When I recently interviewed Paul O'Neill and Dr. Richard Shannon about the amazing improvements in patient safety that had been made in the Pittsburgh Regional Health Initiative organizations, they each seemed a bit frustrated that these simple, yet effective, methods for reducing hospital acquired infections (HAIs) hadn't spread more widely, more quickly. Dr. Shannon has repeated his results in Philadelphia (see the second of the two charts below, with the first being the improvements achieved when he was at Allegheny General in Pittsburgh).
This article (“Effort To End Surgeries On Wrong Patient Or Body Part Falters”) talks about how simple proven methods to reduce surgical errors aren't being adopted very widely.
Dr. Shannon was making dramatic improvements in 2002. The story has been published in journal articles, books, and DVDs. How long will it take for YOUR hospital to achieve these results? What are the barriers? Surely, they are managerial, not technical…
From the article:
What seemed pretty straightforward in 2004 now seems more complicated. “I'd argue that this really is rocket science,” said Mark Chassin, a former New York state health commissioner and since 2008 president of the Joint Commission, which has issued refinements to the 2004 directive. Chassin said he thinks such errors are growing in part because of increased time pressures. Preventing wrong-site surgery also “turns out to be more complicated to eradicate than anybody thought,” he said, because it involves changing the culture of hospitals and getting doctors — who typically prize their autonomy, resist checklists and underestimate their propensity for error — to follow standardized procedures and work in teams.
So what are we doing to change the culture? How long will it take? What still remains to be done?
Another quote from Dr. Peter Pronovost, a leader in this area:
“It's disheartening that we haven't moved the needle on this,” said Peter Pronovost, a prominent safety expert and medical director of the Johns Hopkins Center for Innovation in Quality Patient Care. “I think we made national policy with a relatively superficial understanding of the problem.” Pronovost suggests that doctors' lip service to the rules, which he calls “ritualized compliance,” may be a key factor. Studies of wrong-site errors have consistently revealed a failure by physicians to participate in a timeout.
How can we change the culture from an old automotive industry style “make the numbers” culture of a “safety culture,” like they have in aviation?
“Health care has far too little accountability for results. … All the pressures are on the side of production; that's how you get paid,” said Hopkins's Pronovost, who adds that increased pressure to turn over operating rooms quickly has trumped patient safety, increasing the chance of error.
So it's not as simple as that “stupid little checklist,” eh? Adopting the new tools without the changes in management mindsets and culture are going to get you the same results. This was true in a car factory and it's true in a hospital. So what do we do?
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