Arthur’s Blog

The time has finally come to start writing a blog. What should I write about? Obviously the fields of knowledge that I’ve experienced, influenced and interacted with over the past 40+ years; healthcare administration, hospital operations, healthcare policies and procedures, administrative standards of care, and laws impacting the operation of acute care hospitals, all of which leads to a focused discussion of how best to maximize safety for hospital patients.

The audience that I hope will read and interact with the Blog includes litigators, both plaintiff and defense attorneys, CEOs, senior healthcare executives and frontline managers, graduate students preparing for careers in healthcare administration and members of governing bodies of licensed healthcare facilities, who are the individuals who accept legal and fiduciary responsibility for the institutions they serve.

One might think for a moment that this multi-various audience would not benefit from a singular channel of information. But closer examination suggests that the optimal way to generate the clearest understanding for all parties is to look through the same prism. Specifically, appreciate the national healthcare administrative standards, and a hospital’s policies, procedures, rules, regulations, and protocols that define caregiving expectations. If we then add into this mix one of the principal priorities of every healthcare facility, namely maximizing patient safety, we can then develop a clear insight to the fact pattern and its ramifications in legal disputes.

Unfortunately, all too often healthcare issues are discussed only on the “macro” level; that is a discussion of national healthcare policy, healthcare cost and reimbursement issues, patient access, and mergers and consolidations. Obviously all of these agendas are important but not to the extent that they exclude inclusion of discussion of the “micro” issues; patient safety, quality of care delivered, impact to individual patients, and staff and managerial compliance with detailed policies, procedures, rules, regulations, and protocols that are in place to maximize patient safety. So, to the extent that the micro issues are omitted from the discussion, we are missing a very core, critical, and relevant dimension, namely the impact on individual patients.

Therefore one of the major goals and objectives of this blog is to increase the priority of the micro issues and insinuate the relevant elements into the mainstream of the debate. By definition, the patient should always be the central element in a dialogue involving a hospital as a community institution, physicians, caregivers, and ancillary and support staff. Why is this focus important? Because in the final analysis hospitals are in the caregiving business. Administrator’s principal priority is to manage the “environment of care” to maximize the safety of the diagnostic and therapeutic platforms for physicians, nurses and other professionals who confront disease, alleviate pain; that is, have a positive impact on the human condition one individual at a time.

Is focusing on the micro issues of patients incompatible with the larger “macro” issues? It may or may not be but the real issue isn’t whether there is an incompatibility but rather how to integrate the discussion so that the larger scope issues are discussed while never losing focus on the impact and implications to our primary constituency, the community we serve, and in specific the patients who seek our services.

I’ve had the privilege of serving in senior executive positions over a 16 year career in acute care teaching hospitals, teaching graduate students in a number of accredited graduate programs in healthcare administration, and an extensive career offering expert witness testimony; that is teaching litigators, jurors and the court about the complex functions of hospitals. One major goal of this blog is to focus litigators and the court to appreciate how compliance or noncompliance with relevant administrative standards, hospital policies procedures, rules, regulations and protocols impacts and influences the care delivered by licensed healthcare professionals, and
how understanding the expectations of the administrative policies and procedures that impact the delivery of patient care will result in valuable clarity when adjudicating claims of hospital corporate negligence.

The combination of my professional experiences and unusual blending of major professional career components is indeed unique. Rarely from my first-hand experience and interaction with professional colleagues have I encountered others who have had same case volume and substantive experiences interpreting hospital administrative standards in the context of litigation. Thus, presenting issues that bring all of the professional elements noted above and discussing the various perspectives is unique; bringing a fresher perspective, albeit complex perspective, to this process.

For example, when evaluating a legal matter involving allegations of hospital corporate negligence we will explore the corporate statutory expectations of the Governing Body, the role and responsibility of the Chief Executive Officer and ultimately through the chain of command, the CEO’s management designees, frontline staff, and supervisors that extend to the patient’s bedside. Through this type of analysis and discourse we will attempt to reconcile the administrative standards of care, state and federal government licensure laws governing hospital operations, the hospital’s policies, procedures, rules, regulations, and protocols that are the hospital’s approach to compliance with administrative community standards and the fact pattern of specific cases. We can then come to understand successes or failures attributable to the hospital as it attempts to comply with administrative standards of care and the impact if any on individual patients. By keeping the focus on the impact to specific patients we will generate a clearer societal focus as the healthcare and legal industries converge to adjudicate a complaint. All readers should be aware that diagnostic and therapeutic interventions that occur in a hospital setting by their nature cannot be guaranteed. So not all unsatisfactory outcomes are sustainable as legal matters.

The blog will draw from case studies and reference case law, the national administrative community standards, state and federal statutes, and my personal experiences as a testifying expert. Not only do I intend to share knowledge and educate the reader, but hopefully also stimulate a dialogue among the readers. Where appropriate I will be more than happy to repost germane responses to the subjects being presented.