Thursday, September 30, 2010

Lean is the Way of the Future in Healthcare

Donald Berwick MD, the newly appointed head of the Centers for Medicare and Medicaid Services (CMS) gave his first public speech September 13, 2010, to attendees of America’s Health Insurance Plans (AHIP) conference on Medicaid and Medicare. He called on leaders to join in the pursuit of “Triple Aim” to improve healthcare in the US.

Triple Aim has three goals:
1)     Improve quality of care with one of his priorities patient safety.
2)     Better health for populations.
3)     Reduce per capita cost by eliminating waste.

Lean Thinking in healthcare will address safety, the quality of care and will decrease costs.  

Our system is so fragmented that it is difficult to see the “whole” patient process. The quality of care suffers as a result. Each unit of care functions independently creating poor communication with critical patient information being lost. Healthcare waste such as duplication, rework, and movement further dilute the clarity of the care process.

The implementation of Lean Thinking will streamline patient care, and remove waste. Lean identifies the patient experience as a “whole” system rather than separate functions. This becomes a team method of providing care. This way of seeing care from a new perspective, makes the process clear to all the caregivers.

Communication breakdown is a major contributor to patient errors. To reduce these failures, communication standards are developed as part of the new streamlined process. This helps eliminate much of the guesswork and assumptions that often drive how decisions are made regarding care.  

As steps and waste are removed, the quality of care improves. Each step that is removed decreases the potential for errors. As this occurs the cost per capita of care goes down.
The Lean healthcare culture and philosophy provide the environment in which these results can be achieved. I believe

 “Lean is the Way of the Future in Healthcare”

©2010 Solutions for Lean Healthcare Inc.

Thursday, September 9, 2010

Checklists Continue to Improve Patient Safety

Surgical Checklist Reduce Deaths Washington Post, January 15, 2009

A study prompted by the World Health Organization (WHO) and Harvard School of Public Health showed that the implementation of a surgical checklist throughout eight countries improved the death rate by more than a third. Atul Gawande, a Boston physician who led the study said, “A checklist seems like a no-brainer, but the size of the benefit is dramatic.” If every OR in the US implemented this checklist, we could save between $15 billion and $25 billion a year on the costs associated with surgical complications. Surgeons are discovering the use of a checklist similar to an airline check is a simple tool that can prevent errors in the operating room.

Donald Berwick, currently the head of the Centers for Medicare and Medicaid Services (CMS), and past President of the Institute of Healthcare Improvement (IHI) supports the use of a checklist in the OR. He said, “I cannot recall a clinical care innovation in the past 30 years that has shown the results of the magnitude demonstrated by the surgical checklist. This is a change that is ready right now for adoption by every hospital that performs surgery.” Very few U.S. hospitals were using the checklist and Berwick planned to introduce it to 4,000 hospitals.

This WHO study confirms that the use of a checklist improves patient outcomes. This is another example of a proven best practice standard that is easy to implement, but there is no mandate for US hospitals to use such a list. JCAHO is considering including more of the steps, but as of the July 1, 2010, the Joint Commission National Patient Safety Goals did not include a complete safety checklist. The current goals that are in place regarding wrong site surgery, (WSS), are non-prescriptive allowing hospitals to implement their own policy and method to meet the standards. It is obvious that these Joint Commission standards are not providing safety to our patients as evidenced by the fact that we continue to have critical surgical errors. California is one example.

Avoidable mistakes rise in California despite hospital efforts San Francisco Chronicle June 2, 2010

In the latest fiscal year, California hospitals reported 197 cases of "retained foreign objects" for a total of 350 incidents over the past two years. Three years ago, a new law gave state public health officials the authority to issue administrative penalties for violations that put patients at risk of death or injury. California intends to use $800,000 of the almost $3 million in such hospital fines that have been collected since 2007 to research how to help hospitals reduce their chances of leaving objects behind after a surgery or procedure. I ask why we are spending this money to do more research, where there is a proven method available.

It is difficult to measure the current state of errors since there is limited published information. The state of California is an exception. They publish fines that are levied to their hospitals regarding surgical errors on their website California Healthline. As bad as these reports may seem, I applaud California for even making this data available. I believe that transparency is a key factor to improving our healthcare system. This is one of the best sites that provides detailed information daily on all healthcare issues occurring in California and nationally. It would be nice for other states to have a site like this.

The fact remains that we are rich with technical advances and exceptionally talented healthcare professionals. It is beyond imagination that we can let the state of our system continue. The use of a checklist is standard work made easy and reliable every time. It has proven to save lives.

Is anyone really listening to what is happening in our healthcare system? Surgical errors continue to plague our nation’s healthcare organizations, and it seems as if even trying to make improvements is in constant chaos.

On April 2010, Ontario, Canada made the use of the checklist mandatory.

©2010 Solutions for Lean Healthcare Inc.