MD’s "Passive Aggressive" with Standard Practices

0 – ‘Wrong site' surgeries on the rise

It's supposed to be a standard practice, since 2004, for preventing “wrong site surgeries” — placing a big “X” on the surgical site, to prevent the surgical team from operating on the wrong arm, wrong leg, etc.

There were still at least 84 cases of wrong site surgery in 2005 and those are the ones that are reported.

For one, an “X” seems somewhat ambiguous. Wouldn't it be a better visual control to write “YES” and “NO!!” on the right and wrong legs, for example? I've heard of people doing that. “X” could mean “cut here” or “don't cut here.”

Why don't some doctors comply?

“Nurses are supposed to call a “time out” in the operating room, according to commission protocol, calling everyone's attention to a final safety check in an effort to ensure that the right procedure is performed on the right patient.

But some surgeons, particularly those who believe they would never make such a stupid mistake, often ignore the safety protocols, says one chief surgeon. “They think this is useless,” says Glenn Rothman, chairman of surgery at Banner Desert Medical Center in Mesa, Ariz. “Doctors fight it because they are the captains of the ship. There is a lot of resistance to standardized conduct.”

Doctors and nurses spar over the safety checks. Rothman says some surgeons make a tiny, mole-sized mark on a patient instead of a big, bold “X.”

“I call them passive-aggressive marks,” Rothman says. He is working to develop a standard stamp to put an end to such conflicts in his hospital and in others nationwide.

Some surgeons all but ignore the nurse's call for “time out” before the operation begins, Rothman says. “Doctors think nurses are just trying to torture them,” he says.”

Scary stuff, isn't it? As the article suggests, as a patient, you have to look out for yourself. Demand that your surgeon follow these best practices.

Whether you are involved with lean in a hospital or a factory, think about compliance to standard practices at your site, particularly related to safety and quality. Do people “wear” their safety glasses up on top of their head in a passive-aggressive way? Do people do quality checks in a half-hearted way, just to be able to put a check in a box?

Avoiding this requires discipline and, more importantly, leadership to make sure people understand “why” these practices need to be followed — what's the impact on them personally, the customer/patient, or to the organization?

Even “good doctors” make “dumb mistakes.” You'd think the good doctors would have more interest in following the standard error proofing procedures to help avoid mistakes that could happen to anyone on a bad day.

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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

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