Reference no: EM13765866

The senior management of a large Midwestern nursing home gathered data on its quality of patient care and patient safety. They found that the quality of patient care and safety in the nursing home was deficient. To solve the problem, the managers, with the help of a total quality management expert, implemented a sophisticated continuous quality improvement (CQI) process with structured monthly meetings to review relevant data. Except for the senior nurse manager, other clinical employees did not participate or receive information on the deliberations of the meetings. While the top managers were very satisfied that the CQI addressed the problem in a systematic and formal manner, the clinical staff employees were very frustrated in their efforts to report medical errors. This was because, for every medication error, staff members were assigned one point and disciplined after three points. They could even be terminated as the disciplinary process progressed. The points accumulated over the year were also used to determine the annual salary increases and promotions of the nurses.
Based on the above performance appraisal system, the nursing home reported an improvement in the reduction of medication errors. However, adverse clinical outcomes for patients remained unchanged. To investigate this problem, the top management team hired a new HR consultant. After promising that all information would be strictly confidential, the consultant was able to convince the clinical staff to talk freely about the problem of patients with adverse outcomes. In fact, the clinical staff admitted not filling out incident reports because of the punitive reporting system and expressed concern about the disconnection between the nursing home's goal of improving medication safety practices and the nursing home's approach to error.

1. What would you do when implementing a CQI process to reduce medical errors?

2. How would you change the incident reporting and performance appraisal systems?