Critical Decision-Making for Providers: Mike’s Wet Floor Dilemma

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Table of Contents

Scenario Summary
Consequences of Failure to Report
Impact on Patient Safety
Risks of Litigation
Impact on the Organization’s Quality Metrics
Effects on the Workload of Other Hospital Department
Addressing the Issue as a Manager
References

Scenario Summary

Mike is a lab technician working at the hospital, who has been running late for work several times in a row. His supervisor is displeased with him not being on time and warned him that if the trend continues, it could be considered grounds for termination. The job is very important for Mark, as he provides for his wife and a child. On this day, Mark went to work 20 minutes earlier but was stuck in a traffic jam. Because of it, he barely made it in time. At the entrance, he discovered a spill left by someone else. He has a choice to either guard the spill and risk being late again, or ignore the problem and show up in his office on time. Each of these choices has a plethora of consequences for Mike, for patients, and the hospital.

Consequences of Failure to Report

In the case study, should Mark decide not to safeguard and report the spill, the worst-case scenario occurs. A patient walking down the hall slips and falls, breaking her hip. As a result, the patient’s health is compromised, the hospital is being charged for damages, and Mike’s position is put in jeopardy after he confesses that he did see the spill but did not do anything to prevent the tragedy. Had he chosen not to confess his indirect role in the event, he would not have suffered any personal consequences aside from a hit to his sense of righteousness.

Impact on Patient Safety

The primary duty of a physician is to preserve the patient’s health and guard it against internal and external threats while they are at the hospital. Patient safety is considered one of the important pillars of nursing in every methodology and philosophy of medicine (McCutcheon & Stalter, 2017). Negligence, such as the one demonstrated by Mike, is a cardinal offense to these rules. As a result, patient safety was compromised, and the woman suffered a serious injury as a result. It could have been worse, too, as she could have hit her head during the fall, which could have resulted in brain damage or even death. The choice to ignore patient safety in the name of personal objectives was a selfish one, unbefitting a doctor, as it compromised the safety of patients and doctors throughout the entire facility.

Risks of Litigation

The risks of litigation in the situation described in the scenario where Mike fails to report the spill are obvious. Claiming litigation over falling and receiving injury due to a wet floor accident is based on three parameters, which are as follows (Balasubramanian, 2017):

Establishing a duty of care – determining whether the organization that owns the place has a responsibility towards the plaintiff for ensuring safety and security of movement and interactions in their facilities;
Breaching the duty of care – determining whether the duty of care was breached as a result of negligence on the part of the organization;
Presence of an injury – litigation is much more likely to occur if the victim received significant injuries requiring medical care.

In the situation described in the case study, the patient has all three parameters well-established to press charges. While the patient is in the hospital, the healthcare organization is responsible for her safety and must ensure that all spaces are reasonably safe for the patient to remain and travel through. The failure to remove the spill was a clear breach of the duty of care, as it resulted in the creation of a hazardous surface that led to the patient’s injury. Finally, the woman broke her hip, which is a significant detriment to one’s health.

Impact on the Organization’s Quality Metrics

The failure to secure the spill on Mike’s part would have a negative result on the organization’s quality metrics. It is almost certain that the hospital would not receive a good review from the patient as a result of her fall. In addition, it would add to the list of serious injuries received by the patient and likely prompt an investigation of some kind. The rate of hospital-acquired injuries for the hospital will go up, the number of available resources for injured patients will be reduced (as the hospital would need to care for the patient hurt by their own mistake), and the score for patient-centeredness would go down as well.

Effects on the Workload of Other Hospital Department

The failure to address the spill would increase the workloads on the ICU unit, which is where the patient will likely be delivered to monitor her after the fall, followed by long-term care for the duration of her recovery (Metcalf, Wang, & Habermann, 2018). The hospital would have to dedicate the time and efforts of several physician specialists and nurses to evaluate the patient’s injury, apply a cast, and help maintain her during her stay. Surgery will likely be required, as hip bones tend to break at the place between the joint and the femur, resulting in a very difficult position to immobilize. Given the nearly constant shortage of nursing personnel throughout the American healthcare system, increasing the patient toll due to negligence will have significant consequences on the organization’s capacity to deliver quality service to the rest (Metcalf et al., 2018).

Addressing the Issue as a Manager

Mike’s manager is put in a very difficult position as a result of his actions. Deciding what should be the most moral and ethical solution to the problem is not easy. Despite Mike being guilty (as per his testimony) of negligence, it was not him who created the spill in the first place. The case study does not explain what caused the spill or how long it has been there. It could have been created by another hospital worker, in which case they should bear the brunt of the blame for the patient’s traumatic experience. Nor is it clear how many other nurses and employees passed by the spill without care.

If utilitarian ethics are to be applied to the situation, terminating Mike’s contract would only exacerbate the issue. It will not make the patient feel better, as he was not the person responsible for the spill. Nor would it help Mike undo his mistake or change his ways, as he would not be allowed to continue working in the hospital. The purpose of punishment under the utilitarian framework is not to serve an abstract notion of justice, but to reduce the amount of negativity in the long run (Mandal, Ponnambath, & Parija, 2016).

Since Mike realized his mistake and came out on his own instead of staying quiet, a severe punishment would not serve any purpose. If anything, it would encourage others to stay quiet next time an incident similar to this one occurs, fearful of retribution. Therefore, as a manager, I would reprimand Mike but let him keep the job, and use the example to deliver the message to everyone else, that minor inconveniences (such as being late) should not prevent them from doing their higher duty in ensuring patient safety.

References

Balasubramanian, S. (2017). The future of legal medicine: Trauma care, medical innovation, and much beyond. Journal of Legal Medicine, 37(1), 12-18.

Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology, 6(1), 5-7.

McCutcheon, K. A., & Stalter, A. M. (2017). Discovering my nursing philosophy. Nursing, 47(5), 68-69.

Metcalf, A. Y., Wang, Y., & Habermann, M. (2018). Hospital unit understaffing and missed treatments: primary evidence. Management Decision, 56(10), 2273-2286.

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