Do You Know More Than a Hospital CEO About…
If you’re a regular reader of my Lean Blog, you might know more about preventing Hospital Acquired Infections than many healthcare CEOs do, says a report in the Washington Post: “Hospital infection deaths caused by ignorance and neglect, survey finds.”
The idea that simple checklists can help prevent infections is a topic we’ve covered here a lot, so I won’t repeat everything that’s been written, but the “CEOs not being aware” angle of the WaPo article is intriguing / frustrating. Hat tip to Paul Levy’s blog post on this subject and the three people who emailed the article to me yesterday (thanks!).
The article recounts how checklists work and the benefits. Many infections are indeed preventable, including oft-deadly central line infections:
An estimated 80,000 patients per year develop catheter-related bloodstream infections, or CRBSIs — which can occur when tubes that are inserted into a vein to monitor blood flow or deliver medication and nutrients are improperly prepared or left in longer than necessary. About 30,000 patients die as a result, according to the Centers for Disease Control and Prevention, accounting for nearly a third of annual deaths from hospital-acquired infections in the United States.
Before we get to the CEOs, there are complaints from infection control officers (a parallel to the Quality Department for those of you in manufacturing… can you farm out quality to a department or is it top management’s responsibility, as Dr. Deming would have said?).
Seven in 10 said they are not given enough time to train other hospital workers on proper procedures. Nearly a third said enforcing best practice guidelines was their greatest challenge, and one in five said administrators were not willing to spend the necessary money to prevent CRBSIs.
I guess training takes time and money, but how much money does it really take? Since the ROI (if you have to think that way) is positive on preventing infections, isn’t that time and training a good investment in addition to being the best thing for the patients?
What role do CEOs play, since they don’t touch patients?
When hospital leaders decide to create a culture in which preventing infections is a priority, he added, nurses feel empowered to remind physicians to follow the checklist when inserting catheters, physicians are provided antiseptic soaps as part of their catheter kits and infection control personnel have the best tools to monitor patients.
“If anyone in that chain of accountability doesn’t work, you won’t get your [infection] rates down,” he said. “But it’s the hospital’s senior leadership that is ultimately responsible.“
Yes, it’s about culture and leadership… back to Deming again.
So why don’t CEOs get more involved? Dr. Pronovost argues that many of them are, you could argue, clueless about the issue.
Pronovost said part of the problem was that many hospital chief executives aren’t even aware of their institution’s bloodstream infection rates, let alone how easily they could bring them down.
How do CEOs not know about this?
After I posted this on Twitter yesterday, my friend @pujalords (a former Toyota guy) wrote in multiple tweets:
maybe it’s because they don’t want to know the real infection rates, so it’s easier to plead ignorance….or perhaps it’s because they don’t have meaningful incentives around patient quality outcomes… generic explanation is that hospital execs (as most execs) likely don’t spend time “on the floor” i.e., poor gemba mindset.
Great points. So what do we do? If too many hospital CEOs aren’t aware, how can you help? Maybe everyone needs to print this article and hand deliver to your local hospital CEO, even if you work there?? Or, go green and email it to them.