Patient Safety: Whose Job Is It Anyhow?

Today I went somewhere that I've never been before.  Despite working my job in the emergency department for the last 2 and a half years, I had never been to the medical staff dining room.  As I perused the bulletin board filled with newspaper clippings of local physicians in the news, I came upon a letter to the editor written by a physician somewhere in the midwest.

 The headline  made reference to airlines and checklists and caught my eye right away.  Unfortunately, the writer used his podium to rail against the current patient safety movement.  He made fun of checklists, insisted that an "airline" style of patient safety is too expensive and manpower intensive, and, in general, failed to acknowledge medical errors are a huge issue!

Reading though to the end, I was disappointed that the authors' narrow view misses the fact that if we are to improve patient safety, we all must focus on change.  The airline industry is often held as an example because of the remarkable record of safety.  It wasn't always this way.  In the late 1970's, a spate of incidents caused the entire industry to take a critical look at their processes and design new ways to deal with the errors.  Checklists, team training, simulation, process redesign, and multiple other safety innovations were the result of their efforts.  They took the time to test their ideas and redesign them.  In short, they changed, and they're still doing it!

Medicine can learn a lot from their efforts.  The message isn't that 2 doctors (pilots) per patient (plane) with 3 nurses (hostesses and hosts) and a host of support staff armed with checklists will make care safer.  The message is that we need to study our processes, learn about the latent conditions that predispose us to err and make changes to eliminate them.  We can create tools to improve care.  These may be checklists but they're not the only tool to use.  We can study staffing and it's effects on waiting, technology, teamwork, and more.  This list goes on and on.  Perhaps the best thing we can learn from the airline industry isn't about the tools they use, but the methods they used to create the environment in which all players want to be a positive deviant.  After all, being ahead of the curve when it comes to refining the process of providing safe care is at the heart of our oath towards humanity: "Primum non nocere, or first, do no harm."