Case Study 1: Vidant Health
In the Ethics and Professionalism for Healthcare Managers text, the authors highlights two cases for your consideration (pages 134 140).
Review one of the case studies. Utilize and directly refer to these resources as you address the questions associated with the case study of your choice. Your personal resource list, compiled in the first discussion in Units 1 and 2, will be useful for analyzing this case study as well.
Follow APA guidelines to cite and reference all of your resource materials in your work. Refer to the Health Care Administration Undergraduate Program Library Guide for assistance.
Respond to the main discussion posts of at least two learners as early in the week as possible to allow for continuing conversation. Compare and comment on the management actions chosen by your peers with your own. Offer constructive comments, ask questions, and thank your peers for additional insights you gained from their compositions.
The Case of the Techno Ankle
Dr. Shane Aidan was frustrated! He was a well-respected orthopedic surgeon, but this case was becoming more and more perplexing. Fiona Macfee, a 40-year-old woman, broke both bones in her ankle in a skating accident. Repairing her ankle required two successful surgeries. However, the surgical wound would not heal. Consequently, Dr. Aidan ordered a negative pressure using a vacuum assisted closure (VAC) machine to assist in her healing. Past experience led him to believe that it would speed healing in a case like Fiona’s.
Something was clearly different about this case. Although Fiona had home care with wound specialist nurses, her progress in healing was slow. In addition, Fiona complained about the quality of care. Dr. Aidan wondered whether the specialists were contributing to the lack of healing progress. His fear was substantiated when he receive a call from Fiona. She reported that a new wound care specialist came to her home and changed the position of the dressing. However, the nurse applied the dressing to healthy tissue instead of correct site. The result was that Fiona experienced an incredible pain in her ankle. She turned off the machine but was unable to make contact with anyone from the agency that was supposed to care for her. She asked for an evaluation of her ankle and a new referral for her care.
Dr. Aidan was also concerned about the loss of credibility to his practice and even considered the potential of a lawsuit. He decided to take control of the technology dilemma.
He called a meeting during Fiona’s next appointment. Attendees were representatives from the company that created the technology, wound care specialists from the home health agency, his office staff nurse, and Dr. Aidan. Using Fiona’s ankle as a prop, the representatives discussed the purpose of the machine and how to change the dressings correctly. They also observed a new wound care specialist (not the one who was responsible for the error) as she applied the dressing and offered suggestions.
Both Dr. Aidan and his staff nurse asked questions about how the technology applied to Fiona’s particular wound and how to enhance future healing. After serving as the prop, Fiona asked her questions about the treatment and her healing. In the end, all those who attended felt more knowledgeable about the application of this technology to Fiona’s case. However, Fiona was not impressed.
Commentary on the Case
Why did Dr. Aidan set up a multi-staff conference?
Consider Dr. Aidan’s dilemma. He was relying on technology to assist healing in a difficult case. However, he was not in charge of all aspects of her treatment. He relied on the integrity of the wound care specialist team and their knowledge of this technology. However, because her healing was slow, he had concerns about the home health wound care specialists and their contribution to the slow healing. Before the incident, he was considering changing agencies. When the incident happened, the action was to get all parties together and do some technology calibration. This might ensure that all parties involved in Fiona’s care were working together through common knowledge.
Dr. Aidan might also be concerned about a potential lawsuit and its effect on his practice. The ability to bring all the participants in Fiona’s care together would allow them to communicate and create better understanding, which might mediate any future harm. Dr. Aidan hoped that Fiona would view this meeting as quality assurance on her behalf—a perception that might prevent her from consulting an attorney. In addition, Dr. Aidan could verify that the wound care specialists had the most current information on the technology. This knowledge could give Fiona assurance that her home care would contribute to her healing rather than cause further harm.
Which ethics theories and principles apply to this case?
In this case, the theory of deontology is at work. Even though the bones had healed, Dr. Aidan still had a duty to the patient. He felt obligated to make sure that Fiona could resume her normal life. This duty included the complete healing of her surgical wounds. Calling a meeting of the professionals who contributed to Fiona’s care and verifying that these professionals had correct information on the technology was one way to demonstrate active deontology.
While deontology is the most obvious theory at play here, also consider utilitarianism. Dr. Aidan was concerned about making the best decision for his practice. Having a meeting at his office during a patient’s appointment meant that he incurred costs. For example, he did not see other patients during the meeting. However, using a cost/benefit analysis based on utilitarian principles, he determined that the cost of holding a meeting was well worth the benefit of preventing future problems. In addition, he could save thousands of dollars in lost revenue by preventing a lawsuit.
With respect to principles, beneficence and nonmaleficence were evident. Dr. Aidan wanted to prevent future harm to Fiona by ensuring the correct use of wound care technology. Before he prescribed this technology, he wanted to be sure that it prevented harm by increasing healing time. In terms of beneficence, Dr. Aidan made the decision to take time out of his practice to have this meeting. While this action was not required, it demonstrated his concern for the patient and her healing. He also hoped that Fiona would view his actions as taking extra steps to benefit her care.
Another principle to consider in this case is autonomy. The autonomy of the professionals was respected because they were allowed time to ask questions and gain knowledge necessary for the correct use of the technology. However, Fiona’s autonomy was not a priority. During the appointment, she acted more as a prop than as a person. However, at the end of the conference, she was allowed to ask questions, which demonstrated some level of respect for her as a person.
Will this conference change Dr. Aidan’s decisions about technology?
Dr. Aidan needed to consider future decisions about the use of technology based on ethics and economics. From an ethics view, he will weigh benefit to the patient with potential harm. As he learned in this case, technology, when used improperly, can add to a patient’s problems rather than promote healing. It can also result in legal action if not properly used.
From an economics view, Dr. Aidan must also be careful not to succumb to the “lure of the latest.” That means he will have to weigh the cost of immediately obtaining the newest technology versus the benefit of this technology for his patients. He will also have to remember that newer is not always better. Again, he must base his decisions on research and practical wisdom rather than on the influence of a well-spoken sales representative.