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Supervision often a weak link in error prevention

From the November 14, 2001 issue

Current interventions to improve patient safety have emphasized a systems perspective when analyzing mishaps and reengineering the medication use system. Some of the more popular system-based interventions include improving facility design and workflow, using technology and robotics, adding forcing functions to procedures and equipment, and improving product labels. In spite of such efforts, research shows that unsafe practices continue to exist even where traditional human engineering principles are dominant.

Furthermore, healthcare professionals don't report errors or near misses at a rate that would be optimal for learning more about their causes. Many work environments are punitive, leading people to worry about making a mistake and having a mishap held against them. Paradoxically, these concerns increase anxiety on the job and the chances of error. Such outcomes have been observed among physician, nurse, and pharmacist healthcare teams in hospital environments as well as in community pharmacies.1 Problems in interpersonal relationships on the job are largely unexplored factors related to these issues.

A common denominator in building better team relationships and effective performance is quality supervision. Supervision is not only about feedback, or overseeing work that is in process or completed. The interpersonal processes by which such practices are carried out also are important. What creates some of the anxiety, stress, and mental distractions associated with error and job dissatisfaction are relatively negative and autocratic supervisory practices. Research shows that professionals who rated their supervisors lower on supervisory and interpersonal skills made more mistakes, intercepted fewer errors, and were significantly less satisfied with their jobs and less productive. Supervisors perceived as effective had better supervisory and people skills and encouraged excellence as well as appropriate independence on the job.

People are not born with great interpersonal and supervisory skills, but they can be trained to supervise appropriately and interact more effectively with their staff. Unfortunately, such training is not pervasive and inexperience in how to work with people often leads to problems. For example, in the absence of training and knowledge, people with supervisory responsibilities usually default to "control modes" of managing others rather than "working with modes" of interacting. In industries outside of medicine, training for supervisory and interpersonal skills has resulted in reduced safety problems and increased job satisfaction and productivity. Shouldn't we follow suit?

Reference 1: Edmundson AC. Learning about mistakes is easier said than done. J Applied Behav Sci. 1996; 32: 5-28. Also Contact Tony Grasha for reference to additional research in this area.

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