Chicago, IL -- Preventing medical errors by changing the culture of medicine is challenging but necessary, according to patient safety expert Robert M. Wachter, MD, who spoke today during The American College of Obstetricians and Gynecologists (ACOG) 57th Annual Clinical Meeting. Dr. Wachter illustrated practical solutions to help ob-gyns prevent medical errors in both the hospital and private practice and described how aviation offers some useful lessons in this pursuit.
"I'm so pleased that Dr. Wachter could join us today to address patient safety which is my presidential initiative and a priority for ACOG," said Douglas H. Kirkpatrick, MD, ACOG President. "As I've said before, the principles of patient safety are quite simple, but implementation is difficult. As ob-gyns, we need to make patient safety a priority in our offices as well as in our hospitals.
Discussion on patient safety often focuses solely on hospital changes, according to Dr. Wachter. However, there are common elements that apply to both the hospital and to the private practice setting. For example, he said, the role of systems thinking and standardization are important in all settings. For example, he said, the role of systems thinking and standardization are important in all settings. There are two primary differences, though, between hospitals and physician offices when it comes to implementing patient safety programs.
"In a practice, you can't really have specialized jobs - there's no patient safety officer, no information technology (IT) technician. And, in a hospital, the patient is a captive population. When risky things happen, the patient is still in the building," Dr. Wachter said. This differs from private practice, where the greatest risk may be when patients move in and out of the practice, from one doctor to another, from one practice to another. A patient may have an initial appointment with her ob-gyn, then go to a radiologist across town and to a lab at a third site, making it much harder to keep track of the patient and all the possible risks, he explained.
Lessons from Aviation
Aviation is frequently held up as a strong example of how standardization and team training can prevent errors. "But what we do is much, much more complex than flying an airplane. We shouldn't thoughtlessly embrace techniques from aviation, but there are lessons [from it] that we can embed in health care," according to Dr. Wachter.
The cockpits of a particular airplane all look the same with the controls in the same place, continued Dr. Wachter. Whereas in an operating room, there are often multiple set-ups for the same procedure, depending on the physician's preference. In addition, pilots routinely train for emergencies to prepare them when crises arise.
Dr. Wachter analyzed the successful emergency landing by Chesley "Sully" Sullenberger, the US Airways captain who landed safely in New York's Hudson River after a flock of birds took out both the airplane's engines.
"Part of what kept Sully so calm is that he had trained for situations like this on simulators," Dr. Wachter said. "In health care, there is no tradition of using simulation and teamwork training to help prepare for the unexpected but potentially catastrophic failure, but there should be. Another lesson is the language pilots use. There's no ambiguity. When Sully's engines went out, he said simply 'my aircraft,' and the co-pilot repeated it back. And it was clear who was in charge."
Changing the Culture of Medicine
Changing medical culture to evaluate and improve systems can seem daunting, but it's necessary and achievable to improve patient safety and quality, Dr. Wachter said. "One way I try to explain this to clinicians is by getting them to think about a Broadway play. When things have gone badly, health care professionals have traditionally focused on changing the actors. Over the last decade, we've learned that the best way to keep patients safe is to focus more on rewriting the script. In other words, we are more likely to ensure safety by improving error-prone systems - with checklists, computers, standardizations, and redundancies - than by trying to perfect the human condition.
Dr. Wachter said health care professionals need to feel free to speak up when they think something is wrong. "You can't even begin to move forward unless people begin to think about their work in a different way. Once they've changed their mental model to focus on systems rather than individual failings, they should then focus on structures and policies to support safety: the role of training and simulation, public reporting, hospital patient safety committees, and personnel such as patient safety officers."
Dr. Wachter is professor and associate chair of medicine at the University of California, San Francisco, and chief of medical service at UCSF Medical Center. An internal medicine specialist, he is a recognized authority on patient safety and authored the book Understanding Patient Safety and coauthored Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes. In 2008, Modern Physician magazine named him as one of the 20 most powerful physician executives in the US. Dr. Wachter is a leader in the hospitalist movement and is credited with coining the term 'hospitalist' in 1996.