Rains It Pours

Abstract

Faith Community Hospital is in a state of chaos due to problems stemming from organizational process, ethical issues and lack of communication. In this paper I will attempt to show how the lack of a clear and concise mission statement is the root of their problems.

Framing the Problem

As stated by the Director in the article the three main issues occurring at Faith Community Hospital are organizational processes, ethics issues, and communication systems. The underlying problem linking all of these factors is the Hospitals' mission statement. The employees have failed to understand the intent of the arguably ambiguous mission statement. Without clearly defined and agreed to mission and vision statements, organizations frequently find themselves adrift, in real financial trouble, and unable to make an ongoing, impact on the community. The lack of a coherent mission statement is, in my opinion, the root cause of the aforementioned problems.

It's not surprising that in a busy, demanding and complex environment such as a hospital occasional differences of opinion arise about care of a patient, either among family members, nurses, physicians or other caregivers. Often opinions differ about issues regarding acceptability of a patient's quality of life or likelihood of survival. Sometimes the medical care team has difficulty accepting that the patient is not going to survive; other times it is the family who has trouble coming to grips with a terminal outcome. Occasionally they must deal with a family that is demanding care that the caregivers believe is unwarranted. In the currently chaotic state that is Faith Community Hospital, this has become a very common occurrence.

Making the Decision

Ethics

To address patient-centered issues such as patient care or ethics, Faith Community Hospital, could form an Ethics Committee. It would be composed of many physicians from a variety of specialties, nurses, social workers, clergy, lawyers, and representatives from the community. Meeting monthly, or more often if needed, this committee of the medical staff would report directly to the Medical Board. The committee will be asked to consult on individual cases involving patients. The committee may be asked to render an opinion when patients, families, physicians or hospital staff expresses uncertainty or disagreement about treatment. An example would be a family request for heroic efforts to extend the life of a terminally ill patient in a coma.

Organizational Process

An immediate professional evaluation of a patient's condition upon arrival in the Emergency Department should be implemented. Documenting on the medical record the immediate professional evaluation, acuteness of the condition and monitoring prior to treatment. An established process to review the care of patients should be implemented. Discrepancies should be reviewed, documented and actions taken to correct such discrepancies should be documented as well. A small sampling of patient's medical records should be reviewed on a daily basis for any issues. An ongoing program of identification of high-risk problems, unexpected outcomes and important clinical guidelines should be established. Methods to resolve such problems achieve such guidelines and anticipate the unexpected should be implemented.

Communication

A new set of Policies and Procedures will need to be implemented to avoid all of the organizational process nightmares that currently abound. The activities of the departments should be defined in writing. Coordination with the hospital should be ensured by review of all procedures by the physician designated as the medical director. Such policies should define means by which the hospital meets standards as defined by the appropriate institutions.

Mission Statement

The Hospital can also form a Strategic Planning Committee to create a plan, which includes the institutions mission statement and goals, and base it on a study of internal and external indicators. The internal indicators are based upon institutional research information compiled from physicians and staff. External indicators would include the media, the public, and lawyers. The strengths of the physicians, staff and Board of Trustees have an impact on the development of the mission statement