While sitting around the station table, a lot of stories are shared, often focusing on the “cool” calls we ran and what the neighboring agency is doing wrong. We rarely talk about our own mistakes but are quick to discuss the mistakes other people have made.
In today’s prehospital environment, we are often the only medical provider on scene, working in high stress situations on little sleep, which is the perfect condition for mistakes to be made. Making a mistake as a prehospital provider is bound to happen which, in most instances, is not the end of your career, despite what you may think. We must be able to learn from our mistakes and overcome them – a task that not only falls on us as providers but also on our leadership team.
When a mistake is made, it’s important that providers feel safe to be honest about the mistake – with ourselves, the patient and the patient’s family, as well as hospital staff and agency leadership. Whether we notice the mistake or it is pointed out to us, it’s critical that we report it. Reporting our own mistakes shows a willingness to learn and improve. It allows for the opportunity to share our thought process with the leadership team and how the mistake was made.
After reporting a mistake, take a moment to reflect on it. Ask yourself three questions:
- “Why/how was the mistake made?”
- “Is there something I don’t understand and need additional education/training on?”
- “How can I prevent this mistake in the future?”
After reflection, be sure to learn from your mistake. If you feel that the error was made due to a lack of sleep, consider cutting back on your shifts or changing your lifestyle habits. If you can chock the mistake up to an educational gap, seek additional training on the topic. By finding the root cause of our own errors and addressing them, we can showcase our integrity and self-respect to management and our peers.
How leaders should handle mistakes made by providers
As a leader, when you become aware of a mistake, take a moment to fully understand the situation before reacting, as your response could affect your agency’s culture and morale for weeks, months or even years. Remember, every interaction you have with your employees is being judged. When a mistake is brought to your attention, how you handle it will set the tone for the foreseeable future with your crews and will greatly impact how providers interact with you.
When a provider comes to you with a mistake, try to put yourself in their shoes. After listening to the provider, ask yourself three questions:
- “Was it a malicious act?”
- “Was it a system error?”
- “What was the patient outcome?”
Most of the time, the incident was not malicious in nature. Provider mistakes typically fall into three categories: a system error; a human error; or a combination of the two.
A system error is an error that took place due to general orders, daily operations or a hole in a protocol. An example of a system error is a provider doing a weight-based medication and administering more than the maximum dose, but the maximum dose is not listed in the protocol for the medication.
A human error is an error that took place due to the provider overlooking something or not knowing something. An example would be a provider misinterpreting fine v-fib as artifact on your monitor.
A combination error might be a provider on mandatory overtime who is on hour 40 of his 48-hour shift and who, while caring for a patient, fell asleep during transport and failed to address a change in vital signs.
Eliminating leader bias
Leaders are often removed from day-to-day operations. While most leaders likely worked the streets in the past, it may have been years since they were once in their employees’ roles.
For a broader perspective on the incident, consider presenting the case to a panel of employees made up of a mix of leaders, providers and physicians from your system. These types of group discussions can help eliminate bias and elicit the professional opinions of others in the field. To further remove bias from the conversation, you can present the case to the panel without the provider’s name.
Creating an after-error action plan
Once a cause or explanation for a mistake has been determined, then you can determine what action needs to take place. Obviously, there are some errors that could result in termination or the loss of certification. However, if the error is not malicious and does not require that level of discipline, a plan is needed to prevent it from happening in the future, as well as how to support the offending provider going forward.
Treating system errors
Any system errors need to be addressed immediately; if not, you are setting your organization up for future errors. Usually, system errors can be fixed by a change in protocol.
Treating provider errors
When an error is determined to be due to a provider error, leaders should focus on these six areas when discussing remediation:
- Create a remediation plan. If a mistake is due to a provider error and not a protocol gap, leaders should create an action plan that encourages employee growth and improvement.
- Focus on growth-oriented assignments. When creating a remediation process for an employee, it may be tempting to assign busy work – tasks that do not pertain to the mistake that took place. Instead, leaders should assign tasks pertaining to the error that took place. For example, if a provider misidentified a cardiac rhythm, their post-error training assignments should include education related to better identifying cardiac rhythms.
- Include the provider in the remediation process. The remediation process should include both the leadership team and the employee to ensure the plan is personalized for the provider’s growth and improvement. Assigning work that does not align with a provider’s goals or learning style is not setting them up for success. Any remediation plan should include clearly defined goals and expectations that are agreed upon by all parties.
- Foster a learning environment post-mistake. Following an error, consider whether to allow a provider to continue working in their role during the remediation process. Remember, we want the remediation plan to serve as a growth multiplier – not a form of punishment. If we identify an error as being a mistake, we need to foster a learning environment, not a punishing environment. Docking pay or demoting providers over a simple mistake is punishing them for being human, which will not only demoralize the provider in question – it will be viewed by others as a reason not to self-report.
- Help providers to move past the mistake. Many providers are type-A personalities, which means they pride themselves on being high-achieving, near-flawless employees. A mistake can cause providers to question their self-worth as they replay the call in their head. They may question their response to previous calls or even consider leaving the profession. As leaders, we need to genuinely ask providers “what can we do to help you overcome this mistake?” Giving providers the opportunity to express how a mistake has impacted their ability to perform in the role will give you insight into their thought process and how you can best help them.
- Offer mental health supports. Following a mistake, many providers may want to speak with someone who is not in a leadership role. If your organization has a peer support team or an assigned chaplain/therapist, you can encourage those in charge to reach out to the provider.
To err is human, and providers are human
Even in EMS, mistakes are bound to happen, but it’s how an organization navigates an error at both the leadership and provider level that dictates the future of the industry. As a profession, we should encourage a working environment where we are safe to share our mistakes and learn from them, using those lessons to fuel our growth. This type of learning environment is created by honest providers and caring leaders who strive to see everyone succeed.
