tag:blogger.com,1999:blog-32053362.post2942545232712651185..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Reverse the expectation of punishmentPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-32053362.post-170053465634830032012-02-22T10:44:53.414-05:002012-02-22T10:44:53.414-05:00Excellent points, Jesse. See here for a more full...Excellent points, Jesse. See here for a more full discussion: http://runningahospital.blogspot.com/2008/07/guide-to-just-decisions-about-behavior.html<br /><br />The idea is that there are certain events that are always blame-free and others that are certain to require disciplinary action. In the former category, we have mistakes that are made when there is no policy or process in place, when the person incorrectly interpreted an ambiguous policy or process, or when he or she was actually following the official policy. In contrast, people can expect disciplinary action when they intentionally cause harm or tamper with the error reporting process (i.e., engage in a cover-up); when they recklessly or intentionally disregard patient safety; or when they repeatedly violate hospital processes, policies, or standards.<br /><br />But no chart or formula can cover all events. It is appropriate to acknowledge that judgment will be used in the “gray areas,” where someone failed to participate in a patient safety initiative; where the error or near miss resulted from a minor deviation from policy or process; or where carelessness—as opposed to intent—led to a deviation from accepted standards. In evaluating errors within the gray area, we look to see if the act or omission was reckless or repeated, or whether it undermined our patient safety initiatives.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-4538785072814749442012-02-22T10:39:59.464-05:002012-02-22T10:39:59.464-05:00Yes, but...
In a true just culture model, there s...Yes, but...<br /><br />In a true just culture model, there still needs to be some accountability.<br /><br />In this case, if the surgeon purposefully prevented the use of the pre-procedure time out, there should be some accountability. Otherwise, you are empowering "bad behavior". That is the crux of the issue: no-one should be punished for normal human error (though they may need some re-training, coaching, or more likely there needs to be a system change), but they should be held accountable for "bad" or inappropriate behavior. The lack of that last, I believe, is one of the reasons that medical staff have been an impediment to improving safety culture.Jessenoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-86259858612158481052012-02-22T09:35:58.873-05:002012-02-22T09:35:58.873-05:00Paul,
An important point. However, I think this i...Paul,<br /><br />An important point. However, I think this is somewhat of a grandiose example (obvious error, immediate need to resolve, etc.) <br /><br />How can you apply the same principles to outpatient services, where possibly even the provider is unaware that they've made a mistake because the end result is not as catastrophic/obvious? That is, what other methods could be utilized to uncover/understand wasteful errors?<br /><br />S.PiggSPigghttps://www.blogger.com/profile/11455996358536821232noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-49031116712627010412012-02-22T05:41:04.846-05:002012-02-22T05:41:04.846-05:00It is an outrage that this attitude necessarily pe...It is an outrage that this attitude necessarily persists after so many years of talking about a just culture, etc. As an early reader of your excellent book, Paul, another quote from it comes to mind, from the CEO whose hospital had killed several NICU babies:<br /><br />"The crux of his entire presentation was this comment: "My objective today is to confess," Wiles said. "I am accountable for those unnecessary deaths in the NICU. It is my responsibility to establish a culture of safety. I had inadvertently relinquished those duties" by focusing instead on the traditional set of executive duties (financial, planning, and such)."<br /><br />Until CEO's learn to 'own' these errors instead of blaming someone else and firing them, nothing will change. Walk a mile in our shoes.<br /><br />nonlocal MDAnonymousnoreply@blogger.com