HSC698 Capstone Project: Analyzing Safety Culture at Queenan Health

This case study examines the safety issues within Queenan Family Medicine and Maternity Care Health System (QHS), focusing on a specific incident involving delays in performing a c-section and its impact on patient safety. The analysis covers the ethical and legal considerations surrounding patient safety, highlighting potential violations related to informed consent and beneficence. A revised mission and vision statement for QHS is proposed, emphasizing collaboration, comprehensive healthcare services, and a commitment to safety and ethical conduct. The report references relevant guidelines and principles from organizations like FIGO and ACOG, underscoring the importance of prioritizing patient well-being and minimizing harm. Desklib provides a platform for students to access this and other solved assignments.

Developing a Vision for Safety
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Introduction
The research is an attempt to comprehend the issues that have recently come to light with the
healthcare system of Queenan Family Medicine and Maternity Care Health System (QHS). QHS is a
healthcare institution in Canada and focuses on the provision of family health care to patients in the
Ontario region. The healthcare institution believes in the deliverance of efficient and continuous care
to its existing and recurring patients. The team consists of primarily two physicians – Dr. Emily
Queenan and Tammy Tuffy. Although the Queenan healthcare institution has offered exceptional
care and services to patients; however, there are a high number of cases of negligence that have come
to light recently (QHS Official Website, 2019).
The research will include a detailed analysis of the Obstetrics and New born care department
based on the case study that was provided for the research. The case study revolves around the delay
in the performance of c-section which has ultimately caused high risks to the life of the patient and
her new born. According to the patient, Hospital A is set up for normal deliveries and in case of a c-
section performance, patients are sent to Hospital B where the team tends to prepare for the c-section
by the time the patient reaches Hospital B. The travelling of the patient from one hospital location to
another, cause delays in c-section which causes a significant amount of threat to the life of the patient
and the infant both. The following sections will analyse the effect of the issue on safety and the legal
and ethical considerations surrounding the issue.
Analysis of How this Issue Affects Safety in QHS
The issue in focus is a large threat to the safety of the mother and the infant since the delay in
the c-section often leads to an increase in complications. The same thing is recorded to have occurred
in this case as well. Due to a delay in the deliverance of the infant and the c-section, a number of
complications arose that directly affected the very survival of the infant who was delivered in a
hurry. As a result of the complications, the infant has suffered medical problems that have obstructed

the presence of a normal life for the infant. Thus, the issue causes serious safety considerations for
patients in this institution.
Ethical and Legal Considerations for Patient Safety
According to the FIGO Committee (2012), the ethical considerations for patient safety are not
only relative to the mothers but also to the infants who are born in the supervision of health care
professionals across the globe. In case of the recent case specific, the ethical considerations on part
of the healthcare professional lies in giving adequate amount of information about the healthcare
services provided by the institution during prenatal care. The mother must be informed about the
hospital procedures in case of different scenarios and appropriate number of recommendations must
be given. Apart from this, it is essential to disclose all important aspects of information regarding the
possibilities on the outcomes of the delivery and ensure that all measures are adopted to offer the
best in class care to the mother and the new born. In addition to this, complete respect to the patient
autonomy of decision-making must be given (Samsioe and Abreg, 2012).
The ACOG committee highlights a number of theories and principles of ethical
considerations that state the high amount of importance that must be given to the principle of
beneficence which, in its literal meaning implies the promotion and placement of patient well-being
above every other aspect of health care delivery. It also implies that no harm on part of the medical
professionals must be caused to the patients (mother and the new born). With the transferring of the
mother in this case from Hospital A to Hospital B and no prior information being shared with the
mother regarding the same has caused serious ethical violations.
Digiovanni (2017) states that in addition to the ethical considerations, the legal considerations
have a direct relationship with the deliverance of health care services. In accordance with the
government and the federal healthcare institutions, every medical professional who fails to deliver
the ethical considerations or causes a serious harm to the safety of their patients may face serious

charges for misconduct. In cases where the number of litigations are too high with one professional
or if the degree of misconduct has endangered the future of their patients permanently, then the
license of the medical professional can be disbanded and the closure of the institution of the
professional may be commenced as well. Binayakiya, Deo and Upadhyay (2015) further add that a
number of legal principles are laid down by the central government to protect patients and medical
professionals both in case of a misconduct. Some of these include, taking consent from patients prior
to the treatment, disclosure of all details of the disease and recording the consent through prior
documentation. Consent may not be required in case of emergency services, prisoners or court
orders. Apart from this, a legal consent from the spouse can be taken in case of obstetrics. The
presence of a female practitioner is crucial in accordance with the law when examination is being
done. In this case, all the legal considerations were taken into account; however, the institution failed
in terms of its ethical considerations significantly. The case of medical negligence is clearly
applicable since there is high clarity on the rising of complications during deliveries and delay in
care caused the life long trauma to the mother and the new born both.
QHS Mission Statement
Mission Statement – To collaborate the different locations of Hospitals and formulate one single
destination for the foremost healthcare services in the field of Obstetrics, Emergency Services,
Cardiac Care and Safety Considerations for Employees.
Vision Statement for QHS
Vision Statement – QHS vouches to reach the position of the #1 destination for patients with every
healthcare requirement. The expansion will consider the existing and the potential healthcare
requirements of patients in our region and deliver the top most services with safety and ethical code
of conduct.

References
ACOG Committee. (2013). Ethical Decision-Making in Obstetrics and Gynaecology. ACOG
Committee. Retrieved from:
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-
on-Ethics/Ethical-Decision-Making-in-Obstetrics-and-Gynecology?IsMobileSet=false. [Last
Accessed: 16th May 2019]
Binayakiya, P. D., Deo, S. H. and Upadhyay, R. S. (2015). Medico – Legal Issues Related to
Obstetrics. National Journal of Research in Ayurved Science. Vol 3.
Digiovanni, L. M. (2017). Ethical Issues in Obstetrics. Obstetrics and Gynaecology Clinics of North
America. Vol 37(2). Pp 345-57.
FIGO Committee. (2012). Ethical Issues in Obstetrics and Gynaecology for the Study of Ethical
Aspects of Human Reproduction and Women’s Health. FIGO Committee.
QHS Official Website. (2019). About Us. QHS Official Website. [online]. Retrieved from:
https://queenan.ca/about/. [Last Accessed: 16th May 2019]
Samsioe, G. and Abreg, A. (2012). Ethical Issues in Obstetrics. International Journal of Fertile
Menopausal Studies. Vol 41(3). Pp 284-287.