Juana G Martinez Vizcaino

ARCHETYPES & ANALYSIS-CHILDREN´S HOSPITAL BOSTON CASE System Archetypes & Analysis of Children’s Hospital Boston Case Juana Martinez EDD8300 Leadership Through Personal and Professional Development --Dr. Melissa Rivera System Archetypes & Analysis of Children’s Hospital Boston Case SYSTEM ARCHETYPES AND ANALYSIS OF CHILDREN´S HOSPITAL BOSTON CASE 2 Boston Children’s Hospital ranked in the 2019-20 year as the # 1 Children’s Hospital in the United States, has faced challenges in the past, questioning the validity of their services (U.S. News & World Report, 2019). In 2003, a child that had undergone surgeries, was undergoing yet another procedure which resulted in his untimely death. As a result, prior situations that had taken place were questioned given the Hospital had not made all necessary changes ensuring mistakes such as this one did not recur. In this paper, the case of the child’s death, will de diagnosed. Also, the assumptions and consequences of the Medical Staff will be further analyzed. Furthermore, the archetype Tragedy of the Commons, will be explained as to how it applies to this case. Finally, an analysis of the organizational changes never made alongside way the Hospital can become a learning organization will be provided. Diagnosis of Case Problems in Systems Terms In the Children’s Hospital Boston Case, the underlying issues that led towards the passing of a young boy were due to systems laws, and organizational learning. These were complexity and ambiguity. The complexity was as a result of the prolonged seizure right after the surgery multiplied the complexity due to the connections among the various players in this case scenario (Senge, 2006). Ambiguity was caused since the staff of MSICU, Epistemologists, and the Fellow, did not seem to be on the same page and collaborate effectively in order to prevent the tragedy from taking place. Thus, the complexity and organizational size made it hard for anyone to clearly understand what needed to be done exactly. Furthermore, in this case those involved made decisions convinced that there are few options, given they had limited understandings and people are routinely satisfied within a situation, convinced that there are few options. Hence, in this case scenario it is clear all those involved in the case told their own story with a limited understanding of what was SYSTEM ARCHETYPES AND ANALYSIS OF CHILDREN´S HOSPITAL BOSTON CASE 3 happening. Furthermore, according to Stroh (2015) they “honored their individual efforts” (p.201). Since, those involved in the surgery and post-surgery did not follow the procedures as aligned, and when approached each provided their own version, thus stating they did what they could have done given another one of their colleagues was not sharing in on all of their responsibilities. However, they did not question the decisions made by their colleagues, thus not acknowledging what they could have done differently. Assumptions, Conclusions and Consequences of Decisions made by Medical Professionals The Medical Professionals in this case assumed they were each making the correct decisions. However, they failed to see the entire picture. Therefore, several laws within the system were not observed. These were Laws III, & IV. Given that as Law III states, behavior grows better before it grows worse. The medical professionals each made decisions based on what they assumed was needed. Some going as far as overriding the set standards that were implemented for such situations. For example, the Fellow administering less than the required medicine when the patient was having an intense seizure, that did not cease. Thus, there are solutions that in the interim may seem as the quickest and easiest to implement (Senge, 2006). In this situation, administering the medicine calmed the patient, however, as a result of not taking required measures, the patient did not survive. The easiest solutions at the time, though providing the desired effect, led to misfortunes in the long run. Also, all of those involved assumed their decisions were the most efficient and easiest to take at the time. As Law IV states, the easy way out usually leads back in. However, the solution to an issue that may be solved if looked upon from a systematic approach, as opposed to taking the easy way out by choosing the easiest solution (Senge, 2006). Rather than each of them further analyzing how each of their decisions tied back to one another and how they would impact the patient, they opted for the solution that led to solving the case immediately or so as it SYSTEM ARCHETYPES AND ANALYSIS OF CHILDREN´S HOSPITAL BOSTON CASE 4 seemed. Consequently, the solution, only salvaged them at the current moment but resulted in having them having to then further analyze the dire consequences their quick fixes caused. Tragedy of the Commons Archetype diagram & Systems Problems Gains for the Hospital Law III & IV Neurosurgeon DELAY Activity of Epistemologists #1 & #2 MSICU Each staff member made individual decisions Net Gains for Neurosurgery Dept. The Children’s Hospital Boston case study is a clear example of the archetype “Tragedy of the Commons” given that the Epilepsy Fellow in this case took decisions that benefitted her, given she ordered 025mg of Ativan, one-eighth of what would normally be ordered. Her hope was that it would help in ceasing the seizures, thus what seemed to be not giving Phase 2 any SYSTEM ARCHETYPES AND ANALYSIS OF CHILDREN´S HOSPITAL BOSTON CASE 5 time to observe if it helped the situation at all by ceasing the seizures. Since, it lasted longer than 2-3 minutes, becoming a status epilepticus and requiring aggressive treatment. Also, the Neurosurgical Resident, who saw the patient go through the seizure episode, passed all responsibility to the Epilepsy Service, and did not question the amount of medicine being administered, rather see the decisions made as appropriate, shifting the responsibility to others. Epileptologist #1, pointed finger at the Neurosurgical Resident and MSICU Fellow, and how the dosages should have been administered differently. Furthermore, Epileptologist #2, believed that the case was solely responsibility of the MSICU, and how a Neurological Resident was not prepared to deal with medical emergencies. The MSICU Fellow, saw the treatment for the patient as highly unusual however opted to not interfere. The charge nurse assumed surgical service was responsible. Meanwhile Nurses #1 & #2 of MSICU both agreed in the sense they thought it was being mismanaged however failed to question management. Thus, we can clearly see here that each of the parties made decisions in situations where what's right for each part is wrong for the whole. Therefore, logical local decision making can become illogical for the larger system (Senge, 2006). Analysis of Organizational Changes never made Considering the changes that needed to take place were not fully in place even one year prior to the child’s death, it seems the Hospital was more preoccupied with the pressure of guarding their reputation. Thus, the rewards that goes alongside with maintaining their reputation jeopardizes the “commons” intensifying their short-term thinking (Senge, 2006). Based on the SYSTEM ARCHETYPES AND ANALYSIS OF CHILDREN´S HOSPITAL BOSTON CASE 6 actions that took place, the Neurosurgeon, MSICU, and the Epistemologists, were running on their own as if separately rom one another, probably with the aim of gaining their own profits. What’s more, they made decisions based on their own judgements prior to this case. For example, the death that occurred in 2000 found to be the result of a decision made by junior physicians to delay surgery without the advice of the senior physician. Thus, they continued to make changes that though were pinned out by the Department of Public Health, it seemed they had difficulties making all required changes as a result of them not making decisions as a team, but individually as either medical professionals or specific departments. Steps toward becoming a learning organization The systems archetype Tragedy of the Commons once implemented will allow the Hospital towards becoming a learning organization. Given the purpose of the systems archetypes is to recondition the perceptions of the staff (Senge, 2006). In turn, allowing each of those involved in future situations such as these to see structures at play. Therefore, once the circumstances that led to such situation are defined, systems thinking will continuously reveal how they see the reality as it is not as how they imagine it to be. These observations will allow the Hospital to become a successful learning organization where they will be able to handle such complex circumstances. Furthermore, a systems approach could benefit the hospital. Given that though the deaths that had occurred one year prior to Matty’s death prompted them to put into place changes they had not done so prior to this tragedy (Snook & Connor, 2010). Thus, they should have shown more responsibility towards their reality and geared away from the perception that they did not have disabilities that required immediate attention and changes as well as results. Furthermore, SYSTEM ARCHETYPES AND ANALYSIS OF CHILDREN´S HOSPITAL BOSTON CASE 7 they should recognize that each of their actions matter, and should learn from their actions and consequences as opposed to blaming someone else. Conclusion Boston Children’s Hospital, known nationwide as one of the most prominent Hospital’s for children has not been safe from systems issues. In fact, several tragedies have taken place in the facility that prompted the Department of Public Health to question their practices. As a result, they were obliged to analyze the structure of their system. As discussed in this paper, the Hospital’s archetype in these scenarios prompted the medical staff to make decisions that benefitted each individually. Hence, mistakes that were avoidable took place. Therefore, it is advised that moving forward, the perceptions of the staff be modified, and a systems approach be put into practice in order to avoid such misfortunes in the future. References Senge, P. (2006). The fifth discipline: The art and practice of the learning organization. New York, NY: Doubleday. Snook, S. A., & Connor, J. C. (2010). Children's Hospital Boston (A). Boston, MA: Harvard Business Publishing. SYSTEM ARCHETYPES AND ANALYSIS OF CHILDREN´S HOSPITAL BOSTON CASE 8 Stroh, D.P. (2015). Systems thinking for social change: A practical guide to solving complex problems, avoiding unintended consequences and achieving lasting results. White River Junction, VT: Chelsea Green. U.S. News & World Report. (2019, June 18). U.S. News Announces the- Best Children's Hospitals. Retrieved July 29, 2019, from https://www.usnews.com/info/blogs/press-room/articles/-/us-news-announcesthe--best-childrens-hospitals