Comments on: "Dead by Mistake" Report Hits the News http://www.leanblog.org/2009/08/dead-by-mistake-report-hits-news/ Mark Graban's leanblog.org - Lean Healthcare, Lean Thinking, Lean Manufacturing, Toyota Production System Thu, 09 Feb 2012 22:59:58 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Mark Graban http://www.leanblog.org/2009/08/dead-by-mistake-report-hits-news/#comment-5359 Mark Graban Tue, 11 Aug 2009 12:22:26 +0000 http://leanblog.bigbigdesign.net/2009/08/dead-by-mistake-report-hits-the-news/#comment-5359 Kevin - that's one of the many problems in the healthcare marketplace: none of us have enough information to make an good decision, to reward the high quailty, low cost providers (or even the high quality, higher cost).<br /><br />HealthGrades is one source, but seems sorely lacking and has a business model around hospitals paying to be included. I don't like that.<br /><br />US News & World Report rankings basically tell you which have the best reputation (a reinforcing loop that adds little value).<br /><br />There are some efforts in Wisconsin (http://www.wchq.org/) to share data on quality in a public way. Too bad more states don't have something like that. Kevin – that's one of the many problems in the healthcare marketplace: none of us have enough information to make an good decision, to reward the high quailty, low cost providers (or even the high quality, higher cost).

HealthGrades is one source, but seems sorely lacking and has a business model around hospitals paying to be included. I don't like that.

US News & World Report rankings basically tell you which have the best reputation (a reinforcing loop that adds little value).

There are some efforts in Wisconsin (http://www.wchq.org/) to share data on quality in a public way. Too bad more states don't have something like that.

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]]> By: Kevin R http://www.leanblog.org/2009/08/dead-by-mistake-report-hits-news/#comment-5358 Kevin R Tue, 11 Aug 2009 10:01:20 +0000 http://leanblog.bigbigdesign.net/2009/08/dead-by-mistake-report-hits-the-news/#comment-5358 As a consumer, is there an easy way for me to find out which hospitals give the best care? I often feel that I don't have much of a choice in hospitals, and even when there is a choice, I don't know how to find out real information about how the hospital is run other than the general reputation that other people say it has.<br /><br />I would love to see a public database that is easy to use to find out how hospitals perform. As a consumer, is there an easy way for me to find out which hospitals give the best care? I often feel that I don't have much of a choice in hospitals, and even when there is a choice, I don't know how to find out real information about how the hospital is run other than the general reputation that other people say it has.

I would love to see a public database that is easy to use to find out how hospitals perform.

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]]> By: Mark Graban http://www.leanblog.org/2009/08/dead-by-mistake-report-hits-news/#comment-5357 Mark Graban Mon, 10 Aug 2009 23:32:29 +0000 http://leanblog.bigbigdesign.net/2009/08/dead-by-mistake-report-hits-the-news/#comment-5357 Kyra - great comment.<br /><br />Andrew - you ask a great question. The leading lean hospitals have struggled at times with physician relations. Some have made a lot of effort to bring them on the same page -- orient them around goals everyone can agree with (patient needs, quality, etc.). Some hospitals have "gotten tough" and punished physicians who refused to play nice with others or to follow proven safety procedures. I think punishment is only a short-term solution - it may send a message, but people might get better at hiding their misdeeds instead of changing their ways. No easy answers. It takes a lot of administrative leadership and a lot of medical leadership, both, it seems. Kyra – great comment.

Andrew – you ask a great question. The leading lean hospitals have struggled at times with physician relations. Some have made a lot of effort to bring them on the same page — orient them around goals everyone can agree with (patient needs, quality, etc.). Some hospitals have "gotten tough" and punished physicians who refused to play nice with others or to follow proven safety procedures. I think punishment is only a short-term solution – it may send a message, but people might get better at hiding their misdeeds instead of changing their ways. No easy answers. It takes a lot of administrative leadership and a lot of medical leadership, both, it seems.

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]]> By: Mark Graban http://www.leanblog.org/2009/08/dead-by-mistake-report-hits-news/#comment-5356 Mark Graban Mon, 10 Aug 2009 23:30:16 +0000 http://leanblog.bigbigdesign.net/2009/08/dead-by-mistake-report-hits-the-news/#comment-5356 I think that Scientific American, of all places, blew it in their blog/article headline, as I commented there:<br /><br /><a href="http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=deaths-from-avoidable-medical-error-2009-08-10&posted=1&posted=1#comments" rel="nofollow">LINK</a> I think that Scientific American, of all places, blew it in their blog/article headline, as I commented there:

LINK

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]]> By: Kyra Edeker http://www.leanblog.org/2009/08/dead-by-mistake-report-hits-news/#comment-5355 Kyra Edeker Mon, 10 Aug 2009 17:16:01 +0000 http://leanblog.bigbigdesign.net/2009/08/dead-by-mistake-report-hits-the-news/#comment-5355 Mark,<br />You make some good points on the software tools physicians and hospital staff are forced to use. As someone who has (and is) designing an EHR system for use in medical offices, I've done competitive reviews and field studies to see how medical personnel are using these tools. It's obvious that many systems are designed without consulting doctors, nurses or billing folks <i>throughout the process</i>; that most are never user tested until they go into "beta" in a test hospital or office; and that the "beta-testing" information then goes to shape the software into a narrow channel of use that won't work for the majority of users and environments. No wonder they're frustrated and fight using the system every time they're supposed to. <br /><br />The basics of user experience design can go a long way to easing some of this pain. Watch and interview a wide swath of users in their day to day environment, analyze for efficiencies, design, user test, design again, user test again, build, test again, tweak, test again. You get the idea. Like lean, consulting the expertise of the 'front line' worker and a kaizen approach to continually improving the software can lead to easier, faster and more consistent uptake of electronic record keeping. Mark,
You make some good points on the software tools physicians and hospital staff are forced to use. As someone who has (and is) designing an EHR system for use in medical offices, I've done competitive reviews and field studies to see how medical personnel are using these tools. It's obvious that many systems are designed without consulting doctors, nurses or billing folks throughout the process; that most are never user tested until they go into "beta" in a test hospital or office; and that the "beta-testing" information then goes to shape the software into a narrow channel of use that won't work for the majority of users and environments. No wonder they're frustrated and fight using the system every time they're supposed to.

The basics of user experience design can go a long way to easing some of this pain. Watch and interview a wide swath of users in their day to day environment, analyze for efficiencies, design, user test, design again, user test again, build, test again, tweak, test again. You get the idea. Like lean, consulting the expertise of the 'front line' worker and a kaizen approach to continually improving the software can lead to easier, faster and more consistent uptake of electronic record keeping.

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]]> By: Andrew Bishop http://www.leanblog.org/2009/08/dead-by-mistake-report-hits-news/#comment-5354 Andrew Bishop Mon, 10 Aug 2009 15:38:48 +0000 http://leanblog.bigbigdesign.net/2009/08/dead-by-mistake-report-hits-the-news/#comment-5354 Mark:<br /><br />When you ask "how do you lead physicians... if the doctors are not employees?" you hit on a critical point, I think. It goes beyond the question of whether they are employees or not, however, to a question of recognizing their place in a system, recognizing that someone might be able to help them improve (vs. "I'm the doctor, I know best"). <br /><br />Contrast the relationship of a physician to his work to that of a front line employee in our business (or Toyota...) where we recognize the critical role of front line supervision in driving change. What is the equivalent of a front line supervisor in a physician's work life? <br /><br />This is not to say the lessons of lean can't be applied. But I think that the paradigm of physician as top dog AND front line worker presents some interesting problems in application!<br /><br />SO... coming from a completely different world, how would I proceed? I would start with a simple question: How can you (anyone who wants to know) know whether or not the checklist is used every time? Someone (health system administrator, regulators, someone!) needs to do the grunt work of setting standards, making them visible, and then developing a systematic responses to abnormal conditions. Visual factory! But what do I know?<br /><br />How are the success stories you cite coping with this paradigm of the role of the physician?<br /><br />Beyond deployment of tools, how does anyone know that the tools are consistently in use?<br /><br />Do the tools make the job easier? Mark:

When you ask "how do you lead physicians… if the doctors are not employees?" you hit on a critical point, I think. It goes beyond the question of whether they are employees or not, however, to a question of recognizing their place in a system, recognizing that someone might be able to help them improve (vs. "I'm the doctor, I know best").

Contrast the relationship of a physician to his work to that of a front line employee in our business (or Toyota…) where we recognize the critical role of front line supervision in driving change. What is the equivalent of a front line supervisor in a physician's work life?

This is not to say the lessons of lean can't be applied. But I think that the paradigm of physician as top dog AND front line worker presents some interesting problems in application!

SO… coming from a completely different world, how would I proceed? I would start with a simple question: How can you (anyone who wants to know) know whether or not the checklist is used every time? Someone (health system administrator, regulators, someone!) needs to do the grunt work of setting standards, making them visible, and then developing a systematic responses to abnormal conditions. Visual factory! But what do I know?

How are the success stories you cite coping with this paradigm of the role of the physician?

Beyond deployment of tools, how does anyone know that the tools are consistently in use?

Do the tools make the job easier?

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