Piping In or Checking Out; The Delicate Balance

[paramedicmike]

Fair points from everyone...

[Edit] And Mike, I have no doubt that you are in fact creative enough to do so. I guess the parts of your posts that get under my skin a bit is the static nature of the thinking, at least to the way that I read them. "We can't do that because...." Add, "yet" and I'll have a much easier time leaning over to your side of the fence.

It might be a bit static. But since we're now talking about cultural aspects it kinda' has to be that way. I know you know how culture within the US has become very litigious. We've talked about it here. Much of the things we do both in business and in medicine are driven by an attempt to protect oneself (indivual or commercial) from litigation. This is but one of those protections.

I don't think people are necessarily comfortable with the status quo. I think changing the litiginous nature of society is a much larger task than any body thinks. There is some evidence of the difficulties in the legal attempts of tort reform (just as an example).

Beyond that what kind of cultural changes are you looking for? One of free and open discussion no matter the subject? It'll never fly. Why? Because there are topics, subjects, indcidents and people who just don't want to share their business positive or negative. Despite their social nature, there is a level of privacy most people just won't give up.

If this is really the business model you implemented then I think it's amazing you didn't lose your businesses to lawsuits. A reflection on you? Your management style? Your employees? The process itself? All possibilities. A brilliant stroke of luck? If I believed in luck I'd say this is the most likely answer. As I don't believe in luck I have to look to one, or a combination, of other factors some of which I just mentioned.

Hmmm... seems I need to work a little more on figuring out the new quote /quote system.

[DFIB]

There is another factor that is important. Not every EMS official is objective, fair, or devoid of a personal agenda. If the supervisor has a burr under his saddle and a agenda to promote, public discussions of this nature could be an intimidation tool but they could also offer protection as everyone would see what he/she is doing.

[Curiosity]

If only one person has the problem then there isn't any need for a public educational program to mitigate any future issues. It's one person. Individual counseling should suffice. If more than one person has the problem then there's reason to suspect there's a systemic problem and futher evaluation and education is necessary.

The problem with the system is you will rarely hear of anyone else making the same mistake. Instead of admiting they did the same thing, people learn how to cheat the system and simply not to get caught. Because these meetings are held in private, you're left to speculate about what took place in there. That leads people less inclined to admit they made a mistake and makes them better at covering things up and avoid these private meetings.

You see a co worker walk out of the office crying because he/she documented an error and got spoken to. What insentive do you have to do the right thing next time you mess up? None, because you're scared of the reprimand that's coming. Ive always believed in learning from mistakes. I've said it many times on this forum, we're human, we mess up sometimes, we, induvidually may learn from these mistakes, but again, we're human, we learned not to bring them up for fear of the reprimand. We benefit, but no one else will, and the mistake will keep happening.

If we got over the stigma of mistakes being an embarrassment and instead realize that it's part of the learning process, then we would be more open to publicly discussing them. I have no issues discussing my thought process and how I got to a final decision and have someone correct me and others see where and why I was wrong. I'm not embarrassed about it, I'm glad to have the input of others.

[paramedicmike]

The problem with the system is you will rarely hear of anyone else making the same mistake. Instead of admiting they did the same thing, people learn how to cheat the system and simply not to get caught.

As a personnel issue you don't have the right to hear if someone made a similar mistake... or any mistake for that matter. Unless it's a systemic problem then it's not your problem and none of your business.

The second sentence doesn't jive with the first. It looks like you had two different thoughts in your head and ran them in together.

Because these meetings are held in private, you're left to speculate about what took place in there. That leads people less inclined to admit they made a mistake and makes them better at covering things up and avoid these private meetings.

Why are you speculating about things in which you have no business? Do you typically engage in gossip? Assume the worst? Why is it any of your business what goes on behind closed doors especially if it doesn't involve you?

You're also assuming that people are going to know they made a mistake immediately upon doing so. Do you know of every mistake you've made immediately upon making it? I don't. Sometimes it takes a chart review for a question to be raised. Only then do I realize I've made a mistake.

You see a co worker walk out of the office crying because he/she documented an error and got spoken to.

Seriously? No. Really. Seriously?

What insentive do you have to do the right thing next time you mess up? None, because you're scared of the reprimand that's coming.

If I know I made a mistake there won't be need for any follow up because I'll correct my error, if possible, immediately. Nor will I hide from it.

If I don't know I've made a mistake then finding out is the best thing for me. That way I can learn from my errors and not repeat them.

Are you trying to run with Dwayne's example of the truck driver being terminated for self reporting?

Ive always believed in learning from mistakes. I've said it many times on this forum, we're human, we mess up sometimes, we, induvidually may learn from these mistakes, but again, we're human, we learned not to bring them up for fear of the reprimand. We benefit, but no one else will, and the mistake will keep happening.

Was this ever in dispute?

If we got over the stigma of mistakes being an embarrassment and instead realize that it's part of the learning process, then we would be more open to publicly discussing them. I have no issues discussing my thought process and how I got to a final decision and have someone correct me and others see where and why I was wrong. I'm not embarrassed about it, I'm glad to have the input of others.

Again, you're assuming there is a stigma. If there's any attached then it's you attaching it. If the problem lies with an individual then individual counseling is appropriate for all the reasons that have already been discussed in this thread. If it's a systemic problem then educating everyone without the need to single out any one individual will suffice to address the issue.

[ERDoc]

I think one thing we have to keep in mind is that no one likes to admit their mistakes. I don't think it is so much a machismo thing as it is a punishment thing. Airline pilots are encouraged and protected when they make mistakes. When we make a mistake we are looking at the loss of our license/job/house/etc. We need to create an environment where we do not worry about the life changing consequences when mistakes are made. This should not be mistaken for saying we should allow gross negligence (such as described by the OP), that should not be tolerated.

[Curiosity]

Thanks for the reply Mike. Didn't have to be so mean. Yes, seriously, I've seen my friends walk out of meetings in tears, I know I wouldn't want to be in their position therefor you can guarantee, if I eff something up, I will not be admitting to it to any of my superiors...

They are private meetings...exactly why people speculate about what happened...because we don't know what happened...who the hell are you to say I'm involved in gossiping. I am entitled to my own thoughts about what happened...I never said I talk to others about them...quite the opposit, I despise gossip.

I have my opinions and experiences, and your making fun of them, I though you were better than that. You can guarantee this is my last post about these subject matters.

[paramedicmike]

Thanks for the reply Mike. Didn't have to be so mean. Yes, seriously, I've seen my friends walk out of meetings in tears, I know I wouldn't want to be in their position therefor you can guarantee, if I eff something up, I will not be admitting to it to any of my superiors...

If you thought my response was mean then perhaps some self reflection is in order on your part.

So you're saying because of things your friends/coworkers have experienced, things about which you are saying you only speculate about intead of knowing specifically what's wrong, that you will lie by omission? You're not owning up to your own mistakes, the ones you know you've made, simply because of what happens in other closed door meetings the content of which you know nothing about? Based on that there's the potential here for you to be more dangerous than the medic in the OP.

They are private meetings...exactly why people speculate about what happened...because we don't know what happened...who the hell are you to say I'm involved in gossiping. I am entitled to my own thoughts about what happened...I never said I talk to others about them...quite the opposit, I despise gossip.

So you speculate only to yourself? You don't ask questions of coworkers? Why are you concerned about what happens behind closed doors, anyway? If it was any of your business you'd be in there.

I have my opinions and experiences, and your making fun of them, I though you were better than that. You can guarantee this is my last post about these subject matters.

Please. Someone disagreeing with you is not poking fun at your ideas, thoughts and experiences. Someone countering your points in a discussion is not being mean. It's part of the discussion. If you're taking any of this personally then perhaps some thicker skin in needed. And if disagreeing with you is enough to make you run off from a discussion then I predict your time here will be short lived.

[Just Plain Ruff]

I have made a couple mistakes in the past with patients. None fatal mistakes. The potential is there for all of us to make a potentially fatal mistake.

I once in the heat of the moment gave 5mg morphine to a seizing pregnant patient. Grabbed the wrong syringe(morphine and valium syringes looked identical) I grabbed the wrong one. My partner when he was cleaning up the unit found the syringe and asked me why I gave morphine to the seizure patient instead of valium. I nearly crapped my pants. I immediately informed the doctor taking care of the patient. The patient suffered no ill effects. In fact the doctor called my service expressing thanks for the honesty of crew members with such honesty and relayed that there were no harmful effects to the patient or the baby. I alos reported the error to my supervisor and our risk management. The error was deemed accidental and we changed to different suppliers of morphine and valium where the syringes were different styles because this was not the first error of this kind.

I learned from the error, the discussion was behind closed doors with Risk management and the supervisors. I'm sure there was speculation of those who weren't involved but it was none of their business. But it did get out. I did not run from it, I admitted it freely and did not run from it. It's a mistake, a human mistake and one that anyone oculd have made.

It's human nature to speculate why someone's in the supervisors office. Not any of our business but it's just natural to speculate.

[jsd67]

What is the rank stuff about? I would have simply said that his decision was wrong and explained why. I mean, if it is a matter of life and death then why on earth would someone be afraid to say something?

It is amazing that a job that requires this much responsibility at times takes only 2 months of training, or even less time in some places.

Edited January 26, 2013 by jsd67

[MariB]

It is amazing that a job that requires this much responsibility at times takes only 2 months of training, or even less time in some places.

Many here are Paramedics, which is no where close to 2 months of schooling. An associates takes 2 years.

I am now over halfway through my 9 month EMT classes. We have classes twice a week. 3 to 4 hours a pop, started out once a week. Yes I am sure you can get your EMT in 2 months ( i think its a 150+ hours, not including test days)but many here are AEMTS, paramedics and throw in a couple doctors and nurses, flight nurses etc.

Edited January 26, 2013 by MariB