The Power of Habit – Why We Do What We Do in Life and Business

wages and work rules. Mandatory overtime is a common practice and has been an issue in unionized hospitals across the country. I don’t know whether there were signs with those messages during the 2000 union negotiations, but if so, they would have referred to mandatory overtime, not relationships between physicians and nurses.”

[157] to make sure mistakes are avoided American Academy of Orthopaedic Surgeons Joint Commission Guidelines, http://www3.aaos.org/member/safety/guidelines.cfm.

[158] A half hour later RIDH Statement of Deficiencies and Plan of Correction, August 7, 2007.

[159] There was no clear indication of In a statement, Rhode Island Hospital said some of these details are incorrect, and referred to the August 7, 2007, RIDH Statement of Deficiencies and Plan of Correction. That document says, “There is no evidence in the medical record that the Nurse Practitioner, employed by the covering Neurosurgeon, received, or attempted to obtain, the necessary information related to the patient’s CT scan… to confirm the correct side of the bleed and [sic] prior to having the consent form signed for craniotomy surgery… The medical record indicates that the surgical consent was obtained by a Nurse Practitioner working for the Neurosurgeon who was on call. Although the surgical consent indicates that the procedure to be performed was a ‘Right craniotomy and evacuation of subdural hematoma,’ the side (right) was not initially entered onto the consent form. Interview on 8/2/07 at 2:05 PM with the Director of Perioperative Surgery indicated that patient… was transported from the emergency department with an incomplete (as to side) signed surgical consent. The Circulating Nurse noted that the site of the craniotomy was not included on the signed surgical consent as required by hospital policy. She indicated that the site of the craniotomy surgery was then added by the Neurosurgeon, in the operating room, once he was questioned by the Circulating Nurse regarding the site of the surgery.” In a follow-up statement, Rhode Island Hospital wrote that the surgeon “and his assistant finished the spinal surgery, the OR was readied, and when they were in the hall, about to return to the OR, the OR nurse saw the consent form did not include the side of the surgery and told [the surgeon]. The doctor took the consent from the nurse and wrote ‘right’ on it.”

[160] “We have to operate immediately.” In a letter sent in response to fact- checking inquiries, the physician involved in this case contradicted or challenged some of the events described in this chapter. The physician wrote that the nurse in this case was not concerned that the physician was operating on the wrong side. The nurse’s concern focused on paperwork issues. The physician contended that the nurse did not question the physician’s expertise or accuracy. The nurse did not ask the physician to pull up the films, according to the physician. The physician said that he asked the nurse to find the family to see if it was possible to “redo the consent form properly,” rather than the other way around. When the family could not be found, according to the physician, the physician asked for clarification from the nurse regarding the procedure to improve the paperwork. The nurse, according to the physician, said he wasn’t sure, and as a result, the physician decided to “put a correction to the consent form and write a note in the chart detailing that we needed to proceed.” The physician said he never swore and was not excited.

Rhode Island Hospital, when asked about this account of events, said it was not accurate and referred to the August 7, 2007, RIDH Statement of Deficiencies and Plan of Correction. In a statement, the hospital wrote, “During our investigation, no one said they heard [the surgeon] say that the patient was going to die.”

“Those quotes with all the excitement and irritation in my manner, even swearing was completely inaccurate,” the physician wrote. “I was calm and professional. I showed some emotion only for a brief moment when I realized I had started on the wrong side. The critical problem was that we would not have films to look at during the procedure… Not having films to view during the case is malpractice by the hospital; however we had no choice but to proceed without films.”

Rhode Island Hospital responded that the institution “can’t comment on [the surgeon’s] statement but would note that the hospital assumed that surgeons would put films up as they performed surgery if there was any question about the case. After this event, the hospital mandated that films would be available for the team to view.” In a second statement, the hospital wrote the surgeon “did not swear during this exchange. The nurse told [the surgeon] he had not received report from the ED and the nurse spent several minutes in the room trying to reach the correct person in the ED. The NP indicated he had received report from the ED physician. However, the CRNA (nurse anesthetist) needed to know the drugs that had been given in the ED, so the nurse was going thru the record to get her the info.”

The Rhode Island Board of Medical Licensure and Discipline, in a consent order, wrote that the physician “failed to make an accurate assessment of the location of the hematoma prior to performing the surgical evacuation.” The State Department of Health found that “an initial review of this incident reveals hospital surgical safeguards are deficient and that some systems were not followed.”

Representatives of both the Board and Department of Health declined to comment further.

[161] the surgeon yelled In a statement, a representative of Rhode Island Hospital wrote “I believe [the surgeon] was the one who noticed that there was no bleeding-there are various versions as to what he said at that time. He asked for the films to be pulled up, confirmed the error and they proceeded to close and perform the procedure on the correct side. Except for [the surgeon’s] comments, the staff said the room was very quiet once they realized the error.”

[162] ever working at Rhode Island Hospital again In the physician’s letter responding to fact-checking inquiries, he wrote that “no one has claimed that this mistake cost [the patient] his life. The family never claimed wrongful death, and they personally expressed their gratitude to me for saving his life on that day. The hospital and the nurse practitioner combined paid more towards a $140,000 settlement than I did.” Rhode Island Hospital, when asked about this account, declined to comment.

[163] The book’s bland cover and daunting R. R. Nelson and S. G. Winter, An Evolutionary Theory of Economic Change (Cambridge, Mass.: Belknap Press of Harvard University Press, 1982).

[164] candidates didn’t pretend to understand R. R. Nelson and S. G. Winter, “The Schumpeterian Tradeoff Revisited,” The American Economic Review 72 (1982): 114 -32. Winter, in a note in response to fact-checking questions, wrote: “The ‘Schumpeterian tradeoff’ (subject of a 1982 AER paper and a kindred chapter, 14, in our book) was only a facet of the project, and not a motivating one. Nelson and I were discussing a collection of issues around technological change, economic growth and firm behavior long before 1982, long before we were together at Yale, and particularly at RAND in 1966-68. Nelson went to Yale in 1968; I went to Michigan that year and joined the Yale faculty in 1976. We were ‘on the trail’ of the 1982 book from 1967, and started publishing related work in 1973… In short, while the ‘Schumpeter’ influence is obviously strong in the heritage, the specific ‘Schumpeterian tradeoff’ aspect is not.”

[165] Within the world of business strategy For an overview of subsequent research, see M. C. Becker, “Organizational Routines: A Review of the Literature,” Industrial and