Medical Mistake Disclosure, Just Culture, and High Reliability with Derek Leiner

My guest for Episode #277 of the My Favorite Mistake podcast is Derek Leiner, MD, FACP.

Episode page with video, transcript, and more

Dr. Leiner trained in internal medicine at VCUHealth and the Richmond VA Medical Center. In 2018, he completed a year as Chief Resident for Quality and Safety, a national VA QI and safety training program then began as a staff physician at the Richmond VA Medical Center.  

His career has included teaching, education leadership as an Associate Program Director for a medicine training program, and safety culture leadership.  Derek currently works as an academic hospitalist and is the physician champion for high reliability at the Richmond VA Medical Center.  He has a passion for humanism, collaborative care, and just culture.

In this episode, we discuss a medical error involving a lumbar puncture procedure and the subsequent emotional impact on the healthcare professional involved. We explore the distinction between near misses and patient harm, highlighting the importance of learning from both. The concept of Just Culture is introduced, emphasizing a fair and supportive approach to addressing errors. We delve into High Reliability Organizations and their focus on creating a culture of safety. The significance of open communication with patients and the potential for positive outcomes is also addressed.

Additionally, we examine the "second victim" phenomenon, where healthcare professionals experience emotional distress following errors. The episode concludes with practical strategies for recovering from mistakes and fostering a culture of continuous learning and improvement in healthcare.

Questions and Topics:

• What is your favorite mistake?
• Is this a near miss or patient harm?
• Did I understand your definition of a near miss correctly?
• What was the reaction and response to the incident?
• Can you explain the concept of high reliability organizations and its relevance to healthcare?
• What was the patient's reaction to the disclosure?
• What is your reaction to Doctor Mayer's story?
• What are your thoughts on Just Culture?
• How do you coach others to recover from mistakes and combat negative self-talk?

Key topics discussed:

• Lumbar puncture incident & its emotional impact
• Near miss vs. patient harm
• Just Culture & its implementation
• High reliability organizations (HROs)
• Patient disclosure and reactions
• Second victim phenomenon & support
• Recovering from mistakes & learning
• Systemic factors, human error & normalization of deviance
• Importance of continuous learning & improvement