I have been a consultant in Paediatric Intensive Care at Birmingham Children’s Hospital since 2009. My clinical and research interests are sepsis, palliative care, epidemiology and quality improvement. I subscribe to the idea that human performance can be improved through the use of positive feedback, and that this approach is underutilised in healthcare. I am the lead for an initiative called “Learning from Excellence” which aims to capture peer-reported episodes of excellence for the purposes of learning and improving staff morale.
Learning from Excellence
A call to learn from what goes well in healthcare
Our attempts to improve safety and quality in healthcare have tended to focus on learning from error. Intuitively, this seems like a good idea: if we make a mistake, we would like to learn why it happened and how to stop it happening again. But errors only occur in a minority of clinical encounters, so our focus is quite narrow. We may be missing learning opportunities from the episodes when things have gone very well. Furthermore, by focussing entirely on learning from adverse events, we run the risk of creating a culture of negativity, fear and avoidance. In this presentation, I will challenge the deficit-based approach to learning (i.e. learning from error) as the sole instrument to improve quality. I will also introduce the following concepts: our innate negativity bias – why we can’t help spotting errors, and why tend to overvalue their significance; the second victim phenomenon; Safety-2; intrinsic vs. extrinsic motivation; and Appreciative Inquiry. I will describe a complementary approach to learning in healthcare: Learning from Excellence, and how our team established an Excellence Reporting system in our intensive care unit.