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- Trade-offs of attending supervision versus resident
autonomy and graded responsibility
- Multiple providers means
- Multiple hand-offs
- Diffusion of responsibility
- The Academic “Chain of Command”
- Least experienced care providers often at “sharp
edge” of adverse patient occurrences
- Going up the “chain of command” requires
recognition of a problem requiring senior input
- High-Risk Populations Served by Teaching Hospitals
- Fiscal Constraints of Many Teaching Hospitals
- Limited staffing – students, residents often provide
nonphysician ancillary services
- Equipment shortages
- Historical “Culture of Blame”
- Personal responsibility versus system responsibility
- Inadequate support of caregivers involved in
adverse clinical outcomes
- Need to transform “culture of blame” to
“culture of fairness, culture of improvement”
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