I’m writing this post now at the very beginning of my Internal Medicine PGY-2 year. At the start of my PGY-1 year we had a lecture about patient safety built into our orientation week. I figured it was going to be more of the same that I had heard all throughout medical school and studied for board questions- “See something say something”, “how to escalate problems”, and the like. Instead I was taken by surprise. The overriding theme of the lecture was that we are all going to make mistakes, that nobody was perfect from intern to attending, and that this is unavoidable and ok. It stressed not to throw blame around. Instead that every mistake is an opportunity to evaluate the system we work in.
This peaked my interest and I signed right up for our hospital’s patient safety/QI committee. In this past year I’ve been able to have a small glimpse behind the curtain of hospital policy and now see how extraordinarily difficult and complex every hospital-based decision is as well. Even more so I can appreciate how challenging hospital changes are to implement. Because every rule is so hard to examine and even harder to change, when a mistake is made it is far easier to blame the provider outright – “Well if they would’ve done their job better this wouldn’t have happened.” Maybe this is true in some cases, but blame gets us nowhere as a society and as a profession. If systems are in place that allow these mistakes to occur they will continue to occur over and over again until somebody decides to do the hard work and look deeper for the root cause.
This brings me to why I wanted to attend the AELPS conference. I want to deepen my understanding of patient safety and bring what I learn here back to my colleagues and my hospital. I want to get more of my peers interested about the world of patient safety. It’s vast, complex, and something I never through about before joining my hospital’s committee. After one year I’ve still only seen such a small piece of it, but I believe that I can help foster enthusiasm towards this topic amongst my peers. And with a bigger group of motivated providers we can truly make a change to our patient’s care.