To Err Is Human
My main takeaway from the Marseille experience was a deeper reflection of human nature. It seems silly, but I had never considered the implications of the title of the landmark IOM report: “To Err Is Human.” Rather than an excuse or an indictment, it is a commentary on our natural tendency to commit errors, regardless of training, skill, or experience. No human can ever be perfect all the time. Yet, this is how I grew to think of myself and other healthcare providers. With the appropriate intellect, passion, and attention, we could do our jobs well. There was no room for error and no expectation that any would be made. That way of thinking and working, especially in the broken system of healthcare, is a recipe for disaster. When an error inevitably occurs, the assumption is that an individual is to blame for their incompetence, laziness, or carelessness. This often… Continue reading
Pre-Marseille Post: Why Wouldn’t Someone Follow Proper Procedures?
During nursing school, I received extensive training on preventing adverse events. Despite sitting through countless lectures about infection control and fall prevention, something never clicked for me in the classroom. I reasoned that most – if not all – of the things I should or shouldn’t be doing were common sense. Why wouldn’t someone wash their hands before each patient encounter? Why wouldn’t someone follow proper procedures each and every time? Why wouldn’t someone contact the attending physician if they were concerned about their patient, regardless of the time of day? I imagined patient safety and health care quality occurring in a vacuum of my actions; I assumed that if I was diligent, attentive, and careful enough, adverse events would never happen to my patients. I didn’t realize it at the time, but I also assumed I would be making these rational decisions as a fully rested, engaged, and supported… Continue reading