Problem Definition
In October of 1992, the new computer aided dispatch system of the London Ambulance Service (LASCAD) failed to meet the demands of use and brought their operations to a standstill. Dispatchers could no longer locate ambulances, multiple ambulances showed up for the same calls, errors built up in the queue slowing the system down further, and callers became frustrated as the hours went by with no ambulance showing up (London Ambulance Service Unofficial, n.d.). In addition, it has been targeted for causing the deaths of approximately 20-30 people in the process, due to excessive wait times for transport to the hospital. This unfortunate incident is one of the poster children for examples of the ramifications of poor management and lack of process in software development.
Problem Justification
After scrapping an £7.5 million project to computerize its system, the London Ambulance Service put the project out for bid again. The new budget for development was one-fifth the cost of the prior project that failed and to be done in one-third of the time of the prior effort. Only one of the over 30 respondents was able to come in at or under that £1.5 number with the desired development timeframe (Beynon-Davies, 1999). That alone should have been an indication that something was wrong in the project. However, as typical with government/union type projects, the lowest bidder was selected to complete the project and work began.
A comedy of errors then ensued as the development of the new system continued. According to Beynon-Davies (1993), most of the errors found in the investigation lead directly to project organization, summarized as follows: overambitious timetable, insufficient investigation of winning developer, inadequate project management, incomplete and unstable software, and improper training delivered to the end user. Despite these numerous red flags that appeared throughout the project, development with System Options continued and the system was put into production on October 26, 1992.
On that day, as the call load increased slightly above average on that day, a number of errors occurred in the system. Senior staff would take a preferred ambulance rather than the one that they had been assigned, improperly trained staff pressed the wrong buttons, callers would call back repeatedly increasing the call load and vehicles got lost in the system. As seen in Figure 1 below, the errors compounded on one another leading to the complete meltdown of the system.
Ambulances, started to affect today’s modern health care after the Civil war. Ambulances are specially equipped motor vehicles. Ambulances carry sick, or injured people from the spot of their accident, to the closest hospital. Ambulances are part of the emergency medical services, EMS, which also includes helicopters, airplanes, and boats. Ambulances typically have room for one or more people. Ambulances can also hold many medical personnel and medical supplies.
Thathamkulam led the initiative to revise and wrote Telecare’s Computer Downtime Policy (Memorandum 118-Tele-015). He has further contributed to minimizing costs to the Houston MEDVAMC, as he has developed documentation protocols to ensure quality documentation for SI/HI callers who called from the After Hour off Site Call Centers. He served as a preceptor to new RN staff, he emphasized the importance of RNs including the Financial Disclaimer in all symptom calls received to help control cost due to negligence by failure to inform Veterans in regards to the disclaimer and failure to address the disclaimer in documentation. As a chair person in one of the Performance Improvement projects for Abandonment Rate Committee, he identified that the Telecare unit was experiencing a high rate (36.7%) of caller abandonment according to 2014 abandonment rate data. This was a problem that had been occurring for the last few years. In collaboration with Pharmacy team, IT team and mental health team, he decided to cut short the documentation policy for Telecare nurses, who are receiving symptom calls including suicidal calls. One suicidal call usually takes approximately 30 minutes to one hour, that back up other patients’ calls in the queue. It automatically resulted in increasing the abandonment rate for the incoming calls. He initiated and created a committee to resolve this issue. The committee meets on a monthly basis to evaluate the situation, and he initiated a plan of action that recommended management to hire additional staff and alert to revisit the documentation policy in order to reduce the current abandonment rates. Mr. Thathamkulams’ vast experiences in Mental Health, he was managed to convinced the Telecare management team and suicidal prevention team by eliminating some of the unnecessary suicidal protocol, which helped to reduced the call handling time to 25minitus per each suicidal call. He also monitored about calling procedures of staff to make sure that
Saunders (2012) states that the treatment of a breech delivery requires the paramedic team to work simultaneously and efficiently to perform several interventions. He states that the paramedic team should undertake a primary survey and introduce themselves to the patient on arrival. From the initial patient contact, the paramedics should begin providing reassurance to the patient and their family, both verbally and non-verbally (Saunders, 2012). Reassurance aims to reduce patient anxiety, create a rapport with the patient and encourage an environment of care, respect and understanding (Pincus et al., 2013). The paramedic team should complete a secondary survey, including vital signs and a complete patient history, particularly pregnancy relevant
The development of legislation is not the end of policy issue, usually it’s only the beginning. As these laws are implemented, there are always situations where the law or a specific policy may run into a situation where it is challenged by the public. This is true even when it comes to legislation that is meant to mitigate the worst case scenario. In this post I will be discussing a case that ended in personal tragedy for one family.
Wake County EMS responds to almost 90,000 requests for service annually and serves almost 1 million people, which places the WCEMS system in the top fifty EMS systems in the country based on call volume and size of population served. ("Wake county department," 2012) In response to ever-increasing call volume, a decrease in primary care, and the universal changes in healthcare, which have resulted in more people using EMS and the local emergency room for primary care and non-life threatening events, the EMS Department elected to change their service structure. The department would move away from the traditional EMS mantra of “you call we haul” and having a system being designed around reactive responses to healthcare issues in the community to an evidenced based incident prevention structure. No longer, would it be considered prudent or correct to just continue to add transport resources to address the increasing call volume and continue to place the actual burden of care on the local hospitals, it would become the burden of the EMS system to provide alternatives to properly address the actual healthcare needs of those who called 911. Wake County EMS had already utilized evidenced based ...
Good teamwork is important in a patient centred care. It is a team of health professionals who actively participate, cooperate, interact, communicate expertise, respect, trust and its main focus is to improve patient’s health (Miller, 2008, p.14). Also, the team includes the family of the client and the patient itself (Miller, 2008, p. 15). Therefore, all members have a role to play. For instance, in the nursing practice it involves health promotion and maintenance regarding patient’s health in order to decrease the impacts of negative outcomes (NMBA, 2010). Nevertheless, this can be maintained under the national competency standard (NMBA, 2010). Part of the national competency standard promotes professional responsibility, multidisciplinary approach, critical thinking and client care delivery (NMBA, 2010).
...n had been disrupted, and were not able with withhold the intensity of the storm. This had involved dispatching centers to be shut down, which had left the inability for the dispatchers to provide the necessary information to emergency providers about the emergencies taking place.
When an error occurs, the first step usually taken is to identify the individual that is responsible for the mistake. Frontline providers in health care, like nurses and doctors, are usually held accountable when a mistake occurs that affects patient safety and care. While this is the easiest step, it is not the most effective. "When human error is viewed as a cause rather than a consequence, it serves as a cloak for our ignorance. By serving as an end point rather than a starting point, it retards further understanding [1]." Factors outlined in Henriksen 's hierarchy, e.g. individual characteristics, the nature of the work, human-system interfaces, work environment, and management, need to be taken into account to identify the source of the
Ans: Jean has failed to consider a fundamental rule of “business as usual”. The manager level employees of all departments are cautious about status quo being maintained. In addition to this, Jean has also failed to account the need for cross functional team. The repercussions of which will be in the form of increased pressure on him in making sure users of the software package implemented have right kind of expertise and qualifications to use.
Flynn, Donal J.; "Information Systems Requirements: Determination and Analysis"; McGraw-Hill Book Company; 1992Parnas; 1985; taken from: Sherer, Susan A.; "Software Failure Risk – Measurement and Management"; Plenum Press; 1992Jones, Carpers; "Patterns of Software Systems Failure and Success"; Thomson computer press; 1996Neumann, Peter G.; "Computer Related Risks"; Addison-Wesley publishing company; 1995Petroski, Henry; "To Engineer is Human"; MacMillan Publishing; 1985Flowers, Stephen; "Software failure: management failure"; Chichester: John Wiley and Sons; 1996.Report of the Inquiry into the London Ambulance Service; February 1993. Simpson, Moira (1994); "999!: My computers stopped breathing !"; The Computer Law and Security Report, 10; March – April; pp 76-81Dr. Dobbs Journal; January 1997 edition<a href="http://catless.ncl.ac.uk/Risks">http://catless.ncl.ac.uk/Risks<a href="http://www.scit.wlv.ac.uk ">http://www.scit.wlv.ac.uk <a href="http://www.bbc.co.uk/news">http://www.bbc.co.uk/news<a href="http://abcnews.go.com/sections/travel">http://abcnews.go.com/sections/travel
The cost of Medical equipment plays a significant role in the delivery of health care. The clinical engineering at Victoria Hospital is an important branch of the hospital team management that are working to strategies ways to improve quality of service and lower cost repairs of equipments. The team members from Biomedical and maintenance engineering’s roles are to ensure utilization of quality equipments such as endoscope and minimize length of repair time. All these issues are a major influence in the hospital’s project cost. For example, Victory hospital, which is located in Canada, is in the process of evaluating different options to decrease cost of its endoscope repair. This equipment is use in the endoscopy department for gastroenterological and surgical procedures. In 1993, 2,500 cases where approximately performed and extensive maintenance of the equipment where needed before and after each of those cases. Despite the appropriate care of the scope, repair requirement where still needed. The total cost of repair that year was $60,000 and the repair services where done by an original equipment manufacturers in Ontario.
The individuals involved in error should not be punishing but we all must learn from those mistakes by improving the system. In the case above, a root cause analysis was conducted as part of the learning and improvement process. There were a few breakdowns in the system noted that led to this sentinel event. A large part of the issue was related to the utilization of the chain of command by the nurse. Another problem was attributed to the comfort level of the nurse in reaching out to the next person in the chain of command. A final concern was noted regarding why the resident did not come to assess patient after the first time when he received the call from the nurse. Rizzo (2013) writes that we must remain open to anyone who questions the safety of care being provided and we must foster open, honest communication among the multidisciplinary team members. Furthermore, the healthcare systems cannot build a fear of retribution for these mistakes in their employees if they want to build a culture of
“ Who of you guys know the ABCs of dealing with hazardous waste situations?” asked Bill, taking the last bite of his home made meal, and crumpling up the tin foil. “Armchair, Binoculars, and a Case of beer!”
This paper will reflect on the different uses of Project Risk Management and ways in which it can benefit organizations to have the ability to identify potential problems prior to the problem occurring. Risk, this is not something to be taken lightly whilst dealing with matters that include high end projects meeting specific details, deadlines and expectations for the end client. Project risk management teaches one to be aggressive early on in the phases of planning and implementing the tools for a project. This is usually easier as costs are less and the turnaround time to solve the issues at that present moment is beneficial rather than later. The result in a successful project for one’s self and other key people involved in the process is also another requirement. Stakeholder satisfaction is important because the
The goal in all healthcare settings is to provide high-quality care to their clients. Emergency departments (ED) are no different, but are challenged with balancing quality with quantity in a timely manner. Unlike physician offices and hospital floors, EDs do not get to set a limit on the number of patients they see at a time. There is no control over patient arrival, which can and often does result in controlled chaos. The American College of Emergency Physicians (2014) reports “because of the unscheduled and episodic nature of health emergencies and acute illnesses, experienced and qualified physician, nursing, and ancillary personnel must be available 24 hours a day”. Despite the unpredictable nature of emergency medicine, the goal