By Stephen W. Earnhart, MS

CEO, Earnhart & Associates

Austin, TX

I have always been fearful of making a big mistake, especially if it could cause harm or injury to others. I’ve had nightmares about it. As a nurse, a CRNA, and a consultant, my fear is probably not pathologically paranoia, but a true understanding of risk.

Safety must be a priority. In my world, I look for three things to be successful in the OR environment, and it does not make any difference if you are hospital-based, in an ambulatory surgery center, or surgeon’s office. They are:

  1. Is this a safe physical environment for my patients and staff?
  2. Will we provide a positive experience for patients and staff?
  3. Is it profitable? (Safety is not cheap.)

Increasingly, The Joint Commission, the Accreditation Association for Ambulatory Healthcare (AAAHC), and American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) are focusing on patient safety and outcomes, with good reason. Our goal is the betterment of our patients and not adding burden by mistakes or oversight.

What can you do today to protect yourself and your patients while at the same time avoid the nastiness of liability if you don’t? Consider the following suggestions:

1. Use common sense.

If it doesn’t seem or feel right, go with your gut and question it. If you are working in the surgical environment, you have that sixth sense about what is right or wrong, good or bad — use it. We engage in timeouts to force us to look at the basics before we proceed with the case. You need to extend that to the entire patient experience.

For example, a staff member is wheeling the patient back into the recovery area, and you notice the patient’s arm has slipped, is hanging off the stretcher, and the door is closing. Common sense tells you that the arm could get hung in the door and cause injury. Another example: The IV line is snagged on the IV pole that is about to be removed as the patient is transferred. Stop moving, reach out, and free it.

2. Read your policies and procedures.

This is unquestionably boring. Although I write hundreds of them and hate each one, they are there for a reason. As a staffer, you need to have read them and understand them. It’s part of your job and continued employment. When was the last time you read them?

As I have discovered over the years, not all staff members understand that P&Ps change and are updated constantly. Ask to see the table of contents, if nothing else, and see if you missed something from the last time you reviewed them.

3. Question things that you don’t understand or don’t seem to make sense.

Don’t be obnoxious and make people roll their eyes every time you open your mouth, but as a member of the staff it is your job to make sure what you are doing is correct. Again, if it doesn’t feel right, it probably isn’t.

4. Speak up at staff meetings.

In my world, silence at a meeting means acceptance. If you don’t understand the item under discussion, speak up and say you don’t understand. Too many decisions are made without complete understanding of the implications. If you don’t understand it, others do not, either.

5. See patients as family members or friends.

Try to picture your patients as family members, close friends, or someone you interact with. It often is easier to empathize with them and show compassion as well as improve your job skills.

6. Quit your job.

If you don’t like your job anymore and are just going through the motions, then quit. There is apathy in every workplace. Re-dedicate yourself to your career, or move on before you burn out.

All our jobs require constant awareness and vigilance. If you can be honest with yourself and admit you have lost your edge, then you need to let someone know and get some guidance.

We are fortunate to work in the healthcare industry. It is a much sought-after place to work. Let’s all make it a safer one.

(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be reached at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX, 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: