When my hospital embarked on a zero-defect campaign, I (like many of my colleagues) thought it was a great idea. It would help reduce morbidity and mortality and increase patient and family satisfaction, not to mention provider morale. However, many of us also had some trepidation about what the campaign would mean.
We physicians all want to provide the best care for our patients with a minimum of errors. However, when errors occur, they can be tough – especially if we were part of the error. We feel that we have failed our patients, and perhaps even ourselves.
We may experience guilt, which can be compounded by fear – fear of future adverse outcomes, fear of punitive actions from superiors, and even fear of malpractice or board actions for our mistakes, if they are significant. The blame game can cause extreme tension for the treatment team and be potentially toxic to a collegial and collaborative work environment.
Many of us will try to analyze what led to the defect. Having a checklist, as Dr. Manning and Dr. Winawer suggest, will help us to do that critical analysis in a more organized way. Some physicians may have frank conversations with the affected patients and apologize for the mistakes. Others may become more detail oriented and may be even more critical of themselves. Some may even practice defensive medicine to ensure that they do not repeat the same mistakes, even though the future clinical scenarios may be very different.
Fortunately, despite all the anxiety and doubts that such defects elicit, having supportive colleagues and a constructive work environment often help us deal with errors in a collegial manner, as well as in partnership with patients. The most important thing to appreciate is that the goal of zero defects is a process that involves commitment and ongoing, open, and honest dialogue – not only between us providers and our administration, but also among us and the patients and their families.
Anthony T. Ng, M.D., is a psychiatrist and chief medical officer at Acadia Hospital in Bangor, Maine.
