A Lean Guy Watches CBC’s “Rate My Hospital”
“Approximately 8 to 10% of the individuals who walk through our doors are being hurt by us,” says David Musyj, CEO of Windsor Regional Hospital. That's one of the first things you hear in this CBC program “Rate My Hospital,” which aired earlier this month in Canada. See also this page on the investigative report.
The patient safety challenges are pretty universal across modern Western countries. This isn't just a Canada problem. You see similar estimates of patient harm in Canada, the U.S., England, Germany, the Netherlands, etc.
From the CBC text:
Unlike the United States and the U.K., Canada remains one of the few developed countries that has kept basic information on how well hospitals care for you largely hidden from public view.
The data and information are “largely hidden from public view” in the U.S., generally speaking. The grass always seems greener…
The story talks about the “thousands” of Canadians who die each year from hospital acquired infections. There's one particular story about a woman who died just weeks after contracting a c. diff infection through getting routine surgery at a Vancouver hospital. The widower says people at the hospital were “compassionate” but “nobody took any responsibility.” The hospital didn't publish infection rates (something that's not common here either) and, while some provinces share data, it's not always expressed in equal terms. The UK's NHS has a national website that can be searched to view infection rates allowing people to see where mortality rates are highest.
Dr. Dick Zoutman (who I have met in my travels through Ontario) says hospital acquired infections could be the FOURTH leading cause of death in Canada. 220,000 will get infected each year. They expect between 8,000 to 12,000 dying each year from this “preventable” disease.
About seven minutes in, the story goes to Saskatchewan, where they are “using methods perfected by the automaker Toyota” to fight these super bugs. Maura Davies, the CEO of the Saskatoon Health Region, says “This is like nothing we've ever experienced. We used to report our results and make excuses… and now we have to have a corrective action plan that says here's how we're going to turn it around.”
The hospital uses DAILY data (discussed in management huddles) to drive improvement. “Are people washing their hands? Do we know if they are washing them the right way?” asks Davies.
You can hear a person being taught to wash hands using the Training Within Industry methodology, as they reference “key points” and “important steps.” Read more in this book Getting to Standard Work in Health Care: Using TWI to Create a Foundation for Quality Care. They actually have people observing to see if it's being done the right way. Hand hygiene reports are posted online… transparency leads to pressure to get better.
In the third segment, they talk about an iPhone app for emergency departments in Alberta. A woman chose to go to a hospital that had posted an 18 minute waiting time to see a doctor, choosing that over their preferred hospital that posted nearly a three hour time. At the “18 minute” hospital (supposedly a real time piece of data), they actually waited three hours to be seen and then waited hours more to be admitted… but, in the mean time, bled to death due to an aneurysm.
“Is the app an improvement or a distraction?” The daughter of the woman who died says she thinks the app seems more like an effort to look good or to be “fake.” The app won't tell you if patients are “parked” in the hallways. A doctor says the most dangerous thing in Alberta hospitals is the waiting times.
From a survey of nurses across Canada, ”
- 40% feel burnt out” and they feel “stretched to the limits” and “it's impossible to provide safe care when you're so tired.” 62% feel like they are understaffed. “Our equipment is falling apart” and attempts to fix things are met with “punitive measures” and the government only cares about “cutting costs and saving money.”
“To speak up is to risk being bullied and being threatened with job loss.”
Those are all very serious cultural problems that get in the way of improvement… again, not just Canada. Randomly running a bunch of improvement events or using just some Lean tools won't fix these problems if we don't address the culture and eliminate the culture of fear.
The CBC host says that provincial governments in many cases, encouraged hospital CEOs to NOT respond to questions about what they are doing to prevent surgical errors or infections. But, the CEOs of “132 hospitals responded to us anyway.” 75% of the CEOs didn't respond.
The last piece shows CEO David Musyj in scrubs in the workplace, “not an Undercover Boss per se” (as we had an misunderstanding about before). I give him credit for being “embarrassed” by low hand hygiene numbers and for working to improve things rather than hiding the problem, bringing rates up from 40% to 90% (and they are still working to get to 100%).
Musyj says meaningful change will happen once Canadians start demanding answers.