The Board’s Duty Is To

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The Board’s Duty Is To

  • The Board’s Duty Is To

  • Protect The Public

  • Not

  • Punish The Licensee



Punishment does not improve behavior

  • Punishment does not improve behavior

  • Emphasis is needed on examining what happened and how can we prevent you from doing this again.

  • Support and resources lessen the chance of recidivating.



Individuals disciplined by their employer have a much higher chance of being disciplined by the board of nursing at sometime in the future

  • Individuals disciplined by their employer have a much higher chance of being disciplined by the board of nursing at sometime in the future



200,000 people die from medical errors a year (Andel, et al, 2012)

  • 200,000 people die from medical errors a year (Andel, et al, 2012)

  • More than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month. (HHS, OIG, 2012).

  • When quality life adjusted years (QALYs) are applied to patients that die, the errors committed on an annual basis translates into $1 trillion dollars a year (Andel, et al, 2012)



Regulation and health care facilities need to work together.

  • Regulation and health care facilities need to work together.

  • We need to effectively prevent errors.

  • Examine system as well as individual errors.

  • Punishment may not be the best option for preventing future errors or poor performance.

  • Remediation, counseling, supervision are tools that need to be considered as part of disciplinary action.



People tend to hide errors

  • People tend to hide errors

  • Focus is on punishment

  • Effective when used in the right way.



When do we take no action?

  • When do we take no action?

  • When do we counsel, remediate and supervise?

  • When do we punish/remove from practice?



a system of justice (disciplinary and enforcement action) that reflects what we now know of socio-technical system design, human free will and our inescapable human fallibility.

  • a system of justice (disciplinary and enforcement action) that reflects what we now know of socio-technical system design, human free will and our inescapable human fallibility.







May be due to a deficit in the institution’s policies and/or procedures

  • May be due to a deficit in the institution’s policies and/or procedures

  • May be due to other providers in the health care system

  • Often a combination of factors





Can happen to high performers with no history of past error

  • Can happen to high performers with no history of past error

  • Discipline may not prevent

  • Remediation may not be needed





May need remediation/counseling

  • May need remediation/counseling

  • May need discipline/supervision





Discipline

  • Discipline

  • Remediation/supervision/counseling/job transfer





Repetitive errors – yes, there is a process

  • Repetitive errors – yes, there is a process

  • Repetitive at-risk behaviors – yes, there is a process

  • Both may lead to disciplinary action…



Alternative to Discipline Programs

  • Alternative to Discipline Programs

  • Only effective if the remediation is truly directed towards preventing future occurrence.

  • Monitoring and mentoring.

  • Institution must be aware and involved.



Discipline

  • Discipline

  • May warrant permanent revocation of license



Consistent way of evaluating BON cases

  • Consistent way of evaluating BON cases

  • Based on principles of James Reason, Just Culture, patient safety movement

  • Transparent

  • Patient centered

  • Relies on remediation

  • Partnership with hospitals



Encourage good choices beginning with reporting and identification of errors that might lead to better systems

  • Encourage good choices beginning with reporting and identification of errors that might lead to better systems

  • Identify the difference between errors that are caused by human fallibility, risk-taking behaviors and recklessness

  • Direct discipline according to the type of error.



Patient centered

  • Patient centered

  • Examines intention and distinguishes between types of errors

  • Encourages reporting of errors

  • Encourages partnership between BON and institution

  • Emphasis on corrective activities

  • Accounts for system related issues

  • Looks at repeated occurrences

  • Discipline when needed






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