Case Study
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CASE STUDY INSTRUCTIONS
Read the assigned case discussion and use the questions as a guideline for each submission. All Case Studies should include an introductory and concluding paragraph, as well as headings. All Case Studies should include a biblical perspective with scripture included relevant to the topics covered in the Case Study scenario. Case needs to be in current APA format, 4–5 pages in length, not including the cover, abstract, or reference pages.
CASE:
It’s likely that many people simply skipped the morning newspaper on Thanksgiving 2010. Had they scanned the front page, however, they may have noted a headline: “Hospitals Make No Headway in Curbing Errors, Study Shows.” The article did not make encouraging reading. After 10 years of efforts designed to reduce hospital errors, a study found “that harm to patients was common and that the number of incidents did not decrease over time.”31 To help understand this matter, we can look at one hospital that made an effort to avoid mistakes, and, in doing so, made matters worse.
Springfield General
The chief administrators at the Springfield General Hospital (a disguised name), a large urban teaching hospital, were determined to use technology to solve a nagging and disturbing problem: medication mistakes.32
The Problem Prescribing errors, confusion over drugs with similar names, inadequate attention to the synergistic effects of multiple drugs and patient allergies—those and other related errors that are lumped together under the label “adverse drug event”—kill or harm more than 770,000 patients annually in U.S. hospitals. In added health care costs alone, adverse drug events add several hundred billion dollars a year. And the most common type of error—the simplest to understand and, seemingly, to correct—is “handwriting identification”: poor or illegible handwriting by the prescribing physician.
The Solution Administrators at Springfield General called upon a computerized physician order entry (CPOE) system to solve the problem. CPOE worked to ensure safety and accuracy by the following steps:
All physician prescriptions for medicine and treatment would be entered into the hospital’s IT network.
Those computer entries would be available to all hospital staff, including both treatment and pharmacy staff.
The system would catch all prescription errors: incorrect dosages, duplicate requisitions, patient allergies, and even adverse impact statements of multiple medications being prescribed to a patient.
The system would also display the patient’s complete medical history as well as the latest clinical guidelines for treatment.
Ample evidence existed that CPOE can and has been used to reduce both errors and costs.
The Results Surprisingly, the results at Springfield General were stunningly disappointing. Not only did the CPOE system not eliminate errors, it actually increased adverse drug events.
A subsequent study identified a number of problems:
Incorrect Dosage Information—“House staff often rely on CPOE displays to determine minimal effective or usual doses. The dosages listed in the CPOE display, however, are based on the pharmacy’s warehousing and purchasing decisions, not clinical guidelines. For example, if usual dosages are 20 or 30 mg, the pharmacy might stock only 10‐mg doses, so 10‐mg units are displayed on the CPOE screen. Consequently, some house staff order 10‐mg doses as the usual or ‘minimally effective’ dose.”
Discontinuation Failures—“Ordering new or modifying existing medications is usually a separate process from canceling (discontinuing) an existing medication … medication‐canceling ambiguities are exacerbated by the computer interface and multiple‐screen displays of medications … viewing one patient’s medications may require 20 screens.”
Patient Confusion—“It is easy to select the wrong patient file because names and drugs are close together, the font is small, and, most critical here, patients’ names do not appear on all screens. Different CPOE computer screens offer different colors and typefaces for the same information, enhancing misinterpretation as physicians switch among screens. Patients’ names are grouped alphabetically rather than by house staff teams or rooms. Thus, similar names (combined with small fonts, hectic workstations, and interruptions) are easily confused.”
QUESTIONS:
1: What went wrong? How can you explain how the technology actually led to more rather than fewer mistakes?
2: What theories of change implementation would have helped the administrators at the Springfield General Hospital solve the problem of medication mistakes?
3: How might you have gone about solving the problem at Springfield General? To what extent, if any, would new technology have been helpful?

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Training Workshop Scenario
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You are the newly hired Director of Performance Improvement at the Brownville Memorial Hospital. You were hired to improve the hospital’s compliance with federal, state, and local regulations. Additionally you are responsible to ensure that all standards related to quality assurance, patient protections, infection control, safety, risk management, and staff education are followed. You report directly to the hospital Chief Executive Officer (CEO) and you oversee the Quality Assurance and Performance Improvement (QAPI) staff.
The CEO wants the hospital to upgrade to a higher patient centered medical home (PCMH) recognition level in 18 months. He has given you your first project which is to improve patient and family ratings on the hospital satisfaction survey. As you review previous Press Ganey Satisfaction Surveys you note that patients and families consistently rated the hospital staff poorly on providing information that made it easy to understand and improve their health. Many survey comments stated that patients “found the health information they were given confusing and did not know how to act on it.”
Brownville is a 500 bed hospital situated in a large metropolitan area with more than 750,000 residents, many of whom are Black, Asian, and Hispanic. 35% of the residents are foreign-born and speak a language other than English at home. The median household income is $35,000 per year and more than 30% of residents did not graduate from high school. The hospital provides primary care, specialty care, and support services to area residents with a large direct patient care staff (including physicians, nurses, physician assistants, medical assistants, nursing assistants, social workers, therapists, technologists, technicians, phlebotomists, and pharmacists).
To begin your first project, you have decided to develop and implement a long-term staff education program that will focus on “health literacy.” You and your staff will be rolling out this program to all hospital staff members. The first activity will be a workshop for all existing and new staff. You will deliver the workshop in person to small groups (40 staff members) over the next 2 months.
Your key areas of concern are that all staff (address 2 key areas for assignment):
● communicate clearly with patients
● utilize the patient friendly health education materials available and disseminate take-home materials
● address language and cultural differences (with support from translation services available through telephone)
● help patients to remember how and when to take their medicines
● encourage patients to ask questions
Therefore, you will develop a 20-minute (maximum) workshop presentation that clearly explains health literacy, key communication principles, and addresses 2 of your key areas of concern. You have decided to give the CEO a preview of your workshop at your next meeting so that he knows that you are dedicated to performance improvement.

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Unit III Annotated Bibliography 2
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Unit III Annotated Bibliography
Pick a type of cancer to research. Find articles that answer questions concerning your chosen type of cancer. This
assignment will help you to organize the sources you will use in the Unit V Research Paper. An annotated bibliography
consists of two parts: the reference citation in APA format, followed by the summary for that reference.
• Your sources should address the following topics, which will be included in the Unit V Research Paper:
o Define cancer.
o Describe the type of cancer you selected.
o Describe the diagnosis: symptoms, diagnosis, staging, and prognosis.
o Discuss treatment options, including medicines/alternative treatments.
o Discuss causes/risk factors.
o Include the incidence rate or statistics.
o Explain the resources you would use if you or someone you knew had this type of cancer.
o Discuss what you can do to help the fight against cancer.

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WEEK 3 DB Collapse
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OPMC and OPD websites as well as take a look at the disciplinary cases involving Niels Lauersen and/or Dr. Rohan Wijetilaka. Let’s talk about the issues surrounding regulating practice by health care professionals. The materials are in the week 3 folder. Do you think the process of disciplining health care professionals is effective? Pick one of the two cases or go to the Office of Professional Medical Conduct and check out other cases. They are all pretty sad and sorry. Do you think that physician’s case was handled correctly by the Federal Government and the Office of Professional Misconduct? Do you think the physician should be allowed to practice medicine again?
Identify the differences between licensure and accreditation and certification.
Discuss the pros and cons of the professional disciplinary system approach to licensure issues.

Please review the OPMC and OPD websites as well as take a look at the disciplinary cases involving Niels Lauersen and/or Dr. Rohan Wijetilaka. Let’s talk about the issues surrounding regulating practice by health care professionals. The materials are in the week 3 folder.
Do you think the process of discipling health care professionals is effective?
Pick one of the two cases or go to the Office of Professional Medical Conduct and check out other cases. They are all pretty sad and sorry.
Do you think that physician’s case was handled correctly by the Federal Government and the Office of Professional Misconduct?
Do you think the physician should be allowed to practice medicine again?
Go to your state’s website for physician profiles and see if you really want to see your own doctor

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