by Kathleen Bartholomew
A manager walks onto the unit and observes the secretary texting, a nurse on Facebook and a resident on his Droid checking skiing conditions. What's the most unlikely part of the above situation? The manager walking onto the unit.
As I travel across the country, one thing is eminently clear: Managers are noticeably absent from the front line. It happened very slowly over a long period of time; their workload increased and changed, demanding that they spend more time in meetings and their offices. Staff complain frequently that "I haven't even seen my manager for two weeks--and I work day shift!" While most hospitals have a policy regarding the use of technology for personal reasons during work, very, very few actually enforce that rule.
If it's not enforced, then it's not a rule. It's the norm.
A recent email blast from Plexus Institute entitled "Do Electronic Devices in Health Care Present New Risks for Patient Safety" resonated with me on a very deep level, confirming suspicions gathered from informal conversations across the country. Fifty-five percent of perfusion technicians admitted having cell phone conversations while monitoring machines--and half had texted during surgery. Then a New York Times story by Matt Richtel highlighted a malpractice case in which a neurosurgeon made more than 10 personal calls during surgery to family members and business associates. The problem is bigger than healthcare leaders realize for several reasons.
Acute changes ping our radar, while gradual changes are more insidious. The great danger lies in the fact that human beings simply don't notice small and incremental changes (Human Adaptability Theory). For example, I was called down to California to teach high reliability skills after the anesthesiologist accidentally drew up 10 cc's of Epinephrine instead of Toradol. The 18-year-old patient's heart stopped due to the medication error.
I guarantee you that the norm of bringing a phone into surgery started when some healthcare employee had an emergency (like a very sick child) and put their phone in their pocket on vibrate ... (and no one was harmed); then another member of the team was waiting for a real estate deal on his new house ... (and no one was harmed) ... so they all started bringing them in until one day ... years later ... an 18-year-old in for a simple knee surgery nearly dies. Little mini-Challenger explosions...
We lost the Challenger because in two successive launches NASA was able to forget its own rules regarding the lowest safe launch temperature and convinced itself that prior success with deviation insured future success with deviation--a single solitary voice saying "Don't do this" was overridden. After all, no one died when they bent the rule a little the last time.
Personal use of IT tools during operations and work time is now rampant because of a lack of awareness of the problem, a lack of leadership and normalization of deviancy. A new norm that holds human beings can multitask while driving, operating or performing nursing functions now exists despite the fact that research consistently validates the opposite. What can you do?
- Make a decision. It's only a rule if it's enforced. Ask for your leaders to give examples of how they handled these situations in public meetings. Are cell phones being used in your operating room? If so, you are asking for a ruinous verdict.
- Determine the scope or prevalence with real data. Use Survey Monkey to craft a brief questionnaire asking staff to anonymously report how frequently they see co-workers texting, checking Facebook, making calls or using Blackberries/Droids for personal reasons.
- Ensure that managers have a sufficient amount of presence on the unit to actually enforce the rule. Ask them if they have the time--objectively assess their workload.
- Show support. Managers will not act unless human resources has their back and they have the skills necessary to hold workers accountable. Ever try asking a neurosurgeon to stop talking on his or her cell phone in the operating room? It's not pretty. But if staff know you have their backs, then you'll at least have a better chance than the Challenger crew.
Kathleen Bartholomew, RN, MN ( www.kathleenbartholomew.com) is an author, international speaker and national expert on healthcare culture.
by Kathleen Bartholomew
As I travel across the country, one thing is eminently clear: Managers are noticeably absent from the front line. It happened very slowly over a long period of time; their workload increased and changed, demanding that they spend more time in meetings and their offices. Staff complain frequently that "I haven't even seen my manager for two weeks--and I work day shift!" While most hospitals have a policy regarding the use of technology for personal reasons during work, very, very few actually enforce that rule.
If it's not enforced, then it's not a rule. It's the norm.
A recent email blast from Plexus Institute entitled "Do Electronic Devices in Health Care Present New Risks for Patient Safety" resonated with me on a very deep level, confirming suspicions gathered from informal conversations across the country. Fifty-five percent of perfusion technicians admitted having cell phone conversations while monitoring machines--and half had texted during surgery. Then a New York Times story by Matt Richtel highlighted a malpractice case in which a neurosurgeon made more than 10 personal calls during surgery to family members and business associates. The problem is bigger than healthcare leaders realize for several reasons.
Acute changes ping our radar, while gradual changes are more insidious. The great danger lies in the fact that human beings simply don't notice small and incremental changes (Human Adaptability Theory). For example, I was called down to California to teach high reliability skills after the anesthesiologist accidentally drew up 10 cc's of Epinephrine instead of Toradol. The 18-year-old patient's heart stopped due to the medication error.
I guarantee you that the norm of bringing a phone into surgery started when some healthcare employee had an emergency (like a very sick child) and put their phone in their pocket on vibrate ... (and no one was harmed); then another member of the team was waiting for a real estate deal on his new house ... (and no one was harmed) ... so they all started bringing them in until one day ... years later ... an 18-year-old in for a simple knee surgery nearly dies. Little mini-Challenger explosions...
We lost the Challenger because in two successive launches NASA was able to forget its own rules regarding the lowest safe launch temperature and convinced itself that prior success with deviation insured future success with deviation--a single solitary voice saying "Don't do this" was overridden. After all, no one died when they bent the rule a little the last time.
Personal use of IT tools during operations and work time is now rampant because of a lack of awareness of the problem, a lack of leadership and normalization of deviancy. A new norm that holds human beings can multitask while driving, operating or performing nursing functions now exists despite the fact that research consistently validates the opposite. What can you do?
Kathleen Bartholomew, RN, MN ( www.kathleenbartholomew.com) is an author, international speaker and national expert on healthcare culture.