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Investigating on-site incidents and accidents

November 1, 2006
by NIKI L. ROWE and MICHAEL AMO
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Excerpted from the new book Investigations in Long-Term Care Facilities: Implementing a Standardized Model

Editor's Note: When an unfortunate event occurs involving a resident—a mysterious bruise, a fall, a wanderer found blocks or miles from the facility—the onus is on facility administration to determine the facts and respond accordingly. To do so to the satisfaction of the legal and regulatory systems, as well as the family and community, is no easy matter. Several years ago consultants Niki L. Rowe and Michael Amo of The Amo Group set out to determine facilities' need for guidance along these lines and, in response, to develop a training manual meeting national standards. What follows is an excerpt from that recently published manual, Investigations in Long-Term Care Facilities: Implementing a Standardized Model, available from Vendome Group (see p. 50).

The process of becoming an investigator is more than memorizing and following the steps in a model. It requires that you learn to think like an investigator and inquire like an investigator. All this must be done using the scientific method. This chapter provides the basics for doing just that. Read it with an open mind. Practice it until its content is internalized.

It is one thing to follow the steps of an investigation like a recipe. Thinking like an investigator is another. Our goal is to teach you to think like an investigator. It will undoubtedly take more than a reading of this to accomplish that. It will take practice and skill development. So let's begin.

Think Like an Investigator

A large part of being a good investigator is keeping an open mind throughout an investigation and following wherever the evidence takes you. To do this you must learn the thought processes and logic needed to undertake an investigation. Work hard at learning how to look at investigations and maximize the collection of all evidence. This entails knowing how to examine physical evidence, how to read documents and how to extract from witnesses all that they know. The reward is well worth the work.

The Reward

Besides producing good investigations, learning how to think like an investigator has other benefits. When you have thought your way through an investigation, not merely followed prescribed steps, the following capabilities are greatly enhanced:

  • The ability to arrive at the right conclusion

  • The ability to explain every step of an investigation

  • The ability to defend your conclusion

Inquire Like an Investigator

You need only spend a little time with a seasoned investigator to notice his inquisitiveness. The desire to find answers is infectious. Their approach is to constantly search for fact-based answers to the follow-ing cardinal questions:

  • What actually occurred? (event)

  • Where did the event occur? (scene)

  • When did it occur? (time)

  • How did the event (likely) occur? (method)

  • Why did the event occur? (reason)

  • Who (or what system) caused the event to occur?

Although these are the basic questions of every investigation, there are many derivatives of these questions that surface during the course of an investigation. Facts that answer these six questions must always be sought regardless of the seriousness of the event being investigated. Answers to these questions are not pursued casually; they are part of an investigation plan based on the scientific method.

The Scientific Method and Investigations

The Amo Group's “TAG Four Phase Model of Investigation” provides a series of systematic steps that overlay existing clinical review processes (also called the clinical track), thereby minimizing duplication of staff effort. It is based on the scientific method and adheres to fundamental tenets of police science.

Steps in the Scientific Method

  1. Identify the problem.

  2. Hypothesize.

  3. Collect data.

  4. Test hypotheses.

  5. Draw a conclusion.

To demystify the scientific method, know that it is already used in everyday life and in many activities within long-term care facilities. When trying to determine why your printer will not print (problem), you look for a reason (hypothesis). You check to see if the connections are tight (data). When you find a loose plug, you plug it in and the printer begins to print (test hypothesis). You conclude that the printer must be plugged in to work! In a long-term care facility, when a physician attempts to diagnose an illness, symptoms are considered (problem, hypothesis) and tests are run (collect data, test hypothesis). Based on the findings from these efforts, a diagnosis usually emerges (conclusion).

Again, the relevant steps are:

1. Identify the problem. According to the scientific method, the very first step in an investigation is to identify the problem. It is essential that an investigator clearly understand the allegation being made and the policy or regulation that allegedly has been violated. Clearly identifying the complaint to be investigated establishes the need to do an internal investigation by:

  • Clarifying which facility policies and procedures are in question

  • Identifying which state or federal regulations may have been violated

  • Confirming that an investigation is within the investigator's jurisdiction, i.e., determining whether a law has been violated

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