Two recent stories about quality of care have caught my attention, and they should catch yours, too. They show how creativity and a willingness to try new systems can lead to better outcomes for patients.
The first article, in the Jan. 9 Chicago Tribune, involves the OB/GYN staff at Evanston (Ill.) Northwestern Healthcare. Doctors and nurses there are being trained to follow the safety checks that airline pilots use prior to making a flightpart of a national trend. Some hospitals, desperate to do what they can to solve the problem of medical errors, are adopting aviation practices designed to foster a team environment where everyone feels free to point out mistakes and suggest solutions.
As any reader of this magazine knows, the problem being addressed is severe. Medical errors are killing tens of thousands of people every year. Anyone who enters a hospital does so at his or her peril. Even Dennis OLeary, the outgoing president of the Joint Commission, thinks so. He told this magazine that he wouldnt want to be admitted to a hospital as a patient without having someone along with him to help monitor his care (June 5, 2006, p. 8). I would bring someone with me and have them stay the night, and I would always be asking questions. I think caregivers find that helpful, and it prevents them from making human errors. If I go in a hospital, I know Im vulnerable, and I will do what I can to protect caregivers from unintentionally harming me. If Im apprehensive, Im the same as John Q. Public, OLeary told our reporter.
Ian Grable, a maternal and fetal medicine specialist at Evanston Northwestern, told the Tribune: The complexity of medicine has gotten so much greater that its not possible to do it alone. It needs to be a team all working together toward the same goal.
Safer Healthcare, a Denver-based consulting firm, tailored a four-hour program for the Evanston staff. So far, all labor and delivery room staff have completed the training. Later this spring, operating room staff will follow suit.
Grable says, The whole idea of crew resource management is that we all have expertise and know our jobs, but we dont work together as a team. In medicine as in the airline industry, there is a hierarchy. People dont question those who are more experienced. In the trenches of labor and delivery, we need to eliminate the hierarchy, work together, know each others roles and be able to communicate on the same level.
Communication is extremely important in any business, but where lives are concerned, it is essential. Thats why Evanston Northwestern now schedules meetings throughout the day with all labor and delivery nurses, physicians and even secretaries. Grable explains: We assess each patients condition when they came in, where they are now, and make recommendations. When doctors dont communicate with each other, mistakes can happen. They may be intensely focused on an issue but dont know whats happening around them, he says. An example is when the anesthesia team and surgery are working independently. If something is not going well on the surgical side, then the anesthesiologist needs to know and make choices.
Not everyone necessarily agrees with the idea of employing aviation safety techniques in hospitals. Richard Cook, associate professor in the department of anesthesia and critical-care and director of the cognitive technologies laboratory at the University of Chicago, told the Tribune, We are still waiting for conclusive data saying that this specific type of aviation training makes the OR or hospital a safer place for patients. ... But its far from clear that training conducted over a few days by a few highly paid consultants makes a great difference.
Aviation isnt the only industry being emulated by healthcare organizations these days. The other story I read, in the Nov. 14, 2006, Wall Street Journal, is about how a British hospital adopted some of the techniques of race-car pit crews. The story starts with drama: After surgeons completed a six-hour operation to fix a hole in a boys heart, Angus McEwan supervised one of the more dangerous phases of the procedure: transferring the fragile 3-year-old from surgery to the intensive-care unit.