The process is the problem, not the people: 6 steps to address a broken system

When errors occur, broken or absent processes are to blame — not employees.

That's the point made in a recent post by William Choctaw, MD, JD, a physician advisor for The Joint Commission Center for Transforming Healthcare.

To avoid mistakes, he said, healthcare leaders should follow these six steps to identify and evaluate a broken process:

1. Do not fire the employee. They have valuable information about the event that occurred, and firing someone will lose the trust of other staff members.

2. Withhold judgment.

3. Define the process, whether a policy exists and what the circumstances were.

4. Determine exactly which defect in the process caused the problem.

5. To send a positive message, engage employees who made error in the solution process.

6. Implement a monitoring system to continuously evaluate the improved process.

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