A Resident's Experience Confronting Safety Procedures

One of the most critical components of our on-campus graduate program is the administrative residency, in which young health care administration graduate students spend a full year as an administrative resident in a health care organization, learning in the practical setting under the guidance of their preceptors, the executives of those organizations.  This residency spans the final year of the program, and throughout the residency students maintain contact with their faculty reader to share with them their experiences, their insights, their challenges, and their future directions.  One way in which these perspectives are shared is through monthly journals that the residents complete and submit to the program.  Often, these journals can be thought provoking, as residents share critical lessons gained over the course of their residencies, and this year has been no exception.  The following post comes as an excerpt from one resident's recent journal entry, in which she detailed her experiences confronting safety procedures within her organization.

My residency rotation has shed a bright, inescapable light on the problem of hospital staff and doctors not following safety procedures in the operating room. ...[Our] system held a half-day workshop for all hospital leaders, directors and OR staff, filled with lectures and messages about the importance of the safety practices. These issues were discussed at length at surgery committees, safety huddles and hospital meetings. Yet despite the heightened awareness, staff continued to fall out on safety protocol adherence.

So why don’t staff just follow the procedures? There is a small but certain cost to following safety protocols. It may be a small amount of time added to the process, when staff already have a large workload. However, the risk of an adverse outcome is even smaller. Therefore, staff are tempted to cut corners, since the likelihood of the adverse event is so small (although the magnitude could be extremely high.)

Additionally, there could be a social cost to an OR nurse speaking up and telling a surgeon to redo a site marking or to pay attention during time out. The nurse, who would have to continue to work with the doctor, may be less likely to rock the boat, especially if the situation or the perceived risk is uncertain.

Hospital administration does not adequately address the costs (perceived or real) that come with following the procedures or stopping the line. Status quo conventional reactions and solutions are centered around improving the process to catch any near misses, but do not address the costs that OR staff face.

There is no visible hierarchy of culpability when it comes to enforcing the rules and doling out punishment.  System leadership says that “everyone is responsible” and stresses “team accountability.” However, I have observed ambiguity in the OR, as to who is supposed to start or finish surgical instrument counts. Clarifying the expectation as to who is first and second in line to initiate the safety practices and who needs to stop the line would reduce some of the ambiguity.

How can we address the problem? I believe that the perceptions surrounding patient safety are largely driven by culture and by the habits developed by the staff. It will take continuous education at every safety huddle to promote a sense of imperative urgency to follow safety procedures. This needs to be taught early and often. It needs to become as second-nature as looking both ways before crossing the street: day or night, rain or shine, whether it’s a quiet or busy street.

It is exciting to see the diverse experiences our students enjoy during their administrative residencies, and we are proud of the critical lessons they come away with that can ultimately improve the care provided to patients in communities across the country.