Legacy errors: Why do we normalize not-so-great behaviors in the dental industry?

Michelle Strange, MSDH, RDH, talks about what you can do to stay abreast of the latest infection control guidelines to encourage a culture of safety and compliance among your team members and avoid human error.



Photo Credit: https://www.rdhmag.com/infection-control/article/14281399/legacy-errors-why-do-we-normalize-notsogreat-behaviors-in-the-dental-industry


As health-care providers, we are responsible for providing patients with safe, effective, high-quality care. Nevertheless, human error is unavoidable in the medical field—slips, lapses, and mishaps happen all too frequently due to latent systemic factors such as provider fatigue, inexperience, lack of organizational policies, poor work culture, and normalizing behaviors that lead to legacy errors.

As I was writing this article, the best example of a legacy error popped up in a place that fuels a content creator’s fire: Facebook. A question was asked regarding immediate-use steam sterilization (IUSS), also known as flash sterilization. The poster asked if they or the veteran hygienist were correct: should packed instruments be run on the rubber/plastic setting or the wrapped instruments setting?

You're probably transporting your instruments the wrong way

Single-use items: Let's follow the instructions for use, please


I was pleasantly surprised to see so many people recommend the poster look up the equipment manufacturer’s instructions for use. I will remember this post on the days when I am worried about infection prevention procedures in the dental industry. I want to be shocked by questions like this, but I also know how many times I used to operate off the “I’ve always done it like that” philosophy and didn’t question the task I had been performing for decades. Let this be a sign to question everything you do in your dental office. Ask, is it a legacy error or does it follow proper protocols defined by rules and regulations, manufacturer’s instructions for use, and evidence-based guidelines?



Understanding legacy errors


A legacy error is a mistake or issue that is passed down from one employee to another, from one generation to the next.1 It can be a serious problem that easily finds its way into any medical or dental office, sometimes supplanting procedures that are put in place when there is a lack of control.

You may wonder how legacy errors are allowed to happen in the first place. They predominantly occur due to the absence of accountability to science-based procedures, leading to their normalization over time.

Legacy errors often proliferate when long-term employees train new hires. The trainer, usually an experienced team member, may pass on the out-of-date infection control information and obsolete processes or ignore best practices learned in school. Asking new employees to blindly adhere to the way your practice operates without asking for their ideas is a missed opportunity to learn about the latest procedures, scientific research, and technologies. It can also block the chance to foster teamwork and create a culture around safety.



The problem with legacy errors


Generational errors that I often witness include employees simply eyeballing chemical measurements for things such as the ultrasonic bath solution or the enzymatic cleaner for suction lines. Staff members may fail to read protocols or instructions for use before undertaking new tasks, and instead just rely on what senior members (who might not have read the guidelines themselves) have been doing.

If there haven’t been any adverse events directly associated with these errors, we tend to assume that what we are doing is acceptable. We continue to pass the misinformation on to the next team member and the next, ultimately creating a virus that will eventually infect the entire practice for generations to come.



Eradicating legacy errors


So how do you erase the legacy errors that exist in your office? Here are some ideas you can consider implementing to create a culture of communication, trust, and accountability—one that will ultimately help you stop legacy errors once and for all.



Establish frameworks with regular inspections to avoid complacency