Verified Document

Dealing With DNR Misinterpretation Term Paper

Health Care Management "Culture eats strategy."

The Business Case for Evidence-Based Management

Management literature across all disciplines points to the critical importance of quality decision-making. A fundamental practice problem for decision makers is that the information that is readily available or accessible may be incomplete, outdated, and/or not based on evidence. Quality decision-making is dependent on access to and use of quality information. That is to say that, the old adage used by the early computer scientists -- "garbage in, garbage out" -- is applicable to management decision-making. This tenet is pivotal to management in healthcare for reasons that span the high stakes patient care decisions to the survival of medical institutions in a punishing fiscal environment.

In the service-oriented organizations of healthcare, decisions are part of an interwoven network -- a fabric that encompasses the administrative, operational, and patient care aspects as a unified entity. Poor decisions made in any single business or care unit in a healthcare facility can create waves of repercussions that are felt throughout the institution.

In their review of the Shewhart Plan-Do-Study-Act cycle and the generic eight-step decision-making model, Kovner and Rundall (2006) argue that important considerations are missing from both. The treatment of data gathering and fact finding lacks depth. Decision-making is strengthened when it is derived from a well-rounded and in-depth gathering process that includes data and information from local sources, from current evidence-based best practices, from clinical experience, and is informed by benchmarking to other comparable institutions. Additionally, Kovner and Rundall (2006) would like to see decision-making models...

An evidence-based approach is typically a five-step process: 1) Identify the research question; 2) access and review the relevant research and evidence; 3) evaluate the relevance, applicability, quality, and validity of the information; and 4) present the findings in a manner that is actionable and persuasive. Applying this process to the hospital setting, the evidence-based process overlays a root cause analysis (RCA) to this problem of practice. This means that the following questions are asked -- and answered, as much as possible, by providing evidence: 1) What happened? 2) What should have happened? 3) Why did it happen? And 4) What can be done to correct the error? (Percapio, et al., 2008 as cited in Lambton & Mahlmeister, 2010).
Consideration of the Problem

In a large academic medical center, it has come to light that patients who have Do Not Resuscitate (DNR) orders sometimes do not receive the level or scope of palliative care that could -- and most likely should -- be provided. Under these conditions, patients suffer needlessly and family members have begun to complain and register unfavorable remarks on websites and social media networks. As a nurse in the acute care unit, my primary concern related to this matter is that patients at end-of-life are not receiving the quality of care that hospital identifies as central to its mission. The purpose of this discussion is to identify the network of variables that create and sustain the problem, and to provide evidence-based practice solutions to change and manage the situation.

The members of the hospital staff have expressed concern that the problem seems to…

Sources used in this document:
References

Chen, Y.Y., Gordon, N.H., Connors, A.F., Garland, A., Chang, S.C., and Youngner, S.J. (2014, August). Two distinct Do-Not-Resuscitate protocols leaving less to the imagination: an observational study using propensity score matching. BMC Medicine, 29(12), 146. doi: 10.1186/s12916-014-0146-x.

Henneman, E.A., Baird, B., Bellamy, P.E., Faber, L.L., & Oye, R.K. (1994, November). Effect of do-not-resuscitate orders on the nursing care of critically ill patients. American Journal of Critical Care, 3(6), 467-472.

Kovner, A.R. & Rundall, T.G. (2006). Evidence-based management reconsidered. Frontiers of Health Services Management, 22(Spring), 3-46.

Lambton, J. & Mahlmeister, L. (2010). Conducting root cause analysis with nursing students: best practice in nursing education. Journal of Nursing Education, 49(8), 444-448.
Cite this Document:
Copy Bibliography Citation

Related Documents

Root Cause Analysis
Words: 1186 Length: 4 Document Type: Case Study

RCA) is to simplify the problems at hand it is a systematic approach that can lead, like a trail of clues, investigators to objective truths or at least well assumed ones. The U.S. Department of Health and Human Services endorsed this method as a practical approach as presented in their agency on research quality. The group acknowledged that "root cause analysis (RCA) is a structured method used to analyze

Root-Cause Analysis: Business Problem-Solving
Words: 961 Length: 3 Document Type: Essay

Business Problem-Solving: Root-Cause Analysis The Root Cause Approach Root cause analysis is a popular problem-solving technique that seeks to bring out, and respond to, the deeper causes of a problem as opposed to only those that are visible on the surface (Okes, 2009). It allows one to look deeper into a problem so as to determine what the underlying causes are, and fix these before the problem escalates to an even bigger

General Motor Root Cause Analysis When the
Words: 608 Length: 2 Document Type: Essay

General Motor Root cause analysis When the root cause analysis (RCA) was carried out of General Motors the main problems that were identified were lack of efficiency due to communication and listening problems, the ever rising competition especially from Toyota with their Hybrid series, the redundancy in the design of their cars, the issue of environmental concern among the environmentalists and the whole issue of reliability of their brand. Due to these

Root Cause and Analysis
Words: 586 Length: 2 Document Type: Essay

Explain why a root cause analysis was appropriate for this situation A root cause analysis was appropriate for this particular situation in order to realize particularly what went wrong and the suitable way of fixing it. Imperatively, root cause analyses are utilized when sentry or adverse occurrences take place in the healthcare sector, post event. Basically, an assessment team is sent off, through the use of a toolbox approach with numerous

Causes of Domestic Terrorism Advocates for Political
Words: 2571 Length: 10 Document Type: Research Paper

Causes of Domestic Terrorism Advocates for political change and social concern are at the forefront of domestic terrorism in the United States. Domestic terrorism references groups and individuals based in and operate within the United States. Terrorism is noted as the oldest form of solving human conflict and was historically to declare war. The Federal Code of Regulations defines terrorism, a relevant term, as "...the unlawful use of force and violence against

Causes of Juvenile Delinquency
Words: 2750 Length: 8 Document Type: Term Paper

Causes of Juvenile Delinquency Criminal Justice The problem of juvenile delinquency is becoming more complicated and universal, and crime prevention programs are either unequipped to deal with the present realities or do not exist. Many developing countries have done little or nothing to deal with these problems, and international programs are obviously insufficient. Developed countries are engaged in activities aimed at juvenile crime prevention, but the overall effect of these programs is

Sign Up for Unlimited Study Help

Our semester plans gives you unlimited, unrestricted access to our entire library of resources —writing tools, guides, example essays, tutorials, class notes, and more.

Get Started Now