Error Mitigation

Errors happen everyday in the delivery of care. It is important to recognize that errors happen, but can be identified and corrected before they adversely impact patient safety.

Problem Definition

Problem definition begins with the recognition that there is a problem or potential problem. First, this must be accurately defined and all information gathered regarding the exact nature of the problem. Next, possible plans or solutions are identified, formulated and assessed. If there are multiple solutions, pros and cons must be weighed and the optimum path taken. Then an appropriate course of action is selected. If this does not solve the problem an alternate solutions must be formulated and employed.

To be effective in Problem Solving, caregivers should be familiar with the following:

Information gathering techniques:

The first step in devising solutions is the gathering of information to aid in problem definition. This can be done by using inquiry to solicit information from other crewmembers, by referencing published material, or by using resources outside of your immediate area, environment, unit, etc. The team must be aware that their experience, expectations, and motivation will influence their perceptions of the information. The context or setting in which the information is found will also affect how it is perceived.

Problem solving strategies

Once information has been gathered and the problems defined, several solutions may present themselves. The team will need to prioritize them by considering urgency, usefulness, risk and appropriateness. Once a primary action strategy has been formulated and selected, it must then be implemented. The team must solicit feedback through ongoing critique, and if the chosen action is unsuccessful, other avenues must be explored.

Principles of effective planning

Planning in problem solving situations involves the effective use of all available resources. Frequently, time can be a primary controlling factor and must be considered in any solution. Teams should always strive for the best solution available within the constraints under which they may by operating, whether this is time, usefulness, appropriateness, risk, or other factors.

Problem Definition

To be effective in Problem Solving, the team members should be able to:

  • Identify problems
  • Recognize biases and other obstacles to problem definition
  • Verify conclusions and assumptions
  • Recognize sources of cues and their significance

The skills and techniques listed in this description of effective error mitigation are part of Safer Healthcare's Crew Resource Management programming and team training workshops. These skills are integral in the development of high reliability.

Contact Safer Healthcare

We welcome your questions and inquiries about our programs, products and services. Contact Safer Healthcare's team of CRM experts to learn how we can help your organization increase levels of patient safety and improve the quality of safe and reliable care while maximizing profitability.