27
Volume1 Issue4
|
I
ssues and
P
eople
H
ighReliabilityOrganizations (HROs) operate inchallenging
environmentswhere theconsequencesof errors arehigh
but theprobabilityofmakinganerror is extremely low.
Everyday, theseorganizations encounter situationswith
considerablepotential for adverseoutcomesbut theygen-
erallyprovidepositive results andcommit relatively fewerrors.
1
Airlines
andmedical care systems areexamplesof complexorganizations in
which theconsequencesof errors arehigh. In theUnitedStates,
45,000–98,000Americansdieannually frompreventablemedical
errors
2
while inCanadaup to23,750preventabledeathsper year have
been linked toadverseevents.
3
Accordingly,medical caredelivery
systems inNorthAmericamaynot qualifyasHROs.
Inmedical caredelivery, errorsmadebyhighly trainedprofessionals
are frequentlyattributed to system failures; errors are lessoften
associatedwithunacceptableperformancesby individuals.
4
In
dentistry, therehasbeen limitedanalysisof treatment errors and
adverseoutcomes;weareessentiallya “data-free zone.” Inone
analysis,
5
dentistswere responsible for 18%of reportederrorson the
wrongbodypart and41%of reportederrorsdue towrongprocedure/
wrong treatment. Further, dentists ranked secondamongagroupof
healthcareprofessionals incommittingerrors relating to identification
ofwrongbodypart orwrongprocedure/wrong treatment.
Oneapproach for estimating the incidenceof adverseoutcomes in
dentistry is toconsider legal actions confrontingdentists. For example,
inOntariobetween2001and2010, filesopenedby theProfessional
LiabilityProgramof theRoyal CollegeofDental SurgeonsofOntario
(RCDSO) roseby75% (from875 to1528casesper year).
6,7
This increase
maybeexplainedbyoperator limitations, unrealisticexpectations
of patients, procedural risks and simply the increasednumbersof
practisingdentists. Inviewof thesefindings and recent analysesof
adverseoutcomes inmedical caredelivery, dentists shouldproactively
investigateadverseoutcomes and their prevention. Ashealthcare
professionalswhoperform treatmentswith inherent risk, oneof the
most important dutiesof dentists is tooptimizepatient safety. In
this contextwecan learn from themedical profession,whichhas
consultedextensivelywith theairline industry to improvepatient
safety.
8
Lessons from the airline industry
There is increasing interest in functional similaritiesbetween the
aviationflight deckand themedical operating room.
9-11
In theair
or inanoperating room, the lives andwelfareof humans are the
responsibilityof theair crewor theoperating room team, respectively.
In thecontext of dental practice,wenote that bothairlinepilots and
dentistsperformcomplexprocedures that requireexpertiseand team
participation.
Acknowledgement:
Dr.McCulloch is
supported by the
CanadaResearchChair
Program (Tier 1).
The views expressed
are those of the authors
and do not necessarily
reflect the opinions
or official policies of
the CanadianDental
Association.
This article has been
peer reviewed.
RichardD.Speers
DDS
Dr. Speers is in
private practice in
Toronto,Ontario.
ChristopherA.
McCulloch
DDS,PhD,FRCD(C)
Dr.McCulloch is a
CanadaResearch
Chair inMatrix
Dynamics, faculty of
dentistry,University
ofToronto,Toronto,
Ontario.
