One of the basic problems with the first-do-no-harm concept is that it may possibly contradict the organizational behavior typically accepted within the healthcare setting. Therefore, to change the situation, it will be necessary to shape the employees’ behavior by appealing to their motivations. For this purpose, the charismatic leadership of such person as, say, Lucian Leape, could possibly improve the current state of affairs. There were, are, and will always be other people who can inspire healthcare specialists for better performance; for example, politics, the example of Barack Obama, with his disapproval of the “manufactured crisis”, should be mentioned (McWilliams 2013, para. 13). The given type of behavior provides an example of how ethical dilemmas must be addressed.
Within the healthcare setting, ethical principles work equally well as in the rest of the spheres. It must be kept in mind, though, that, unlike in other settings, in the healthcare field, the life of a patient is often at stake (De Leval, Francois, Bull, Brawn, & Spiegelhalter 1994). Confrontation and conflict can be associated with such biological metaphor as a fight between two species (e.g., orangutans) for authority. Rationing can be compared to shark pilots, who both jeopardize their life by trusting the shark, yet follow its lead to survive. Secrecy principle can be associated with a bird trying to hide its egg. Lying to the patient is unacceptable; every patient must know his/her condition, no matter how sever it is. Scaremongering, in its turn, can be related to such metaphor as a scaredy-cat. As for whistle blowing, it can be related to sentry meerkats telling the rest of the group about the danger approaching.
There are many ways to define power, including the perspective of the power beholder, his or her subordinates and the people whose interests the given power pursues, as well as those whose interests it may possibly infringe. Within the field of healthcare, the definition of power is narrowed down to the perspective of a doctor–patient relationships, which calls for a comparison between the traditional definition of the phenomenon and the one that healthcare considers. Within the healthcare settings and from the position of a person who often faces the risk of triggering a patient’s death by making a mistake, power can be defined as the ratio of the authority of a particular healthcare specialist to his/her responsibilities.
As Lucian Leape (IHI Open School 2009) explains, mistakes occur not because of the lack of professionalism, but mostly because of the faults of the existing system, starting with similar labels on ampoules with different medicine, which was the case described by WorldNewsAustralia (2011), and up to the inconsistencies of the patient observation standards. The so-called bottom-up regulation of quality, which comes most often in the form of malpractice suits, has its pros and cons as the means to reduce the number of medical mistakes. On the one hand, the examples of doctors and hospitals having been sued for considerable amounts of money for a mistake that cost someone his/her life are very graphic; therefore, they are efficient in that they show what malpractice can result in for doctors and medical establishments. However, the key problem with the bottom-up approach is that it only threatens with a punishment without actually doing anything to improve the current system. Bottom up regulation can also be observe din such fields as education, where students shape the learning process, since a teacher has to adopt an individual approach towards them and, thus, bend the learning process in accordance with the students’ needs.
Much like the bottom-up regulation, the top-down one also has its doubtless benefits, as well as its obvious weaknesses. Starting with the negative aspects, the given approach presupposes that the role of government in shaping the healthcare settings should be enhanced, which already is a big problem, seeing how the latter as little to no idea of the specifics of particular healthcare clinics.
However, to improve the existing system of healthcare services delivery, one has to make basic changes, which require that the person in charge should have certain power, which the members of the government obviously have. Therefore, the top-down regulation can be used as the means to improve the environment in which specialists work, therefore, reducing the premises for mistakes to be made. Bottom-up and top-down regulation principles can also be observed in other spheres. In education, for example, top down regulation presupposes that governmental bodies are able to shape education system, as well as affect various educational establishments. The given phenomenon is quite effective when global problems are addressed, yet is hardly applicable when local issues demand urgent solution.
Do you run an audit in your practice (however simple)?
I do run a simplified version of an audit, despite the associated difficulties. It must be admitted, though, that embracing every single aspect of healthcare services in a single audit process is practically impossible seeing how there are too many fields and aspects of healthcare services operations to consider. An inevitable limitation of any audit, the given problem poses a considerable threat to the quality of healthcare services provide for the patients. While at present, no means to check every single detail of the healthcare mechanism is available, the process of an audit can still be perfected to meet high standards and prevent the instances of malpractice. Among the most efficient methods of improving the audit procedure, the following ones must be mentioned:
- Information transparency;
- Knowledge sharing principle;
- Patient’s health being the top priority;
- Analysis of the healthcare staff’s performance.
By utilizing the aforementioned methods, I will be able to achieve my goals of providing the patients with proper healthcare services.
Reference List
De Leval, M R, Francois, K, Bull, C, Brawn, W, & Spiegelhalter, D 1994, ‘Analysis of a cluster of surgical failures: Application to a series of neonatal arterial switch operations,’ Journal of Thoracic and Cardiovascular Surgery, vol. 107, no. 3, pp. 914-924.
IHI Open School 2009, Why do errors happen? How can we prevent them.
McWilliams, R 2013, ‘Plain speaking: first, do no harm,’ Capital Gazette. Web.
WorldNewsAustralia 2011, Epidural tragedy mom speaks out. Web.