I was recently thinking about how much time has passed since the report on “To Err is Human”. I think it is fair to say that some things are certainly better. Awareness of error is better. Reporting is better. Some types of errors have improved – for example hand writing errors are much better now that we have computer order entry. But it is fair to say that some things seem worse.
As we continue to try and improve the systems that cause error, it is hard to feel as though all of the possible levers of change are being pulled. There has been some good changes and efforts. Yet, if you think about how hard change can be, one wonders if part of our problem is that we, in the entire health care system, have not sustained the efforts needed to really make change.
Insurance companies are refusing to pay for some medical errors and readmissions. There is some effort to to require transparency of outcomes. Yet to change things it feels like we really need a sustained and unrelenting effort to change the way we educate the many different disciplines that provide care. And efforts have been made. There are new efforts to look at competencies prior to graduation, but now it seems that some of those efforts might be slowing.
Change takes time. A lot of time. There is almost always resistance. There also many competing priorities. Leaders also talk about change fatigue. They believe that their employees get tired of all the change. But, I don’t believe that. I don’t think that people have “change fatigue”. I think they have “failure to change fatigue”.
So what do I mean by that? I think that people get tired and cynical from the requests from their leaders to make changes. They understand that the changes will take time and be hard. They wonder if they should make the effort since it often is on top of the work that they already are doing. They have seen “leader after leader” come tell them to make change. Those leaders sometimes demand change not because it is needed, but because leaders think they need to make changes to show that they are “leaders”. But then the next leaders shows up and demands a different change. Sometimes demanding that the last change be halted. Is it any wonder that employees get frustrated and instead of making change, just hunker down waiting for the new leader to go away. They don’t believe that we as leaders will sustain and be consistent in our work toward change.
So…if we really want to improve safely might I humbly suggest that all the lever so the healthcare system commit to the changes we need to make to create the better world we all want for our patients. It will take time and it will be hard. Yet, if we can sustain those efforts over the long term, maybe we can get there.