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Harm Test
--Did the employee intend to cause harm or know harm would likely result?
Yes
Malicious Action
-Discipline and/or legal proceedings are warranted.
Consider:Suspension/terminationReferral to police or regulatory agencies.
Review:Organizational processes to determine how and why patients were not protected from the individual's actions.
No "If employee did not intend to cause harm or know harm would likely result"
Impairment Test
-Did the employee show evidence of substance abuse?
Yes
-Did the employee have a known medical or mental condition?
No
Impaired judgment
Consider:- Suspension/termination- Sick Leave- Referral to Occupational Health
Review:Organizational systems/ processes to understand whether substance abuse or health issues could have been recognized and addressed earlier.
NoThe employee did not show signs of substance abuse
Risk / Error Test
-Did the individual deviate from agreed protocols/accepted practices?
Yes
-Were the protocols and practices available, workable, and in routine use?
YesThere were protocols and practices in place or
YesThe employee had a known medical or mental condition
Risk Test 1
-Did the individual knowingly make a dangerous choice or take an unacceptable risk?
Yes
Reckless Action
Consider:- Disciplinary action- Corrective training or re-education- Improved supervision- Possible adjustment of job duties- Attention to existing health issues, if necessary
Review:Organizational protocols/practices for clarity, consistency, relevance.
NoThe individual did not knowingly make a dangerous choice or take an unacceptable risk
Risk Test 2
-Did the individual make a potentially unsafe choice?
Yes
Risky Action
Consider:Coaching to improve decision-making skills and increase risk awareness.
Review:Organizational systems/processes that permit or encourage shortcuts, work-arounds, and routine rule violations.
NoThe individual did not make a potentially unsafe choice
Error Test
-Did the individual make a knowing slip or lapse in judgment?
Yes
Unintentional human error
Consider:- Consoling and supporting the individual- Involving the individual in QI interventions - Individual's history of similar mistakes
No No protocols or practices were available, workable, or in routine use. AND
NoThe individual did not deviate from agreed protocol and accepted practices
Substitution Test
-Would other individuals with similar skills and knowledge act the same way in similar circumstances?
No
-Were there any deficiencies in training, experience, or supervision?
No
-Were there any significant mitigating circumstances that might justify the individual's actions?
No
-Does the individual have a history or pattern of similar actions?
Yes
Consider: - Disciplinary action- Referral to disciplinary/ regulatory agencies- Corrective training or re-education- Possible adjustment of job duties
Review: Organizational protocols/practices for clarity, consistency, relevance.
No The individual did not have a history or pattern of similar actions OR
Yes There were significant mitigating circumstances that might justify the individual's actions OR
YesThere were deficiencies in training, experience, or supervision OR
Yes Other individuals with similar skills and knowledge would act the same way in similar circumstances
System Failure
-Identify and review system/organizational weaknesses