You’re not going to necessarily say all the time ‘I made an error.’ Yeah, I want people to think I’m a great doctor. I don’t make mistakes.
This comment came from one of the participants of my study, Effects of Shame and Guilt on Error Reporting Among Obstetric Clinicians and illustrates how deeply internalized the belief is that making an error equals being a “bad” clinician.
The Creation of the Delusion
A personal experience I remember well was in a hospital leadership meeting where the dashboard with the goals and targets for the next five years was unveiled. When we reviewed the goals for quality and safety, I saw that one of them was zero medical errors. Being well versed in the science of error and human behavior in organizations, I knew this was an impossible goal. I sheepishly raised my hand and said,
I understand that conceptually we would want to aim for zero medical errors, but we will never get there, so I’m wondering if we shouldn’t set a more realistic goal?
You could have heard a pin drop. The meeting participants looked at me with blank stares and the facilitator’s facial expression clearly conveyed disappointment that I was not on board with such an important goal. I soldiered on nonetheless,
I just want us all to be on the same page in acknowledging that – since we are dealing with clinicians who are human – there will always be errors. I’m concerned that if we think otherwise, and send that out as our message we will do more harm than good.
The Mixed Message That Does More Harm than Good
Though intellectually everyone knows humans make mistakes, the expectation of perfection has been deeply ingrained in the healthcare community psyche. This expectation is punctuated by the belief by many that medical errors can be eliminated.
Despite healthcare systems introducing approaches to reducing medical errors that acknowledge expected human error and system factors, the acceptance of this idea has only taken hold at the surface level and has yet to penetrate to the level of the collective belief system among healthcare members. Evidence of this is the practice of encouraging transparency and asking clinicians to report their errors, while at the same time initiating “error free” and “zero error” patient safety campaigns (1).
The contradiction in this message stems from the desire to ask clinicians to be vulnerable and to come forward with their medical errors, however, implicit in the second part of the message is the expectation that errors shouldn’t happen.
Mixed Messages as a Defense Routine
Organizational guru Chris Argyris described this kind of mixed message as an organizational defense routine that typically gets conveyed as if the message is not inconsistent and thereby becomes undiscussable (2).
The message is made even more undiscussable by the sheer naturalness with which it is delivered, which leads to automatic defensiveness and mistrust among organizational members. This occurs mostly at the unconscious level. We feel it but we may think and say otherwise.
My experience in the leadership meeting mentioned above is an example of how undiscussable the inevitability of clinician error is.
Undoing the Unrealistic Expectation of Zero Medical Errors
The problem with allowing this false expectation to continue in our industry is it prevents us from getting to root of all of our medical errors because clinicians will be more inclined to cover them up if the prevailing belief is there shouldn’t be any.
Errors are an unavoidable reality of clinician practice. When this is acknowledged, accepted, and internalized to the level of the collective belief system, only then will we be able to make significant strides in reducing medical errors. Under these circumstances, in addition to efforts aimed at preventing errors, a greater emphasis can be made to build systems and processes that can catch them when they do happen and mitigate any harm they can cause, to both patients and clinicians.
- Fairbanks, R. J. (2013). Proceedings of the human factors and ergonomics society annual meeting. Healthcare systems design at a crossroads: Challenges, opportunities and strategies.
- Argyris, C., & Schön, D. (1996). Organizational learning 2: Theory, method and practice. Reading, MA: Addison-Wesley.