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Big cultural barriers to better reliability in healthcare

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Craig Clapper is a partner at Press Ganey Strategic Consulting and  a founding partner of Healthcare Performance Improvement and Kerry Johnson is another Press Ganey partner and a founding partner of Healthcare Performance Improvement, acquired by Press Ganey in 2015.

In a recent piece in FierceHealthcare, they looked at eight cultural barriers that slow the healthcare sector’s progress to making sustained reductions in medical errors and, more broadly, achieving better reliability in the sector. Their list:

Acceptance of errors as system complexity grows

“When caregivers feel overwhelmed by the complexity of healthcare or operate outside established processes, a medical error is much more likely to occur.’’

Dysfunctional external accountability

“There are many regulatory agencies in healthcare—The Joint Commission, the Centers for Medicare & Medicaid Services, state agencies and various payers, for instance. While most share the objective of improving the delivery of safe, high-quality care, each has a different mandate and set of metrics that can cause an organization to focus on the near horizon of process and accountability rather than on the ultimate shared goal of zero harm.’’

Lack of comprehensive internal oversight

“In high-reliability industries, risk management is focused on preventing errors and detecting and correcting high-risk situations. In healthcare, risk management tends to be reactionary, with a focus on mitigating loss after an error rather than on preventing error before it can occur. Proactive oversight of processes and guiding principles creates a strong mechanism for internal enforcement on high reliability.’’

Slow introduction of high-reliability principles

“As a complex environment with high-stakes outcomes, it is critical that healthcare providers look outside the industry for operational solutions. To be successful, healthcare organizations should focus on behaviors rather than outcomes.…’’

Fear of retribution

‘’The perceived consequences for identifying serious safety issues can sometimes overshadow the goal to eliminate avoidable patient harm. Internal and external pressures can negatively impact the goal of creating a high-reliability culture. Internally, peer review systems can be punitive and focus on individuals rather than system accountability. No one wants to be responsible for a co-worker losing his or her job.’’

Personal failure is unacceptable

“Perfectionist personalities and professional pride can perpetuate an attitude that ‘only bad doctors or nurses make mistakes.’ We must embrace a culture of full transparency and reporting of errors.’’

Overly developed sense of urgency

“Healthcare providers have a tendency to escalate emerging issues to urgent issues. Factors like impatience, too little time, higher likelihood of proceeding in the face of uncertainty, and patient demands that can be so intense that the ‘end justifies the means’ can provoke caregivers to move ahead too fast when intervention at an earlier stage could prevent a safety event.’’

Standardization is perceived as a burden

“For organizations that embrace a culture of personal authority and individualism, introducing protocols, guidelines and regulations can be seen as bureaucracy. Some clinicians can view process controls as ‘cookbook medicine,’ or feel that dictating care delivery undermines their expertise. ‘’

To read their article, please hit this link.


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