Tag Archives: Health care

ER Checklist

The popular ER TV show highlighted the importance of using checklists in surgery yesterday.

Such powerful quality tools, like the checklist, are just waiting to be used. But far too many fail to use these simple improvement tools. And in health care those failures are potentially critical.

Related: Checklists Save LivesThe Power of a Checklistmanagement improvement dictionaryArticles on Improving the Health Care System

Applying Disruptive Thinking to the Healthcare Crisis

Update: Sadly MIT delete the video. It is a shame educational institutions lose interest in knowledge just a couple years later. Thankfully we didn’t have to rely on the people deleting web content at universities to keep all the historical content we have in books from hundreds of years ago. I think it is a huge lose to what the mission of these schools should be but that attitude doesn’t seem to be shared by the schools.

The Innovator’s Prescription: A Disruptive Solution to the Healthcare Crisis:

Christensen spies symptoms of such disruptions bubbling up in the healthcare industry, such as molecular diagnostics, imaging technologies and high bandwidth telecom, and business model innovations. Integrated health systems like Kaiser Permanente have a leg up in deploying and optimizing these disruptive technologies.

The push for widespread healthcare reform must come from employers, who in spite of their declared intent to cut healthcare costs also know “they profit when their employees are healthy and productive.” Affordable healthcare, he concludes, “doesn’t come by expecting high end, expensive institutions or expensive caregivers to become cheap, but by bringing technology to lower cost providers and venues of care, so they can become more capable.”

Clayton Christensen is the rare management thinker that I feel real provides profound insights into thinking about management. There are many other good management thinkers that offer valuable idea, just most of them (in my opinion) really are presenting material in ways that offer managers a good way to take action on all the long known good management ideas that we fail to adopt successful for decades.
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The Ergonomics of Innovation

The Ergonomics of Innovation by Hayagreeva Rao and Robert Sutton

the IHI case teaches us that innovations spread quickly when organizations focus relentlessly on selecting and spreading ideas in ways that ease the burden of thought and action for everyone involved. This mind-set differs from the one that burdens most organizations, where innovation
is seen as difficult, expensive, and protracted. The IHI staff’s ergonomics-of-innovation mind-set focused on making things easier and cheaper for everyone, including the staff itself.

IHI focused on small things that had a big impact without placing a big load on hospital staffs (reducing the number of infections, for example, hinged on frequent and thorough hand washing). In this way, the organization adopted what Karl Weick calls a “small wins” strategy.

Berwick and his team believed that simply asking hospital staffs to “try harder” to save lives wasn’t enough; people need concrete, easily learned and implemented tools.

Related: Saving Lives: US Health Care Improvement5 Million Lives CampaignPBS Documentary: Improving HospitalsHospital Reform – IHI on CBSArticles on Improving Health Care PerformanceDrug Prices in the USAposts on innovation

Management Improvement Carnival #40

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 carnivalsCurious Cat health care article libraryCurious Cat Management Improvement blog Health Care postsimproving health care links

Drug Price Crisis

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

The mounting U.S. drug price crisis can be contained and eventually reversed by separating drug discovery from drug marketing and by establishing a non-profit company to oversee funding for new medicines, according to two MIT experts on the pharmaceutical industry.

Following the utility model, Finkelstein and Temin propose establishing an independent, public, non-profit Drug Development Corporation (DDC), which would act as an intermediary between the two new industry segments — just as the electric grid acts as an intermediary between energy generators and distributors.

The DDC also would serve as a mechanism for prioritizing drugs for development, noted Finkelstein. “It is a two-level program in which scientists and other experts would recommend to decision-makers which kinds of drugs to fund the most. This would insulate development decisions from the political winds,” he said.

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 2006Measuring the Health of NationsAntibiotics Too Often Prescribed for Sinus Woes$600 Million for Basic Biomedical Researcharticles on improving the health care system

USA Spent $2.1 Trillion on Health Care in 2006

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 GDPMeasuring the Health of NationsUSA Paying More for Health Care

Measuring the Health of Nations

Measuring the Health of Nations: Updating an Earlier Analysis

In a Commonwealth Fund-supported study comparing preventable deaths in 19 industrialized countries, researchers found that the United States placed last. While the other nations improved dramatically between the two study periods (1997–98 and 2002–03) the U.S. improved only slightly on the measure.

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?

According to the authors, if the U.S. had been able reduce amenable mortality to the average rate achieved by the three top-performing countries, there would have been 101,000 fewer deaths annually by the end of the study period.

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 Managementposts on improving health careImproving Hospital Performancearticles on improvement health careBest Research University RankingsTop 10 Manufacturing CountriesDr. Deming’s Seven Deadly Diseases of Western Management

Stratification and Systemic Thinking

I am reading a fascinating book by Jessica Snyder Sachs: Good Germs, Bad Germs. From page 108:

At New York Hospital, Eichenwald and infectious disease specialist Henry Shinefield conceived and developed a controversial program that entailed deliberately inoculating a newborn’s nostrils and umbilical stump with a comparatively harmless strain of staph before 80/81 could move in. Shinefield had found the protective strain – dubbed 502A – in the nostrils of a New York Hospital baby nurse. Like a benign Typhoid Mary, Nurse Lasky had been spreading her staph to many of the newborns in her care. Her babies remained remarkably healthy, while those under the care of other nurses were falling ill.

This is a great example of a positive special cause. How would you identify this? First you would have to stratify the data. It also shows that sometimes looking at the who is important (the problem is just that we far too often look at who instead of the system so at times some get the idea that it is not ok to stratify data based on who – it is just be careful because we often do that when it is not the right approach and we can get fooled by random variation into thinking there is a cause – see the red bead experiment for an example); that it is possible to stratify the data by person to good effect.

The following 20 pages in the book are littered with very interesting details many of which tie to thinking systemically and the perils of optimizing part of the system (both when considering the system to be one person and also when viewing it as society).

I have recently taken to reading more and more about viruses, bacteria, cells, microbiology etc.: it is fascinating stuff.

Related: Science Books by topicData Can’t LieUnderstanding Data

Great Visual Instruction Example

antibiotic visual instructions

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 ErrorsVisual Instructions ExampleVisual Work InstructionsStandardized Work InstructionsHealth Care Pictographs5sEdward Tufte’s: Envisioning Information

The Power of a Checklist

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

A decade ago, Israeli scientists published a study in which engineers observed patient care in I.C.U.s for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions—but that still amounted to an average of two errors a day with every patient.

In the early years of flight, getting an aircraft into the air might have been nerve-racking, but it was hardly complex. Using a checklist for takeoff would no more have occurred to a pilot than to a driver backing a car out of the garage. But this new plane was too complicated to be left to the memory of any pilot, however expert. With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident.

Yet it’s far from obvious that something as simple as a checklist could be of much help in medical care. Sick people are phenomenally more various than airplanes. A study of forty-one thousand trauma patients—just trauma patients—found that they had 1,224 different injury-related diagnoses in 32,261 unique combinations for teams to attend to. That’s like having 32,261 kinds of airplane to land. Mapping out the proper steps for each is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much. In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try.

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

Teams also complained to the hospital officials that the checklist required that patients be fully covered with a sterile drape when lines were being put in, but full-size barrier drapes were often unavailable. So the officials made sure that the drapes were stocked. Then they persuaded Arrow International, one of the largest manufacturers of central lines, to produce a new central-line kit that had both the drape and chlorhexidine in it.

Related: Why Isn’t Work Standard?Visual Work Instructionsposts on quality toolsEuropean Blackout not Human Error-Not