Friday, October 29, 2010

The Culture of Lean Healthcare

We are all dedicated professionals with the safety of our patients at the forefront of our minds and yet failures continue to occur.

In my presentation, “The Human Side of Lean” the theme is about the “people,” our human side. I discuss how quality and the design of healthcare systems impact the culture and the way we do our work. It is all about the people.  Anyone who is involved in a serious adverse event is changed for the rest of their life. It alters the way they provide care and the trust they have in the system. Lean is an important part of the formula because the focus of Lean is on the people and the culture. Lean is an effective method to help people make improvements.

In a Lean culture organizations become learning environments and one of continuous improvement steered by the people

I know we are all on the same page in our efforts and devotion to provide excellence in patient care, but there are huge barriers to overcome to make that happen. Culture is the one thing that must change to make sustaining improvements. In June 2009, American Society of Quality’s (ASQ) White Paper on Health Reform supports this need for culture change. It states, “ASQ believes the most critical need of all in health reform is for meaningful, lasting changes in the deeply embedded cultures related to health and healthcare in the country.”

There are many who believe that the physicians are to blame for the culture of healthcare today, but remember they are also working in a severely flawed system. We have failed to give them a system they can trust. I believe some of the way physicians interact is due to these failed systems. Yes, they want it their way because some of the other ways do not make sense or offer the guarantee that things will happen as planned, on time with zero defects.   

It is our responsibility to make the systems work and to provide the structure and the tools to prevent the possibility of errors.  With the complexity of our systems, and the overload of information, it becomes impossible to give error free care without these changes.

Lean Healthcare strives for zero percent defects and provides the structure needed to improve patient care and support our team

We do not intentionally do harm to our patients, but it is an expected outcome. Hospital Acquired Infections (HAI)  are among the top ten leading causes death in the United States, and drive up the cost of health care by up to $20 billion per year. Research indicates that these infections strike hundreds of thousands of surgical patients and the percentage of patients acquiring these infections has steadily increased over the past six years.

In a speech by  Secretary of Health and Human Services (HSS) Kathleen Sebelius,  she discussed the 2008 National Healthcare Quality Report (NHRQ) reports on the quality of health care in America and challenged hospitals to work to reduce health care associated infections. Sebelius also called on hospitals across America to commit to reduce Central Line Associated Blood Stream Infections (CABSI) in Intensive Care Units by 75 percent over the next three years.

In the 2009 NHRQ report, they found that health care quality in America is suboptimal. The gap between best possible care and that which is routinely delivered remains substantial across the Nation. HAI’s are one of the most serious patient safety concerns. The HAI rates are not declining. Of all the measures in the NHQR measure set, the one worsening at the fastest rate is postoperative sepsis.

There is no urgency in fixing this problem. The culture of patient safety is a culture of the nation, not just the healthcare organizations. With $50 million in grants given to states in 2008 to help fight healthcare-associated infections (HAI), the CABSI goal should be 100% this year.

There are JCAHO standards on the Culture of Safety, and yet organizations have changed very little on how they deal with people who are involved in adverse event. They still look at the person who made the error rather than the system. After doing many root cause analysis, it became evident to me that this person is just the last person in a totally failed process. Disciplinary action will not fix the problem and will only further prohibit the reporting of events. Even with standards in place, there continues to be errors, they do not fix these issues or change the culture.

A culture of safety is an founding principal of Lean  

Sadly, in the March/April 2010 issue of Patient Safety, there is an article providing guidelines on what to do after an adverse event. Not only are we making errors, but we do a poor job supporting our clinicians to cope with this type of event.   

Every time there is harm to a patient, it has a life changing effect on the patients, families, providers, and leadership within these organizations. I know that eventually we will improve and figure out some of the answers, but I am committed to find ways in which we can do so rapidly and effectively.

Insanity is doing the same thing over and over again and expecting different results.
Albert Einstein

“There has to be a Better Way”
Lean Healthcare is an Answer

©2010 Carol Lepper Solutions for Lean Healthcare Inc.

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