What’s the true cause of medical errors? A new study challenges previous conclusions that burnout is related to higher frequencies of self-reported errors, and finds that lack of teamwork and engagement could be more significant factors.
At first glance, the idea that burnout causes medical errors seems to make perfect sense—it’s easy to assume that physicians in personal distress will underperform at their jobs. However, Evangelia Tsiga argues that we’ve been asking the wrong questions, in the wrong way, when it comes to understanding medical errors. In a report titled, “Examining the Link between Burnout and Medical Error: A Checklist Approach,” (February 2017), Evangelia Tsiga presents a straight-forward, evidenced-based checklist for physicians.
The newly published Medical Error Checklist (MEC) is an innovative tool that highlights the causal role of specific risk factors to patient safety. This self-assessment tool can help predict your likelihood to make a mistake, based on environmental factors. Supporting the improvement of patient safety & quality of care is a fundamental part of what we do here at RL—studies like this are a great example of the research on patient safety that could potentially decrease experiences of adverse events.
In other studies on burnout and medical errors, a “single-item assessment” was used. This means that large groups of doctors were asked one question. The problem with this method, Tsiga explains, is that it creates a starting bias that makes the respondent “believe that two constructs are related by an implicit theory (i.e., making mistakes and being stressed).”
A checklist with multiple points takes away that pressure and allows responses less marked by bias. Checklists are used by high-risk professions like pilots, submarine crews and nuclear plant operators. To put it quite simply, they work. This is the same theory that Tsiga uses for the high-risk subject of medical errors.
How Does the MEC Work?
Tsiga writes that the checklists can “be used for training purposes in daily medical practice as well as in promoting the involvement of doctors in quality and patient safety programs.” It was developed using focus groups and comparison studies.. The visual style of the checklists makes it quick and simple to fill out—without adding much time to your day, you can keep an eye on your risk factors.
What Did the MECs Reveal?
Interestingly, this survey of 231 doctors showed that internists and pediatricians report more medical errors when there’s a lack of teamwork. Depersonalization, a feeling of detachment where the world around you has little significance, was also a moderate factor for this group. For surgeons, the results were different; they reported more medical errors only correlated with a lack of engagement.
Although it may seem intuitive that burnout causes medical errors, this study indicates that the relationship has been “overestimated.” It might not be the long working hours or years of clinical experience—the root of medical errors could be poor teamwork and dissociative mindsets.
So what should be improved? Tsiga suggests that hospital organizational factors play much more of a role in medical errors. “Engagement is defined as a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption.” The root of lowering incidences of HAIs and improving quality of care could come down to how the hospital functions as an employer.
What Can You Do?
In addition to self-assessments using Tsiga’s MEC, you can encourage other medical professionals to use the checklists. It can help everyone gauge risks that could lead to errors, and perhaps indicate areas of improvement for the hospital’s administration.
Could you and your colleagues benefit from team-building exercises? Is there room for improvement when it comes to communication? Does everyone feel positive and fulfilled at work—if not, how can dedication be renewed? It doesn’t have to be trust falls and kumbayas, but learning how to work better in a community will be better for both you and your patients.
“Providing safe healthcare depends on highly trained professionals with different roles acting together in the best interests of the patient,” Tsiga concludes. “In order to achieve that, health professionals need to be able to work effectively in teams. Indeed, team training programs that address teamwork and communication for health professionals are increasing in number, being more heterogeneous and being evaluated for frequently. In addition, the findings highlight the importance of leadership programs in healthcare. Ultimately, physician leaders are responsible for leading healthcare and will directly impact the quality of care delivered to our patients.”
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