A number of you have emailed me, yes I'm aware of this horrible, ridiculous development that followed earlier reports of the success hospitals were having in reducing infections and improving patient care through “stupid checklists” (a form of Standardized Work) that aren't stupid at all. They're so simple, they're brilliant and they are saving lives, I mean WERE saving lives.
As Dr. Atul Gawande wrote about in the New York Times, a really misguided federal agency has shut the program down for some unbelievable reasons. You just have to read his column and then come back here.
Gawande pulls few punches in setting up the piece:
“In Bethesda, Md., in a squat building off a suburban parkway, sits a small federal agency called the Office for Human Research Protections. Its aim is to protect people. But lately you have to wonder.”
I learned about this New Year's Eve and I tried to not let it ruin my holiday, nor did I want to start the blogging year on such a negative note. It must be incredibly frustrating for the people who have been working on this initiative — to be making such great progress with a method that is repeatable and transferable to other hospitals and to forced to shut it down. Will the government pay for the care of patients who get infections as a result???
Maybe the fault in the Johns Hopkins program was that they purposefully set up this medical research structure of “we're using checklists for these patients and NOT using them for these… let's compare the results.” That seems to be the tradition in medical research… it seems to be a bit different than the Lean notion of kaizen, don't you think? With kaizen, we would start with checklists in a small area, pilot to see the results, and then, given that it works, spread it to other areas as quickly as possible. Would the government see that any differently? I'd have to think you can't pilot changes in a small area first… but then again, if something works, why wait? To that end, why is the government not using its muscle to insist that EVERY hospital use the checklists method instead of slapping those who are, partly because it might make some doctors look bad?
Argh, there's more I want to write, but I need to step away from the keyboard and calm down again. This really worries me, the impact this might have on Lean methods and other process improvements that are going on in hospitals. I'd hate to think people would get scared and think it's safer or better to do nothing… the government doesn't seem to care if you do nothing to improve hand hygiene and prevent infections.
Gawande summarizes some of the history of healthcare quality improvement:
Scientific research regulations had previously exempted efforts to improve medical quality and public health â€” because they hadn't been scientific. Now that the work is becoming more systematic (and effective), the authorities have stepped in. And they're in danger of putting ethics bureaucracy in the way of actual ethical medical care. The agency should allow this research to continue unencumbered. If it won't, then Congress will have to.
Ah the irony, as improvement becomes more “scientific,” it somehow becomes more threatening to the feds. As I'm going through final editing of my book, this is really making me wonder about how “Standardized Work” and “kaizen” are really going to be implemented more widely in this industry. Maybe the hospitals who have done well so far should be lucky to have been “under the radar” if you will? Maybe we need less promotion of Lean and more action. What the bureaucrats don't know can't hurt them… but them taking action on stuff they know little about… that hurts patients.
Other blogs on this topic:
- Wachter's World
- Gemba Panta Rei
- To EHR is Human – Great headline, “Bureaucracy Kills!”
- Health Care Renewal
- Health Beat
- Health Care Organizational Ethics
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