What’s the Best Way to Improve Patient Safety?

SAN DIEGO — A panel of otolaryngologists was assembled onstage to discuss how their field could make changes to improve patient safety when Ravi Samy, MD, associate professor of otolaryngology at the University of Cincinnati in Ohio, asked a question: Would you rather work with a top-performing, A-level healthcare team in a B-level system? Or would you rather work in an A-level system with a B-level healthcare team?

Dr. Samy knew his answer: He’d choose top people over a top system.

“I’d rather work with phenomenal people around me, knowing that the system might not be at its best,” he said.

But in a thought-provoking discussion here at the Triological Society Combined Sections Meeting, in which physicians were forced to consider their own vulnerabilities as well as those of their broader environment, the other panelists had a different take. You and your colleagues might be top-level performers, but what if you have an off day? they asked.

People’s Vulnerabilities

Capt. Ryan Carron, a naval aviator who became a patient safety advocate after losing his son shortly after birth following a series of medical errors, suggested that it’s unreasonable to expect that someone will always perform well.

“Have you ever been a B person, or perhaps a C person?” he asked Dr. Samy, who responded, “Absolutely.”

“We all have external stressors,” said Capt. Carron, who draws from his experience in the military to describe how medical systems can better protect patients. “We all have times when we are not A personnel. I think we also have people on our team who are, period, not A personnel. For me, … I want an A system.”

Chad Zender, MD, associate chief medical officer at the University of Cincinnati, agreed.

“If we’re going to function in healthcare and provide the care we need, we have to have the systems built to work with the people who are available to us,” he said.

“Unintentional Variation”

Dr. Zender said that there are a variety of environments or problems that can lead to catastrophic medical errors. Sometimes there is a good plan and a good outcome, and sometimes there are just bad plans with bad outcomes. But he drew attention to the area in the middle—which he called “unintentional variation”—in which the plan is good but doesn’t account for unintentional events.

“I’m not talking about taking away the ability to have intended variation, where you want a different antibiotic [than the standard] because the MRSA screen was positive,” he said. “We just don’t want the wrong dose or the wrong antibiotic to show up in the room accidentally.”

In a word, the idea is reliability.

“We want a highly reliable process in healthcare that allows us to provide the health services intended consistently and failure-free over time,” he said.