Residents Actively Identifying Systems Improvements for Patient Safety

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Patient Safety and Quality

Neslihan Alp
Dr., University of Tennessee at Chattanooga

Excessive medical errors are known to be a pervasive problem in American health care. Healthcare institutions commonly use incident reporting systems to identify medical errors and improve patient care. Dramatic safety improvements in other high-risk industries, such as nuclear power and air transportation, have been achieved by identifying and correcting potential systems problems before accidents occur. Resident physicians in training have provided substantive recommendations for improving patient safety.

Since the report of the Institute of Medicine in 1999, increased awareness of medical errors has occurred; but health care changes have been slow. Academic medical centers struggle to fulfill their multiple roles as centers of excellence in research, teaching, and health care while providing the "safety net" for the uninsured.

Other industries have successfully implemented workplace improvement teams comprising employees most closely involved in production. Toyota Motor Company has pioneered the Toyota Production System in which line workers are organized to recommend improved manufacturing processes. "Kaizen (Continuous Improvement) Teams" are excellent examples of teams empowered to improve quality and effectiveness. Residency physicians, who become very well acquainted with the healthcare processes in their teaching hospital, have not been organized nor empowered to provide systems-based assessments of patient care even though they arrive with substantial hospital experience in other locations. We have identified a number of ways to improve patient care and associated systems from indepth analysis of resident incident reports. We postulate that residents, with appropriate education, can provide valuable organizational recommendations to improve patient safety and care processes.