Tag Archives: Health care

Errors in Thinking

photo of Jerome Groopman

The Doctor’s In, But Is He Listening?, text and podcast from NPR:

Jerome Groopman (photo) is a doctor who discovered that he needed a doctor. When his hand was hurt, he went to six prominent surgeons and got four different opinions about what was wrong. Groopman was advised to have unnecessary surgery and got a seemingly made-up diagnosis for a nonexistent condition. Groopman, who holds a chair in medicine at Harvard Medical School, eventually found a doctor who helped…

“Usually doctors are right, but conservatively about 15 percent of all people are misdiagnosed. Some experts think it’s as high as 20 to 25 percent,” Groopman tells Steve Inskeep. “And in half of those cases, there is serious injury or even death to the patient.”

Errors in thinking: We use shortcuts. Most doctors, within the first 18 seconds of seeing a patient, will interrupt him telling his story and also generate an idea in his mind [of] what’s wrong. And too often, we make what’s called an anchoring mistake – we fix on that snap judgment.

An understanding of theory of knowledge is helpful to counteract errors in thinking. How we think is not perfect, and an understanding the weaknesses and faulty conclusions we are susceptible to making is helpful. That can help avoid jumping to conclusions that are faulty and to design systems that counteract such behavior.

Related: Epidemic of DiagnosesWrite it DownThe Illusion of UnderstandingIllusions – Optical and Otherhealth care improvement posts

Read an exceprt [the broken link was removed] from the book: How Doctors Think by Jerome Groopman .

Simple Solutions That Work

Nurse, the maggots [the broken link was removed]

Maggots clean wounds 18 times faster than normal treatments, can conquer MRSA and would save the NHS millions.

Recent studies have indicated that maggot therapy can cut treatment duration from 89 days to just five, and slash the cost from £2,200 to £300 per patient. Moon describes the grubs as “a highly cost-effective, highly efficient but forgotten and undervalued method of treatment”, and Caroline Flint, the Public Health Minister, says that using fly larvae (maggots) is “increasingly common” and “an illuminating idea”

In trials in Wales and Manchester, says Moon, patients not only recovered faster but noticed less smell and felt less pain from their rotting flesh when maggots were allowed to eat it. “Maggots are highly precise,” she says. “Unlike surgeons, they remove only the rotting tissue. Surgeons have to cut out healthy tissue to clear the wound, thereby creating a larger wound and more bleeding.”

I can believe we would avoid such a simple solution even it is more effective (the health care system seems perfectly capable of avoiding simple effective solutions to me). I hope we pursue scientific study of the most effective solutions – even if they don’t fit with the current way of thinking. It seems to me the health care system needs to find creative and cost effective solutions.

Related: USA Health Care System Costs Reach 16% of GDPLean UK HospitalsManagement Improvement in Healthcare – Maggot Therapy Project [the broken link was removed] – Maggots make medical comeback

5 Million Lives Campaign

IHI has created the 5 Million Lives Campaign [the broken link was removed] in the wake of the successful saving 100,000 lives campaign.

Despite the extraordinary hard work and best intentions of caregivers, thousands of patients are harmed in US hospitals every day. Hospital-acquired infections, adverse drug events, surgical errors, pressure sores, and other complications are commonplace. Based on data collected over several years from multiple partner institutions, IHI estimates that nearly 15 million instances of medical harm occur in the US each year – a rate of over 40,000 per day. This is a burden larger than most patients and professionals, and even some health care researchers, realize.

It is time to declare this toll unacceptable; time to end it.

IHI understands how to manage improvement: this campaign has great possibilities to improve the health care system. See previous posts about IHI’s work: Going Lean in Health CareSeven Leadership Leverage PointsFixing Health Care from the InsideDeming Institute Conference: Tom Nolan

Management Improvement History and Health Care

Squeezing the fat from health care [the broken link was removed] by Hanah Cho is another article on lean healthcare. This one provides a better view of the overall picture – especially compared to all those claiming to be one of the first lean thinking effort in healthcare. A good sign was that the author referenced, Going Lean in Health Care, a great report by IHI (James Womack and others).

It is nice to see a recognition of management history (so often missing):

Workers may remember theories such as Total Quality Management, Six Sigma, re-engineering and other business techniques that use flow charts, problem solving and role playing to help make their organizations more effective.

But some health care management experts say that some hospitals – like corporations – have gone through numerous quality improvement methods, only to abandon them for the latest management program.

I think it is wise to think about what improvement methods were tried in the past and try to understand why they failed in order to improve the chances of success today. I think the many of the things which tripped up TQM, Six Sigma, re-engineering… efforts in the past are waiting to do the same to those efforts today, including lean thinking efforts.

Related: PBS Documentary on Improving Hospital ManagementHealthcare Costs Spike Again

Thoughts on Hospital Management by Deming

Dr. W. Edwards Deming, 1951

The latest newsletter from the W. Edwards Deming Institute [new link since the old link was broken] includes the photo of Dr. Deming from 1951 and: Some notes on management in a hospital by W. Edwards Deming, Ph.D.:

Fifteen hours elapse between dinner and breakfast. I was hungry in the middle of the night, first night. Fortunately had candy bars on hand. I have learned how to acquire and store up food like a squirrel if I get hungry during the night.

Dr. Deming had a sense of humor (the smile in the picture is quite different from the photos I normally see).

A physician cannot change the system. A head nurse cannot change the system. Meanwhile, who would know? To work harder will not solve the problem. The nurses couldn’t work any harder.

I will attend the W. Edwards Deming Institute Fall Conference in Washington DC, October 14th and 15th – send me a note if you plan on attending.

Related: PBS Documentary: How Hospitals Heal ThemselvesDestroyed by Best Effortsblog posts on Deming’s management ideas

Lean Health Care Works

Lean Health Care? It Works! [the broken link was removed] by Patricia Panchak

In 1971, the U.S. spent 7.5% of its gross national product on health care — about $75 billion. We now spend 14.5%, which is about $1.3 trillion.

The article was written in 2003, by 2005 health care spending reached 15.3% of the USA economy.

A group of Iowa manufacturing executives has already taken Jimmerson’s recommendation a few steps further: They’re teaming up with their health-care providers, showing them the benefits, educating them on the principles and practices, and helping them to implement lean. “We’re doing this with the hopes that somewhere along the line, we’re going to save some money and that maybe our health-care costs won’t be so astronomical,” says David Speer, director of LeanSigma at Maytag Appliances, Newton, Iowa.

The problems to fix in health care are huge and will take a long time to fix but we need to build on the efforts of those who have been working on improvements. Read more articles on improving the health care system.

Previous posts:

Vacation: Systems Thinking

There’s more vacation time on tap for you (in the USA) by Chris Taylor:

U.S. employees are taking less time off than ever: Not only is the average number of annual vacation days granted to them a mere 12.4 – less than that of the average medieval peasant – but more than a third of us don’t even use all of our allotted time off.

While a dramatic contrast, I don’t really believe it is accurate. I believe workers in the USA get 8 to 10 paid holidays in addition to the 12.4 paid vacation days. Which contrasts with my view of medieval peasants. Part of the vacation issue is a decision, by workers, to seek more pay rather than more vacation. I want to look at the point to some of the organizational issues here though.

Several factors make it desirable to work those you have more. Health care insurance costs are high, if you can get 1900 hours of work a year for the health care premium instead of 1500 hours that can add up to a great deal of savings. Of course if you decrease the health of your workforce, in doing so, that will drive up the costs per worker (but that is one of those unknowable numbers Dr. Deming discussed while the expenditure per worker is easy to see). It costs money to hire, train, manage… people. The fewer you have the less associated costs. Assuming other things stay the same. Or course that assuming is the tricky part.

Yet more studies have shown, not surprisingly, that an overworked employee is more likely to make mistakes and get angry at their bosses – and 30 percent of us feel chronically overworked. Indeed, job burnout costs the U.S. economy an estimated $300 billion a year in accidents, employee turnover, diminished productivity and medical costs, according to the American Institute of Stress.

It would seem the American Institute of Stress might have a bias, but even so…

Continue reading

Health Care Pictographs

health pictograms from Japan

New pharmaceutical pictograms

The Risk/Benefit Assessment of Drugs-Analysis and Response (RAD-AR [the broken link was removed]) Council of Japan has released a new batch of pictograms for use on pharmaceutical packaging. No more deciphering complicated dosage directions and warnings — a glance is all it takes now.

See all the pictographs [the broken link was removed]

I don’t understand all the pictographs. If these are helpful in Japan, (assuming others in the USA see it the way I do) it might be an example of how a good idea would has to be modified to apply elsewhere. It also might be that at first we need to develop localized version but it would be helpful to move toward a universal system of pictographs to the extent possible.

Orignal article (in Japanese) [the broken link was removed]

Previous healthcare post: using design to reduce medical errors.

VA Medical Care

The Best Medical Care In The U.S. [the broken link was removed]

studies show that 3% to 8% of the nation’s prescriptions are filled erroneously, the VA’s prescription accuracy rate is greater than 99.997%, a level most hospitals only dream about.

This data certainly should make most hospitals interested in learning what is going on.

And for the past six years the VA has outranked private-sector hospitals on patient satisfaction in an annual consumer survey conducted by the National Quality Research Center at the University of Michigan. This keeps happening despite the fact that the VA spends an average of $5,000 per patient, vs. the national average of $6,300.

Overall this is an interesting article. I am sure there are plenty of problems in the VA system – it is huge and complex. However, they may also have valuable ideas for the health care system that is very much in need of improvement. Also see: PBS documentary on improving hospitals.

When hospitals were evacuated from New Orleans during Hurricane Katrina, the VA’s patients were the only ones whose medical records could be accessed immediately anywhere in the country.

Univ Michigan Hospital Adopts Toyota Methods

U-M hospital takes page from Toyota [the broken link was removed] by Sharon Terlep. This continues the trend (trend rather than fad because I like that it is happening :-)) of hospitals adopting lean management methods.

In health care, the one-at-a-time approach could mean taking a patient’s call, pulling the patient’s records, scheduling a visit and performing the exam that day, rather than creating a backlog of appointments or letting people crowd a waiting room. That way, if something goes wrong, it’s easy to target where the problem happened and fix it right away.

This article gets some of the ideas down but I think presents them in a fairly confusing way. So take this for what it is a report on one more hospital trying these ideas. Then read the many available resources to learn about one-piece flow, poka-yoke, eliminating waste, identifying errors, kaizen… rather than relying on this article. The purpose of this article is just to report on the new methods being used at the hospital not provide a detailed report on exactly how the new methods actually work – that would take a much longer form of presentation than a short newspaper article.