I’m working on a nursing question and need guidance to help me understand better.

Instructions:

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This worksheet has two parts:

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1. A table to analyze each of the Office of Inspector General (OIG) allegations and justify corrective action solutions using IRAC methodology.

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2. A series of questions that will target the issues in the Phoenix Veterans Affairs Health Care System (PVAHCS) case most relevant in the development of a new enterprise risk management (ERM) plan.

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Resources:

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Use the following resources to complete this worksheet:

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Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System

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Enterprise Risk Management: Issues and Cases

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Note: This text investigates ERM case studies, both inside the healthcare industry and out. It also explores the key issues for implementing ERM strategies.

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Impact Assessment Framework

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VHA Publications Index (policies = regulations and directives)

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Below are examples of directives. After reviewing the website, you may find more directives applicable to this case.

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#1604: Data Entry Requirements for Administrative Data

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#2011-002: Office of the Medical Inspector Reports

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#1231: Outpatient Clinical Practice Management

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#1230: Outpatient Scheduling Process and Procedures

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#6300: Records Management

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#1128: Timely Scheduling of Surgical Procedures in the Operating Room

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#2006-041: Veterans Healthcare Service Standards

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#1026: VHA Enterprise Framework for Quality, Safety, and Value

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University of Washington Bioethical Principles

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Note: The site link above includes the ethical principles found in the C985: Analytical Methods of Health Leaders course.

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Part 1. IRAC Table

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Formulate an IRAC (issue, rule, application, and conclusion) response for each of the five OIG violations that includes the following:

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• Issue: Summarize the relevant facts for each violation in the OIG report.
• Rule: Discuss the relevant ethical principles and legal or regulatory requirements for each violation.
• Application: Analyze how the violations deviated from the ethical principles and legal or regulatory requirements discussed.
• Conclusion: Recommend appropriate ERM corrective actions or solutions for each of the violations.

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Clinically significant delays in care
Summary of relevant facts:
Discussion and analysis of deviation from ethical principles and legal, or regulatory requirements or standards:
ERM corrective action or solution recommendation:
Omission of the names of veterans waiting for care from its electronic wait list (EWL)
Summary of relevant facts:
Discussion and analysis of deviation from ethical principles and legal or regulatory requirements or standards:
ERM corrective action or solution recommendation:
Noncompliance in following established scheduling procedures
Summary of relevant facts:
Discussion and analysis of deviation from ethical principles and legal, or regulatory requirements or standards:
ERM corrective action or solution recommendation:
Organizational culture that emphasized goals at the expense of patient care
Summary of relevant facts:
Discussion and analysis of deviation from ethical principles and legal, or regulatory requirements or standards:
ERM corrective action or solution recommendation:
Scheduling deficiencies systemic throughout Veterans Health Administration (VHA)
Summary of relevant facts:
Discussion and analysis of deviation from ethical principles and legal, or regulatory requirements or standards:
ERM corrective action or solution recommendation:

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Corrective Actions or Solutions

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Justify how the corrective actions or solutions recommended above will address the underlying causes of each of the OIG violations:

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Clinically significant delays in care

Omission of the names of veterans waiting for care from its EWL

Noncompliance in following established scheduling procedures

Organizational culture that emphasized goals at the expense of patient care

Scheduling deficiencies systemic throughout VHA

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Part 2. Probing Questions for ERM Assessment

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Answer the following questions about the PVAHCS case intended to inform development of the ERM response.

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1. Consider the prevention of risks with an ERM program. Consider the allegations included in the OIG report. How might an ERM program at the PVAHCS have potentially prevented or immediately mitigated some of these issues?

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2. Examine patient safety issues at the Phoenix VA. What patient safety issues does the PVAHCS case illustrate from an ERM access, ethical, and legal or regulatory perspective?

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3. Consider increasing visibility to patient concerns. How might have an ERM program at the PVAHCS helped give greater visibility to patient concerns about care?

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4. Identify risks. How could patient concerns and safety issues have been identified earlier? Which risk assessment processes or tools would have been most appropriate?

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5. Prevent inaccurate data reporting. Given the allegation that managers were directing staff to report inaccurate data, what oversight and accountability practices and measures could be implemented to guard against similar occurrences in the future? Who should be responsible for implementing these practices?

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6. Assess the impact of inaccurate data reporting. Using the Impact Assessment Framework, perform an analysis scan of the impact dimensions specifically focused on the Leadership and Culture outcome under the Organization and Workforce dimension. In particular, what impact does the allegation of management directing staff to report inaccurate data have on operations at the PVAHCS?

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7. Determine responsibility. Which parties are ultimately responsible for the allegations in the PVAHCS case? Summarize what leadership principles and practices should have been followed.

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8. Identify the impact on VHA patients. According to the OIG Report, up to 40 deaths may have been caused by alleged improper practices at the PVAHCS. What other impacts to patients are anticipated if the current practices continue?

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9. Describe potential risk effects on VHA staff. Describe potential impacts on VHA staff, both those employed in the PVAHCS and throughout the rest of the VHA system. What risks do those effects pose to the VHA system?

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10. Assess the impact of allegations on reputation. How did these allegations harm the reputation of the PVAHCS? Is reputational risk a legitimate concern of an ERM program? If so, what should be addressed in the development of an ERM program to proactively anticipate and mitigate this risk?

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References: