Turning Safety vs. Profits Into a Fair Fight

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Heart surgery is a complicated procedure done on unhealthy patients. Occasional bad outcomes are easy to understand.  On the other hand, a bad outcome that was preventable is less acceptable.  Exam…
Heart surgery is a complicated procedure done on unhealthy patients. Occasional bad outcomes are easy to understand. On the other hand, a bad outcome that was preventable is less acceptable. Examples of harm from preventable mistakes include giving a wrong medication because a verbal order was misunderstood, failure to correct an overlooked but important lab value, failing to intervene on a patient that is rapidly deteriorating, forgetting an important step in procedure. Oftentimes, other clinicians recognize missteps by their colleagues but fail to speak up in time. Even more disheartening is how rare it is for hospitals to learn from these errors so they can prevent them from happening again. These types of process and system flaws used to be common culprits of harm in other hazardous fields such as aviation, nuclear power and the military. But 40 years ago these fields all began to adopt the basic tenets of a high reliability organization (HRO). Once its rigorous methods of communication and teamwork were learned, it virtually eliminated preventable errors. It is impossible to find a plane, power plant or military team that does not lean on HRO tenets as its #1 guiding principle. Yet most hospitals –equally hazardous to these other fields – are a long way from becoming an HRO. Most fail to even acknowledge that errors in patient care are common within their walls. They do not have a blame free environment for reporting problems, so the most severe errors tend to remain hidden. They have been unwilling to commit resources to uncover and address system defects. They do not rank becoming an HRO anywhere near their #1 priority. The interesting question is why? Understanding how powerful concepts like this fail to spread in hospital is an often overlooked first step towards improving safety.

A major roadblock for becoming an HRO is tension between two fundamentally opposed ideas – whether the #1 priority should be finance or safety. For the late Paul O'Neil, former…
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