I've been following the National Patient Safety Foundation's listserv for a few weeks. As suggested by Dr. David Lawrance, at University of Illinois at Urbana-Champaign, the conversations and interchange are professional, thoughtful and helpful.
A great comment came through yesterday from Catherine Carson, Director, Quality & Patient Safety at Daughters of Charity Health System. The topic was benchmarking, and the initial question was "Are you willing to share your falls benchmarks?"
After a number of answers were submitted, Catherine replied:
A thought for this email stream: When the goal is zero – as in zero hospital-acquired infections, or falls – why seek a benchmark? A benchmark would then send the message - that in comparison to X, our current performance level is okay, which is a false message when the goal of harm is zero. So be careful when reporting benchmarks, because you are sending a message of acceptable performance.
I say, "Brava!" It is certainly all right and helpful to look at the process improvement experiences of other places, but don't compromise when it comes to setting your own standard. For categories of preventable harm, the only intellectually defensible goal is zero.
Even 'six sigma' standards are not 'zero.' Why not accept 'three or fewer' surgical site infections in every million joint replacements?
ReplyDeleteHow would you feel if you were were one of the three?
ReplyDeleteSeriously, there are some kinds of of harm that will always have some small irreducible statistical probability. But there are others for which zero is possible.
For example, there really should be no wrong-site surgeries.
The state of Michigan hospitals and others have shown that you can also have zero central line infections for extended periods of time.