I have a shorthand saying about finding the underlying cause when a clinician is involved in harming a patient: If you can say, "It could have happened to anybody," the cause is not personal.
Unfortunately, though, there have been too many stories about nurses being blamed for errors in hospitals when the actual causes were underlying human factors problems or work flow poor designs or other systemic issues.
There are very few stories about hospitals that have acknowledged this error of blame and apologized to the nurse and the community.
Here's one example of the latter, from Medstar Health. Annie's story presents a message to us all about the need for a just culture in an organization--and about valuing the people with whom we work.
Unfortunately, though, there have been too many stories about nurses being blamed for errors in hospitals when the actual causes were underlying human factors problems or work flow poor designs or other systemic issues.
There are very few stories about hospitals that have acknowledged this error of blame and apologized to the nurse and the community.
Here's one example of the latter, from Medstar Health. Annie's story presents a message to us all about the need for a just culture in an organization--and about valuing the people with whom we work.
Great post! Reminds me of your NYTimes article from some time ago - blaming employees will only result in errors being unreported rather than organizational improvement.
ReplyDeleteWe have this problem with the local hospital. Its still deny and defend and they have a horrid reputation for being jerks. People are stuck going to them because they're a monopoly but there have been a few breakthrus.
ReplyDeleteSad really. For everyone involved.
I would patronize Dr. Ring in a NY second. Any doctor with courage like this gets my $$$.