Health Leadership and Management, Surgical Risks - Essay Example

Health Leadership and Management          Prepared for:          On:           By:       Health Leadership and Management Introduction       Risks are inevitable in our day to day activities. Usually, a risk is any factor that can pose a danger to some one's health thereby compromising their achievements and goals. These factors are realized in all areas and sectors including the health care sectors. There are many risks that happen within a health care setting. These risks can threaten the lives of the patients, clinicians, workers and the general public. They include communicable infections, fire, overdosed and wrong medication to patients or even operation mistakes and errors (Spry, 2005).       Surgery at the wrong parts, being operated whereas there is no need, delayed medical intervention, wrong diagnosis, failing to inform the patient on the risks associated with the procedure and not informing the patient on alternative methods are some of the major risks patients are exposed to (Health and medical negligence Australia). Surgical risks are major problems as they can easily lead to irreversible health problems. These risks can however be prevented or stopped through risk management process. This strategic process involves establishing the context of the risk, risk identification, analyzing the risk, treating the risk and then monitoring the risk. The aforementioned processes are discussed below.     Risk identification       Risks are always reported within most health care setting. The risk identified in this essay is surgical error. Surgical errors are not a new setting in the health care sector and they appear to be common occurrences in the theater. Surgery is usually very safe so long as the surgeons, nurses and anesthetics play their roles accordingly. However, small unnoticeable errors may be done by either and can accumulate with time leading to adverse health effects on the patients. Surgical errors mostly occur when operation is carried out when it is not necessary or on the wrong parts. These errors can be as a result of a mistake on the doctor's part. This could be due to fatigue as some of them work for long hours and are usually tired. Lack of enough rest makes them prone to making mistakes while performing surgeries especially at night. There has been an increase in cases of mortality related to these issues which compromises the patients' health leading to this unfortunate occurrence. Rising incidents of mistakes and errors since the late twentieth century has drawn a lot attention to the government and the general public. However, little is being done because the information regarding errors in hospitals is kept private (Solicatoradvice.com, 2009). Surgical errors are rarely disclosed to the patients, their family and the government. Rising cases of theater related deaths has been raising eye brows for a long time now. These errors cause patients not to recuperate as required. At times the consequences are adverse plucking precious and productive lives from the face of the earth. In case of an error in the operation table, the appropriate corrective measures should be taken. Failure of a surgeon to disclose surgical errors once they happen is one of the major set backs in finding a solution to these errors. If an error is suspected to have occurred during surgery, it should be disclosed to the hospital authorities with immediate effect in order to try and avert the error before it is too late. After all, we should never forget that we are human beings and to err is human. Practitioners should try and explain what happened, according to moral theory by Kant. Lying would deprive the patient and the practitioner the moral dignity.       Appropriate follow ups on patients after undergoing a surgery is one way which can be used to determine this kind of a risk. It is vital for follow up programs on the patient to determine whether they are healing as required or not. Mostly, patients with surgery risks may stay for a long period of time with a wound at the point of surgery. If this happens, the nurses or the family members should report the case to the hospital to verify if there are post surgery risks. This has made many people to be back to the operation tables so that the necessary correction is done. There are several factors that can cause the prevalence of post surgery complications and risks. In most hospitals, there are very few doctors who are unable to handle the massive number of patients who need specialized care. It is not a wonder for a doctor to be woken up in order to attend to emergency surgeries. This puts the patient in a lot of risk as the doctor may be unable to perform the tasks effectively. Such cases are characterized with surgery in the wrong parts or operating a person who did not require a surgery. The low number of surgical doctors has also led to inexperienced doctors being employed in some hospitals. This is even a worse situation because the chances of post surgery risk occurring is very high (Sydney Morning Herald, 2006). Context of the risk According to the Australia/ New Zealand standard, Risk management is the process of improving safety and quality care of patients by reporting, analyzing and learning from the past adverse effects. Risk management is a process that cannot be divorced from establishment of the risk context. This is because effective risk management process demands that the context in which risks occur be identified so as to determine the areas where efforts to curb the risk should be concentrated. There are two contexts which can be utilized in the risk management process. Strategic context defines how organizations do or complete a certain projects. On the other hand, organizational context defines how an organization is structured and how it carries out its project. This includes the knowledge of the managers and how they are prepared to deal with the surgical risks. These two contexts together with the risk management context are manifested in the general risk management process. Establishment of risk context involves defining the problem, determining the limitations, determining the management strategies and developing a criterion for evaluating the risk. This is done at both the strategic and organizational levels (Risk Management context, 2004).       Surgical risks are caused by several factors. Theater doctors work for long hours without resting and there are high chances of developing fatigue. They are therefore prone to making mistakes while performing surgeries as aforementioned. Since there are several professionals in operating room for instance the surgeons, nurses and anesthetics, there are probabilities of risk occurrence. In many public hospitals, overcrowding is not new phenomenon and the doctors and nurses available may be unable to handle emergency patients perfectly. Is such cases, patients may be operated on only to realize later that there was no need to do so.   Surgical risks aroused the professionals and the government and there was need to reduce the occurrence of these risks or prevent them totally. There are several methods that were proposed to minimize risks in the surgery rooms. Best practice guidelines in     Australian and New Zealand were set with the objective of reducing surgical risks. These guidelines have to be followed by each person who gets to the operating rooms. A set of surgical standards should be put in place to ensure patient safety (HQCC, 2007). Some of these standards were put down by the Health Quality and complains commission in Queensland Australia. With the standards in mind, there are low chances of a risk being caused by the surgeons, nurses or anesthetics. Evidence based medicine is an integral part in determining the costs of a surgical procedure and monitoring the post operative conditions of the patients. Health records of patients should be properly stored. These records act as evidence determining whether a certain therapy worked or not, provided good results or not. The data should also be linked appropriately as it acts as a reference at the hospital level or can be used by individual surgeons. The data can be used in the surgery room settings in avoiding or averting past mistakes and crises. Patient and workers data should be kept in private and should be only accessible to the relevant authorities (clinical Excellence commission, 2006). Data can also be used to study patients’ past histories. Data pertaining to a certain patient is important in determining pats therapies and the therapies they can be administered in case of a re current condition. Data and records should be protected accordingly from other risks such as fire. It should therefore be put in such a way that it can be retrieved under any circumstance. Surgeons should be involved in strategic planning and good interpretation of past data in order to be able to have good clinical relevance and best practice in the surgery rooms. By this, surgery at the wrong parts or surgery when not needed would be a thing of the past. Determination of financial risks that might occur is also vital. Surgical errors can be catalysts of great financial to both the patient and the hospital. In case there is an error in surgery, additional costs have to be incurred by the hospital in the correction of that error. Also there have been court cases sparked by these errors causing injuries. In the final end, the hospital or the health care setting may end up paying a lot of money in damages. Management of such risks has to be done accordingly and timely. Standards set by the various boards have to be followed to minimize any financial risks. Some families have also lost dearly in the context of financial risks as there are additional costs especially when a patient is re-admitted to the surgery table (Ansari, 2008). Health care risk management teams should be formed to reduce the occurrence of not only financial risks but also any other risks that may compromise a patient’s health or the health facility operations. They have to ensure that quality care is provided to the patients at relatively low costs. These teams should also be involved in adopting better technologies to minimize the occurrence of risks in the health care setting. Operation of the organization will largely depend on its ability to make good policies and implement them accordingly in reference to the surgical errors and other risks. Good risk management teams can achieve all this so long as there is commitment and experienced risk management team. Analysis of the risk This process deals with the determination of the factors that cause risks, evaluate risk and afterwards treat the risk. Analysis involves assumptions mostly and there is need to use reliable sources and techniques to perform this process effectively. Risks within the operation room always happen. However, the occurrence of the risk may cause adverse effects to the patient and even lead to mortality.  Some of the risks are acceptable depending on their occurrence and if the protocols and guidelines were followed accordingly. Analysis of the risk factors also depends on whether the risk is simple and small or large and complex. Simple risks do not require detailed analysis while the more complex require very detailed analysis. Risk evaluation has to be done to help in the risk analysis process. Prejudgment should not be made but the judgment should be based on the analysis carried out and the available evidence. Intervention of the risk depends on the seriousness of the risk. Some require immediate intervention or emergencies (Pradhan, 2006). At times, some risks may demand to be referred to other clinical set ups because of unavailability of some equipments or professionals. Policies and guidelines governing a clinical set up determine its abilities to deal with certain risks. The set up may be unable to deal with some risks sparking the need to refer the patient to other clinical set ups as aforementioned. Risk Treatment The best way of treating risks related with surgical errors is the prevention of occurrence of these errors. Treatment of risks is done to reduce the chances of occurrence of adverse health effects to the patients. Standards, protocols and guidelines should be followed accordingly if these risks have to be prevented or reduced. However, some patients find themselves in the theaters once more to correct some of the mistakes for instance operation at the wrong parts. Other complications may include wounds not healing at the required pace. Fungal and bacteria infections can be witnessed in some surgery patients if the necessary sterilization is not performed leading to delays in healing. This calls for intervention in the healing process by giving additional therapies so that the patient’s health is not compromised (Surgical Journal of Third world Medicine, 2007). Programs, protocols, guidelines and standards are now being practiced in the surgery schools and medical universities. Evidence based practices are being taught in these areas so that the best care is provided to the patients. Also, the surgical doctor students are engaged in challenging assignments to help them in practicing the evidence based model. In 2001, the royal Australasian College of surgeons (RACS) engaged their surgical students in a challenging activity of auditing the strategies of maintaining standard care to surgical patients. (RACS, 2008) There is a standard risk treatment procedure that should be followed in treatment of these risk factors. Risks are different and are handled by different groups or agencies depending on their specialization. The first step in the treatment of a risk factor is to determine which agency can handle that risk. Once this is identified, the patient should be referred to the relevant agency for quality care. Assistance and any other form of support should be provided to the agency managing the risk factor. Preparation for the risk management has to be done at this level. Also, response and recovery procedures are identified. After the risk has been treated, there is need for monitoring or follow ups to determine whether the patient is responsive to the treatment or not. Monitoring and review of Risks There is a need to monitor risks by the management teams. This helps them to be able to manage risks easily and effectively as the necessary plans and control measures are put in place timely. Commitment and discipline of surgeons, nurses and anesthetics should drive the monitoring and reviews of the major risks in the surgery rooms. At times, these medical practitioners put the lives of the patients at risk. Not that they do it deliberately, but an occurrence that could have been prevented occurs. In such a case the practitioners should be dealt with accordingly so that such an action never re occurs (Risk Management context, 2004). Monitoring patients after the surgery is also important in determining whether the necessary therapy was given or not. Follow ups by nurses and other medical practitioners play a major role in the provision of quality services to the patients. There can be development of relatively new conditions to a post surgery because of the massive commodification taking place in this ever changing world. Such developments can only be recognized through monitoring and assessing the patients’ condition after the surgery. This can be an effective method in reducing chances of occurrence of adverse effects to the patients. The above factors can not be realized without emphasizing the need for good communication between organizations and agencies. Not one or no single agency is self reliant. Consultations are there and in the health care setting, good communication skills have to be exhibited if management of risks has to takes place without a hitch. There are several stake holders in risk management an only effective communication strategies can make them realize their achievement and visions (to manage risks). Both internal and external stakeholders have to be involved actively in the action plans made. The risk management team should be able to get feed backs from the other stake holders if there is good communication strategy among them (Tomkinson, 2005). Good communication strategies are vital in the cooperation of effective risk management procedure. Once action plans and other relevant interventions are done, the medical practitioners should give reasons as to why they did that and if it was the best option. Surgeons and nurses have to communicate with a surgery patient to be informing him or her why the procedure is necessary. Patients should also be informed on the possible consequences and the benefits of the procedure in an interactive discussion with either the surgeon or the nurse. No surgery no matter how simple should be done without the consent of the patient after being informed accordingly. Good communication strategies can also help in the reduction of occurrence of surgical errors thereby reducing financial risks. This especially important during the operation where several stake holders are involved for instance surgeons, nurses and other staff. These strategies would boost their cooperation between them facilitating effective surgical procedure. Communication and consultation has to be ensured throughout the risk management process. This ensures that all the stake holders are involved in the risk management process thereby reducing the chances of mortality as a result of these risks. The agency in charge is informed on time and the necessary support and advice provided timely is there are good communication strategies. In such cases, there are low chances of occurrence of adverse effects to the patient. No stake holder should air his/ her own perceptions on the risk and should instead consult with the other stake holders. By this, the necessary intervention of victims of surgical errors can be provided on time (Tomkinson, 2005). Conclusion Health care risks are a common phenomenon nowadays. This can compromise the patient’s health condition. However, with good risk management teams, this can be prevented and its prevalence reduced. Good communication strategies among the various stake holders also play a pivotal role in risk reduction and prevention. It is the responsibility of the various health care sectors to ensure that the appropriate care is taken not only to surgical patients but to all patients. If only all practitioners were responsible enough and realized the importance of morals and the knowledge that effective communication is power, errors in the health care setting should be a problem of the past. How we would have a healthy population with less or no health problems.                References Otango Daily Times. 2009. Surgery checklist designed to avoid hospital errors. Retrieved on 4th August 2009 from, http://www.odt.co.nz/news/national/71585/surgery-checklist-designed-avoid-hospital-errors Bognár A, Barach P, Johnson JK, et al. 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