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The why matters


You cannot avoid employee mistakes, but you can make sure the same mistake isn't made twice.

staff, employee error, healthcare, practice management

©Iurii Sokolov/

When a mistake is made, very often the blame is pointed at who did it, and that person is held accountable regardless of the reason behind the mistake, the severity of the incident, or past performance or actions. Too often the reaction to an employee error is to begin the process of termination, and in some cases, it is immediate! But this is not the best action to take in the majority of the incidents.

Constant staff turnover results in increased costs and reduced patient satisfaction. Hiring and training new staff members and the varying levels of new staff productivity can deplete up to 70 percent of a practice’s revenue. And patients gain a negative impression of the practice when they are greeted by different staff members at each visit, and there is no opportunity for patient and staff to establish relationships if there is always someone new. 

A better solution when confronted with a mistake is to ask why. W. Edwards Deming of total quality management fame suggests that only 15 percent of the mistakes made by employees are their fault. Rather, 85 percent of the time, it is the fault of the “systems,” which includes the training and tools supplied by the practice.

Don’t stop at the first why; drill down to the second, third, and up to the fifth. Why did you do it that way? (That’s the way we’ve always done it.) Why have you always done it that way? (That’s the way others were taught.) Why were they taught that way? (That’s the way Jane was taught, and she taught me.) Why was Jane taught that way? (That’s how Peggy, who left the job five years ago, did it.) Once you get to the real issue or reason why, it is then possible to determine the necessary corrective action steps.

How do you go about this? In asking why, be prepared to lead or direct the question to the root issue involved with the situation. This will require active listening and not jumping to conclusions. Often, we think that the issue has been identified with the first or the second question and decide to not delve further. Be patient in asking the questions. 

Once the core why is understood, work with the staff to determine the solution to the problem. Ask “how do you think we can fix the situation?” or perhaps, “now that you know the reason, give it some thought, and we can talk about it again tomorrow.” Staff members often have greater insight into what steps would improve their workflow and are more likely to engage with the solution when they have a voice in the process (versus the solution being dictated by upper management). Follow up in a couple weeks to assess the effectiveness of the solution and ensure that the correct why was identified and corrected.

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