When productivity trumps safety we all lose.

In human error, Normal Accident Theory, Resiliency, Safety climate on September 30, 2012 at 9:32 am

““You are judged by numbers in the lab,” McShane said. “There is a culture of pressure to get it done with no new ­resources. But there is no ­excuse for [cheating] at the end of the day.” (, 2012)

So goes the story of Annie Dookan, a chemist in a Massachusetts crime lab who is suspected of compromising evidence in many of the 34000 samples she has tested in her 9 year career.  Her motivation seems to be no more nefarious than trying to look like a stellar employee.

What does this have to do with patient safety? It is common in hospitals today to push the border in terms of productivity.  Add some more patients, add new procedures, add no more  staff.  In safety studies this can result in what is known as drift.  You get through one shift with suboptimal staffing and nothing bad happens so you chance it again, then again, and little by little in order to cope: staff develop workarounds and short cuts that all begin to be seen as normal (culture) and less risky as staff has not gotten feedback on any bad results. If staff continue to be judged on output (census, patient turnover, lower expenditures) they will seek to make these their priority rather than follow safe procedures.

According to Cook (2000) work processes do not chose failure but drift toward it as production pressures and change erode the defenses that normally keep failure at a distance. “This drift is the result of systematic, predictable organizational factors at work, not simply erratic individuals.  To understand how failure sometimes happens, one must first understand how success is obtained-people learn and adapt to create safety in a world fraught with gaps, hazards, trade-offs, and multiple goals.”

In safety critical environments that deal with people’s lives, leaders should be preoccupied with failure not productivity. A leader is responsible to identify drifts by being present in daily processes. Drifts can be identified by observing staff behaviors, reviewing peer reports and asking people what types of things they are worried about. Asking staff to “do their best” without a supporting environment will not result in a high performing system. Productivity goals should be made based on an analysis of the work not by how much money is in the budget. I think it’s time as a nation we say in all instances “if there isnt enough money to do things right, don’t do them at all.”

 Annie Dookin made some bad choices but she worked in an environment where bad choices were acceptable and when peers did speak up, nothing was done. Who is responsible for this?

And who is responsible for the incarceration or punnishment of some people who might be innocent who are imprisoned: all because a culture of productivity over-ranked safe procedures. In these circumstances, just as in healthcare, humans always suffer.

Safety first. Productivity second. These cannot just be words and slogans. They have to be guiding principles that are evident in everything we do, in healthcare and in crime labs.  It scares me that this lab was run by……..The Department of Public Health 😦

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