Sunday, March 17, 2013

Where things stand . . . and what comes next.

A recent article by Bob Wachter, Peter Pronovost and Paul Shekelle in the Annals of Internal Medicine gives a helpful update about the state of efforts to improve patient safety.  These are people who know of what they speak, as researchers, practitioners, teachers, and observers.  (I count them among my best teachers, by the way.)

Read the whole thing, but note this conclusion:

A decade ago, our early enthusiasm for patient safety was accompanied by a hope, and some magical thinking, that finding solutions to medical errors would be relatively straightforward. It was believed that by simply adopting some techniques drawn from aviation and other “safe industries,” building strong information technology systems, and improving safety culture, patients would immediately be safer in hospitals and clinics everywhere. We now appreciate the naivety of this point of view. Making patients safe requires ongoing efforts to improve practices, training, information technology, and culture. It requires that senior leaders supply resources and leadership while simultaneously promoting engagement and innovation by frontline clinicians. It will depend on a strong policy environment that creates appropriate incentives for safety while avoiding an overly rigid, prescriptive atmosphere that could sap providers' enthusiasm and creativity.

Well put, I think.  I'd like to go a step further, though, with an addendum that reflects my experience as CEO of a hospital.  An effective patient safety program requires that a hospital become a learning organization.  As the folks at Cincinnati Children's Hospital put it years ago, "We want to be the best at getting better."  A learning organization is one in which all members of the staff, not just frontline clinicians, participate in process improvement.  In our hospital, we often found that it was the housekeepers, food service workers, security guards, supply folks, and transporters who noticed and called out important problems in the delivery of care.  Bob and Peter and Paul didn't mention these non-clinicians in their summary.  I don't think they would disagree with me, though, and I respectfully offer this addendum with the hope that all of us remember to explicitly include them as we think about what should come next.


Beverly H Rogers said...

From Facebook:

As a pathologist, I never forgot your story of the transporter who stimulated a redesign of specimen transport to pathology in your shop, Paul. In addition, I recently read that it was housekeepers at one hospital who had the best ideas for room cleanliness and hand hygiene, and wound up teaching the clinicians.

Kaimer said...

Well put. In my experience the ancillary staff were sometimes more helpful with providing valuable information about the patient because they didn't only look at the clinical issues as the caregiving staff did. They saw and recognized very imporant behavioral, psychological and social issues in the treatment experience of a patient. This was because they looked at the "whole" patient, not just the "clinical" patient. This is one of the most important aspects of patient care that we too often dismiss...The observations of all staff levels in the delivery of care is just as important as those of the caregivers. Thank you for mentioning this important factor.

Bill Reenstra said...

From Facebook:

Paul, I very much like your point. I would argue that clinicians have a hard time accepting the fact that other members of the hospital staff can/must play a role in process improvement. As I read the summary from the artcle, it seems clear to me that the authors are blind to this point. This mindset of clinicians that is taught to medical students and I have seen in most all of the clinicians I worked with during my career, is the largest impediment to process improvement in US hospitals.

T.A.Ferrara said...

Clinical staff can lead and set example. If we do not pay attention and honor the remarks of all the non-clinical staff, we are ignoring information which will make our care better and our patients safer.

Peter said...

A quick reflection re: the need to include EVERYbody in changing the entire environment of care delivery. I once cared for a retired Navy Admiral, who became confused at home. I took their call and scurried to the hospital to meet them. He was a fairly fit man of 60 or so with prostate cancer. When I got to the E.R., I learned he was already on the ward. I rode and ran to his side, only to find that he'd been handcuffed to his bed! Two security personnel had pinned him down and cuffed him, lest he fall or hurt an 85 lb nurse. His serum Calcium was 13.8 mEq/l.

It took me weeks to convince the family not to sue.