three children, and he was planning to kidnap them and leave the state. He suggested they leave the bar and drive by each of the houses. His friend declined, saying that he was not feeling well, and left the bar. Worried that possession of this information would jeopardize his own parole, the friend called the therapist who ran the anger management group, who in turn called Christie and the other two social workers. Christie was horrified. Even though she had not been the one who inadvertently displayed the contact information of the three foster families, she immediately informed her supervisor, who reviewed the hospital’s disclosure policy with Christie and encouraged her to meet with Donna and Dan as soon as possible. She encouraged Christie to explain simply and honestly what had happened and offer an apology and ongoing support. She and Christie then role-played a possible scenario. Donna and Dan were surprised but welcoming when Christie asked to come to their home. As soon as they were seated around the kitchen table, Christie explained that a mistake had been made. The outpatient clinic’s medical records had all been moved to a secure computer platform a year ago, but both family service agencies still used paper records. One of the other social workers, who was new to the case, had carried a chart to the termination hearing in case information was needed, and she had set the chart on a table where Charlie’s father had seen the foster parents’ addresses. Christie apologized, tearing up slightly, and then outlined suggested steps to protect all three families and also prevent future breaches of confidentiality. She had applied for a restraining order to prevent Charlie’s biological father from contacting the families or coming near their homes or places of work. She had scheduled a meeting with the other social workers in hopes of establishing security precautions. Donna and Dan thanked her and felt comfortable that Christie had done all she could. Speaking Up Organizational behavior and culture promote or inhibit workers’ ability to speak up when they observe problems (Weiss & Morrison, 2018). For healthcare professionals, “speaking up” is communicating patient safety concerns and quality of care through information, questions, or opinions where immediate action is needed to avoid patient harm. Researchers found that the organizational climate, particularly a climate of healthcare worker resignation, contributed to a milieu of workplace silence. This silence fed the dynamic of nonreporting of safety concerns and related issues. Speaking up—asserting one’s opinion, questions, or observations about unsafe patient practices—is often difficult for healthcare workers. Unsafe acts that can place a patient in immediate harm complicate this organizational dynamic considerably. Bearing in mind that obstacles to speaking up, many of which have been identified in this course, must be understood so that training and education can address barriers to improvement, researchers (Schwappach & Richard, 2018) identified the following obstacles that perpetuate a culture of silence regarding unsafe patient acts. ● The presence of an audience, namely patients, relatives, or coworkers ● Power hierarchies and related dynamics ● Fears of harming relationships with coworkers and superiors ● Helpless feelings of resignation
The next morning Donna called the other two foster mothers. Neither of them had been made aware that Charlie’s biological father knew their addresses. When they called their social workers, they were informed that they were no longer employed at the agencies, and new social workers would be assigned as soon as possible. Case Study 3 Discussion When things go wrong due to some failure in care, as in this case, the failure should be promptly acknowledged, the causes explained as they are understood, and an apology made. In medical settings, it is usually the physician in charge of the case who discloses the mistake. In behavioral health settings, the best person to make the disclosure is the person closest to the patient and their family. Organizational leaders must fully support caregivers as they strive to be more transparent. This case also raises questions about the culture of blame. Termination of the social workers seems like a snap decision. Certainly, an error was made; however, what are the contextual factors that contributed to this error? Was training and communication about transporting records conducted by the agency? Questions of this type, and others, need to be studied and discussed to reduce errors that harm. However, this discussion needs to be systemic in nature to delimit the culture of blame. Full disclosure does not end with truth telling and settling on a plan of remediation. It is an ongoing process of communication and support, with the goal of repairing trust. Patients and families should be offered counseling. If they choose to continue receiving services at the organization where the mistake occurred, professionals should remain in close contact, accompanying the family on their course of recovery as long as necessary (Helmchen et al., 2011). When successful, a full disclosure process repairs trust and allows healing relationships to be maintained, even in the face of tragedy. Self-Assessment Question 3 Janet is a newly hired licensed vocational nurse working a large inpatient psychiatric unit for acute care. It is a Friday afternoon, and the unit is fully occupied. Her director of nursing, Mark, is anxious to leave for the day and is finishing final medication rounds for the patients. Several patients are receiving an antipsychotic medication that is clearly segregated from other medications, which in this case are antidepressants. Mark becomes distracted and accidently directs Janet to dispense the antipsychotic medications to the wrong patients. Janet does not follow this directive and corrects the mistake herself. Going forward, Janet is unclear if she should say something to Mark about his mistake. What is the best course of action? a. Say nothing because Mark is her superior. b. Address the matter privately with Mark. c. Try to ignore when medications are dispensed on the unit because it’s too stressful. d. Advise patients to carefully check that they have received the correct medications. Okuyama, Wagner, and Bijnen (2014) identify the following important factors that influence healthcare professionals’ reporting behavior and suggest that organizations assess these factors when designing speaking-up training programs. The factors are: ● The professional’s motivation to speak up to help the patient, such as the perceived risk for patients (e.g., immediate harm), and the ambiguity or clarity of the clinical situation ● Contextual factors, such as hospital administrative support, interdisciplinary policymaking, teamwork and a person’s relationship with other team members, and attitude of leaders/superiors
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Book Code: PCUS1624
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