In Human Factors, Patient Safety on February 21, 2011 at 7:06 am

Paul Levy had a great post on his Not Running a Hospital blog (formerly Running a Hospital) about signage. Since this is a topic in the human factors realm, I would like to share his post and relay a story from a friend.

A couple of days ago my friend visited a local Boston community hospital known for its customer service to have a simple KUB (abdominal xray).   She was told to dress in a hospital gown (I will post more about hospital gowns in the future…is having patients all look alike adding or subtracting from safety????) and wait in a waiting area.  After almost 60 minutes, she noticed staff hanging around the desk and talking and laughing.  Drawn to attention by this, she noticed a small sign near the desk that read “if you have to wait more than 15 minutes please let us know.”  She became upset at having spent an extra 45 minutes of her workday because no one had pointed out the sign or the policy.  Clearly this hospital had identified some glitches in its process to post this sign. While we want to involve patients, it should not be their responsibility to monitor their wait time.  Why not just scan your waiting room 4 times an hour and mark who is there on a dry erase board? Employees can have all sorts of visible reminders to do this.  Also notify the patients that your goal is to see them in 15 minutes from their check in time. Most people probably never even see the sign.

With another recent case of a kidney transplant mix-up (luckily causing no harm to the patient) we really have to redefine our hospital processes.  We have to involve the patients but by the time the process ends with them, we need to make sure we have made enough hard stops that an error will never reach them.  Some people will report that if the patient helps to stop the error then the redundancy system works.  And signs probably won’t do much good unless they are reviewed and explained. In most cases signs should be a reminder and a redundant communication, not a primary communication.  An error being stopped at that level should be a VERY rare occurrence.  Also to consider is a study by Davis, Sevdalis & Vincent (2011) which found many patient in the UK reluctant to engage in safety behaviors that became more challenging in nature to a doctor or a nurse.

See previous post on TEAM UP with patients from the DOD

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