Welcome to Health Care POV | sign in | join
Stepwise Success

Winning the Blame Game

Published October 10, 2008 9:11 AM by Scott Warner
Blaming is a neat trick we all use:  we hold someone else responsible for what happens, becoming either a bystander or a victim.

The blame game is played by blaming.  Our failure to provide world-class service is the fault of the building architects, the registration clerk, the doctor, the nurse, the boss or the patient. Once blame is placed, we "win" and move on, having done our part. Fixing the problem is -- you guessed it -- somebody else's job.

It's less fun when the laboratory is blamed: a patient complains their physician told them the lab missed a test (that the physician did not order); a nurse writes up the lab for not drawing a fasting sample (that was ordered in the information system after breakfast was delivered); a doctor blames the lab for rejecting a body fluid specimen (that was clotted because it was collected in the wrong tube).

When the lab is blamed, the blamer is often part of the problem. But facts seldom sway winners in this game. We will never hear, You're right, it's really my fault.

But we can play by a different set of rules that changes the game itself. Let's call it the "explain game." The way the explain game works is simple: instead of blaming a person or a department when something happens, we explain how it happened. This can be painful, because it means we ignore personal attacks. It means stating facts without conclusions or linking events to the failure of one individual. It means acknowledging that systems enable mistakes. Rather than presume the why of a person, we explain the how of a system.

And then we do what the blame gamers are incapable of doing -- we fix the system. That's something I wouldn't mind being blamed for.

 

6 comments

"If you are thinking of starting a blog--work related or not--ask first. There are likely opinions about

February 19, 2009 11:16 AM

Do a Yahoo search engine, type "mixed organisms, urine culture", you will see a lot of protocols from different laboratories or you can ask the authority itself, the American Society of Microbiology ( www.asm.org ). Have fun!

Efren Ventura, Clinical Laboratory Scientist, December 5, 2008 10:53 PM
McAlester OK

The species of the three Gram negative rods isolated from the culture in question were: Escherichia coli (#1 cause of urinary tract infections; at least I was taught that in school four years ago), Enterobacter aerogenes, and Klebsiella pneumoniae.  Are any of these organisms considered "normal" urogenital flora rather than "pathogenic" at any facilities out there?  I'm very interested in hopefully hearing more than one answer to this question... :)

Stephanie Mathis, Generalist - Clinical Laboratory Scientist, Danville Regional Medical Center December 5, 2008 2:42 AM
Danville VA

There should have been no work-up done initially on this specimen. Three organisms = mixed urogenital microbiota. You can enumerate the colony count of the organisms when reporting but the ID & Sensi you will leave it to the physician to order after an appropriate patient clinical judgment.

Efren Ventura, Clinical Laboratory Scientist December 2, 2008 9:28 PM
McAlester OK

How many of you clinical laboratory professionals out there were taught that ANY species of Gram negative rod is considered "pathogenic" when isolated from a urine culture?

I erroneously assumed that the only "contaminants" in this type of culture were Gram positive organisms other than Staph aureus, Strep agalactiae (group B) or Enterococcus.  

I was accused of inappropriately working up a urine culture by the previously mentioned laboratory supervisor in Rockingham County, NC after - guess what?! - she received a complaint from a pediatrician who claimed I had unnecessarily performed ID/susceptibility testing on "contaminant" organisms, requiring him to track down a 3-year-old boy's parents as the family went on a beach vacation in order to write the patient an antibiotic prescription.

The microbiology technologist working on the previous day (Friday) had subcultured three different species of Gram negative bacilli, each of which were growing at about 33,000 CFU/mL in this little boy's urine culture. (May I add that absolutely NO organisms that are typically considered skin flora/contaminants in a urine culture grew from this specimen- just these three Gram negative species.)

I, however, was the lucky recipient of my supervisor's "any doctor is always right, so ALWAYS blame the tech who can't be trusted to do anything right" philosophy after I came in the next day (Saturday).

This "blame game" may be a major reason why other technologists who have become certified within the previous ten years leave the clinical laboratory science field!

Stephanie Mathis, MT(ASCP), Generalist - Clinical Laboratory Scientist, Danville Regional Medical Center November 5, 2008 1:01 PM
Danville VA

I worked weekends at a 200-bed community hospital north of Greensboro, NC near the NC/VA state line in 2006.  During training, I was instructed by the microbiology section head to call all MRSAs and multi-drug resistant microorganisms to a physician "first thing in the morning."  However, when the laboratory supervisor received a complaint from an irate doctor about being called at 6:30 on a Saturday morning, she did not think highly enough of me as a laboratory professional to consider my side of the story.

I had erroneously obtained the name of this physician, who had ordered a culture on a previous specimen from the same patient, from the Vitek sensitivity analyzer.

The laboratory supervisor could have acknowledged that good medical technologists sometimes make mistakes because they are not perfect 100% of the time - and advised me to look up current patient information in the computer system in the future.  However, this woman unfairly used the hospital's disciplinary policies to basically punish me for doing my job with a written reprimand citing my "not following instructions."  Apparently, I was actually supposed to follow the contradictory instructions of the Blood Bank section head, who was working on that particular weekend, that "if she were me, she would not bother that doctor with calls before 9:00 on a weekend morning."

This is not the only complaint this supervisor/former phlebotomist of 30 years (who was alleged to have earned "mail-order" MLT certification) received about a doctor regarding a technologist's work to which she reacted on a knee-jerk basis by playing the "blame game" at the expense of employees whom she should value and appreciate.

Stephanie Mathis, MT(ASCP), Generalist - Clinical Laboratory Scientist, Danville Regional Medical Center November 5, 2008 9:50 AM
Danville VA

leave a comment



To prevent comment spam, please type the code you see below into the code field before submitting your comment. If you cannot read the numbers in the image, reload the page to generate a new one.

Captcha
Enter the security code below: