which the patient subsequently swallowed . Fortunately the patient did not inhale the driver , but still had to go through the process of having a chest radiograph .
Photo : Advisory Board for Human Factors in Dentistry , UK
Another example is when a patient presents with an emergency relating to a tooth that needs extraction . A decision to extract the tooth is made . Upon administering local anesthesia , there is an adverse event with the patient fainting , resulting in the extraction being aborted . At a subsequent visit , it transpires that fainting episodes had occurred at other , previous visits but were not documented in the clinical records . During analysis , it transpired that the dentist was always running late with appointments , as the clinic was overbooked and usually under a lot of pressure .
Is it possible to reduce the prevalence of errors caused by stress and fatigue ?
The main factor in the etiology of error is time pressure , and this is best addressed with better time management .¹ There are some simple things that a clinical team can do to minimize stress , after identifying the cause . If during clinic time there are frequent interruptions , e . g ., with people walking in and out of the operatory , such interruption should be stopped . If the clinic is constantly running late , then using self reflection to identify what is going on and addressing the reasons will help to change things and when treating patients treatment plans should be kept simple and manageable to reduce risks . This should be done ideally individually but also as a team supporting each other .
Clinicians often worry more about others than themselves . Unless we can raise our
Some of the representatives of the National Advisory Board for Human Factors in Dentistry . From left to right : Peter Dyer , Cemal Ucer , Ulpee Darbar , Fiona Ellwood , Len D ’ Cruz , Simon Wright , Priya Chohan , Hannah Pugh , Shareena IIlyas .
own awareness of the challenges and acknowledge the value of “ me time ” in keeping the balance , it can become an upward climb with no end in sight . And this may lead to a higher chance of mishaps occurring with a negative consequence on our wellbeing . Being open about these challenges is also invaluable in not feeling alone , especially as clinicians work in dental surgeries that are self-contained spaces . Asking for help early is critical to avoid risk . Taking these simple steps will help change mindsets and manage our mental resources , which are key parts of patient safety .
What other mindset changes are essential ?
Focusing on the individual who caused an error promotes a “ blame culture ” and overlooks the reason the error occurred in the first place . Thus , we need to change our mindset to consider a system-centered approach that acknowledges all humans will make errors and that the underpinning systems and environments they work in should be designed to prevent such errors .
Donald Berwick said , “ We must accept human error as inevitable and design around that fact .” It is OK to make a mistake , but it is important to talk about it and learn from it as well as others learning from it . Changing mindsets is not easy at the best of times ; however , if done in a proactive and non-threatening way , where retribution is not the reward , we may get to the point of encouraging openness and acknowledgement .
In today ’ s healthcare system , a “ we can do no wrong ” approach is detrimental not only to patient care but also to ourselves , as evidenced by growing litigation . Unfortunately , evidence shows that certain personality types , such as the macho , impulsive , anti-authoritarian ,
“ A ‘ we can do no wrong ’ approach is detrimental not only to patient care but also to ourselves .”
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