On Being Wrong (and Human)
May 16, 2011 | In: Healthcare Barcoding Influencers
By Susan Carr
I’ve developed a soft spot for error—not for the stubbornness and denial that too often accompany error, nor of course for the harm that can result from it. I’ve been charmed recently by people who are comfortable admitting error and who accept that being wrong is part of being human. Learning to accept and even embrace the fact that mistakes are inevitable establishes humility as the foundation for improving performance and living contentedly with others and ourselves.
At the unSummit on Bedside Barcoding (www.unsummit.com), Jerry Fahrni, PharmD, gave a talk called “The Real Work Starts After Implementation.” Jerry is an effective speaker—informative, confident, and relaxed. In that style, he talked about many things that went wrong with the barcoding implementation at a large hospital for which he, as the IT Pharmacist, was responsible. He had prepared thoroughly to go live with barcoding for medication administration—assembled an interdisciplinary team, tested software and hardware, saw to myriad details that are well known elements for success—and, yet, all kinds of problems presented themselves as the hospital adjusted to working with the new system. Labels were misapplied over other labels, obscuring important information; drop-down menu items were chosen because they appeared at the top of a list, not because they were the correct choice; barcodes got scratched in handling, etc. Some glitches remained mysterious and eluded correction through weeks of investigation. Jerry conveyed the bafflement, surprise, satisfaction, duh! moments, and lessons to which we all can relate. The audience was engaged and sympathetic as Jerry’s stories rang true.
Read the full column in the May/June issue of Patient Safety & Quality Healthcare at www.PSQH.com
1 Response to On Being Wrong (and Human)
Jamie
June 29th, 2011 at 10:35 am
The presentation highlighted, if nothing else, that technology will only be as effective as those who are charged with using it.