Greenville Community Hospital (GCH) was located in an affluent suburb of a metro
ID: 349733 • Letter: G
Question
Greenville Community Hospital (GCH) was located in an affluent suburb of a metropolitan area. A large psychiatric hospital was geographically adjacent. In fact, the two hospitals shared facilities, such as a conference center and some office buildings. Thanks to good teamwork between the two, a consistent pattern of admitting patients via the Emergency Department (ED), then to the psychiatric hospital had emerged.
Lately, however, an uptick of substance abuse-related ED admissions had created a large backlog in GCH. The patients could not be admitted to the psychiatric hospital because they were short on beds for long-term rehab. Drug rehabilitation facilities in the area were either too expensive ($24,000–$40,000 for 28 days), if private pay, or overbooked, if Medicaid supported. In the meantime, the patients had multiple health issues secondary to drug use. The patients were now being placed on a non-secure unit, along with routine medical–surgical patients.
On a night lit by a full moon, Rosemary, a floor nurse, went in to take vital signs on a young female patient who had been admitted for a heroin overdose. She found the girl in bed with her boyfriend, having sex. When she told the boy visiting hours were over and he had to leave, he leaped up, screamed obscenities, and chased her out of the room. Rosemary ran for the nursing station and help. Fortunately for her, he was ataxic and uncoordinated due to his own illegal drug ingestion. She made it to the desk and called security just as he collapsed to the floor. Then she called for a rapid response team to revive the boyfriend.
She wondered how much longer she could do this job. There was no way to call for help, no safe place or room for staff to hide from aggressive patients. It was only a matter of time before she was injured—or killed.
DISCUSSION QUESTIONS
1. What are the facts of this case?
2. What are the management implications of this case? What should management be doing to protect their employees?
3. If Rosemary had been injured, who would have been responsible? What if the visitor attacked another patient? What are the legal and ethical obligations GCH has to its employees and to its patients and how do they apply to this case?
4. What would be the optimum physical space for these patients? How much do you think it would cost to install a panic alarm in the patients’ rooms? At the nurse’s station? A safe room? What are the costs of doing nothing?
5. Create an emergency plan for the staff in this unit while they await administration’s decision on renovations.
Explanation / Answer
Q1. As the case points about the problems posed due to sharing facilities of the two hospitals, facts that need to be looked into are:
A. The two hospitals share facilities with no demarcation.
B. The case does not mention the responsibilities of either management to handle disputes and problems such as mentioned in the case.
C. Drug abuse and other sensitive patients were shifted to non-secure unit owing to the low bed availability
Q2. Management implications: 1. Discomfort among employees regarding the safety
2. Loss of trust regarding safety among regular medical-surgical patients
3. Confusion in management regarding responsibility in turn of mishap or problems with patients
Q3. Legal and ethical obligations that an employer generally owes to its employees in such a case would involve the management to ensure
A. health and safety regulations- Now the case does not describe any responsible authority in terms of sharing duties or exit plans for the shared facility.
B. have a dedicated department to look into the complaints and concerns of the employees- As Rosemary is clearly disturbed about her working environment, it shows there is no clear authority to look into such complaints.
C. Prevention against sexual harassment - Many countries have specified laws stating it to make hospital have a safe workplace for women especially. For example, Civil Right Act of 1964 in the US enforced by the EEOC (Equal Employment Opportunity Commission) defines sexual harassment as unwelcome sexual conduct that has a negative impact on the employee.
If Rosemary had been injured, the hospital with which she is employed would be responsible for any compensation benefits, as described in the employment contract. Also, In the US, assaulting a nurse makes it a felony.
Now, in order to avoid such a condition, a proper care facility needs to be built. If the visitor or any drug sensitive patient attacks another patient, it becomes a problem for the management of both the hospitals. Thus the possible solution is to use some portion of the shared facility dedicated to such patients with trained staff and specialised resources such as alarm system etc.
Q4. The opportunity cost of not employing alarm system / doing nothing-
A. The loss of employee leads to hiring cost. The cost involves not only recruitment cost but also indirect cost such as training cost.
B. The loss in regular patient leading to a business drop owing to the safety issues.
The panic alarm system installation normally involves material cost, installation charges, and implementation of standard operating processes. A normal alarm system can cost up to $400 inclusive of installation charges. However, to be effective, it should be paired with CCTV's and access systems.
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