I’ve been rethinking an I’ve been thinking from five years ago, in which I compared medication errors with baseball blunders.
June 8, 2012 | In: I've Been Thinking
What’s good for healthcare providers is good for technology providers
For the past ten days I’ve been embroiled in site visits and presentations at some of Australia’s leading hospitals. I’ve also addressed several gatherings of technology vendors. Then yesterday afternoon I met for three hours with the Australian Commission on Safety and Quality in Health Care. Down-under peeps are awesome. We talked about technologies OZ has and even more about technologies they wish they had. We have much to be grateful for “up over” here in America. In between meetings, I took in an Aussie Rules Football (footy) match—a real thriller. I watched a few snippets of the Queen’s Jubilee on the telly this morning—a real yawner. Monarchists are dwindling down here. One gets the feeling Aussies just as soon watch Major League Baseball, even though it’s generally regarded as boring to them as cricket is to us.
I’ve been rethinking an I’ve been thinking posted here five years ago, in which I compared medication errors with baseball blunders.
America’s pastime is played before a punitive culture. Errors are tallied on scoreboards. Cameras record bloopers for replaying between innings and airing on Sports Center. And, of course, fans boo from the stands and hiss over Twitter.
However, should a grounder slip through an infielder’s glove, when the inning ends he returns to a nonpunitive dugout. Experienced teammates discern when the guy needs a pat on the back or if he’s better left alone to process and learn from what just happened.
Thank God, hospitals are getting better at providing support rather than rushing to judge and punish employees involved in errors. They’re learning that kicking them when they are down only perpetuates failure to admit, report, and learn from mistakes. Increasingly, hospitals are caring for caregivers overtaken by nightmares for having injured a patient while attempting to do no harm. Together, they look for ways to prevent similar mishaps from occurring again.
Folks outside of hospitals are not so kind. Before anyone knows exactly how a medical error occurred, media and everyday Joe’s are ready to “throw the bums out”—as if none of them make errors in their work.
Furthermore, in baseball, should a pitcher throw a wicked curve for strike three, a center fielder make an over-the-wall catch, or a cleanup batter clear the bases with a walk-off homerun the fans turn insane with affirmation. Fans even applaud things as mundane as a shortstop catching a routine “can of corn” or a batter fouling a pitch to keep his turn at the plate alive.
In contrast, clinicians seldom receive praise for highlight-worthy acts, much less for a myriad of mundane deeds without which we would all be in serious trouble.
Of course they’ll never bat a thousand. They are human, you know. But, for all the day-in-day-out good they do playing their respective positions, caregivers deserve our applause as much as any New York Yankee or Los Angeles Dodger. God forgive our silence in the stands, our damning caregivers with faint praise.
And yet, while I’m detecting a hearty “amen” from caregiver corner, I’m puzzled by how often I hear pharmacists and nurses badmouth companies who all-in-all have brought their hospitals some pretty good automation and technology. No, developers don’t bat a thousand either. But what makes us think they care for patient safety any less than we do? Most technology providers I’ve met in our space share our passion. They diligently work to get things right, to make it easier for caregivers to do their work, and harder for them to do anything that would harm their patients.
Sure hospitals must have those occasional come-to-Jesus talks with their technology providers, but to assume vendors don’t care or attempt their best is to foster the very punitive culture we condemn inside our hospitals. I’d guess this doesn’t do much to help vendors admit their errors, learn from their mistakes, and make improvements.
It’s also worth remembering that some problems are not with particular products so much as with how they are used. Albert Pujols is arguably the best hitter of our day with his lifetime .328 batting average. Imagine him blaming bat-maker Marucci for his being one of the worst batters in the first month of the 2012 season, with an average south of the Mendoza Line (.200).
The blame game doesn’t foster better ballplayers, create better caregivers, or motivate companies to build better technology.
Whadaya think, mate?
Mark Neuenschwander aka Noosh