In the last blog entry, I said that ranking is not important* within a severity class. For example, if the class is severe patient harm, then all error causes within this class should be fixed. “Fixed” means that:
- if the error rate has a frequency (the error is occurring), then the error rate must be lowered to zero
- if the error has never occurred, it’s risk must be low enough (it can never be zero) – low enough means that the error should not be expected to occur
However, since funds are not limitless one might argue that the purpose of the Pareto chart is to draw a line where funds will run out so that even within a severity class such as severe patient harm, one can stop reducing risk when there is no money. (If this were the case, then ranking would be important since one would want to limit harm).
An alternative is to be more creative with solutions. Referring to the central line infection problem a few blogs ago, there was an expensive (and not as effective) attempt to prevent infections; namely to buy lines coated with antimicrobials. The most effective solution was to use a checklist, which did not add any cost.
In the laboratory, HAMA interference is an example of a error that can cause serious harm. I have heard laboratory directors say there is nothing that they can do – proposed solutions are too expensive. They need to think of an effective solution within cost constraints.
*Ranking could help to lower risk more quickly, since bigger risk items would be ranked higher. In that sense, ranking is still important.