Guest Commentary: An outsider's suggestion for a zero-tolerance policy made for safer patient care
Sometimes it takes an outsider to point out an uncomfortable truth. I encountered that bit of wisdom early in my career, running my first hospital in central Indiana in the mid-1990s.
One of our board members, an auto engineer, couldn't understand why the hospital didn't set a zero-tolerance goal for medical errors. If his company could demand 100% reliability for air bags and engine starters, why couldn't hospitals do the same for trauma care and surgeries?
The observation began my 20-year quest into that most vexing of healthcare issues: patient harm rates that remain unacceptably high.
Soon after our board member posed his unsettling question, the Institute of Medicine released its famous report, To Err is Human. It laid out the shocking finding that up to 99,000 U.S. hospitals deaths a year were caused by medical error. Some subsequent studies showed even higher levels of preventable deaths.
My hospital was then part of a system, and I still remember our CEO being shaken by the report. He said acceptance of error in healthcare had to change.
A year later I found myself designing a new hospital in the Indianapolis suburbs. Here, I thought, was a chance to change things. We would attack medical errors at their roots through intelligent building design, state-of-the-art medical equipment, carefully trained staff and leaders committed to a culture of safety.
We have been immensely proud of that new hospital, even winning recognitions for patient safety. But I found out the nemesis of avoidable patient harm is harder to beat than I imagined.
The 2000s would bring new research that opened my eyes even more to the dizzying complexities of patient safety, making me question the ways provider organizations carry out their vital healthcare mission.
As I underlined and highlighted my way through books such as Leadership and the New Science and Beyond Heroes, and put some of their novel suggestions into practice, I've been inspired. I think we have our nemesis on the run.
Certainly we've had encouraging successes at Indiana University Health. We now have metrics and quality dashboards in place that tell us about every harm event and measure the effectiveness of our safety efforts. (Information most everyone lacked when my career began.) And IU Health certainly isn't alone in making these advances.
Another initiative at IU that's paying off is the use of Lean operating processes to improve quality of care. After committing to a transformation of our operating system four years ago, we've seen individual hospital nursing units cut patient harm incidents to zero; ambulatory diagnostic centers reduce patient appointment wait times from months to days; and physician offices re-arrange their workday so not a single patient phone call, email or fax goes unanswered.
The impact on patient care has been heartening. In the past year alone, IU Health's 14-hospital system cut patient harm incidents by 18%.
In my patient-safety journey I've had to come to terms with hard-to-swallow findings. My father was a small-town doctor and my mother was a nurse, so one finding was especially tough on me: In healthcare, the biggest obstacle to avoiding patient harm is none other than healthcare workers themselves.
We're working to change that as well. Research based in complexity theory shows that, no matter how much training and experience doctors, nurses and administrators have, or how hard they work, if they hope to have a shot at zeroing-out patient harm events they need re-engineered processes and some critical soft skills. Namely, the ability to self-organize, work well in teams and consistently respond with the right moves in the often chaotic world of patient care.
So imparting these vital soft skills with a "standard work" approach has become a priority. We're building teams skilled in flawless "handoffs"—moving patients from one caregiver to the next—and so attuned to their jobs they can adjust on-the-go when things turn chaotic.
A zero-tolerance goal for medical errors? I think I can finally say to my longtime engineer friend: Bring it on.
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