Patient Safety Strategy

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Case 19: Selection of a Patient Safety Strategy
Langley Mason Health (LMH) is located in North Reno County, the largest public health care district in the state
of Nevada, serving an 850-square-mile area encompassing seven distinctly different communities. The health
district was founded in 1937 by a registered nurse and dietician who opened a small medical facility on a
former poultry farm. Today the health system comprises Langley Medical Center, a 317-bed tertiary medical
center and level II trauma center; Mason Hospital, a 107-bed community hospital; and Mason Continuing Care
Center and Villa Langley, two part-skilled nursing facilities (SNFs); a home care division; an ambulatory surgery
center; and an outpatient behavioral medicine center.
In anticipation of expected population growth in North Reno County and to meet the state-mandated seismic
requirements, LMH developed an aggressive facilities master plan (FMP) that includes plans to build a state-ofthe-art 453-bed replacement hospital for its Langley Medical Center campus, double the size of its Mason
Hospital, and build satellite clinics in four of its outlying communities. The cost associated with actualizing this
FMP is estimated to be $1 billion. Several years ago, LMH undertook and successfully passed the largest
health care bond measure in the state’s history and in so doing secured $496 million in general obligation
bonds to help fund its massive facilities expansion project. The remaining funds must come from revenue
bonds, growth strategies, philanthropic efforts, and strong operational performance over the next ten years.
Additionally, $5 million of routine capital funds will be diverted every fiscal year for the next five years to help
offset the huge capital outlay that will be necessary to equip the new facilities. That leaves LMH with only $10
million per year to spend on routine maintenance, equipment, and technology for all its facilities. LMH is
committed to patient safety and is building what the leadership team hopes will be one of the safest hospital-ofthe-future facilities. The challenge is to provide for patient safety and safe medication practices given the
minimal capital dollars available to spend today.
LMH developed an IT strategic plan and identified the following ten goals:
Empower health consumers and physicians.
Transform data into information.
Support the expansion of clinical services.
Expand e-business opportunities.
Realize the benefits of innovation.
Maximize the value of IT.
Improve project outcomes.
Prepare for the unexpected.
Deploy a robust and agile technical architecture.
Digitally enable new facilities, including the new hospital.
Information Systems Challenge
LMH has implemented Phase 1—an enterprise-wide EHR system developed by Cerner Corporation at a cost
of $20 million. Phase 2 of the project is to implement CPOE with decision-support capabilities. This phase was
to have been completed previously, but has been delayed because of the many challenges associated with
Phase 1, which still must be stabilized and optimized. LMH does have a fully automated pharmacy information
system, albeit older technology, and Pyxis medication-dispensing systems on all units in the acute care
hospitals. Computerized discharge prescriptions and instructions are available only for patients seen and
discharged from the LMH emergency departments.
Currently, the pharmacy and nursing staff members at LMH have been working closely on the selection of a
smart IV pump to replace all of the health system’s aging pumps and have put forth a proposal to spend $4.9
million in the next fiscal year. Smart pumps have been shown to significantly reduce medication administration
errors, thus reducing patient harm. This expenditure would consume roughly half of all of the available capital
dollars for that fiscal year.
The CIO, Marilyn Chen, understands the pharmacists’ and nurses’ desire to purchase smart IV pumps but
believes the implementation of this technology should not be considered in isolation. She sees the smart
pumps as one facet of an overall medication management capital purchase and patient safety strategic plan.
Marilyn Chen suggests that the pharmacy and nursing leadership team lead a medication management
strategic planning process and evaluate a suite of available technologies that taken together could optimize
medication safety (for example, CPOE, electronic medication administration records [e-mar], robots, automated
pharmacy systems, bar coding, computerized discharge prescriptions and instructions, and smart IV pumps),
the costs associated with implementing these technologies, and the organization’s readiness to embrace these
technologies. Paul Robinson, the director of pharmacy, appreciates Marilyn Chen’s suggestion but feels that
smart IV pumps are critical to patient safety and that LMH doesn’t have time to go through a long, drawn-out
planning process that could take years to implement and the process of gaining board support. Others argue
that all new proposals should be placed on hold until CPOE is up and running. They argue there are too many
other pressing issues at hand to invest in yet another new technology.

Discussion Questions
1. Describe the current situation as you see it. What are the major issues in this case?
2. Marilyn Chen, CIO, and Paul Robinson, director of pharmacy, have different views of how LMH should
proceed. What are the pros and cons of their respective approaches? Which approach, if either, seems like an
appropriate course of action to you? Explain your rationale.
3. Assume you are to mediate a discussion on this issue and that participants are to come to consensus on
how best to proceed. What would you do?

Sample Solution

with the perils of the outside world alone. This conclusion will ultimately assert that the divide between the home and the outside world is corroded as an irreversible process of modernity.

At the outset of each text, Bimala and Nora are firmly grounded in the domestic sphere. Both women are positioned as housewives whose concerns do not extend beyond the narrow frame of their household “I would cautiously and silently get up take the dust off my husband’s feet without waking him.” (Tagore 18). This effectively removes each woman from matters of the outside world and suggests that there is a sense of privacy and security attached to the domestic household. In doing so, a distinct divide is created between the outside and inside spaces in both texts. This can be seen explicitly in Ibsen’s choice of setting for A Doll’s House, “A comfortably and tastefully, though not expensively, furnished room.” (109), which is clear in its exclusive focus on the middle-class, bourgeoise household. This claustrophobic setting is overt in its marked isolation. It is, at first glance, untouched by the influence of the outside world. However, a close reading of the “tastefully, though not expensively, furnished room.” (109) reveals an unmistakeable consciousness surrounding financial matters. In other words, the pressures of capitalism can already be spotted within the household. In this light, the room’s interiors appear to be a calculated facade imitating comfort yet bearing marks of concern towards matters of wealth and appearance. Mark Sanberg expands upon this idea of innate corruption within the bourgeoise household by stating that Ibsen’s text is concerned with “dislodging the home from its privileged association with domestic ideals and the testing of the “house” as a modern alternative.” (85). Indeed, the distinction between the home and the hou

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