Healthcare Compliance

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

© 2017 Jones & Bartlett Learning, LLC 1

The Condescending Dental Hygienist

CASE FOR CHAPTERS 4, 7, 12, AND 15

By Sharon B. Buchbinder

Instructions

Read the case summary below with a focus on the key management issues. Using the resources

provided at the end of this case study, answer the plan development and response questions as

indicated in APA format. Use a minimum of 3 scholarly references, listed in APA format. A

tutorial on APA format has been uploaded to the assignment. The length of the assignment

should be what is necessary to substantially respond the objectives of the assignment. Use APA

format. Do not use personal opinion to complete this assignment, it is based on legal and ethical

issues, use scholarly sources to find your answer.

Summary

In this case, a competent senior citizen who is still employed as a professor is given the wrong

medication by Chrissy, the dental hygienist, despite clearly indicating her allergies at check in.

The dental hygienist, instead of stopping what she is doing, apologizing, and ensuring that the

patient is safe, continues about her tasks and argues that the patient doesn’t know what she is

talking about, insulting the patient by telling Dr. Rose she is confused. The patient stops the

procedure, gets out of the chair, and proceeds to give herself anti-allergy interventions. The

dentist, who employs Chrissy, just happens along and asks what is going on, whereupon the

patient has to explain the medication error, which Chrissy continues to deny until he tells her she

is wrong.

Legal and Ethical Issues Associated with Medical and Medication Errors

With respect to ethical issues, all health care professionals, including dentists and dental

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

© 2017 Jones & Bartlett Learning, LLC 2

hygienists, and their organizations have an obligation to prevent harm from befalling patients

when they are under their care. When patients suffer from ADEs, the organization has failed to

discharge its legal and ethical obligation to above all do no harm. The tort concept of non-

feasance, or failing to act where there is a duty that a reasonably prudent person would have

fulfilled, is not debatable in this case. The ethical concept of non-maleficence in this case means

“do no harm” or “don’t make it worse.” Chrissy not only did harm to the patient, she made it

worse by attempting to convince the patient she was confused. Health care managers and

clinicians have an obligation to minimize risk to patients. Using Chapter 15, Ethics and Law, this

case presents an opportunity for instructors to review the distinctions and overlaps between

ethics and law, as well as the concepts of respect for persons, beneficence, non-maleficence, and

justice. It also offers an opportunity to review torts and to discuss whether malpractice has

occurred in this case and what legal remedies Dr. Rose or her family might pursue.

Quality improvement and patient safety are the responsibility of the health care

organization, not just the clinical staff. While the majority of medical errors and health care

quality problems stem from organizational processes, in this case, Chrissy was the problem.

While it is unlikely that Chrissy went to work saying, “I’m going to kill someone today,” her

attitude, attribution errors, and actions could have killed Dr. Rose. This event should call into

question whether Chrissy is re-trainable. She needs to understand not only the harm her actions

could have caused, but also the ethical dilemma she created for her employer.

Key Management Issues

The four key areas for discussion in this case are:

 Medical errors and avoidable drug errors (ADEs); and,

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

© 2017 Jones & Bartlett Learning, LLC 3

 Legal and ethical issues associated with medical and medication errors.

Medical Errors and Avoidable Drug Errors (ADEs)

After reviewing this case, provide the following,

 Summary of case: This should include not only what was in the case, but additional

research you conduct on the outcomes of the case. What happened? Who was found

responsible? What were the legal ramifications?

 Analysis and assessment: What are the quality control problems in this case? This

will come from whichever quality assessment technique you chose.

 Performance improvement plan (PIP): This is where you say what SHOULD be

done to prevent this error from occurring again, based on your analysis.

 Methods to incorporate or overcome local, contemporary, and corporate

cultures: List and describe a few (no more than five [5]) validated approaches to

accomplish this.

 Identify and overcome other barriers to implementation success: Aside from

culture, what else could be a barrier? Education? Training? Lack of resources,

including money?

 Develop a maintenance plan: What will you do to be sure the organization never

forgets? Will you require onboarding orientation that addresses this issue? Will you

require annual refresher courses for current employees?

 Develop an assessment plan: What METRICS will you use to evaluate the

effects of the PIP? How will you know when you have accomplished what you set

out to do?

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

© 2017 Jones & Bartlett Learning, LLC 4

Next, answer the following questions,

1. According to Van Den Bos and colleagues (2011), a medical error is:

2. What causes these errors? Keers and colleagues conducted an extensive literature review

of qualitative and quantitative studies of causes of medication administration errors

(MAEs) in hospital settings. They found:

Resources

Gleeson, K. M., McDaniel, M. R., Feinglass, J., Baker, D. W., Lindquist, L., Liss, D., & Noskin,

G. A. (2010). Results of the medications at transitions and clinical handoffs (MATCH) study:

An analysis of medication reconciliation errors and risk factors at hospital admission.

Journal of General Internal Medicine, 25 (5), 441–447.

Hospital Research and Educational Trust (HRET). (n.d.). TeamSTEPPS national

implementation. Retrieved from http://www.teamsteppsportal.org/

Keers, R. N., Williams, S. D., Cooke, J. & Ashcroft, D. M. (2013). Causes of medication

administration errors in hospitals: A systematic review of quantitative and qualitative

evidence. Drug Safety, 36, 1045–1067.

Koenig, C. J., Maguen, S., Daley, A., Cohen, G., & Seal, K. H. (2012). Passing the baton: A

grounded practical theory of handoff communication between multidisciplinary providers in

two department of Veterans Affairs outpatient settings. Journal of General Internal

Medicine, 28 (1), 41–50.

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

© 2017 Jones & Bartlett Learning, LLC 5

Mallow, P.J., Pandy, B., Horblyuk, R., & Kaplan, H.S. (2013). Prevalence and cost of medical

errors in the general and elderly United States populations. J Med Econ, 16(12), 1367–1378.

Patterson, E. S., & Wears, R.L. (2010). Patient handoffs: Standardized and reliable measurement

tools remain elusive. The Joint Commission Journal on Quality and Patient Safety, 36 (2), 52–

61.

Pilot, S. (2002). What is fault tree analysis? Retrieved from http://asq.org/quality-

progress/2002/03/problem-solving/what-is-a-fault-tree-analysis.html

Pinalla, J., Murillo, C., Carrasco, G., & Humet, C. (2006). Case-control analysis of the financial

cost of medication errors in hospitalized patients. European Journal of Health Economics, 7,

66–71.

The Joint Commission. (2016). 2016 Comprehensive accreditation manual for critical access

hospitals (CAMCAH). Chicago, IL: The Joint Commission.

The Joint Commission. (2015). National patient safety goals effective January 1, 2015: Hospital

accreditation program. Retrieved from

http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf

Van Den Bos, J., Rustagi, K., Gray, T., Halford, M., & Ziemkiewicz, E. (2011). The $17.1

billion problem: The annual cost of measurable medical errors. Health Affairs, 30 (3), 596–

603.