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- W2410367935 abstract "The consensus this week is that medicine lags behind other industries that are safety critical. The principal remedy will be to change from a culture of blame to a learning culture, in which the focus of inquiry shifts from the individual to the system in which errors were made. In other words, make the system work, and the individuals will take care of themselves.Computer programmers make errors too, and the systems that programmers use to deal with them are interesting because the tools that they use today will be ours tomorrow. In the open source model of development (www.opensource.org) databases of software bugs are maintained on the internet: users can contribute to them freely, and as the software is modified and fixed, so the bugs fall off the end of the database (www.chiark.greenend.org.uk/debian/Bugs/).Setting up a similar system for medical errors would be a radical notion but would cut down on the number of intermediaries involved in communicating sources of error that the present systems require. Of course, the great difference between software and humans is that once the software is “stable” it requires no further effort. Back in the real world, the best place to start looking for material specifically oriented to the medical domain on the web seems to be www.smi.stanford.edu/people/felciano/research/humanerror/.Over on the east coast of the United States a team of managers and accident and emergency doctors has devised a scheme for looking at error in their own workplaces and minimising it (http://teams.drc.com/powerpoints/Jim/ACEP_1207_site/index.htm). They've made use of Powerpoint's natty feature for converting proprietary files to HTML, which makes turning a talk into a website very easy indeed. The downside of the approach is that the resultant files of text plus graphics are comparatively large—downloading the whole talk (94 Powerpoint slides) takes 2 Mb. Alternatively, for a case study from a British intensive care unit, download www.dcs.gla.ac.uk/∼bussed/HECS/HECS.html." @default.
- W2410367935 created "2016-06-24" @default.
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- W2410367935 date "2000-03-18" @default.
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- W2410367935 title "Website of the week: Error in medicine" @default.
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