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Archive Staff & Patient Safety 2020

'Goof-Proof' ORs Need Time, Care & Resources

Q&A with Robert Wachter, MD, the physician who literally wrote the book on patient safety.

Robert Wachter, MD

You authored the world's bestselling primer Understanding Patient Safety. What's the single most important component of keeping patients safe?
Medical errors don't happen because doctors or nurses are bad or careless. They occur because systems are dysfunctional, overly complex and don't anticipate that humans will blow it from time to time. Organizations that have made themselves safe have strategies to get frontline providers to understand safety science and "goof-proof" operating rooms and surgical procedures. That requires hard work. It's not something we learned in medical or nursing school.

How has patient safety evolved in recent years?
We've gone from a paper system to a digital system. The impact of that on patient safety has been mostly positive. But computers create their own kinds of mischief. New kinds of errors occur stem from physicians and nurses spending so much time looking at screens instead of patients, they're no longer talking to their colleagues in ways they used to or they turn their brain off and don't notice that the computer is doing something wrong.

How has COVID-19 altered the fundamental approach to patient care?
The pandemic created a need to be much nimbler. Organizational changes that normally would have taken a year of meetings and debates were made in a week because of the outbreak. That's been healthy for organizations that typically take too long to make decisions. That said, the biggest transformation that COVID will leave behind is telemedicine. At UCSF, use of telemedicine for appointments went from 1% to 70% in months. To me, that's for the good. The healthcare system's adoption curve would have lasted 10 years if left on its own. Instead, it basically took three months.

What is the biggest challenge in protecting patients from harm?
There are so many competing imperatives compared with when the patient safety field began 20 years ago following the release of the Institute of Medicine's To Err Is Human. Back then, organizations focused the bulk of their efforts, resources and initiatives on patient safety. A few years later, the quality movement began. Then, as cost pressures rose, the value movement started. Now, we're also focusing on improving patient satisfaction and decreasing physician burnout. And we're also attacking healthcare disparities and improving health equity. These are all really good, really important things, but they are competing against each other. Because of that, there's no question that safety is getting less attention now than it did 15 years ago when it was the only kid on the block. OSM

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