By Christopher Burns
A study in 2000 showed that there were about 109,000 deaths per year as a result of unnecessary surgery, wrong medication, and preventable infection, making medical error the third leading cause of death in the United States. But that doesn't count deaths that result from "disruptive behavior" between doctors and nurses in the middle of an operation. A new survey by VHA reports that verbal abuse, shouting, arguments and passive aggressive behavior in the operating room is causing pain, poor medication, misdiagnosis and patient death. This is a fresh example of how a breakdown in team decision making can have deadly results.
17% of the doctors and nurses surveyed said they had experienced episodes of rage in the OR, and 76% of those said that the "adverse event" resulted in injury to the patient. And it's not just doctors shouting at nurses. A new generation of nurses are shouting back. At least it is not as bad as it used to be. In the old days, one OB/GYN said, we often threw scalpels and placentas at each other.
The breakdown of information management among medical teams, flight crews and project participants is now understood to be a widespread and preventable danger. Groups can learn behavior that will mitigate rage, miscommunication, and suppressed dissent. "Crew Resource Management" is a widely employed training protocol which encourages team members to discuss their different interpretations of the facts with more respect. Dr. Gerald Healy, president of the American College of Surgeons, has put CRM to work:
"At my department at Children's Hospital of Boston, our medical error rates have dropped to zero after airline pilots taught us team training, and team training resulted in lower death rates, and more satisfied patients in the cardiac surgery program at another New England hospital."
There are other ways as well to organize and train teams for better information management, and success may differ from country to country, from culture to culture. But one thing is clear: none of us knows as much as all of us know. Dealing with more different views of the situation means more work, that's true. And authority is often challenged in the process.
But it isn't only lives that are saved by a more open and respectful dissent. A study by the Department of Defense showed that among advanced research and development labs, the team characteristic with the highest correlation to success was the way it was organized. Some were run by a single, authoritarian figure. Others had carefully crafted rules and procedures that everyone followed. But the labs with the best record of breakthrough development were collegial and open. All evidence was shared and disagreements were respectfully discussed. The labs were noisy and fun, sometimes behind schedule and occasionally disorganized in their presentations. But nobody threw calculators at anybody else, no shots were fired, and great ideas were regularly brought to life.
The next time you go in for an operation, talk to your doctor about this. Politely.
(Originally published at GoArticles and reprinted with permission from the author, Christopher Burns).
Christopher Burns is one of the country’s leading experts on information management in organizations, and the author of Deadly Decisions: How False Knowledge Sank the Titanic, Blew up the Shuttle, and Led America into War. For more information, please visit: Deadly Decisions.
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