Production pressure in the work environment: a current australian perspective
Roger Browning1, Richard Riley1, David Gaba2, Steven K Howard2
1Royal Perth Hospital, Perth, Australia 2Stanford University, Palo Alto, California
Background:Pressure to put efficiency, output, or continued production ahead of safety has caused catastrophic accidents in various industries. The authors assessed the attitudes and experiences of anaesthetists concerning production pressure and compared these with results obtained from a previous survey conducted in California in 1994.
Methods:A written survey was distributed to all attendees at a national anaesthesia conference held in Perth WA, in October 2007, and to all anaesthetists at six major metropolitan hospitals in Perth. Questions were asked about attitudes towards production pressure and patient safety issues, frequency of occurrence of various operating room events, encounters with situations involving unsafe actions and ratings of sources of production pressure. The same questionnaire was used in both surveys to allow direct comparison of results.
Preliminary Results:We received 173 completed surveys. Over one third of respondents (36%) have observed production pressure result in what they believed to be unsafe actions by an anaesthetist. These events included elective surgery in patients without adequate evaluation or with significant contraindications to surgery. A significant number of anaesthetists felt "internal" pressure within themselves to get along with surgeons, avoid delaying surgery, and avoid litigation. They also reported a lesser degree of external pressure from surgeons to proceed with cases instead of cancelling them and to hasten anaesthetic procedures. Comparison with the previous survey shows remarkably similar results.
Conclusions:Production pressure from internal and external sources is a reality for many anaesthetists and is perceived in some cases to have resulted in unsafe actions being performed. This appears to be largely unchanged since the 1994 survey.
