How leaders can minimize harm in health care, in other industries, and in all areas of life.
“How can we change this process to prevent this error from happening again?” the senior ward nurse asked the group. It is a common question, one that I have heard thousands of times from experienced and dedicated health care professionals of all stripes.
I have worked in health care for many years, serving in positions from volunteer to emergency medical technician to senior attending physician to chief of staff at a hospital to chief medical officer of a large network. In every position, “do no harm” is a fundamental theme. This famous statement from the writings of Hippocrates encapsulates quality improvement, patient safety, access to care, and many other goals in modern medicine.
“Do no harm” can be thought of as eliminating risks that could lead to a bad outcome, such as injury or death. Occupational and Environmental Medicine physicians learn that there are four ways to decrease risk in the workplace and in the environment:
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Everything that we do, or fail to do, impacts us for good or for ill for the rest of our lives. Our teachers were right…each of us has a permanent record.
A little boy couldn’t resist the urge to pull the hair of the girl sitting in front of him. Across the room, a little girl couldn’t help chatting with her friend while the teacher was talking. These incidents happen every day in thousands of classrooms across the United States. Modern teachers have a variety of new techniques for dealing with such infractions, but in bygone days teachers would often respond with the same threat: “if you do that again, I will write that in your permanent record.” The children would immediately stop, at least for the moment, because everyone feared bad reports in their permanent record.
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Going on a mission trip or a humanitarian event to a developing country? Prepare yourself by doing this.
“Doctor, this will be a very long war if for every division I have facing the enemy, I must count on a second division in hospital with malaria and a third division convalescing from this debilitating disease.” General Douglas MacArthur to Colonel Paul F. Russell, US Army malaria consultant, May 1943.
Just like soldiers going to war, people on humanitarian missions anywhere in the world can fail to accomplish their mission due to illness or injury. Whether missionaries seeking to advance the gospel of Christ, secular humanitarians trying to dig a well and build a school in a rural African village, or a combination of both, medical problems can inactivate the best intentioned and most capable teams. This article is intended to help people medically prepare themselves to go overseas on humanitarian missions. You can also watch the video.
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A comprehensive and highly useful military model for analyzing and addressing problems that does well in non-military settings as well.
My staff and I were meeting at the end of a long day. As representatives of the regional headquarters they had been working with their counterparts at our subordinate medical facilities on an important project with a tight suspense, and they had met resistance. One exasperated lady at a hospital said, “Tell your boss that we have full time jobs already!” Another one said, “This regional initiative just isn’t my top priority right now”, and one of my staff said “Sir, there just aren’t enough hours in the day.” Everyone who has worked long in leadership and management has heard these complaints time and again.
There is always a temptation to ignore such concerns and keep pushing, but that is rarely the right thing to do. One concern from my staff is that they did not feel as though their counterparts in the clinics and hospitals considered them value added. They wanted cooperation on these vital projects but did not perceive that they had much to give in return. This is a perpetual problem and when I worked in a hospital, I felt the same way about the regional staff.
Continue reading “DOTMLPF-P Analysis and Military Medicine”