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■ Significant uncertainty errors are situation is the harm and suffering

made in areas of medicine where caused by the action of individuals


no objective rules or standards are whose sole purpose is to relieve
available. This leads physicians to suffering and in whom the victim
rely on their training and places a profound and personal
experiences or on literature that trust—doctors and nurses.… [T]his
supports their particular protocol or very personal sense of affront and
treatment plan. Physicians who betrayal that accounts for the intense
review untoward outcomes of such emotion surrounding medical injury,
errors are hesitant to be critical particularly when caused by error.”
because of the lack of standards. The cultures of physicians and
nurses emphasize precision, high
Physicians may place greater standards of performance, and a
weight on adherence to normative or strong sense of personal responsibility
ethical behavior than on technical and (Jones 2002). Fundamentally, health
judgmental actions. Their rationale professionals do not take kindly to
seems to be that moral rectitude and error, except with respect to its
conforming to professional standards educational value in the training
are easier to judge than the environment. Therefore, encouraging
mechanics of medical practice. The both an open dialog about error and
medical profession needs to balance an approach that emphasizes the
its excessive focus on individual systems nature of most adverse
control with a greater sense of outcomes is not a simple task.
corporate responsibility (Bosk 1981). Healthcare leaders must commit to
the task of reducing medical error by
How Health Professionals Deal setting it as an organizational priority,
with Error but such an effort is insufficient
Healthcare leaders must understand unless it becomes part of the
the manner in which health organizational fabric.
professionals view and deal with According to Max DePree (1989),
error. As Leape (2001) stated, “While leaders must “liberate” people to do
many other human enterprises, such the right thing, utilizing their own
as aviation, building, and military skills and talents. In this view, every
operations, are associated with member of an organization has an
substantial hazard, in no other opportunity to show leadership.

18 | LEADING A PATIENT- SAFE ORGANIZATION

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