Advertisement

Journey to Refine Acute Care Hospital Process Improvement Projects for Ethically Complex Patients: Applying Complexity Tools to the Problem of Identifying Which Patients Need a Little More Attention than Most

  • Evan G. DeRenzo
Chapter

Abstract

Clinical medicine and clinical medicine ethics differs from clinical research and clinical research ethics, primarily, in that clinical medicine is much messier. That is, clinical research seeks to avoid confounders in the study by stripping the study population of as many extraneous variables as is safe for the research participants. In clinical medicine, there is no such correlate. The messiness of clinical medicine is simply a fact of patient care that contributes majorly to the medical, psychosocial, and ethical complexities of the care of clinical patients.

Over the past several decades, my colleagues from various institutions and professional backgrounds and I have come together at various times to identify patient populations that represent groups of patients who predict medical, psychosocial, and ethical complexity. Our ultimate intention for this work is to develop methodology that can identify the patient groups who will need just a bit more support to avoid problems brought about by these patients’ medical and/or psychosocial complexity. This work is being performed to help hospitals know where to put their quality assurance/quality improvement (QA/QI) dollars.

Progress to date brings this work to validation of the specific patient populations identified as predictors of medical, psychosocial, and ethically complex care. Further, in the process of this variable validation research, we are examining the prospect of using big data analytics applied to hospital electronic medical records to identify these special populations.

Notes

Acknowledgements

Study 1: This protocol was approved by the MWHC hospital’s IRB on October 25, 2009. No personally identifying information was collected.

Study 2: This protocol was approved by the MLHS hospital’s IRB on September 19, 2014. No personally identifying information was collected.

References

  1. 1.
    Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53:143–51.CrossRefGoogle Scholar
  2. 2.
    IOM (Institute of Medicine). Crossing the quality chasm: a new health system for the 21st century. Washington: National Academy Press; 2001.Google Scholar
  3. 3.
    Wang MC, Hyun JK, Harrison M, Shortell SM, Fraser I. Redesigning health systems for quality: lessons from emerging practices. Jt Comm J Qual Patient Saf. 2006;32:599–611.CrossRefGoogle Scholar
  4. 4.
    Stacey RD. Strategic management and organizational dynamics; the challenge of complexity. New York: Prentice-Hall; 2003.Google Scholar
  5. 5.
    DeRenzo EG. Individuals, systems, and professional behavior. In: Mills AE, Chen DT, Werhane PH, Wynia MK, editors. Professionalism in tomorrow’s healthcare system: towards fulfilling the ACGME requirements for systems-based practice and professionalism. Hagerstown: University Publishing Group; 2005.Google Scholar
  6. 6.
    Gatter R. The mysterious survival of the policy against informed consent liability for hospitals. Notre Dame Law Rev. 2006;81:1203–73.Google Scholar
  7. 7.
    DeRenzo EG, Schwartz J, Selinger S. Harnessing complex hospital care: hospital practices must match the moral ends of treatment. Sci Prog. 2009. https://scienceprogress.org/2009/02/harnessing-complex-hospital-care/. Accessed 27 Mar 2017.
  8. 8.
    CDC (Centers for Disease Control and Prevention). Defining overweight and obesity. 2012. http://www.cdc.gov/obesity/defining.html. Accessed 17 July 2012.
  9. 9.
    Joint Commission. Sentinel event data, event type by year, 1995–2011. 2012. http://www.jointcommission.org/assets/1/18/Event_Type_Year_1995-2011.pdf. Accessed 19 July 2012.
  10. 10.
    IOM (Institute of Medicine). To err is human: building a safer health system. Washington: National Academy Press; 2000.Google Scholar
  11. 11.
    Carroll AE, Parikh PD, Buddenbaum JL. The impact of defense expenses in medical malpractice claims. J Law Med Ethics 2012;40:135–42.CrossRefGoogle Scholar
  12. 12.
    Seabury S, Chandra A, Lakdawalla D, Jena AB. Defense costs of medical malpractice claims. Law Soc Rev. 2012;24:105–20.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.John J. Lynch MD Center for EthicsMedStar Washington Hospital CenterWashington, DCUSA

Personalised recommendations