Background and Importance of Study
Surgery is a form of practice in the medical field, to put it crudely, it is the act of manually taking out the problem within a patient’s body. As with any other delicate practice within any profession, surgery is not immune to mistakes made by its practitioners. In the best case scenario, the malpractice is easily fixed, in the worst; it can lead to problems in the future of the patient’s life or even death.
Malpractice in the field of surgery is also as old as the practice itself with surgery dating back to the prehistoric period with amputations being one of the oldest techniques alongside bleeding a patient to ‘cleanse’ the blood of impurities. Another form of malpractice in surgery is what is called ‘wrong-site surgery’ wherein the wrong area of the body is treated or the wrong procedure is used .
Problems, issues and concerns
Wrong-site surgery (WSS) is a serious form of malpractice as it can and has led to serious complications in a patient, even worse; this is not a problem that has been or could easily be fixed. In a news report filed with Medscape Medical News in 2011, it was found that wrong-site surgery cases in America happens at least 40 times a week despite programs and effort being placed into finding a solution to the given problem .
WSS is not just a problem which affects the health of the patient however; it is also a problem to the credibility and morale of the surgical team. WSS also leads to problems in other surgical specialties as well and even financial damage to the health institute in which the WSS occurred. While the cases of wrong-site surgery is not high in general and especially when compared to the number of cases where insurance claims were made due to other surgical malpractices, Wrong-site surgery is still a problem as it is one that can be avoided if a few simple things are done right. This is the very reason why, not only are cases of wrong-site surgery well documented thorough the years, WSS is a big concern, because the solutions for it are very easy to apply and yet WSS still happens .
The fact that it still happens despite the ease that it could be avoided is another concern as it begs the question: who is to blame for yet another “this should never happen again” incident? This question in turn raises yet a few more questions as to what is the biggest problem in wrong-site surgery. As stated above, problems with wrong site surgery are numerous in nature and all of them serious, but this paper will focus on the leadership level of the problem.
Thus, the main question of this research paper can be broken down into: What are the preventable problems faced by leaders of a surgical team which leads to wrong-site surgery and what are the solutions (if any) to these problems.
Prevention is always better than a cure, as the saying goes. This saying holds to the idea that stopping the problem from even developing is better than creating contingencies to deal with the problem once it arises. Unfortunately, this is also only applicable to problems that can be controlled by humanity and as with the studies into wrong-site surgery have shown, WSS is a preventable problem. Thus the solution is prevention itself and there have been more than one published study into what prevention solutions are applicable in WSS.
An example of this can be found in a journal published back in 2013. It was found that in the US Medical Liability database that surgical errors between the years of 2002 and 2008, 107 of these where WSS, in one died, 38 led to more serious cases and harm. In all of these cases, it was found that they all began from a series of simple mistakes and accidents categorized into poor communication, misdiagnosis and failure in the implementation of final pre-operation checks .
In the end, the easiest and fastest solution that was given for the problem was the implementation of the World Health Organization’s Surgical Safety Checklist in the various hospitals studied including those that were based in France and the United Kingdom. Of course, it was also stated in the same study that the effectiveness of the implementation depended on the leaders in the hospital itself.
In the 36th chapter of a book written Mulloy and Hughes back in 2008, it was found that most wrong-site surgeries happen because of the medical team either not following procedures, or the universal protocols to prevent WSS. It was also recommended that to prevent future wrong-site surgeries, team leaders need to double check final preparations and other pre-operational procedures of their team before entering the surgery room. However, the same chapter also stated that there is no solid strategy to prevent future cases of WSS. While the evidence they used was practiced based, it was still found that there is no guarantee that the strategies, or the implementations placed by the hospitals or specific leaders can prevent more cases of WSS from ever happening .
Another example of preventing wrong-site surgery can be found in an article entitled “Dermatologic surgery: Outcome of 6 years of protocol use for preventing wrong site office surgery” back in 2011. It was found that in the 6 years since the implementation of protocols to prevent WSS, there were no cases of WSS in the cancer center that was studied, but there were however, 18 cases of failure to identify the original cancer site .
While a good example of a solution that can be implemented in the leadership level of a medical institution, there are a few limitations to the study, first that it was done in only one center and second is the fact that while no WSS happened (which was the objective of the implementation), other problems were not prevented.
There have been a number of other solutions that were tried, tested and ultimately failed in their relevance to preventing WSS. An example of this is a study published in the Journal of Patient Safety wherein it was found that patient participation in preventing WSS is not an effective solution despite the fact that they got 68.2% compliance from both patients and doctors .
Another criticism is also found in an article published in Nursing back in March of 2008. It was stated by the author that all it really took to prevent wrong-site surgery is doing the job right. What he meant by this is the fact that prevention is the easiest solution and also one that can be done by simply doing what is expected, of both doctors and nurses. These expected things are checking on procedure, double checking on labels, graphs and other apparatus and being ready before surgery .
While this may seem easy to follow (and they are), the author also noted that there are a number of factors that can impede a doctor or a nurse from doing their job right both before, during and after a surgery such as the lack of sleep due to back-to-back surgeries, emergencies and the like. As mentioned in the early part of the criticism section, there is no particular way or universal protocol that can guarantee a 100 percent error-free procedure especially when it comes to a highly sensitive procedure such as medical surgery. In the case of WSS however, doing things like double checking things, and being ready before surgery are some of the evidence-based ways to prevent it. Surgery is a manual procedure and just like in every other manual procedure, there is and will always be a factor of human error.
The role of leadership on WSS
In the case of Rhode Island Hospital, numerous cases of WSS have been recorded. According to the author of a journal article from the Providence Journal, Felice (2009), the recorded WSS cases occurred despite the hospital’s management’s efforts to eliminate such errors which included “statewide adoption of surgical safety procedures” and collaboration with the Rhode Island Joint Commission, a hospital accrediting agency. One particular WSS case of interest was when a reputable surgeon and a patient of a hand medical condition—whose names will not be disclosed, got involved. According to investigations, it appeared that the patient suffered from a bilateral hand condition which required a surgical correction. In the case, the surgeon that performed the operation did operate the correct finger on one side but operated the wrong finger on the other. This was only one of the many reported and documented cases of WSS at Rhode Island Hospital. When the hospital management’s leaders were interviewed about their sentiments on the almost never ending occurrence of WSS, they said that they are doing their best to keep such events from happening and that they are very committed to safety; and that every time something like a WSS occurs, they see to it that every case receives the attention that it deserves and that their commitment to safety just becomes stronger. The hospital leaders also acknowledged that events like this cannot be fully prevented because just like in the cases that happened in the hospital, it was like every form of preventive measure and protocols were already done and yet they still continuously face the same problems.
In general, the responses that the authorities got from the Rhode Island Hospital leaders were fairly reasonable. Additionally, it can be assured that what they were saying about how prepared they were for every surgical procedure to prevent errors are right because there are other organizations aside from the hospital involved to verify their statements. However, they should not stop on improving their commitment to safety. In most cases, the hospital shoulders all the expenses of patients who are victims of WSS and the same is true in Rhode Island Hospital. While this is a good thing, the leaders should still aim for a zero-WSS-case environment, although as what evidence would suggest, this is virtually impossible.
Based on the different collection of cases of WSS reviewed, especially on the case of Rhode Island Hospital, it can be asserted that there are two main causes of WSS. The first would be the gross negligence of the practitioners or professionals involved in the procedure and the second would be the human error. As proven by evidence, there were a lot of things that were done to limit the number of WSS caused by professional negligence or malpractice which eventually converted into significantly less cases of WSS. Unfortunately, the second cause, human error, is not that controllable as compared to the first cause, which is why in the journals that were reviewed, a significant number of WSS cases still occur despite having placed numerous measures against medical and surgical malpractice and negligence. Still, putting such protocols in place would be better than doing nothing. Leaders and policy makers should focus on reducing the instances of medical malpractice and negligence as much as possible so that WSS cases caused by these factors would not add up to the number of WSS cases caused purely by human error.
Justification for decision
In the numerous articles found and in the ones used in this paper, it can be found that there really is no guaranteed way to prevent wrong-site surgery from happening as it is a problem rooted in what is usually called the “human factor” of a problem. The only way to get rid of it would be to take humans out of the equation, something that cannot be done at all. Thus leaders are left with a limited number of options. These include reinforcing already established protocols and guidelines, double checking the “to-do” list before, during and after an operation, and handing down sanctions to people in their team that do not comply with the rules .
In the end it can be concluded that while the problem of wrong-site surgery cannot truly be taken away from the world, there are ways to prevent it from happening or letting the situation exacerbate. These preventive measures can be done with the help of people with positions that give them leadership.
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