Chain of Command

Subject:   Chain of Command: Resolving Differences  of Professional Opinion
Policy Number:
Effective Date:  July 2017
Revision Dates:              

Purpose

To maintain the safest and highest level of patient care at the University of Washington School of Dentistry (SOD), faculty and students must have a way to resolve disagreements in the approach to patient care when supervising faculty differ on the plan of care. This policy provides guidance for students and providers to resolve such conflicts without fear of retribution.

General Policy

A dental training clinic provides an important learning opportunity for students to observe how differences of professional opinion occasionally arise among providers. Normal variations in treatment approach stem from differences in education, training and expertise. These differences are an expected part of professional collaboration and are typically resolved through a respectful exchange of views. When a consensus cannot be reached in the usual manner, it is the right and obligation of the providers to seek resolution from a clinical authority identified by the School in an established Chain of Command.

Implementation

I. Procedure

The diagram “Chain of Command: Resolving Differences of Professional Opinion,” see Appendix A, illustrated the levels of authority within the School’s clinical management structure and the sequence for making final care decisions.

  1. The involved faculty should confer together with the pre-doc or post-doc student or Resident away from the patient to discuss their rationales for their individual perspectives. Complexities of the case, including evidence, standard of care, student ability, and patient factors such as availability and ability to pay may need to be taken into consideration.
  2. If the parties agree upon a final plan, the initial supervising faculty, along with the student, should discuss their final decision with the patient. It may be necessary to explain to the patient the perspective each faculty member had which caused the difference of opinion.
  3. If the parties do not agree upon a final plan:PRE-DOC: If one of the providers is a pre-doctoral dental student, the Clerkship Director or Co-Director will make the final decision, or the Clinic Director of the General Practice Clinic. If multiple Clerkship Directors disagree, the Associate Dean for Clinics makes the final decision. Note: If one of the providers is the Associate Dean for Clinics, the disagreement will be resolved by the Dean. The Dean has the right to delegate decision making as he or she deems necessary (e.g. to engage a content expert or particular dental specialist.)POST DOC:  If one of the providers is a post-doc or resident, the Grad Program Director of the clinic will make the final decision, or the Clinic Director of the General Practice Clinic. If multiple Clerkship Directors disagree, the Associate Dean for Graduate Studies makes the final decision. Note: If one of the providers is the Associate Dean for Graduate Studies, the disagreement will be resolved by the Dean. The Dean has the right to delegate decision making as he or she deems necessary (e.g. to engage a content expert or particular dental specialist.)
  4. If the Clinic Director, Clerkship Director (or Co-Director) has not resolved the disagreement or Grad Program Director, the Department Chair and/or Associate Dean for Clinics (or Associate Dean for Graduate Programs for post-doctoral cases) will have the final decision. Dual Role: If one of the providers who are in disagreement also is also the person responsible for making the final decision, the disagreement will be resolved at the next highest level.

II.       Documentation

Documentation in the electronic health record (EHR) should include only the facts of the case and ultimate decision.

If the disagreement over patient care involves inappropriate behavior, delay of care, or inadequate communication, the event is reported using the Patient Event Form (see Appendix B). An Event Report is a confidential, quality improvement record, and is used only for that purpose.

All parties are expected to maintain professional behavior during the process in their communications with patients, other faculty, students and staff.

As outlined in the Integrity at Work Handbook, see Appendix D, workforce are encouraged to treat one another in a respectful manner and refer to differences of opinion in professional judgment promptly. Each new workforce member (individual faculty, staff and student) is required to read the Integrity at Work Handbook, with compliance monitored through Swank. The handbook is also available on the school website.

Appendices:    

Appendix A, Chain of Command Diagram
Appendix B, Patient Event Form
Appendix C, Integrity at Work Handbook

Dean of UW SOD:

Joel Berg, Dean of the UW School of Dentistry

Date: July 19, 2017

Appendix A

Chain of Command Process (PDF)
Chain of Command graphic

Appendix B

Patient Event Form

Appendix C

Integrity at Work (PDF)