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2018-09-21

health care: The willingness to learn from mistakes

Where people work, mistakes happen.

This is a fact, which can safely deny no one.

However, differ, depending on the work area, the consequences of these errors.

In high-risk Professions, such as, for example, the air and space travel, but also of medicine, errors can quickly have severe consequences. Of course a fault can also have out-of-tune patient or financial losses. But in the most serious case, human lives, destinies.

Proactive and structured Work, sufficient human resources, good training and regular continuing education, good training and mutual collegial support are a few factors to minimize error.

Especially important: Avoidable errors prevent. And from near-accidents to learn.

Not every error you have to make yourself

As an employee in the health care system, we should not learn only from our own bad decisions, but also from the misadventures of their colleagues.

For this purpose, we need an open, honest, and professional culture of mistakes.

A huge challenge for the staff in the hospital or an employer in the health sector.

In many clinics to be used for this reason, in the meantime, different error reporting systems. In these systems, Almost-accidents, anonymously and with no penalty in detail reported. We are currently using a System called CIRS. This stands for “Critical Incident Reporting System” for reporting critical incidents.

Anonymous and penalty-free

Here were messages to be liberated in the course of all personal data and to risk divided. It will be ensured that the sender can’t be traced. Depending on the System, this data is then available to the employees. We get, for example, regularly “Newsletter” by E-Mail, inform us about particular incidents and derived measures is instructive.

In other systems, there are databases that are made available to employees. Here you can be structured and sorted the reported situations. This open dealing with Almost-not helps accidents to us to repeat mistakes and our own structures and processes critically.

On the employees

Thus, each employee can help to identify hazards and the potential for Errors and eliminate them. We see some of the great misfortunes in the media, seldom resulted in a bad decision in a disaster. Often it is the concatenation of many small and large missteps and Inattentiveness with error-prone communication. From a harmless Situation, the consequences can be severe event.

In the case of the large number of areas of work and the many different requirements in the hospital, usually only the experts can recognize the hazards and identify. Of course, it is the ultimate goal, to make these sources of error to find and eliminate it before it happens. We are working on that every day.

Good mistake-management culture in the hospital

At the same time, it is enormously helpful that near-accidents are consistently evaluated. Thus, measures can be developed, how such situations are prevented in the future.

As station management, it is especially important to me that my employees make use of all existing possibilities and therefore actively to a good error culture to participate.

Ultimately, it must apply to all employees in the hospital, the old Hippocratic principle:

Primum non nocere, secundum cavere, tertium sanare.

In English: first, do not harm and, secondly, to be careful, thirdly, the cure.

Photo: Fotolia / v. poth

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