ࡱ> q%( '@/ 00DArialBlackmantt6 0DTimes New Romantt6 0 DWingdingsRomantt6 00DArial Blackmantt6 0"@ .  @n?" dd@  @@`` xpbo /<JLOPQRSTUVWXYZ[\]^_` 0AA@87? ʚ;ʚ;g4ededg 0ppp@ <4dddd@w 0t6 <4dddd@x 0tg4KdKdvv3*OThree Most Under-Recognized Ethical Issues Facing Most Healthcare OrganizationsPP(Promoting unrealistic expectations: over-promising and under-delivering to staff, patients, community Rationalizing inappropriate or incompetent behavior Failing to acknowledge and address executive mistakesZB8Ethics and Ethics Standards(Ethics make right choice in face of competing values and focusing on what ought to be decision, action or behavior, especially when there is conflict or uncertainty Organizational Ethics Standards  improve care, treatment, services and outcomes by recognizing and respecting the rights of each patient and by conducting business in an ethical manner (Joint Commission 2008)fZZ!ZZCV!D:7Lack of Attention on Executive versus Clinical Mistakes88(Rationalization of management as art versus science  in denial Ambiguous decision-making processes and performance criteria  inadequate metrics Difficulty in obtaining consensus about what constitutes  right decision  not immediately apparent Management ego, fear of reprimand or job loss  arrogance, defensiveness, insecurity MME;/Definition and Examples of Management Mistakes00(8Definition  making or not making decision without assessing evidence and stakeholder perspectives, placing patients, staff, organization and/or community at risk Examples Failure to act promptly when conditions change, to delegate and hold subordinates accountable, to fulfill commitments, to allocate resources fairly, to serve as an effective role model and to empower others Pattern of making decisions prematurely, belatedly or secretively (alienating and demoralizing subordinates and staff), exhibiting or tolerating abuse of power BZpZZpF<*Factors Contributing to Executive Mistakes++(Relentless pressures to accommodate special interest groups and multiple constituencies Competent leaders compromised by flawed systems and bureaucracies Lack of time and encouragement to acknowledge, evaluate and learn from mistakes Tendency to make unwise appointments of competent clinicians to management positions Deficiencies in preparing, developing and mentoring future executives .ZZG=(Mitigating Impact of Executive Mistakes ))(Admit, disclose and analyze mistakes, recognizing difficult choices sometimes will be wrong choices Accept professional/personal fallibility and imperfections Promote organizational culture where freedom to take reasonable risks, to fail and to learn is reality, not simply rhetoricZH>@Representative Steps to Reduce Executive Mistakes in Healthcare AA(Make use of case studies to encourage discussion of mistakes and learning opportunities created by mistakes Conduct staff survey to determine if disclosure of mistakes is considered likely or if fear of retribution discourages admission Develop policy on management mistakes, including definition, criteria for reporting, assurance of non-recrimination, to whom mistakes will be disclosed, description of available resources and specific steps to be taken when reportable mistake has occurred PI?9Representative Steps to Reduce Executive Mistakes (cont.)::(vPrepare, implement and monitor organizational and professional codes of ethics Incorporate questions about mistakes in annual senior management and supervisory performance reviews Conduct formal audits of major financial and strategic decisions to assess whether results met forecasted outcomes and, if not, to identify how decision-making process could have been improved wwT@)Benefits of Addressing Executive Mistakes**RInevitability of mistakes is acknowledged Admission of fallibility by executives will earn respect of clinical colleagues Individual and organizational credibility will be enhanced Promoting examination of mistakes will improve management and organizational performance Ultimate beneficiaries are patients, staff members and communities  SPQ/JKLMNOPQRS J  0` fff33` 3KI3ff` 33ff` /p` 3%*3|` Jy3fff3f` 3ff3̙` 33ff33` DDyq3f` ̙3n` w3ff` }ff>?" dd@,?nKd@ P nA@F`d n?" dd@   @@``PR"   @ ` `2p>> n f P (    6 #" ``   Z*   6 #" `` `  \* T X  "X  Nxd#" `P D0   68d#" `U B0   S |"UY <   c $x"YW <    c $б"YU <    c $t" <    S ณ#" `SV B0    S $"Y <    c $("X <   <@ #" `  `  T Click to edit Master title style! !$  0Ó " `p  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  6ʓ #" `^ `  X* H  0޽h ? }ff80___PPT10. 07  Pixel  0 }`(  : T   "  TXd #"   D0   c $HX "9)e  B0 6b e  # "e   S X"ie  B0   S X"9) B0   S X"0 B0    S @X"?e  B0    S X") B0    S X"?G B0    S HX"oG B0    S X"9G B0   S XX"iA B0   S X"A? B0   6DX #" `` ` X X*   6X #" ``  X Z*   6X #" `` ` X \*   0hX "P   X T Click to edit Master title style! !  0X " P  X W#Click to edit Master subtitle style$ $H  0޽h ? }ff80___PPT10. 07 0 *(    00\ P   \ X*   0 \    \ Z* d  c $ ?  \  0\  0 \ RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  6\ _P  \ X*   6X\ _  \ Z* H  0޽h ? 3380___PPT10.H4@E $(  $ $ 0$| ; 0   p (  pX p C     p S , 0    The Use and Misuse of Incentives is another article you should have, so I won t elaborate on these observations except to note that we should be exquisitely sensitive to the possibility that well-intended incentives can produce unexpected and undesirable consequences. I should also note here that disclosure is never easy. Last month, the Minneapolis Star Tribune published an article titled,  Minnesota Hospitals Strive for Safety, But Errors Still Increasing. In spite of efforts to make Minnesota hospitals safer, the reporter wrote, the number of deaths & injuries from errors or accidents rose again last year, according to a report released by the MN Dept. of Health. The Health Commissioner said that changing the attitudes among hospital staff has proved harder than adding new safety procedures. However, hospital officials replied that the rising numbers are likely the result of better reporting and an increasingly open culture about acknowledging mistakes.@X<;.~@%H p 0޽h ? 3380___PPT10.-PN> < 0   tN (  tX t C      t S և @   P  A couple years ago, I asked a physician if he would co-author an article with me for the Hastings Center Report to be titled,  Physicians Should Not Always Pursue Good  Clinical Outcomes. Cardiologists, pulmonologists, and nephrologists can take legitimate pride in preserving organ function but someone must take responsibility for assessing the whole patient, not just an organ s viability. (Can we afford to provide unlimited care? YES!) When we do too much to patients and too little for patients, when we treat too much and care too little, patients risk becoming the victims rather than the beneficiaries of technology. Quality initiatives related to end-of-life issues can be among most challenging and also most satisfying of all hospital performance improvement programs. This past Wednesday, after making ethics rounds in the ICU of a local hospital, I met with its Bioethics Committee to report on 21 telephone interviews I conducted with the next of kin of patients who had died in the ICU during a four month period after a minimum stay of three days. By asking only five questions of relatives, we obtained very helpful feedback about end of life care & services which are too rarely evaluated as part of quality improvement programs.lH t 0޽h ? 3380___PPT10.-p = 0 . & x (  xX x C    &  x S  0   6The value of practicing evidence-based medicine is indisputable, so why haven t we witnessed the benefits of evidence-based mgt? Is it because we don t have evidence-based mgt? When we delay in learning from each other and promoting best mgt practices that affect the quality of patient care, we are  on a daily basis  implicitly compromising patients, families and staff. Throughout the country, there are institutions achieving success in: Reducing the incidence of  never events, Preventing disruptive behavior among staff members to avoid endangering patients and damaging staff morale, and Achieving progress in other vital areas by implementing innovative programs that should be replicated by other organizations. In a February 6 NYT column, Dr. Pauline Chen wrote a column titled,  When Doctors and Nurses Can t Do the Right Thing. She talked about the cost of  moral distress and a study )published in the July 2008 issue of the Journal of Advance Nursing) that reported moral distress was the reason 15% of nurses left their job.nZKH x 0޽h ? 3380___PPT10.-@> 0 H@|(  |X | C    Q@ | S  0  Q I suspect most of you are familiar with Trinity Health as the nation s 4th largest Catholic health system led by Joe Swedish. I have highlighted two sentences in this eloquent set of comments by the organization s Chief HR Officer, but knowing Joe, I am confident he say their mission imperative of quality is a work in progress.*KH H | 0޽h ? 3380___PPT10.-T? 0 d(  X  C    Q  S d"Q 0  Q f6Although I have not been the CEO of a Catholic hospital or health system, I have had the privilege of working with Catholic facilities. I have also made site visits on behalf of the AHA for the Circle of Life award that recognizes innovative end of life and palliative care programs and the Quest for Quality Prize, so I have first-hand knowledge of the respect and high esteem you have legitimately earned. Other faith-based healthcare institutions, as well as those that are not faith-based, expect Catholic hospitals to create and sustain organizational cultures that are national models for innovation in quality improvement programs Given her background, experience and role, Sister Doris is exceptionally qualified to discuss the mission leader s role in creating a culture of quality.H  0޽h ? 3380___PPT10.-r|@y%6P'E3T@ LB0"WRNYz[]_*bVdh`s {&DZf<T1Oh+'0 hp   Slide 1County of San MateoPixel*67Microsoft Office PowerPoint@n@0OcD3@ª(Gg  h 1  y--$xx--'---$xx----$xx----$xx----$xx----$xx----$x x ----$ x x ----$ x x ----$ x x ----$ xx ----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$x x ----$ x!x! ----$!!x"x"!----$""x#x#"----$##x$x$#----$$$x%x%$----$%%x&x&%----$&&x'x'&----$''x(x('----$((x)x)(----$))x*x*)----$**x+x+*----$++x,x,+----$,,x-x-,----$--x.x.-----$..x/x/.----$//x1x1/----$11x2x21----$22x3x32----$33x4x43----$44x7x74----$77x;x;7----$;;x>x>;---'}--$II--'--$ > II> >--'--$((((--'--$''22'--'}--$>II>>--'--$''(2(2'--'--$(33((--'}--$(3 3 ((--'--$(3(3(((--'--$ 3 >>3 3--'--$3>>33--'@Arial-. $2 17Executive Mistakes  ."System8-@Arial-. 2 >G in Healthcare.-@Arial-. 12 V@Paul B. Hofmann, DrPH, FACHE.-@Arial-. -2 ]EHofmann Healthcare Group C.-@Arial-. *2 eIMoraga, California, USA.-՜.+,0     $ On-screen ShowSan Mateo Medical Centerk   ArialTimes New Roman Wingdings Arial BlackPixel"Executive Mistakes in Healthcare Leading in Challenging Times PThree Most Under-Recognized Ethical Issues Facing Most Healthcare OrganizationsEthics and Ethics Standards8Lack of Attention on Executive versus Clinical Mistakes0Definition and Examples of Management Mistakes+Factors Contributing to Executive Mistakes)Mitigating Impact of Executive Mistakes ARepresentative Steps to Reduce Executive Mistakes in Healthcare :Representative Steps to Reduce Executive Mistakes (cont.)*Benefits of Addressing Executive Mistakes  Fonts UsedDesign Template Slide Titles _0**  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`bcdefghijklmnpqrstuvxyz{|}~Root EntrydO)Current UserwSummaryInformation(a,PowerPoint Document(DocumentSummaryInformation8o