussions, but should require consent in any situation where the situation is not dire (Spiegel, 2003, pp.1) In other situations, ER employees must consult with family members, next of kin individuals, living wills, etc. To gauge a sense of necessity and consent for treatment being given. However, the standard should be: when in doubt, administer…