Harvard Case - Children's Hospital Oakland: End-of-Life Dilemmas
"Children's Hospital Oakland: End-of-Life Dilemmas" Harvard business case study is written by Arthur A. Daemmrich, Lauren Davis. It deals with the challenges in the field of Organizational Behavior. The case study is 16 page(s) long and it was first published on : Mar 23, 2016
At Fern Fort University, we recommend a multi-pronged approach to address the ethical and operational challenges faced by Children's Hospital Oakland (CHO) regarding end-of-life care. This includes fostering a culture of open communication, implementing clear policies and procedures, and providing robust training and support for all staff involved in these sensitive situations.
2. Background
This case study centers on the ethical and operational dilemmas faced by CHO in managing end-of-life care for critically ill children. The hospital grapples with conflicting perspectives between families, medical staff, and hospital administration regarding the best course of action in these emotionally charged situations. The case highlights the complexities of balancing parental wishes, medical expertise, and ethical considerations, particularly when faced with limited resources and potential legal ramifications.
The main protagonists are:
- Dr. Elizabeth 'Liz' Jones: A pediatric intensivist struggling to balance her professional duty to provide optimal care with respecting parental wishes, even when those wishes conflict with medical recommendations.
- The Parents: Facing the agonizing decision of whether to continue life-sustaining treatment for their child, grappling with grief, and struggling to understand complex medical information.
- The Hospital Administration: Navigating the legal and ethical complexities of end-of-life care, balancing patient well-being with resource allocation and potential legal liability.
3. Analysis of the Case Study
This case study presents a complex scenario where multiple stakeholders with differing perspectives and priorities collide. To analyze the situation, we can utilize the following frameworks:
Organizational Culture: CHO's culture appears to be one of strong medical expertise and a commitment to providing high-quality care. However, the case highlights a potential gap in communication and understanding between medical staff, families, and administration regarding end-of-life care. This lack of clarity creates tension and conflict, impacting patient care and staff morale.
Team Dynamics: The case demonstrates the importance of effective team dynamics in managing complex medical situations. The interactions between Dr. Jones, the parents, and other medical professionals highlight the need for clear communication, empathy, and collaborative decision-making.
Decision-Making Processes: The case exposes the complexities of decision-making in end-of-life care. The process involves balancing medical expertise, parental wishes, ethical considerations, and legal constraints. This requires a structured and transparent decision-making process that incorporates all stakeholders' perspectives.
Emotional Intelligence: The case emphasizes the importance of emotional intelligence in dealing with sensitive situations. Medical staff, families, and hospital administration must navigate intense emotions, grief, and uncertainty. Effective communication, empathy, and active listening are crucial for navigating these complexities.
Power and Politics in Organizations: The case underscores the power dynamics within the hospital. The medical staff holds significant expertise and influence, while families are often in a vulnerable position. The hospital administration must navigate these power dynamics to ensure ethical and compassionate care while also adhering to legal and financial constraints.
4. Recommendations
Develop a Comprehensive End-of-Life Care Policy: CHO should develop a clear and comprehensive policy outlining its approach to end-of-life care. This policy should address the following:
- Communication: Establish clear communication protocols for discussing end-of-life care with families, including the use of trained professionals, standardized language, and multiple communication channels.
- Decision-Making: Define a transparent and structured decision-making process that involves all stakeholders, including families, medical staff, and hospital administration.
- Ethical Considerations: Clearly outline the hospital's ethical framework for end-of-life care, including the role of palliative care, comfort measures, and the avoidance of futile treatments.
- Legal Considerations: Address legal requirements and potential liabilities related to end-of-life care, including informed consent, advance directives, and legal representation.
- Resource Allocation: Establish guidelines for resource allocation in end-of-life care, considering the needs of patients, families, and the hospital's overall resources.
Implement Comprehensive Training Programs: CHO should implement mandatory training programs for all staff involved in end-of-life care. This training should cover:
- Communication Skills: Develop effective communication skills for discussing sensitive topics with families, including active listening, empathy, and non-judgmental language.
- Ethical Considerations: Educate staff on the ethical principles underpinning end-of-life care, including respect for autonomy, beneficence, and non-maleficence.
- Legal Considerations: Provide staff with an understanding of legal requirements and potential liabilities related to end-of-life care.
- Palliative Care: Train staff on providing palliative care, focusing on pain management, symptom relief, and emotional support for patients and families.
Foster a Culture of Open Communication and Collaboration: CHO should actively cultivate a culture that encourages open communication, collaboration, and empathy between medical staff, families, and hospital administration. This can be achieved through:
- Regular Meetings: Establish regular meetings between medical staff, families, and hospital administration to discuss end-of-life care decisions and concerns.
- Support Groups: Offer support groups for families facing end-of-life decisions, providing a safe space for sharing experiences and receiving emotional support.
- Mentorship Programs: Develop mentorship programs for new staff members, providing guidance and support from experienced professionals in navigating end-of-life care.
Invest in Technology and Resources: CHO should invest in technology and resources to support end-of-life care, including:
- Electronic Health Records: Utilize electronic health records to facilitate communication, track patient data, and ensure continuity of care.
- Telemedicine: Explore the use of telemedicine to connect families with specialists and provide remote support.
- Palliative Care Team: Expand the palliative care team to provide specialized support for patients and families facing end-of-life decisions.
5. Basis of Recommendations
These recommendations are grounded in the following principles:
- Core Competencies and Mission: These recommendations align with CHO's core competencies in providing high-quality medical care and its mission to serve the community.
- External Customers and Internal Clients: The recommendations consider the needs of both external customers (families) and internal clients (medical staff and hospital administration).
- Competitors: The recommendations aim to position CHO as a leader in end-of-life care, attracting families seeking compassionate and ethical care.
- Attractiveness: The recommendations are expected to improve patient satisfaction, reduce legal risks, and enhance the hospital's reputation.
6. Conclusion
By implementing these recommendations, CHO can create a more supportive and ethical environment for end-of-life care. This will involve fostering a culture of open communication, providing robust training and resources for staff, and developing a comprehensive policy that addresses the unique challenges of end-of-life care for critically ill children.
7. Discussion
Alternatives:
- Status Quo: Maintaining the current approach, which could lead to continued conflict, dissatisfaction, and legal risks.
- Outsourcing End-of-Life Care: Contracting with a specialized end-of-life care provider, which could lead to a loss of control and potentially higher costs.
Risks and Key Assumptions:
- Resistance to Change: Some staff members may resist changes to policies and procedures.
- Financial Constraints: Implementing these recommendations may require significant financial investment.
- Legal Challenges: Navigating legal complexities related to end-of-life care remains a challenge.
Options Grid:
| Option | Benefits | Risks | Cost |
|---|---|---|---|
| Comprehensive Policy & Training | Improved communication, ethical care, reduced legal risks | Resistance to change, financial investment | High |
| Status Quo | No immediate change | Continued conflict, dissatisfaction, legal risks | Low |
| Outsourcing End-of-Life Care | Specialized expertise, reduced internal burden | Loss of control, higher costs | High |
8. Next Steps
- Develop a Task Force: Establish a task force to develop a comprehensive end-of-life care policy and training program.
- Pilot Program: Implement a pilot program to test the effectiveness of the new policy and training program.
- Evaluation and Feedback: Continuously evaluate the program and gather feedback from staff, families, and patients.
- Dissemination: Share best practices and learnings with other healthcare institutions.
By taking these steps, CHO can effectively address the ethical and operational challenges of end-of-life care, creating a more compassionate and supportive environment for patients and families during their most difficult times.
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Case Description
After suffering severe complications from a relatively minor surgery at a California children's hospital in early December 2013, a young teenage girl was declared brain dead. However, to her family, the girl seemed responsive and they refused to accept the hospital's statement that their daughter was deceased. The hospital arranged visits with social workers and other staff in an attempt to help the family understand that their daughter was dead and, after three days, informed the family of its plan to move the teen's body to the morgue. The case quickly became a nationwide media event. The family acquired a noted lawyer to ensure the teen received the care the family thought was needed, while the hospital hired a public relations firm to become the hospital's voice in the issue, a move that might have exacerbated the problem. With such a complex and tragic crisis that rapidly unfolded, should the hospital have a policy in the event that family members disagree with an official medical diagnosis? How could the hospital have managed the aftermath of the teen's death and prevented a media embarrassment?
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