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1. Improving safety by developing trust with a just culture.

Author

Small, Deborah, Small, Robert M, and Green, Alice

Subjects
*PROFESSIONAL employee training, *CONTINUING education units, *HUMAN services programs, *QUALITY assurance, *HUMAN error, *CONTINUING education of nurses, *PROFESSIONALISM, *PATIENT safety, *CORPORATE culture
Abstract

Why you should read this article: • To enhance your knowledge of the concept of just culture when measuring and assuring safety • To identify how to apply a just culture approach to your organisation • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article presents a simple conceptual road map for implementing a just culture in healthcare settings. The concept of just culture was developed as one of five fundamental elements of a safety culture by psychology professor James Reason in 1997. A just culture requires an unbiased method of judging human error and is designed to develop organisational trust so that adverse medical events (errors) are reported and corrected before they combine with other errors to cause injury or death. To implement a just culture properly so as to increase organisational safety, practitioners must understand its role in enabling the error reporting needed to develop a safety culture. This article reviews these foundational concepts and explores the human causes of errors that a just culture addresses, the psychological importance of a just culture in enabling error reporting and how to implement a just culture in organisations. [ABSTRACT FROM AUTHOR]

Published
2022
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2. Want payment for your outpatient services? Avoid these pitfalls with managed care.

Author

Small, Robert H.

Subjects
*MEDICAL care, *HEALTH insurance reimbursement, *MENTAL health services, *PATIENTS, *MEDICAL personnel, *THERAPEUTICS, *SYMPTOMS
Abstract

Reports on the role of managed care organizations in determining whether services are medically necessary in the U.S. Likelihood of provider organizations to be reimbursed for behavioral health services to managed care patients; Requirement that clinicians note a patient's Global Assessment of Functioning score; Consideration of the endpoint of treatment to be when a patient is capable of tolerating his or her symptoms.

Published
2004

3. Shed belief that all services should be covered, and reduce volume of non-reimbursed services.

Author

Small, Robert H.

Subjects
*MEDICAL care costs, *HEALTH insurance reimbursement, *MEDICAL personnel, *PATIENTS, *HEALTH planning
Abstract

Behavioral health clinicians tend to believe that all services that they provide to patients should be reimbursed when publicly funded or commercial health plans are involved. The reality, however, is that many services are not covered, which can result in a significant number of hours of clinical work for which provider organizations are not reimbursed. Few provider organizations can afford that, especially in the current economic climate. Some organization leaders may actually not be aware of the full extent of non-covered services being provided by their clinicians. To minimize the adverse financial impact of providing an excessive volume of non-reimbursed services, leaders of behavioral health provider organizations need to establish a culture that actively discourages the common clinician attitude of, "If I say it should be covered, then it should be covered." Clinicians need to learn that health plans decide what services are covered and not covered, and that clinicians are responsible for minimizing the provision of non-covered services.

Published
2003

4. A Rare Case of C2 Sensory Blockade with Preserved Phrenic Nerve Function in an Obstetric Patient.

Author

Coffman, John C., Fiorini, Kasey, Cook, Meghan, and Small, Robert H.

Subjects
*PHRENIC nerve, *OBSTETRICS, *HYPOTENSION, *DYSPNEA, *AGITATION (Psychology), *PHYSIOLOGY, *PATIENTS
Abstract

High neuraxial blockade is a serious complication in obstetric patients and requires prompt recognition and management in order to optimize patient outcomes. In cases of high neuroblockade, patients may present with significant hypotension, dyspnea, agitation, difficulty speaking or inability to speak, or even loss of consciousness. We report the unusual presentation of an obstetric patient that remained hemodynamically stable and had the preserved ability to initiate breaths despite sensory blockade up to C2. The presence of differential motor and sensory block documented in this case helped enable the patient to be managed with noninvasive ventilatory support until the high blockade regressed and we are not aware of any other similar reports in literature. [ABSTRACT FROM AUTHOR]

Published
2016
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