One of the unfortunate realities of working in healthcare is that bad things happen. There are wrong-site surgeries, medication errors, and unexpected deaths, to name a few. Thankfully, they don’t happen often; we work hard to keep people safe, so when things like this happen, we do a lot of investigation.
Often, these things aren’t one person’s fault; they’re a combination of processes that failed or actions not taken, so we do something we call an RCA, or root cause analysis. It’s designed to not place the blame on an individual, but to look at processes and where we can improve.
We create a timeline of events, gather the people who were involved, outline the contributing factors, and discuss what we knew when we knew it. It’s easy to fall into hindsight, but we have to keep in mind that certain details weren’t known at the time. We also come up with ideas for preventing this from happening again.
RCAs are good things. They always result in change, improvement, learning, and the chance for the staff to come to terms with what is usually an emotional situation.
It occured to me that we don’t have the same kind of analysis after a service failure.
When it comes to patient complaints and, to a large degree, patient grievances, we apologize, maybe take some money off the bill, talk to the person against whom the complaint was made, do a little coaching, and that’s about it. We don’t do nearly the amount of problem-solving that we do with quality and safety events.
Why is that?
For starters, I think we still believe that good service is a nice-to-have, not a have-to-have in healthcare. There are still plenty of clinicians who feel that if you didn’t die, you’ve got no reason to complain.
I think the bigger issue, though, is that it’s just harder to measure. It’s easy to know when something that is never supposed to happen happens. Quality issues are black and white; did you end the surgery with the same number of sponges you started with? Was the right dose of medication delivered at the right time and by the right route? These are yes-no questions. It happened or it didn’t.
Service isn’t so simple. They’ve tried to make it black and white with checklists that contain all the steps in AIDET and all the evidence-based practices we strive to do. Did you knock before entering the patient’s room? Check. Did you round on the patient every hour? Check. Did you manage-up the previous nurse who’s going home for the day? Check.
All of these are good, but they don’t guarantee the patient will have a good experience. Sometimes we do these things but in a manner that comes off as insincere. It happened, but the patient didn’t feel it. How do you measure that?
Patient experience is a gray area in an industry that prefers black and white. When the patient complains, we say,”She was just crabby, We did everything we could do and we still couldn’t make her happy. That’s just how some people are.” And that’s that. We shrug our shoulders and say, “Oh well,” and put her in the They’ll-Never-Be-Satisfied bucket. No real investigation, no problem solving, no improvement plan.
We just don’t see service events as being as serious as quality ones. And until we do, we will continue to have them.
Can you imagine how things would change if we did an RCA on every patient complaint? It feels impossible and overwhelming now but, if we did them consistently, we’d have fewer and fewer of them.
Does your health system treat them differently?