Errors in healthcare organizations occur due to system and process, why investigating individual errors…
By Mrs. Mary Khoury RN, Masters in Quality and Management Healthcare Organizations, CPHQ, Quality Auditor and Coordinator for Hospital Accreditation Ministry of Public Health, Lebanon
Human errors are inevitable in complex systems like hospitals while heavy workload and stress increase errors. Managing these errors needs significant involvement while the commitment of leaders and patient safety culture shall be a priority.
Accountability starts with leadership through the creation of a sustainable, resilient and efficient system and process free from quality defects, deficiencies, duplication of efforts and variabilities that are failures in the system.
The hospital shall use a defined and standardized process for identifying and managing errors. Standardization of the practices throughout the organization and creation of a non-punitive, blameless environment and culture are evident through continuous trainings for employees, learning by practice and teaching rather than blaming them and therefore, encouraging reporting of errors to develop proactive activities and mitigation strategies to reduce their occurrence in the future.
Leaders are responsible for monitoring the effectiveness of the actions with clear and defined follow-up for possible system redesign. A long-term commitment to the process with alignment at the start is critical before it gets tough. Decisions by leaders should be based on reliable and accurate data or performance measures along with effective benchmarking to create an efficient system.
Guidelines, algorithms, clinical pathways and Standard Operating Procedures can decrease the unnecessary levels of care, length of stay, cost and therefore, improve the appropriateness of services provided and decrease errors.
Quality is appreciative by the employee and perceptive by the patient. Errors can be preventable, strengthen your system and process, appreciate your employees and respect their team contributions and engagements to create a commitment to the organization.