Back when I worked in homeowners’ insurance tracking, the job was somewhat complicated at
times. There were many different items that needed attention, letters to be sent, lines to be
updated, and rules that had to be followed. The rules that we followed came about through
mortgagee requirement, federal or state law, or a combination of the two. We had a computer
system called NSSCAR that tracked illogical conditions, which I reviewed each morning and
contained the previous day’s work. We also performed self-audits and internal audits, had an
external quality assurance and quality control (two separate services), and reviewed loans for
accuracy when working a new item. Additionally, the big threat over our head revolved around
CFPB (Consumer Financial Protection Bureau) errors, which carried hefty fines. These could result
from sending a letter more than once for insufficient coverage on a prefabricated home or failing
to update or remove flood insurance lines on the loan with FEMA (Federal Emergency
Management Agency) flood mapping data if provided, to name a few.
Accuracy was a huge deal with the organization and our performance was largely based upon
maintaining accuracy greater than 98%. We were invited to put our own prevention measures in
place, which I conducted via an Excel spreadsheet that contained the loan number, items that
were checked for update, action taken, and notes for every loan I touched and item that I
worked, day by day. Of course, I still made errors from time to time because I am human, but my
spreadsheet was a great part of my success.
Medical errors and the correction, documentation, and reporting of said errors is a highly
important part of medicine. Just as the work that I completed kept loans in good standing and
ensured that properties remained insured per mortgagee interest, medical errors and the
recordkeeping associated with them are incredibly important as well, as they concern the health
and safety of the patient population and keep tabs on dangerous practices. Dovey and Phillips
(2004) have an interesting editorial regarding the potential ambiguity of the term “medical error”
and lack of a widespread understanding of what does and does not constitute a medical error.
This same editorial discusses primary care doctors exhibiting difficulties in the identification of
medical errors that are not routine, as they so frequently encounter certain medical errors that,
as such, these errors become expected or anticipated. Therefore, providers and health care
professional being unclear on what exactly to report, along with the supposed severity of the
error, could result in a reduced number of medical errors being reported, and thus result in less
than accurate data.
Leaders have the ability to alleviate some of the stress and strain of error reporting and handling
the aftermath. Unfortunately, my leadership did not handle any errors with grace, even errors
that truly had minimal impact and that could be a great learning opportunity. In fact, they
managed to sully my impression of “learning opportunity” by the intensely negative connotation
the term held in our department. Being forthright about what occurred, creating a plan to move
forward, and treating others as we would like to be treated, as we have all made a mistake
before, is paramount to turning a negative situation into a positive experience that will result in
professional growth. Members can still be held accountable while being able to retain their
dignity. One method I appreciated that another team utilized was a monthly review of all errors
received for the department, with no names or other identifying information, to discuss the
errors with the entire team so that they could learn and grow stronger together without the
shame of being named and blamed. This may also lend to more authenticity or openness
surrounding errors in general. This is a point touched on by Dovey and Phillips (2004), when they
referenced that including all errors, even minor or simple, assists with opportunities to improve
the system and create a safer environment to practice in.
References
Dovey, S. M., & Phillips, R. L. (2014). What should we report to medical error reporting
systems? Quality and Safety in Health Care, 13, 322-323.
