The school organized 'Storytime Saturday' for the children in junior kindergarten. Parents would need to accompany their wards and together experience a story telling session. So last saturday I took my younger daughter Noora to listen to the story about the toad princess. At the end of the story, there was a lively discussion on the benefits of bedtime story reading. The teachers led the session and much was said about how it can improve parent-child bonding, imparting of good values, improvising language and lots more. I was so impressed with the school's initiative and thought that we should do this more frequently at home. That Saturday after a long day of shopping, we reached home tired and wanting to jump into bed as soon as possible. With the inspiring morning session still in my mind, I suggested we should have a story session if the kids were not too tired. What should have happened then was to have me read out a nice story, the kids listening attentively and they would gradually fall asleep. But what happened was nothing of the sort. I asked my elder daughter to get one of the books, sit in her bed and read out the story. My younger daughter and myself made ourselves comfortable on the bed. Within a few minutes I was asleep. Parent-child bonding, language training and everything else went up in dreams. The intent was good, the benefits were clear and environment amenable but it things did not turn out the way they should. A similar combination of circumstances and unintended outcomes occur unfortunately in patient care.
I am reminded of this today as I try to think of the effectiveness of training in clinical organizations The objective of training is always to impart the knowledge and experience of the trainer to the trainee and in clinical environments it mostly involves skills training. It is expected that at the end of training the trainee will eventually be able to duplicate what he or she has learnt and that too in a real environment. It can go wrong and even the most well intentioned trainee may fail to competently execute a newly learned skill. Once we have mastered the skill, we are more confident to undertake the task but we still can go wrong because of several reasons. One could be due to an error in judgment while executing a task. The kind we can make when we try to discern the type and location of pain of a patient reporting at the emergency room. Another reason could simply be the inability to make a decision when overwhelmed with complex circumstances. This is the kind when you are confronted with a young boy brought in with multiple injuries from a car accident. You did everything you could towards the injuries but you pump in the antibiotic that he is allergic to. The patient was accompanied by his father but no one on your team remembered to elicit this important piece of information from him. The second type of error is not due to lack of competence or absence of knowledge. It is simply the result of failing to execute an activity in a careful sequence.
I believe that such errors can be avoided or at least the probability of it happening can be reduced by having standard operating procedures or SOPS as it is commonly referred to. It could even be a defined clinical pathway where in a clearly charted out sequential course of action is meant to be followed. The problem with SOPs (and in this discussion I will include clinical pathways) is not just who should create and issue one but most importantly how it should be written up. I will try to summarize my opinion and I must say that the same rules would apply for SOPs on virtually anything even outside healthcare. In my view, SOPs must be detailed yet not too restrictive and it should leave room for professional judgement wherever possible. But being detailed does not mean intuition is ignored. We do not need to answer the 'does the pant zipper need to be downed before or after' type of questions. Yet we should also remember that SOPs will be used by newly trained or less experienced persons. Hence we should never leave out the essentials, must be clear, lucid and most importantly easily communicable.
Communicability reminds me of an afternoon at the school playground. It was probably in grade 4 or 5 and we all seated ourselves on the ground in a circle. The teacher whispered something in the ears of one of my classmates seated next to her. There were about twenty of us and each one would have to listen carefully and then whisper what he had heard into the next one's ear. The words would travel the circular route and when it reaches the last person he was supposed to reveal to all what he had been told. It turned out be a very amusing experience when an unspeakable something was announced to our curious bunch. It was a good laugh that afternoon in the playground but when I think of it now I realize that it is not an unusual occurrence even in the most sophisticated of technical environments.
No comments:
Post a Comment