Possible, but difficult, revisited

We have been able to operate on the two patients that we delayed last week due to a lack of blood, plus one more Wednesday.  The blood bank went out and had a very successful blood drive in the surrounding villages on Sunday.  There is another patient (17 years old) awaiting surgery who has been acutely ill and requires further evaluation prior to mitral valve surgery.

Many of the readers of this blog (if there are many readers of this blog) know for the last 8 years I have been the director of the Quality Improvement and Patient Safety program in my department at the University of Rochester.  This was challenging and often frustrating, and along the way I learned many lessons and developed an interest in errors and their prevention.  Although when I arrived here, I was relieved to be able to work and “not have to fix everything,” I guess I should not be surprised that I cannot just turn off the constant thinking about how to make things better.  The cardiac center does many things well, especially for a place that has only been open for four years.  Like every place, though, there are opportunities to improve communication, reduce the risk of error, and provide more patient-centered care.  There are many challenges for me in this environment.  These include but are not limited to: an incomplete understanding of the medical-legal environment of Cameroon, an incomplete understanding of the culture as it pertains to working on improvement, significant language barriers at many levels, a different education process for the nurses and staff, and significantly more limited resources than we had at Strong.  Even in the U.S. it is always challenging to identify the resources to implement our ideas for improved safety; here it is even more difficult to improve infrastructure to make care safer.

In the news I saw that Great Britain appears to have taken a step backwards in safety by criminalizing certain failings.  I am hoping that they will be very clear about what behavior is criminal and not include errors in these prosecutions as many places have done.  I have been reading Sydney Dekker's The Field Guide to Understanding Human Error.  It will be interesting to think about how to apply his ideas to medicine in Cameroon.