A simple innovation to improve hospital quality and safety

When I moved from the news business, writing about crime and investigating corrupt politicians and police officers, to the healthcare industry in the mid-1970s, we measured only the basic hospital performance indicators — including census, staffing, inventory, days in accounts receivable and average length of stay. The data was not in real time by any stretch of the imagination. By the time the information was produced and distributed to managers, the horse was already out of the barn and in the next county.

Today, we measure almost everything. The question is: are we getting any better in terms of quality and safety? Are we now paying too much attention to the numbers and not enough to the people?

We are certainly better at collecting and producing data in a timely manner. Financially, most hospitals are better. But what about the quality and safety issues? Are our patients safer? Do they receive better care?

It is not like we don’t have a multiple of compelling reasons, including financial survival. Quality, safety, and patient satisfaction will drive future levels of reimbursement from the government and commercial payors. It is imperative that we get on top of this problem once and for all.

Before we start talking about the costs of achieving success, we should remember that it all revolves around people and process. As an industry we have spent hundreds of millions of dollars trying to address quality and safety issues and we are still not even close to where we need to be. Maybe it is time to try a new approach.

A leading chemical industry safety expert who consulted with several hospitals on quality and safety said she was stunned to see how little transparency there was in the hospital quality improvement process. After the attorneys and risk managers charged into the breach, scrubbed the scene and admonished the participants, there was very little honest discussion about what went wrong and how it could be fixed so the events did not happen again. Her overarching theme is startlingly simple: what we have been doing is not working and the outcomes will not change unless we rethink our entire quality improvement approach, sans the lawyers and risk managers. It is not that difficult, she said. Do what other industries are doing.

Proctor & Gamble Chairman and CEO Bob McDonald emphasized in a recent speech that innovation was the way of the future. Only 10 of America’s Fortune 50 companies in 1955 are still in business today. The rest failed to innovate, he said. Hospital leaders, especially those who feel invincible, should take note. The speed of change is moving at a significantly faster pace today, especially in healthcare, and the demise of organizations will come much sooner.

If we cannot innovate to solve our troubling quality, safety and cost challenges, who will be around in 10 years? What can we do now that successfully changes our current performance trajectory and inevitable failure rate?

Maybe we should start by making it mandatory for every nurse, doctor, pharmacist, patient care aide, and housekeeper to think of each patient as a member of their family, someone they love and want to protect — a new hospital Golden Rule. The other obstacles to quality and safety that we have created – complexity, cost, alignment – are just excuses for not trying to innovate. Often, doing the simple stuff is the better way to care for our patients.

Maybe it is all about people, process, and a willingness to innovate.

John Self is an executive recruiter for the healthcare industry and can be reached at JohnGSelf Associates.

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  • http://twitter.com/Colin_Hung Colin Hung

    A very insightful post and you ask a very key question: are we as patients and providers safer than before. Certainly the technology of medicine/care has improved, but can the same be said for the processes around healthcare safety and quality? The answer is unclear.

    You also raise another interesting point – that healthcare should look beyond it’s own boundaries and learn from the other industries/businesses who have tackled similar problems. It’s true that healthcare is unique, but that doesn’t mean best practices from others can’t be studies and adopted.

  • Will

    In hospitals, the underlying attitude is “Go, go, go! Get that _________done!” Not exactly what you would want if it were you or yours on the table/bed.  Why is this? It is because the money flows to those who do the most stuff, see the most patients. Until that incentive changes, there will be no significant changes. Follow the money.
            The Time-Out came to surgery via the aero-space business, as i recall. Anyone want to fly before the plane/crew has been systematically checked to see that it/they are ready to fly?  Try slowing down a procedure while you do a checklist—–you won’t be in that job long.
            I had hoped to find a simple innovation that would improve hospital quality (like hand washing) in this artilce. Alas, i didn’t.


    Mr. Self, I certainly agree that the so-called quality assurance measures being relied upon by our nations’ hospitals are horrendously expensive, time consuming, paper tigers and—in house risk management and Joint Commission—are not achieving hard practical results for the
    patients.  Like you, I believe that individual work ethics and integrity of hospital personnel could benefit from more frequent applications of the “golden rule.”  In fact, I ran a quick scan of the text of The Medical Profession Is Dead and the Doctor Is “Critically ill!”, and found the “golden rule” referenced ten
    times.  One of them is as follows:  ‘No other area of medicine could benefit more, from application of the golden rule, than end-of-life care throughout our nations’ nursing homes and skilled care facilities.’ —Alan D. Cato MD, F.A.A.F.P. (retired), and author of The Medical Profession Is Dead
    and the Doctor Is “Critically ill!” (Oct., 2010) Amazon Books.com

  • GeoffryLee

    Having attended an IHI (www.ihi.org)  meeting in Dallas several years ago, I worked with doctors, nurses and administrators like myself from the US Great Britan, Holland and Spain.  To a person, we all agreed that the ‘system’ is broken.  Having recently been in the hospital environment after managing a large multiphasic clinic, I was dumfounded at the missed Dx, duplicate EHR #’s, patients discharged with page 7 of someone else’s medical record, discharged with the wrong meds not to mention poor doctor/patient communication. There are a lot of good, caring, highly professional people in our profession; however, QA issues (even hand washing ) doesn’t seem to be addressed effectively. I have dressed out for numerous surgical proceedures, rotated thru the ED as well as ICU, along with monitoring patient in rooms, as I had to personally know what I was dealing with..so I know that there are a lot of excellent professionals out there…but….

  • http://profile.yahoo.com/4I2HWXUGUD35TDAO7A6T4HI2SA jennifer

    While I generally agree with Mr Self’s thesis, I respectfully differ with his conclusion.  The “Golden Rule attitude” will not fix even one broken process, much less cure a sick system.  Direct patient care is already permeated with caring and compassion — until the caregivers burn out because the system makes it too hard to do the right thing.  The outside expert did not tell you anything that you could not have heard in any staff break room, but she has more credibility because her consultation had a dollar cost directly assigned.  Corporate exhortations to “be nice to our customers” only offend the voiceless caregivers who are already working themselves to death trying to take care of people in an inefficient, irrational environment.  The lawyers and risk managers are not obstacles in our pathway to improvement.  They are participants, because they show us where we are failing.  

  • http://www.facebook.com/people/John-G-Self/1354275188 John G. Self

    I understand that “caring” will not fix the broken processes.  I also understand that to refer to the American healthcare “system” is a very generous description since we are, in reality, a bunch of silos focused on sick care with perverse incentives regarding outcomes.  But central to any sustainable change  in each organization’s performance is their culture — and their values.  I have noticed that hospitals that excel are the ones whose CEO is an evangelist for quality and safety — who talks about it, preaches about it — constantly. Yes, you must have committed nurses, aides and other care team professionals who get it — but if the CEO does not set the example, and if patient safety is not central to every thing that is done,  you are left with the losing proposition of bottom up change and that rarely improves anything.

    Healthcare leadership and its impact on performance is an issue that is prominent in my blog at HealthCare Voice.  http://www.johngself.com/healthcarevoice/

  • http://pulse.yahoo.com/_GJCNF5QLKW7ROYAZZGB7HFH57Y jamesp

    Mr. Self, I DO see every patient as a family memebr and ask myself, Would I tell this person the same thing if they were my wife/brother, etc?

    The BIG problem I have w/your piece is, “The other obstacles to quality and safety that we have created – complexity, cost, ”

     To quote Tonto, who is “WE,” kemosabe????

    I as a physician did no such thing. Politicians/attorneys/administrators/legislators, i.e. THEY.. not WE did so!!!!   The five most overused words in this nation are, “There oughta be a law!” Be careful what you ask for!

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