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Disclosure of the patient safety incident can be justified from at least two perspectives. From the patient perspective, such a decision signifies respect to the child’s parents. The open and honest revelation would also mean that the healthcare organization does not try to withhold the incident but shares concerns with the community and initiates the decision-making process. From an ethical perspective, healthcare providers are obliged to keep transparency in care delivery (Harrison, Walton, Smith-Merry, Manias, & Iedema, 2019). Hiding the truth about the quality of care is thus unethical as all the patients have the right to know all aspects of services that are delivered by a healthcare organization.
This decision is likely to influence value-based healthcare by attaching great importance to it. As a Chief Nursing Officer, I supported such type of care by honestly disclosing the incident to the media and stating that the examination of the medication administration procedures was ordered. Pinpointing the lessons learned and trying to improve patient satisfaction rates and care efficiencies, I abide by the principles of value-based healthcare.
However, the decision to disclose the incident is linked with several risks. Firstly, by publicly admitting that the child’s death was a result of the medication administration error, I also state that the healthcare organization fails to provide high-quality care to the patients. This may entail legal action against the healthcare establishment and the reduction in the number of patients. This decision may have a deteriorating effect on me both personally and professionally. Personally, I may be heavily criticized for not firing the nurse who is guilty of the child’s death, which will result in experiencing substantial emotional distress. Professionally, my reputation may be undermined by the incident showing my inability to implement successful drug administration processes.
It is worth mentioning that even though honest and open disclosure is an important part of patient-centered care, healthcare professionals are usually afraid of revealing the incidents to the media. The first reason for that is the fear of triggering a malpractice lawsuit, and the second reason is the discomfort of publicly acknowledging that an error occurred and taking responsibility for it. However, there is also the third reason, which may appear to be not so obvious. When disclosing the poor patient outcome, the CNO is also expected to outline the steps which will be taken by the organization to prevent recurrences. The lack of a ready-made solution or the unwillingness to make one may be viewed as the third reason why the CNOs avoid disclosure.
Unfortunately, the decision to withhold disclosure to the public has negative repercussions on value-based healthcare. Instead of admitting the failure and concentrating on the improvement of patient outcomes, the CNOs focus on how to escape the responsibility for the incident. When revealed, the information about the patient safety incident will aggravate the patient-doctor relationship and reduce patients’ trust in healthcare professionals (Ock, Choi, Jo, & Lee, 2018). Therefore, unwillingness to disclose the incident undermines patient-centered care and continuous learning.
The child’s death caused by the incorrect medication is such a terrible thing that it is hard for me to cold-bloodedly consider how I would want the CNO to handle the issue. If I were the patient’s family, I think I would want the CNO to disclose the incident in detail and apologize for what has happened. Even though the medication error cannot be corrected, it is important to keep the family informed and show respect for human suffering. Also, I would expect that the CNO informs the community about the steps and measures that will be taken in order to avoid fatal patient outcomes caused by medication administration errors in the future.
References
Harrison, R., Walton, M., Smith-Merry, J., Manias, E., & Iedema, R. (2019). Open disclosure of adverse events: Exploring the implications of service and policy structures on practice. Risk Management and Healthcare Policy, 12(1), 5-12.
Ock, M., Choi, E. Y., Jo, M., & Lee, S. (2018). Evaluating the expected effects of disclosure of patient safety incidents using hypothetical cases in Korea. PLOS One, 13(6), e0199017.
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