Humans are prone to mistakes. There’s an inherent factor of human error in every action we perform. Over time, technology has become an indispensable tool in medicine. Electronic health records (EHR), medical billing software, and other technologies now play a crucial role in modern healthcare. These advancements have become increasingly complex, making it inevitable for errors to translate over.
According to a 2013 study in the Journal of Patient Safety, hospital errors contribute to almost 400,000 patient deaths per year. In an article in Dermatology Times, Dr. Eliot Mostow, M.D. claims cognitive bias to be a main aspect of these errors, suggesting that years of experience can produce a presumptuous frame of mind. Physicians have perceptions, judgments and biases that can affect their approach to the patient and how they make a diagnosis. The three cognitive biases he lists are:
- Anchoring: Immediately selecting one diagnosis without considering other possibilities.
- Attribution: Concluding the source of a problem based on biased understandings.
- Availability: Assuming a diagnosis because it’s familiar to the physician or more likely than another possibility.
Each of these could result in misdiagnosis and the consequences associated with it. Mostow agrees, however, that there are many other factors involved. He goes on to say, “there’s lots of potential for issues we loosely call ‘errors.’ But it’s not all black and white.” He emphasizes communication among staff as a major element. It is important for the team dynamic to reflect that the doctors and other staff members understand each other and are able to interact efficiently.
Dr. Mostow’s proposed solution for error prevention is the PDCA cycle: Plan, Do, Check, Act. Following a checklist can help highlight the objectives for staff and standardize how procedures are performed. In order to develop a checklist, clear and concise objectives need to be established. It is also recommended that items are added to improve communication among team members. All team members should be involved in the checklist creation process.
When drafting the checklist, use natural pauses in workflow as breaks, use simple sentences and straightforward language, and make sure the checklist fits on only one page. The sign of a good checklist is its ability to fit in with the actual practice workflow. It is best to discover any errors or problems early on, when they are still correctable. Dr. Mostow recommends revising the list until it is successful. The idea is that everyone is doing the same thing, the same way, which can minimize small mistakes and improve overall patient care.