Healthcare is often stuck in the mindset that's considered outdated in lean manufacturing settings — the old idea that better quality must inherently cost more.
In the automotive industry (and the rest of manufacturing), companies assumed there were tradeoffs. When Toyota started importing high-quality low-cost cars, many automakers thought this was impossible. Conspiracy theorists thought that Toyota was “dumping” products at a price lower than their cost, which is illegal. It took time for companies to realize that Toyota was getting better quality through better processes — not by having more quality inspectors. Through error proofing (“poka yoke”) and other methods, Toyota could “build it right the first time.”
In healthcare, hospitals often rely in inspections to “catch” errors rather than working to prevent them. This can be seen in laboratories, blood banks, and pharmacies — it's considered better to have more inspection steps. If a double check is good, a triple check is even better, or so the thinking goes.
One error that can occur in a surgical setting is leaving objects inside a patient that remain after the patient is sewn up. In the linked article, a technology solution is being implemented:
It's a medical mistake that strikes nearly 1,500 people every year — they wake up from surgery only to find out later that something's been left behind.But Clarian Health is now using a new, high-tech approach to try and prevent that from happening, 6News' Stacia Matthews reported.
Does this really require a technology solution? What about better processes? Many hospitals go through a process of counting items after surgery, using a checklist of items that were brought into the operating theatre.
This article talks about the counting in hospitals:
Hospitals typically count everything three times — once during set up, again before surgery and immediately after. Regan reported that sometimes that count is wrong. He found something that can stop that from happening.
Do these checklists always get used? Maybe not… so we have to use technology? This adds cost — it's an inspection. This type of method for quality improvement will lead to higher costs than a process-driven solution.
Doctors and nurses at Clarian North use a special wand that, when waved over a patient while they're still on the operating table, can pinpoint any sponges or gauze left behind using micro-biocompatible tags.
So now we have to buy more expensive sponges with tags in them and the wand. This is probably cheaper than the cost of re-opening a patient to retrieve lost items (and it's better for the patient), but it's too bad we can't find a way that ensures perfect quality without this extra investment.
“I like it because I can feel confident that I haven't done any harm to my patient,” said Clarian North Dr. Amy Moon. “I know that when I leave the case, 100 percent, for sure, that there is no doubt in my mind.”
So is this “inspection” or “prevention”?? It feels like inspection to me… and a costly one, at that.
Clarian Health is one of the first in the nation to use the technology.
Will we be seeing more of this? Are we prepared to pay for this? Or can we find a less expensive way that's just as effective? Does anyone have experience working in this area, preventing items being left inside patients?
Maybe there is no better way… this article talks about a hospital being fined for this surgical error and describes of the process:
According to the incident report, the nurse and scrub technician – who were required to count the sponges before the surgery and after it was completed, before the incision was closed – both said they followed the required procedure. However, the technician “stated that this particular case was very bloody and the lap pads (sponges) could have stuck together.”
The doctors also stated that counts are not always sufficient for preventing sponges from being left behind. Of the cases that the Boston doctors looked at in which counts were performed, 88 percent involved a final count that was erroneously thought to be correct.
The chips in the sponges are said to be the size of a penny. They undoubtedly cost more than that! I just wouldn't be ready to give up yet on a low-tech process-driven solution that would actually cost less.
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