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Date de chargement sur le serveur : 26-01-2010 00:00
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Catégorie : Facteurs_Humains
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Abstract : While debate continues over various estimates on the amount of preventable medical
harm occurring in health care, there seems to be a general consensus that health care is not as safe and reliable as it might be. It is often assumed that copying and adapting the success stories of nonmedical industries such as civil aviation and nuclear industry will make medicine as safe as these industries. It is not that simple. This paper explains why proposing a bench-marking approach to safety in high risk industries is needed to help translate lessons to health care. The most significant difference among industries is not so much in the relevant safety toolkit. These are similar for most industries but rather the difference lies in the industry’s willingness and mindset to abandon historical and cultural attributes and beliefs linked to performance and autonomy in a constant drive towards a culture of safety. Five successive systemic barriers are identified that presently keep health care from becoming an ultra safe industrial system: (1) the need for placing limits on the discretion of workers, (2) the need to reduce worker autonomy, (3) the need to transition from a “craftsmanship” mindset toward achieving the principle of “equivalent actor”, (4) the need for system-level (i.e., senior leadership) arbitratio n in the optimization of safety strategies, and (5) the need for simplification. Finally, health care must overcome three unique problems: a wide difference of risk among medical specialties, difficulty in defining medical error, and a series of structural constraints (public demand, teaching role, and chronic staff shortage). Without such a framework to guide development, ongoing efforts to improve safety by adopting these strategies may yield reduced dividends. Rapid progress is possible only if health care is willing to address these structural constraints in order to overcome the five barriers to “ultra-safe” performance.
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