Conclusions - by the very nature of culture and humanity, humans tend to be group animals -- they thrive in groups, coalesce into groups, indeed, the very process of moving from hunter-gatherer to cities was part of a group behavior. Group norms are internal rulings that are followed by individuals so that the synergistic effect of the group will be more efficient. These values usually focus on the way members of that group look and behavior towards themselves, and the hierarchical structure they tend to set up to "police" their efforts. Norms help groups solve problems, define and address new situations, make better decisions, and even process their daily work. Groups, in this case members of the medical community, join these groups in order to reflect specific notions and values associated with the overall group. Normative behavior in the medical field is covered by a willingness to help, to "do no harm," and to provide the best possible solutions to the set of circumstances given. There is a clear difference in issues in which a patient expires due to inadequate equipment, prior condition, or even no apparent clinical reason if all procedures were followed to the best of the caregiver's ability -- and a case in which because of substance abuse or other incompetencies the wrong medicine is ordered or something surgical is mishandled. Thus, all errors are not malpractice; and all errors are not purposeful or caused by a lack of attention or ineptitude (Kohn, Corrigan and Donaldson, 2000)
Traditionally, in the medical field, errors are attributed to mistakes made by individuals who may be punished for those mistakes. Typically, the approach is to correct the error(s), create a new set of rules and additional checking steps within the system, hopefully preventing area. However, a newer model for improvement, based on the Total Quality Management Programs in business, takes a different approach. In this model, the focus is on identification of the underlying system defects that allow the opportunity for an error to even occur. Then, instead of placing a Band-Aid on a problem that already exists, systems are in place so that errors do not happen in the first place. This approach also takes into consideration the holistic environment of care; the medical personnel, patients, physical environment, and available technology (Dewar, 2010; Peratec, 1995).
While there is no clear solution to the problem of medical error, the systems are simply too complex to guarantee a 0% error margin, we can perhaps move from viewing all medical error as incompetence, and begin to see more of a systematic paradigm of healthcare in which all sides take adequate responsibility for their own tasks, including the patient, and understand that there simply are no guarantees when it comes to complex biological systems. Honest reporting of errors would go a long way to identifying the real nature of the problem, but in such a litigious society, it is difficult to believe that complete transparency in errors is likely. Instead, perhaps the medical field can utilize some of the safety and error prevention techniques from the aviation industry: ensure the patient's informed consent policy is clear and comprehensive; encourage second opinions on many diagnoses; perform regular root cause and TQM tests on procedures; reevaluate systems (computer and human) for synergy; hospital accreditation; and a system in which errors are reported accurately (Error Disclosure, 2009).
Physicians Want to Learn from Medical Mistakes. (2008, January 9). Retrieved November 2010, from Agency for Healthcare Research and Quality: http://www.ahrq.gov/news/press/pr2008/errepsyspr.htm
Error Disclosure. (2009, March). Retrieved from Agency for Healthcare Research and Quality: http://psnet.ahrq.gov/primer.aspx?primerID=2
Improving America's Hosptials. (2010, March). Retrieved November 2010, from the Joint Commission's Annual Report on Quality and Safety: http://www.jointcommission.org/NR/rdonlyres/D60136A2-6A59-4009-A6F3-04E2FF230991/0/2010_Annual_Report.pdf
Dewar, D. (2010). Essentials of Health Economics. Philadelphia, PA: Jones and Bartlett.
Epidemiology of Medical Error. (2000). British Medical Journal, 320(7237), 774-81.
Hayward and Hofer. (2001). Estimating Hosptial Deaths Due to Medical Errors. Journal of the American Medical Association, 286(2), 415-20.
Johnson, S. (2007). Making Up Is Hard to Do. The hastings Center Report, 37(2), 45+.
Kohn, Corrigan and Donaldson. (2000, June). To Err Is Human. Retrieved November 2010, from the National Academies Press: http://www.nap.edu/catalog.php?record_id=9728
Peratec. (1995). Total Quality Management: The Key to Business Improvement. London: Chapman and Hall.
Rathert, Fleigh-Palmer and Palmer. (2006). Minimizing Medical Errors: A Qualitative Analysis of Health Care Providers' Views on Imrproving Safety. Journal of Applied management, 11(2), 44+.