[EXTERNAL] Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture

Grefe, Rosemary RGrefe at CHILDRENSNATIONAL.ORG
Thu Jun 14 19:10:07 UTC 2018


I am responsible for running a diagnostic service that does not fall under CLIA requirements.  Testing quality is totally dependent on the desire of the individual provider running the service rather than guaranteed by standards that must be met.  This allows many short cuts to save time and money.  It also results in a lot of poorly collected  data that is used in the diagnosis and treatment of patients.

Rosemary

From: NANCY GENN [mailto:nancy.genn at COMCAST.NET]
Sent: Thursday, June 14, 2018 1:53 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [EXTERNAL] Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture

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There was a study, either Harvard or Johns Hopkins, contrasting PCP's and specialists, along 2 variables, diagnostic accuracy and diagnostic certainty.   Although specialists had a greater degree of accuracy than PCP's, their error rate was still measured very high (I remember it being about 17%), but they were astoundingly certain that their diagnosis had been correct and rejected  the notion that they needed either further objective testing or another opinion (70%).  The interpretation of the researchers was that it was arrogance that contributed to the high rate of diagnostic error.  It was about 5 years ago.  If I find it, I'll send you the citation.



Nancy Genn
On June 14, 2018 at 12:51 PM ROBERT M BELL <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>> wrote:

Thanks Tom and Bob,

Is that the the lack of caution that comes with any degree of arrogance?

Does arrogance itself have a role in diagnostic error?

Has that ever been studied?

Does anyone know?

Rob Bell




On Jun 13, 2018, at 8:52 PM, Tom Benzoni <benzonit at GMAIL.COM<mailto:benzonit at GMAIL.COM>> wrote:

From 35+ years in the front lines of health care, this is for sure so.
And the arc is increasing.
I've recently moved from an area that always felt a bit inadequate to one that is self-assured.
The prior was much safer than the latter.
Ever hear the phrase "Fat, dumb and happy?"

tom benzoni

On Tue, Jun 12, 2018 at 12:26 PM Bob Latino <blatino at reliability.com<mailto:blatino at reliability.com>> wrote:

While this is referencing the Oil & Gas industry, there are some interesting stats related to the 'zero commitments' we were talking about earlier.



"Unsurpirsingly, there is even a correlation between committing to a ‘zero accident’ vision on a project and killing more people. In a thoughtful recent study, British colleagues have demonstrated that projects subject to a ‘zero safety’ policy or program actually slightly increase the likelihood of having a serious life-changing accident or fatality (Sheratt & Dainty, 2017)."



Just an FYI.



http://www.safetydifferently.com/oil-and-gas-safety-in-a-post-truth-world/#comment-3802<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.safetydifferently.com_oil-2Dand-2Dgas-2Dsafety-2Din-2Da-2Dpost-2Dtruth-2Dworld_-23comment-2D3802&d=DwMFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=AwdxkIfJWQ0pgMs0A60cHAjX-od1OKpfyg9GNaoJR68&s=GcmZmRT46VUGhX98B-C4DKF8CvdBf0p4ld24z2U82Xo&e=>



Robert J. Latino, CEO

Reliability Center, Inc.

1.800.457.0645

blatino at reliability.com<mailto:blatino at reliability.com>

www.reliability.com<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.reliability.com_&d=DwMFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=AwdxkIfJWQ0pgMs0A60cHAjX-od1OKpfyg9GNaoJR68&s=fjtlKbTgiGFqfMlkNDcaqqFz1SJzuZmXMGl7hlc0PY4&e=>





From: Mark Graber [mailto:Mark.Graber at Improvediagnosis.org<mailto:Mark.Graber at Improvediagnosis.org>]
Sent: Tuesday, June 12, 2018 11:07 AM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>; Bob Latino <blatino at reliability.com<mailto:blatino at reliability.com>>
Subject: Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture



That Decker article on ‘getting to zero’ is amazing – thanks for forwarding it Bob.

It was exactly this question, can we get to zero, that prompted my first-ever paper on diagnostic errors, arising from assertions at national meetings that we could completely eliminate serious safety events.   Don Berwick had it right: “The search for zero error rates is doomed from the start”.



Its also the wrong question; Better questions are:  How can we make progress, and how can we measure that?  And… now with the knowledge that unintended consequences will accompany whatever we do, how do we minimize those while maximizing accuracy, timeliness, and safety?



Mark



Mark L Graber MD FACP

President, SIDM

Senior Fellow, RTI International

Professor Emeritus, Stony Brook University









From: Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>>
Reply-To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>>
Date: Tuesday, June 12, 2018 at 10:03 AM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture



Along this thread I thought this article may be of interest.  Declarations of 'zero' metrics, often has unintended consequences.  While on the surface they seem logical and admirable, they can suppress feedback loops for fear of affecting the zero metric (such as zero harm).



The article is authored by noted safety researcher Sidney Dekker.



Does this 'zero' mentality fall into the realm of how success in reducing Dx error is measured?  Is it applicable?



Regards

Bob Latino



Robert J. Latino, CEO

Reliability Center, Inc.

1.800.457.0645

blatino at reliability.com<mailto:blatino at reliability.com>

www.reliability.com<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.reliability.com_&d=DwMFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=AwdxkIfJWQ0pgMs0A60cHAjX-od1OKpfyg9GNaoJR68&s=fjtlKbTgiGFqfMlkNDcaqqFz1SJzuZmXMGl7hlc0PY4&e=>





From: Rory Jaffe [mailto:rjaffe at CHPSO.ORG]
Sent: Monday, June 11, 2018 3:04 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture



The other studies show a reasonably strong link.



Some of the problems in making an overall assessment is that culture is very local, varying broadly from department to department within an organization. Within-organization variability is generally much higher than between-organization vulnerability on safety culture surveys. So studies that look at “culture” in the organization as a whole tend to have weaker results. The specific papers do show a decent link.



Also backing this conclusion is that, in other industries, this has been studied and there is a definite link between culture and safety.



I think there is a consensus in health care that there’s a link. Look at “to err is human” and subsequent publications from the National Academy of Medicine. These publications strongly presume that culture is important driver of safety.





From: ROBERT M BELL <rmsbell200 at yahoo.com<mailto:rmsbell200 at yahoo.com>>
Sent: Monday, June 11, 2018 10:47 AM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at list.improvediagnosis.org<mailto:IMPROVEDX at list.improvediagnosis.org>>; Rory Jaffe <rjaffe at chpso.org<mailto:rjaffe at chpso.org>>
Subject: Re: [No SPF Record] [IMPROVEDX] Culture



Thanks Rory Jaffe,



Very kind.



Do you yourself have an overall opinion? I looked at the Weaver article which evaluated many studies. and, from my limited interpretation, that did not seem too positive.



Is there a general consensus amongst the medical profession as to whether culture is important in preventing errors?



Is to ERR more resistant to intervention than we think?



Rob Bell





On Jun 11, 2018, at 9:58 AM, Rory Jaffe <rjaffe at chpso.org<mailto:rjaffe at chpso.org>> wrote:



Weaver SJ, Lubomksi LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM. Promoting a culture of safety as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):369-374. doi:10.7326/0003-4819-158-5-201303051-00002.





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