UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS
Root Cause Analysis Root cause analysis is a method to work backwards through an event to examine every action that led to the error or event that occurred; it is a complicated process. A simplified method to conduct an event analysis follows:
● Patient—what patient factors contributed to the event? ● Personnel—what personnel actions contributed to the event? ● Policies—are there policies for this type of event? ● Procedures—are there standard procedures for this type of event? ● Place—did the workplace environment contribute to the event? ● Politics—did institutional or outside politics play a role in the event? (Weiss, 2009)
Complaints have emerged, however, that the method uses too many resources for too few improvements (Wu, Lipshutz, & Pronovost, 2008). The authors posit that most organizations try to drill down to a single cause, ignoring system failures. Furthermore, they insist that correc- tive action is seldom taken due to lack of resources, professional disagreements, and absence of management support. They recommend improving system-wide dysfunctions and examining the broader health care environment to find improvements needed across hospitals.
Role of the Nurse Manager The nurse manager plays a key role in the success of any risk management program. Nurse man- agers can reduce risk by helping their staff view health and illness from the patient’s perspective. Usually, the staff’s understanding of quality differs from the patient’s expectations and perceptions. By understanding the meaning of the course of illness to the patient and the family, the nurse will manage risk better because that understanding can enable the nurse to individualize patient care. This individualized attention produces respect and, in turn, reduces risk.
A patient incident or a patient’s or family’s expression of dissatisfaction regarding care indi- cates not only some slippage in quality of care but also potential liability. A distraught, dissatisfied, complaining patient is a high risk; a satisfied patient or family is a low risk. A risk management or liability control program should therefore emphasize a personal approach. Many claims are filed because of a breakdown in communication between the health care provider and the patient. In many instances, after an incident or bad outcome, a quick visit or call from an organization’s repre- sentative to the patient or family can soothe tempers and clarify misinformation.
In the examples given, prompt attention and care by the nurse manager protected the pa- tients involved and may have averted a potential liability claim. Once an incident has occurred, the important factors in successful risk management are:
● Recognition of the incident ● Quick follow-up and action ● Personal contact ● Immediate restitution (where appropriate)
The concerns of most patients’ and their families’ concerns can and should be handled at the unit level. When that first line of communication breaks down, however, the nurse manager needs a resource—usually the risk manager or nursing service administrator.
Handling Complaints Handling a patient’s or family member’s complaints stemming from an incident can be very difficult. These confrontations are often highly emotional; the patient or family member must be calmed down, yet have their concerns satisfied. Sometimes just an opportunity to release the anger or emotion is all that is needed.
The first step is to listen to the person to hear concerns and to help defuse the situation. Arguing or interrupting only increases the person’s anger or emotion. After the patient or fam- ily member has had his or her say, the nurse manager can then attempt to solve the problem by