Is it just the system?!

All that I have read so far about quality improvement in healthcare focuses on the system. It states that we should ensure that the systems we have in place ensure that errors are minimized and that we provide the highest possible quality of care.

Is it really just the system that we need to look at? What about the human factor. The clinician who makes the diagnosis, the nurses who administer care and the patient who is the recipient of it all. What about feelings, emotions, the thought processes; don’t these impact the quality of care? And are we giving them adequate attention?

This thought was initiated by a book I have been reading – ‘How Doctors Think’ – the author of the book Dr. Groopman insists that most errors are not technical errors but are cognitive errors. He goes on to recount incidents from personal and gathered narratives where physicians have misdiagnosed or erred due to emotional prejudices or cognitive errors.

Although I have not explored the scientific literature that discusses the Physician thought process, it is perfectly reasonable to state that emotions and cognitive processes to play a part in the delivery of healthcare. So those of us working in healthcare improvement need to be aware of how the human factor will affect our improvement initiatives and also devise ways of analysing and minimizing the pitfalls caused by this human factor.

We should critically analyse whatever we read and not take it at face-value. Evidence Based Medicine has become the cornerstone of practice today – but are protocols and checklists our route to perfection in healthcare delivery?. The systems need to be designed to make healthcare error-free, but are we missing something? Healthcare is a complicated industry and there is no one solution to all its ails. Solution-exchange, openness to new ideas, critical appraisal of proposed theories and even challenging established theories are absolutely necessary for ensuring continual improvement in healthcare.