Actively caring decision process

In this section, I have reviewed the decision process model Latan6 and Darley proposed as a sequence of choices people make before actively caring on behalf of ano er person. Although developed to xmderstand the bystander effect in emergency situations, this decision framework is certainly relevant for proactive situations and for each type of actively caring behavior defined in this chapter (direct vs. indirect, and environment-focused, person-focused or behavior-focused). 

By "exposure to hazard" we mean any condition, decision, behavior, activity, cultural standard, process, or system (or lack thereof) that increases the probability of the patient s suffering a preventable adverse event. In short, any malfunction in any element of the blueprint that increases the patient s jeopardy constitutes an exposure and is a root cause of preventable adverse events. By "preventable adverse event" we mean healthcare-caused harm, i.e., a patient injury that is not an inevitable or necessary outcome of the patient s illness but rather the result of the care he or she received. Table 2-2 shows some common healthcare safety exposures and related preventable adverse events. 

The next item in the loop is a decision point for possibly introducing the use of inductive reasoning methods into the deliberations. If the deductive process continues to indicate progress, then additional facts are procured or the logic tree is restructured. For example, one witness stated a particular valve was open, yet the post-incident inspection found it to be closed. The team must be careful to ensure that the valve is closed because of the actions taken prior to the incident, and not as a result of post-event response activities. The position of this particular valve may be a critical item in determining which of two scenarios is the more probable case. The incident investigation team would then initiate a short-term action item to conduct a mini-investigation to resolve this question. 

Actually, all healthcare professionals should leant that the center of the healthcare system is the patient, and rather than classifying the patients functions, what is important are those processes that provide an added value to the patients health, and those who lead them. It means establishing alliances between members of the healthcare team. Perhaps we should start viewing the members of health teams as being coresponsible for care, and even incorporate patients themselves into the team, with a first-line role, taking active part in decisions. The clinical pharmacists goal is for patients to see them as an ally, someone on whom they can rely. 

The decision to initiate cleanup and restoration activities on oil-contaminated shorelines is based on careful evaluation of socio-economic, aesthetic, and ecological factors. These include the behaviour of oil in shoreline regions, the types of shoreline and their sensitivity to oil spills, the assessment process, shoreline protection measures, and recommended cleanup methods. Criteria of importance to this decision are discussed in this chapter. 

The terms methods improvement, methods engineering, operations analysis, and woric simplification have been used synonymously in industrial engineering literature. These techniques use a systematic procedure to study and improve methods for carrying out any set of activities to accomplish a task. In health care systems, these could be the work methods used in the actual delivery of health care to the patients or the work methods utilized in support activities. One common tool used to document an existing process or work method is a flowchart, which can also be used to document a new process as it is developed prior to implementation. A flowchart allows a critical examination of the various steps of the process and assists in the identification of unnecessary steps and inefficiencies in the process. Flowcharts show each step of the process as well as decision points and various courses of action based upon the decision. 

The degree of risk involved in an activity or sitnation influences the decision as to whether a breach of duty of care has occurred. Risks which are reasonably likely to happen should have been anticipated (Bolton v. Stone, 1951). However, progressive and appropriate pnpil responsibility as they become more matnre, experienced and independent is acceptable (Jeffrey v. LCC, 1954). Sitnations carrying intrinsically greater risks such as outdoor activities, contact sports, complex technological equipment and some scientific processes are acceptable provided that appropriate... 

Risk assessment represents a careful analysis of the premises, processes and work activities to identify what could cause harm to people to enable decisions to be made as to whether sufficient precautions have aheady been taken or whether further controls are needed. The aim of Risk Assessment it to individualize a risk priority that allows to define a hierarchy of intervention activities (design review, procedures, formation and information) needed to eliminate or reduce the risk. There are many methods for Risk Assessment (FMEA, FTA, HAZOP, What-if, MOZAR, etc.) (Hiromitsu 1996) that are all usable. 

Nothing about me without me (Delbanco and others, 2001). Recognizing patients and families as an active part of the system of care and not passive recipients brings an abundance of expertise and safety nets to the sharp end of care. This policy embraces practices and tools that involve the patient and family in decision making and participation in the care process. It includes providing... 

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