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DAMAGE CONTROL TEAM (DCT)- A new concept in Hospital Management

Today Healthcare has a different meaning than what it used to be decades ago.Due to high costs of health care,  growing awareness amongst people and increasing competition in health sector , the need to provide quality services in health care is much more than ever. With more and more people getting  insured, the affordibility of middle class for quality health care has increased. This has hastened the competition  and hence the need for quality in the health sector.

 While providing services, the most important parameter of quality and proper delivery of services is patient satisfaction. Therefore the endeavour of any hospital should be to satisfy  all the patients  and treat  each and every patient  as most important. While providing services, the  goal  in any system(hospital) should be to reach  perfection. But for several unforeseen  reasons, we do fall short of it,  occasionally drastically. There are always unwanted ‘events’ which can occur and become impediments(obstacles) in providing perfect services to the patients. These events   are not always predictable  and preventable.  So what assumes importance during occurence of  such events is how we react to  them  and how efficiently we do ‘Damage control’.

 ’Events’ can be of many types and can occur in any part of the hospital. But the end result of any such event is  that it directly or indirectly adversely effect patient services leading to patient disasisfaction or maligning the hospital’s reputation.Example of such events are unexpected complication occuring after a surgery, negligence on part of the doctor/ nurse/paramedical staff, quarrel between staff and the relatives,  etc.

 Normally ‘Damage control’ is done by different people( Doctor,nurse, hospital administrator or who ever is available). The end result is that ‘Damage control’ is unstandardized and responsibility of none. The importance of ‘Damage control’ cannot be under-estimated.’Damage control’ measures  must  be rapid as well as efficient at the same time.For this they  need to be  standardized.To make and implement standard protocols  for Damage control is a  difficult task since disasters can be  of unpredictable nature and training to  different kinds of people(  ward sisters, ICU sisters, duty doctors etc)can be  logistically difficult. A ‘Damage Control Team’ (DCT) should be made which is present in the hospital round the  clock.  The DCT  would have thought of as many anticipated disasters  as possible and the  immediate steps to be taken for them.All the  personnel in the hospital would  know whom to call in case of a  disaster, something goes wrong or some patient or  attendant is  unsatisfied. With time, the DCT team will have more experience in  disaster management and their response will be consistent, appropriate(  not  exaggerated) and efficient.

TASKS OF DCT

DCT has 2 important tasks:   1. Damage Control ( After the event has occured)2. Event prevention

1. Damage Control ( After the event has occured): Normally this is done by the person who is responsible for the event or more often by the the clinician in charge of the patient. For example a patient suffers a heart attack after an unrelated operation or develops unexpected complication after an operation. The patient and the relatives are pertubed and agonized. This situation requires that somebody from the hospital side talks to the patient and the relatives , answer their queries, allay their fears and apprehensions, show sympathy and concern etc(Damage control). Normally all this is done by the operating surgeon or his resident. But not infrequently, we see that  doctor/resident do not have   required amount of time and are in proper mind set to do damage control.In such circumstances, the Damage control can suffer adversely.Therefore  a team/person( DCT) meant exclusively for this purpose will do justice to this important but at times neglected task. DCT can reach the site of event immediately and can start damage control.

Another example where the need of DCT is highlighted. Few months back we had a patient posted for Surgery.  While  preparing his parts, the barber made several cuts on his thigh and  abdomen  and the patient started bleeding resulting in  blood stains all over his clothes. The patient was obviously terribly upset and was adamant  on reporting the case to media. This would have tarnished the reputation of the hospital in a big way.Fortunately, the consultant was around and he along with his resident spent time with the patient  ‘cooling’ him down and  finally  everything settled  down.

2. Event prevention: After every event, DCT will meticulously record a) the event b) cause for it’s occurence     c)what damage control measures taken d) how effective these damage control measures proved to be e) how these  damage control measues can be improved. Then this data should be reviewed regularly in hospital commitee meeting and relevant policy decisions be taken. Though all this work is in the domain of hospital administrator / hospital suprindentent but a full team working round the clock under hospital administrator / hospital suprindentent can prove to be more effective.

RESPONSIBILITIES OF DCT

In short, the repuatation of the hospital is full responsibility of DCT. They have to anticipate ‘events’ which can tarnish the image of the hospital, try to prevent such events, do immediate and efficient damage control and critically review and analyse damage control and ‘event prevention’. To put in simple words, DCT is ‘Reputation Protector’of the hospital.

POWERS OF DCT

For DCT to be effective, it need to work in close liasion and directly under hospital administrator / hospital suprindentent . It needs to have the power to suggest and direct hospital employees to do the needful while doing damage control. DCT should interact with patient and  his/her attendants constantly trying to assess their satisfaction level and causes of their dissatifaction.

In short, ‘Damage control’  is an extremely important aspect of hospital management. In most of the hospitals ‘Damage control’ is unstandardized and responsibility of none.The formation of Damage Control Team(DCT) will standardize this task and help to provide this service efficintly and  consistently round the clock.

Senior Surgeon & Internationally renowned DoctorDepartment of Surgery, Fortis Super-specialty HospitalMohali (Chandigarh), PunjabIndia
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