Are Errors Inevitable??
Lots of discussion of the sad case of the mixed up laboratory specimens and Darrie Eason having the unnecessary double mastectomy.
One comment (from a reader of the blog I linked to above) said:
“IN ADDITION, to put things in perspective, THERE IS NOTHING ANYONE CAN DO TO AVOID MISTAKES. Every lab, hospital, treatment center has protocols to ensure patient safety. However, there is nothing anyone one can do (Except GOD himself) to stop any lab tech from making mistakes. Training, supervision is important but ultimately, even ALBERT EINSTEIN himself, if careless, could do a mistake.”
Wow, I couldn't disagree with that statement strongly enough. Nothing we can do? That's the mindset that allows errors to happen, that they're inevitable. That's a dangerous mentality, whether it comes to hospitals, airplanes, or assembly lines. I hope quoted mentality isn't that common in the general public – or your organization. How prevalent do you think that mindset is?? Click “comments” to let us know.
It's hardly playing God, if you will, to try to prevent human error mistakes. The Lean approach and the Toyota Way recognize that humans are indeed human. We DO make errors. Hoping for the best (or praying) isn't any better of a strategy than would be telling people to “be careful.” We have momentary lapses, even the best of us.
I keep thinking back to Dr. Atul Gawande, in his book “Complications: A Surgeon's Notes on an Imperfect Science,” who made the case that he worries about the good doctors making mistakes on their bad days. The bad doctors get drummed out of the system (maybe not soon enough). But, any of us (yes, even Einstein) are capable of errors.
Using true Error Proofing methods is good for the customer (or patient, depending on the setting) and it's also good for the doctors and the hospital employees. Nobody WANTS to make a mistake. We're trying to protect them so one bad day doesn't ruin their career or their life (yet alone patients like Darrie Eason).