Rule-breaking routine

Fiona Moss is a chest physician and, for 10 years, editor of Quality and Safety in Healthcare. In her last editorial for the journal, she chose to focus on an intractable issue that she sees as fundamental to improving the safety of healthcare, which is the fact that clinicians, by which in this instance she meant doctors, routinely break rules and ignore basic and reasonable organizational procedures and practices. As Moss puts it, there is a chasm between organizational intention and individual action (Moss, 2004). Recall the death of David James described in Chapter 8, in which several staff departed from standard procedures, and then consider this paragraph ... 

Routine violation occurs when the breaking of a safety rule or procedure is the normal way of working. It becomes routine not to use the recommended procedures for tasks. An example of this is the regular speeding of fork lift trucks in a warehouse so that orders can be fulfilled on time. 

Routine violations happen when it becomes standard practice In a group or even an entire organisation to break the rule or procedure. Lack of knowledge and failure(s) to enforce the rule make the situation worse, and this is one reason why rules which are actually unnecessary and are not enforced should be eliminated. 

Nonroutine elements may be critical task to an operation and are identified by placing an X in the column Hsted as NR . When breaking the steps down into its individual tasks, look for steps or tasks not performed on a routine basis. These tasks may be done infrequently because they are used only at rule-based decision points and completed only if a process rule tells the employee to take action under certain conditions. 

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