I learned this the hard way:
“What I did find fascinating in this book, although not directly applicable to my own work, is the way in which a focus on human error becomes a justification for bureaucratic control and therefore a concentration of power in a managerial layer. If the assumption is that medical harm is primarily caused by humans making avoidable mistakes, and therefore the solution is to prevent humans from making mistakes through better training, discipline, or process, this creates organizations that are divided into those who make the rules and those who follow the rules. The long-term result is a practice of medicine in which a small number of experts decide the correct treatment for a given problem, and then all other practitioners are expected to precisely follow that treatment plan to avoid “errors.”
“The American moral and social philosopher Eric Hoffer reportedly said that every great cause begins as a movement, becomes a business, and eventually degenerates into a racket. The reform movement to make healthcare safer is clearly a great cause, but patient safety efforts are increasingly following Hoffer’s path.”
