System Safety in Healthcare: How Does Unsafe Work Originate in Patient Care?

Dev Raheja; Maria Escano

doi:10.56094/jss.v55i3.35

Authors

Dev Raheja
Maria C. Escano, M.D.

DOI:

https://doi.org/10.56094/jss.v55i3.35

Keywords:

unsafe work, patient care, problem solving

Abstract

Unsafe work practices can happen in many ways. The following lengthy list includes examples of potential causes:

Excessive work for clinicians
Too many unnecessary reports and requirements
Over-dependence on technology
Conflict between the need for professional autonomy and establishing the dynamically changing best processes
Care delivery “silos” resulting from lack of interdepartmental teamwork
Constant distractions and interruptions
Too many policies and procedures, leading to a tendency to follow marginally effective methods
Over-reliance on electronic medical tracking taking precedence over bedside discussions with patients
Inattention to detail
Lack of motivation to get, or resources for, a second opinion
Quick diagnosis based on past observations
Inadequate attention to medical equipment dangers
Insufficient effort in infection prevention
People pretending the negative would not happen to them
Hospitals looking for quick profit
Questionable alternate boards certifying physicians who may not be qualified
A lack of passion for work
Unfavorable workflows, such as labs located far from the emergency department
A lack of clarity of what is required to assure patient safety
Too much team consensus instead of challenging the quality of intervention

Author Biographies

Dev Raheja

Mr. Dev Raheja has been a System Safety and System Reliability Engineering consultant for over 25 years. His range of consulting encompasses transportation systems, electric power systems, high tech industry, aerospace, defense systems, medical systems, and consumer products. He has conducted training in several countries including Sweden, Australia, Japan, UK, Turkey, Germany, Poland, Singapore, Brazil, South Africa, and Canada. He has done training and consulting work with NASA, U.S. Army, GM, Boeing, Eaton, Nissan Aerospace, Litton, General Dynamics, ITT, BAE Systems, Lockheed-Martin, Harley-Davidson, and United Technologies.

Prior to consulting, Mr. Raheja worked at General Electric, Cooper Industries, and at Booz-Allen & Hamilton. He is the author of several books including Assurance Technologies Principles and Practices (Second Edition, Wiley 2006), and Design for Reliability (Wiley, 2012). A Fellow of the System Safety Society, he has a received Scientific Achievement Award and the Educator-of the-Year Award from the society.

Mr. Raheja serves on the Patient and Families Advisory Council at Johns Hopkins Hospital as a patient safety advocate. He is Associate Editor for Healthcare Safety for The Journal of System Safety and an Associate Professor at University of Maryland where he teaches the “Design For Reliability” course which includes design for safety and trustworthiness.

Maria C. Escano, M.D.

Dr. Maria C. Escano completed her medical degree at University of Miami School of Medicine. She received her post-graduate training at Columbia University/New York Presbyterian Hospital in New York City and St. Agnes Hospital in Baltimore, Maryland. She completed her advanced trauma surgery fellowship at R. Adams Cowley Shock Trauma Center at the University of Maryland.

She has been a regular contributor to scholarly journals for many years and has presented across the country on various topics advocating systems and patient safety initiatives. Dr. Escano is also an extensive traveler, having forged friendships across six continents.