[SOLVED] Ms./Mr. Finnegan, the health administrator (CEO)

[SOLVED] Ms./Mr. Finnegan, the health administrator (CEO)

It is a group case study, and I am playing Ms./Mr. Finnegan, the health administrator (CEO) who is advocating for the creation of a ‘just culture’ and attempting to inculcate an organizational culture in which disclosure is accepted and embraced when mistakes occur.
As a group, evaluate the issue at hand from the perspective of each group member with whom you are working.
Questions to consider when approaching the assignment:
How would you handle such an event as a health manager or leader?
Would you disclose your knowledge to the patient, the patient’s family, or both?
Would you conceal the information for fear of retribution, legal liability, or in an effort to protect the reputation of your healthcare organization?
Support your position using the assigned readings in addition to your own primary resources.
2 to 3 references. Please be sure to use APA style when citing your references.
The Case:
Mr. Smith is a 42-year-old male who has been admitted to the hospital and has not yet given informed consent to undergo the removal of a painful ganglion cyst on his left wrist.  During his pre-op workup, Mr. Smith encounters many individuals—the receptionist, a nurse, a nurses aid, the surgeon, Dr. Wright, and a few other individuals—who “pop in” and out of his curtained area, without introducing themselves—taking supplies or writing information down.
The dynamic in pre-op is crowded and a bit chaotic.  When the surgeon, Dr. Wright, pushes into the crowded curtained area to greet Mr. Smith and his wife, Mrs. Smith, an entire box of sterile gloves falls all over the floor from the shelving on the side of the curtained area.
Dr. Wright quickly moves to the end of the bed where Mr. Smith is lying and proceeds to have his conversation with Mr. Smith from there.  This allowed for a member of environmental services to resolve the spilled gloves on the floor.
The operating room schedule is tight, so Dr. Wright continues to have his conversation with Mr. and Mrs. Smith amid the chaos.  Dr. Wright feels that despite the circumstances, he built good rapport with Mr. and Mrs. Smith.  He feels that he did the best he could, under the circumstances, and leaves the room once he feels as though he has explained the risks, benefits, and alternatives of the procedure.  However, he does not mark the patient’s left wrist as he normally would due to the cleanup occurring on the left side of Mr. Smith’s bed, which is where he would have needed to be standing to mark the patient’s wrist.
An hour later, Mr. Smith has been moved to the operating room, is now under general anesthesia, and Dr. Wright scrubs in.
During the previous hour, Dr. Wright used his time efficiently to review the records of his patients on the surgical schedule for the remainder of the day.  He notes that he has two very similar patients with ganglion cysts on his schedule and that is quite unusual.  However, one is more complex than the other which will require a more complex incision, more pronounced scarring, and a potentially more painful recovery process.  Also, the more complex the procedure, the more time the patient may spend under anesthesia and the more variable mobility may be post operatively.
The other patient with the more complex ganglion cyst is named Mr. Smythe.  He is 40 years old and his cyst is also on his left wrist, similar to Mr. Smith.
Dr. Wright makes a mental note to himself that it would be easy to confuse these two patients because of their similarities and wants to be sure not to do so by marking the wrist of each patient with his initials and a (“+C” for “more complex”) for Mr. Smythe, not Mr. Smith.
Dr. Wright closes Mr. Smyth’s medical record in the EMR, reviews Mr. Smith’s medical record one last time, completes his surgical checklist, and does everything a reasonable physician should do to provide high quality care to his patient and meet, if not exceed, the standard of care.
Dr. Wright directs that Mr. Smith’s left wrist is prepared for the ganglion cyst removal.  The surgical nurses and technicians follow orders and prepare the left wrist for surgery.
Having Mr. Smythe’s case in his head from just reviewing his medical record and strategically thinking through how he is going to manage a more complex cyst, Dr. Wright proceeds to make his more complex, deeper incision on the Mr. Smith’s wrist only to quickly learn that his cyst is non-complex and did not require the depth and complexity of the incision used.
Dr. Wright removes Mr. Smith’s cyst, completes the operation within the standard of care and without observable complication, closes the incision pristinely, and sends Mr. Smith off to post op with a larger and deeper incision than was necessary—but an arguably successful procedure was accomplished as the ganglion cyst appears to have successfully been removed.
Dr. Wright is very upset about what has occurred.  His ethics and values tell him that he should be forthcoming with the patient about what happened, but his fear of being sued and the ease with which he could suppress the information create an ethical dilemma.  He seeks guidance from his risk management and legal departments as well as the health administrator (CEO) to whom he reports.
The CEO is supportive of the creation of a ‘just culture’ and seeks to use transparency and honesty as a way to initiate such a culture change.  Simultaneously, risk management and legal agrees that this should be ‘swept under the rug’ for the sake of protecting the healthcare providers and organizations involved.
An assumption should be made that if/when Mr. and Mrs. Smith are told of the incident, they are very upset and threaten to file a lawsuit against Dr. Wright, the hospital, and all parties involved in his care.
How might this situation be handled to diffuse it as soon as possible and in the best interest of all parties involved?
 


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