Tuesday, March 15, 2011

Safety is in the eye of the beholder

As I was leaving Royal University Hospital on the weekend, I was about to cross the road to get to the parking lot when this -

- crossed in front of me. The driver had meticulously scraped the ice from her side of the windshield, but was relying on the defroster to clear the passenger side. It hadn't quite done the trick. In order to see better, she was hunched forward over the steering wheel, peering through the patch of clear glass.

As she approached, I stopped on the path and let her go by, convinced that she wouldn't see me crossing from her blind side.

I'm sure she thought she was being safe. After all, who gets in a car thinking that they're going to cause an accident? And, maybe she was driving safely. Maybe her view was actually unobstructed. It just didn't look that way to me, and so I started to extrapolate about her overall personality and behaviour based on my perception. It wasn't a flattering assessment.

This morning in my cystoscopy clinic, one of my patients commented on this:

It's a temporary support post in the middle of the room. You can see them in several locations in that department. I say temporary, but it's been there for at least a year.

The man asked what was going on and commented that it didn't look very safe. Without a pause, both the nurse and I reassured him that everything was fine and that there was some work going on. But truthfully, we don't know that. We don't know what the underlying problem is or whether it is being fixed. We also don't have any way to judge how safe this solution is. We just trust the engineers who placed them.

Regardless of what the actual safety situation is, my patient had reason to question what was going on. He had formed a perception of how our hospital approached safety issues. Maybe he wondered if there were any other practices for which we were using jury-rigged safety procedures. Did this affect his confidence in us?

In both situations, the observers formed an opinion based on appearances. While the opinion may have been incorrect, it left a powerful impression.

The safety solutions we saw were both obviously makeshift and not sustainable. Particularly in the case of the partially-blinded driver, pedestrians' well-being relied on her maintaining an uncomfortable position to see through her partially-scraped window. In her haste to start driving, she had convinced herself that she could forgo the usual window-scraping routine because she would be extra careful on her drive to work.

When we break established routine (whether out of necessity or convenience) and instead rely on spur-of-the-moment hypervigilance (AKA "winging it"), patient safety is at risk. Even if everything goes well, consider the impression have we left on our patients who, most likely, have nodded compliantly but remained inwardly skeptical upon hearing our unconvincing reassurances.

** Update (March 24, 2011) Hmmm.  Today, I notice that the support post (see above picture) has been removed from the cysto suite.  Are the structural problems fixed?  What was the problem in the first place?


  1. Very interesting. Can I use this for internal training for our staff? my email is jignesh.padia@saskcancer.ca

    Manmy Thanks,

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