Supervision Can Be a Weak Link in Error Prevention

To improve patient safety, ISMPemphasizes that a systems-basedapproach must be used toanalyze mishaps in the medication usesystem. Some of the more important system-based interventions to help preventerrors include improving the design andworkflow of practice sites, using technologyand robotics, adding forcing functionsto procedures and equipment, andimproving product labels. Despite theseinterventions, research shows thatunsafe practices continue to exist.

Our attitudes toward work and themanagement styles that surround usmay weaken an organization's error preventionefforts. Many work environmentsare punitive, leading practitionersto feel that they cannot make a mistake,and, if they do, it will be held againstthem. Paradoxically, these concerns canactually increase anxiety on the job andincrease the chances of error. This hasbeen observed among physicians, nurses,and pharmacists in both hospitalenvironments, as well as in communitypharmacies.¹

A common denominator in overcomingthe "I can't make a mistake" philosophyis building better team relationshipsand effective supervision. Supervision isnot only about providing feedback oroverseeing work that is in process orcompleted. Real supervision includes anexamination of the interpersonal processesby which such practices are carriedout. Research shows that pharmacistswho were most satisfied with theirjobs and who were involved in fewererrors had supervisors who fosteredappropriate autonomy and were perceivedas democratic, facilitative, andhelpful in setting goals. The supervisorswere perceived as effective becausethey demonstrated better leadership andinterpersonal skills and encouragedexcellence as well as appropriate independenceon the job.

On the other hand, professionals whorated their supervisors lower on leadershipand interpersonal skills or who perceivedthem as overly autocratic andpunitive, made more mistakes and interceptedfewer errors. In the absence oftraining and knowledge, people withsupervisory responsibilities usually defaultto management styles that are more controllingrather than interactive. A focus onnegative outcomes and the use of autocraticsupervisory practices creates someof the anxiety, stress, and mental distractionsassociated with error and job dissatisfaction.See the Table² for a list of characteristics(identified by pharmacists) ofeffective supervisors.

Although people are not necessarilyborn with great interpersonal and leadershipskills, they can learn to superviseappropriately and interact more effectivelywith their staff. Unfortunately, suchtraining is not pervasive in health care,and inexperience in how to work withand supervise others often leads toproblems. To promote effective supervisionand error prevention at your site,supervisors should be provided withleadership training that focuses on managingin a positive and participatorymanner. In addition, all employeesshould be taught how to work withsupervisors through training related tocommunication skills, conflict management,and team building.

Dr. Gaunt is a medication safetyanalyst and the editor of ISMPMedication Safety Alert!Community/Ambulatory CareEdition.

Subscribe to NewsletterPharmacy Times and the Institute for SafeMedication Practices (ISMP) would like to makecommunity pharmacy practitioners aware of apublication that is available.The ISMP Medication Safety Alert! Community/Ambulatory Care Edition is a monthly compilationof medication-related incidents, error-preventionrecommendations, news, and editorial content designedto inform and alert community pharmacypractitioners to potentially hazardous situationsthat may affect patient safety. Individual subscriptionprices are $45 per year for 12 monthlyissues. Discounts are available for organizationswith multiple pharmacy sites. This newsletter isdelivered electronically. For more information, contactISMP at 215-947-7797, or send an e-mailmessage to community@ismp.org.

References

1. Edmundson AC. Learning about mistakes is easier said than done. J Applied Behav Sci.1996;32:5-28.

2. Grasha A. Psychosocial factors, workload, and risk of medication errors. US Pharm. 2002;27(4):HS32-HS52. Available at: www.uspharmacist.com/oldformat.asp?url=newlook/

files/Feat/MedicationErrors.htm&pub_id=8&article_id=859.