Oops, They operated on the wrong knee…
Did you see that some surgeons operated on the wrong knee of their patient last week? (Feb. 18, 2009, Providence) NECN said that “After the botched procedure, the hospital began requiring surgical staff to use permanent markers to mark where the doctor is supposed to operate.” In a similar case at Beth Israel Deaconess 2 years ago, the patient’s leg was marked and they still operated on the wrong leg.
The Sr. VP of Health Care Quality at BIDMC said “that medical workers used a marker to correctly label the side of the patient that should have been operated on but that, somehow, the surgeon failed to notice the marking… Perhaps most crucially, the team of medical workers hovering in the operating room neglected to conduct what’s known as a “time out” before the surgeon first placed his scalpel on the patient. Time outs are safety procedures that require the operating team to verbally call out, “Right patient, right procedure, right location.”
Wait, there’s more
When Deviance is Positive!
Speaking of Handwashing in Health Care Settings… Have you heard about Positive Deviance? Deviance in this case means going against the norm and achieving positive results. Sometimes, if things aren’t going well in some departments, you can look around to see if anyone in the organization is having success with that one issue. If they are, they must be doing something right! You want to figure out what they’re doing, and then you want to get other people to imitate that.
Atul Gawande is a surgeon in a Boston hospital, and he’s written 2 fabulous books on learning in health care institutions: Complications and Better. He describes how doctors, nurses, and administrators can learn – from their mistakes, from surgical errors, from places in the hospital where things are going right.
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Where Cultural Competence & Organizational Effectiveness Meet
As an Organizational Development consultant, I get to think about how effective organizations are: their staff, their initiatives, their ability to deliver excellent service. As I’m also trained in cross-cultural communication, I sometimes look at organizational issues through that lens. When I’m lucky, these two fields coincide, as in my visit last year to the administrative offices of a health care organization, where I saw a patient brochure about “hand-washing for doctors”. You may know that this has been a focus in health care institutions, who are trying to reduce the spread of germs and infections. This brochure said “Have you asked your doctor if he washed his hands?”
Can you see anything wrong with this? There are power issues inherent in this question. For one thing, we tend to defer to doctors, or any authority figure, particularly when they’re wearing a white coat (or a uniform, or a stethoscope). Even I, as a white woman, feel a little intimated in front of doctors. Secondly, when you’re serving people from other countries and other cultures, who may not speak the language well, or who don’t feel fully acculturated, the authority gap is even wider. They could have saved themselves time and money if they had convened some focus groups on this question (or they could have asked people like me! 
