Are We Effectively Preventing Harm in Healthcare?

Key to quality healthcare delivery is to do no harm to patients. Twenty years after the publication of “To Err is Human: Building a Safer Health System” by the Institute of Medicine, healthcare organizations are still challenged by adverse events.  Safety processes and procedures borrowed from the airline industry do help to catch some impending errors. However, the rates of error leading to medical complications and death are still significant because healthcare deals with human beings with complex issues. Patients do not have straightforward medical issues. Moreover, staff are under strain from personal and professional obligations and expectations. The result: we still are not safe.

Of note, both hospitals with high and low mortality are not significantly different when it comes to anticipating and preventing mistakes and complications. Evidence shows that high mortality hospitals actually follow guidelines and practices similar to those followed by low mortality hospitals.  Low mortality hospitals, however, recognize and manage serious complications as they unfold and, thus, are more able to mitigate an imminent catastrophe. They are more able to rescue a situation gone bad. High mortality hospitals are not as proficient when faced with the unexpected; they are not resilient.

Resilience in healthcare organizations refers to this ability to rescue a situation gone bad. Resilience requires the ability to discover a harmful trend and react appropriately under the acute pressure of deteriorating patients. When the unexpected occurs, what is needed is an improved grasp of what may be evolving and the ability to act decisively. To achieve the optimal results during an evolving and potentially catastrophic situation demands the ability to collaborate and count on each individual to be accountable and take responsibility without placing blame and judgment on others.

This already challenging task is made more difficult when high stress situations expose weaknesses in team member relationships (e.g., different assumptions and expectations of task performance, trust, trust worthiness, confidence to take charge, and self-respect). These weaknesses are often unknown until crisis hits.

Eliminating or reducing weaknesses in relationships is, therefore, vital to improving the organization’s culture and climate and, thus, its resilience.  To enhance an organization’s resilience, we must proactively address any strain in relationships affecting collaboration.

How resilient is your organization? If you would like to have further conversations, please reach out to me at DrKaren.Org or contact me directly at