The best surgeon, like the best general, is the one who makes the fewest mistakes. Sir Astley Cooper

Getting doctors involved is critical for ensuring the success of patient safety initiatives. However, for most doctors, this is still a taboo topic. The subject is threatening, because it is focused on preventing errors, and for a doctor, patient errors are synonymous with negligence and lawsuits for malpractice, a topic they’d rather not dwell on. Also, because physicians are so used to having to taking complete personal responsibility for all their actions, that they find that a solution based on a system improvement approach is baffling. The doctors’ objections

Any time hospital management wants to institute a change, there will always be resistance, and this will often come from the senior doctors. Standard objections include the following: * I haven’t ever had a problem so far, so why do I have to change my practice?

Why are you wasting our time?

* How can I take responsibility for someone else’s mistakes?

* I am careful and competent, and if everyone else was also equally careful, there would be no need for all this new-fangled approach.

* We’ve never used any of these techniques all these years, and we’ve managed just fine, so why should we change now?

* Isn’t all this safety business going to eat into my time? How will I be able to remember all this when I have so many patients to see?

* This seems to be the latest fad that the CEO wants to win brownie points for. * If I start disclosing errors, it will increase my liability.

* It’s all very well for the CEO sitting in his air conditioned cabin to preach, but how does he know what’s happening in the trenches?

* If I tell the patient I goofed up, the relatives will beat me up, and who will come to protect me?

* How much is this going to additionally cost my patient?

* Patient safety is the hospital’s headache so why should I care? Let them handle it – I have enough problems of my own without having something new to worry about!

Need for a “safety champion”

If the hospital management needs to get buy-in from its doctors (and without this, no safety initiative will ever work), then they need to emphasize how doctors benefit when their patients get safer medical care. Physicians are human , and their decisions have a large emotional component. Telling stories about how unsafe systems cause needless harm can help to sensitize doctors as to how important their role is in making hospitals safer for their patients.

The best way to implement change is by searching for a physician champion. Find an influential senior doctor to drive your safety initiative , and equip him with the tools needed to convert his peers. Doctors ( especially the surgeons ) need to be taught that teamwork, vigilance, standardized techniques, anticipation of the next step (or misstep), and compassion for our patients are requisites to ensure successful medical outcomes. Team decisions are often more important than neat surgical incisions!

A lot to learn

There’s a lot doctors can learn from pilots. They are both highly trained professionals, operating in complex technological environments and their job entails being responsible for the lives of others. However, safety levels in aviation have taken a quantum leap, but doctors are lagging way behind. Is this because the incentive for flying safely is way more personal than the need to practice medicine safely?

If instead of 100,000 patients in the US dying each year from medical errors, how different would the medical profession’s approach have been if it were 100 doctors who died every year? Because pilots sit in the cockpit and die first if the place crashes, they are highly motivated in making sure that safety comes first. Lacking that incentive, the medical profession has focused more on doing research and developing advanced technology; rather than on ways of delivering care safely.

Flying has become far safer today because it emphasizes simplification and standardization; safety training and retraining; teamwork; and safety nets are built in using checklists and readbacks. Pilots have learned how to listen to their colleagues, and those lower in the hierarchy have learned the importance of speaking up when they have concerns. Physicians are still stuck in the solo mindset, and things won’t get much safer until we begin adopting some of the lessons from high reliability organizations (HRO), such as NASA, ISRO, nuclear power plants and the aviation industry, where the margin for error is very small because errors can be catastrophic.

The most important trait of high reliability organizations is what Dr. Reason refers to as a “constant preoccupation with the possibility of failure.” A highly reliable organization: * Expects failure

* Looks for weak links

* Anticipates error before it occurs

* Rehearses scenarios of failures and strives to think up novel problems that may arise

• Has trained its staff in the recognition of and recovery from error

• Generalizes, not isolates, errors and looks for root causes

Airlines are safer , not because they have better staff than hospitals do , but because they equip their employees with better tools to help them make better decisions ; and systems in place that help catch errors before they occur. We cannot guarantee perfect outcomes for our patients, but we can commit to doing the best we can, to keep them safe and free from harm.