InformaticsDP1response1 - Laura I wanted to comment on your...

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Laura, I wanted to comment on your mention of hospitals categorizing errors or near misses as a process problem instead of a person problem. As I stated in my original discussion post, I have worked in several large hospital systems. One of these hospitals was very focused on holding an individual solely accountable for any errors made, rather than taking a look at the bigger picture and current systems in place. This punitive nature inevitably led, not to fewer mistakes, but fewermistakes being reported. Fewer mistakes being reported leads to a lack of awareness and this “exists because the vast majority of errors are not reported, and errors are not reported because personnel fear they will be punished” (Wakefield, 2008, p.1).At another hospital, very specific policies and procedures were in place not only to reportan error, but to investigate why the error occurred and what could be done system wide so that

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