In healthcare, we are preoccupied with measuring and avoiding error. Whilst, at first glance, this seems to be an entirely laudable endeavour, it may contribute to the development of a culture centred around negativity. To make matters worse, our attempts to understand the ‘root causes’ of our mistakes are based on flawed assumptions. We investigate error in retrospect: precisely the opposite temporal direction of reality. Hindsight bias results in an oversimplification of events whereby incident ‘x’ can be explained by omission ‘y’. More often than not, efforts to prevent recurrence of error result in the imposition of new boundaries, rules and check-lists. We gain control, but lose resilience.
I believe we should now start trying to measure excellence in healthcare. If we can capture it, we may start to understand how to emulate and reproduce it. Focusing on excellence may also promote innovation and improve staff morale and motivation through positive feedback of excellent performance.
I’m not saying we should stop looking at mistakes – we just need to redress the balance.
We have been focussing much attention in healthcare on efficiency, quality, cost-effectiveness, meeting targets and trying to maintain patient safety – but as @adrianplunkett says, we are mostly reporting and measuring failures rather than successes.
There are millions of successes in our healthcare every day across the UK – babies born, operations performed, trauma stabilised, teams being formed from previous strangers in minutes or even seconds when it really counts, ailments correctly diagnosed and unnecessary tests appropriately avoided.
If we can capture these daily examples of excellence and resilience I too believe we will improve our performance, resilience and team morale.
Most of the endeavours to improve safety and efficiency are simply someone’s best guess as to what may work – using ‘common sense’ where true evidence is lacking. Changes are validated by PDSA cycle reports but the reality is that you can make any change look good if you simply show it from a particular angle. What we need are balanced measures of excellence, reliance, resilience and safety – so start reporting excellence and making more of what works rather than looking for the ‘what didn’t’.