The Ergonomics of Innovation by Hayagreeva Rao and Robert Sutton

Related: Saving Lives: US Health Care Improvement - 5 Million Lives Campaign - PBS Documentary: Improving Hospitals - Hospital Reform - IHI on CBS - Articles on Improving Health Care Performance - Drug Prices in the USA - posts on innovation

Mark Graban is hosting the Management Improvement Carnival #40. Mark recently authored a new book, Lean Hospitals. Health care highlights from this carnival include:

• Hospital Error - Heparin in the news again (The Lean Thinker Blog): “I am reasonably certain that the two workers who went on “voluntary leave” (yeah, right) will absorb more than their share of blame as the system solves the problem by asking the “Five Who?” questions.”
• Management 101, 201, 301, and 401 (Paul Levy - Running a Hospital): “The only role of management is to create an environment where people left to their own devices and unsupervised are most likely to engage in behavior that advances the goals of the organization.”
• Why I Work In Healthcare (Lee Fried - Daily Kaizen): “Great people that were trying to work in a broken system.”
• Competing Podcast Interview with Mark Graban (Dwight Bowen - Lean Thinking Network): “Most everyone has been aware of the increasing costs of healthcare - the general public is recently becoming more aware of the patient safety and quality risks they face in a hospital. And these are all problems that can be addressed with Lean.”
• 5S, Poka-Yoke, and Visual Controls (Bryan Lund - TWI Blog): “I need a visual control to tell me if the standard is met, in order to avoid mistakes or failure.”

Related: previous management carnivals - Curious Cat health care article library - Curious Cat Management Improvement blog Health Care posts - improving health care links

In 2005 I posted about some of the problems with drug pricing. It is nice to find at least a couple of people at MIT that want to have MIT focus research on the public good instead of private profit. As I have mentioned too many universities now act like they are for-profit drug or research companies. That is wrong. Drug companies can do so, institutions with purported higher purposes should not be driven to place advancing science below profiting the institution.

Solving the drug price crisis

I see their idea as one worth trying. Lets see how it works. Their book: Reasonable Rx - Solving the Drug Price Crisis by Stan Finkelstein and Peter Temin

Related: USA Spent $2.1 Trillion on Health Care in 2006 - Measuring the Health of Nations - Antibiotics Too Often Prescribed for Sinus Woes - $600 Million for Basic Biomedical Research - articles on improving the health care system

The percent of GDP spent on health care in the USA increased again in 2006 - to 16%. Health care spending reached a total of $2.1 trillion, or $7,026 per person in 2006, up from $6,649 per person in 2005.

Related: USA Healthcare Costs Now 16% of GDP - Measuring the Health of Nations - USA Paying More for Health Care

Measuring the Health of Nations: Updating an Earlier Analysis

Rankings: 1) France 2) Japan 3) Australia 4) Spain 5) Italy 6) Canada… 18) Portugal 19) USA. Maybe the United States is last but still not significantly behind?

It might seem like a stretch to compare the lowest ranked country to the average of the top 3, but, for all those that feel the USA is the best health care system it raises the questions of why they don’t think 100,000 annual deaths is a significant enough problem to lower their opinion of the current system. And remember the USA system costs something like twice as much as the average system: up to 16% of GNP in 2006.

I must say I would rather have the Toyota mindset shown by those talking about the USA health system instead of the claims of how the current USA health system is number 1. In Toyota’s horrible last year they still had a profit of about $14 billion (I believe something like 20 companies have every made that much). The United States health system sure has some things to point to positively but the system seems to be losing ground to the rest of the world more and more quickly while many cling to a belief it is the best system around.

Related: Evidence-based Management - posts on improving health care - Improving Hospital Performance - articles on improvement health care - Best Research University Rankings - Top 10 Manufacturing Countries - Dr. Deming’s Seven Deadly Diseases of Western Management

This does a great job of explaining what you need to know clearly. While this presentation for Azithromycin doesn’t prevent a mistake it sure makes it much more likely that the process can be completed successfully. We need more effort in creating such clear instructions.

Visual clarity is more important than lots of words. Applying that concept is not as easy as it sounds but it is a very important idea for instructions to end use and instructions for processes in your organization. Expecting people to read much is just setting yourself up for failure when they don’t bother (you should consider psychology, and how people will actually use your instructions not how you want them to).

via: Prescription UI

Related: Using Design to Reduce Medical Errors - Visual Instructions Example - Visual Work Instructions - Standardized Work Instructions - Health Care Pictographs - 5s - Edward Tufte’s: Envisioning Information

Great article on The Checklist - If something so simple can transform intensive care, what else can it do? by Atul Gawande

Related: Why Isn’t Work Standard? - Visual Work Instructions - posts on quality tools - European Blackout not Human Error-Not

Area health systems put customer service first by MaryBeth Matzek

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Seven Leadership Leverage Points: for Organization-Level Improvement in Health Care by James L. Reinertsen, MD; Michael D. Pugh and Maureen Bisognano.

Once again the Institute for Healthcare Improvement (IHI) is doing a great job. This white paper does an excellent job of collecting knowledge and suggesting a way forward. And they are having an impact by getting people to participate in improvement efforts.

They have the courage to say one of the 3 sources for there hypothesis as “Hunches, Intuition, and Collective Experience.” While attempting to base plans on data and not hunches is good. Often you must make decisions without data. It is why Dr. Deming was so concerned with mobility of top management: that mobility means many managers don’t really understand what they are managing. Lean thinkers understand the value of having managers with deep knowledge of the areas they manage.
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This post is an edited version of a message I sent to the Deming Electronic Network.

I find the “control charts in health care” thread quite interesting.

From Mike Woolbert’s post
> I have read many comments about the 8 minute ambulance trip.
> This doesn’t seem to be a system measure, but a result measure.

It seems to me the 8 minute (90% of the time) measure is an attempt at a process measure (in a sense, you can see it as a result measure, but it is also a measure that will have an impact on overall results and as such can be used a process indicator). For it to be a process measure rather than than a process target however, it should actual be a measure of what has happened not a statement that we want to have 90% arrive within 8 minutes.

Jonathan Siegel’s comments on this topic were excellent.

The control chart was developed to aid in process improvement. A control chart helps monitor the process (to aid in putting in place counter-measures, when needed, and for identification of special causes). The control chart can be used to see if the process is in control and what the expected results from the system are.
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re: Health Care Spending In The United States Slows For The First Time In Seven Years

The Centers for Medicare and Medicaid Services (part of the United States Department of Health and Human Services) issued a report (the press release states that report will appear in the Jan/Feb edition of Health Affairs but does not provide a link so the link is my guess of where the report will appear) and a news release putting a positive spin on the data.

“Spending growth for prescription drugs decelerated significantly to 10.7 percent, down from 14.9 percent in 2002.” So we only increased spending on prescription drugs by 10.7 percent? I guess that could be seen as positive? To me though increasing expenditures by 10.2 percent seems more like of a problem than a success, though I can’t argue it is less of a problem than the year before. My last post was on prescription drug prices in the USA.
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