The aviation industry uses a checklist to maintain the safety of airline passengers. The use of a checklist has also been proven as a way to decrease hospital acquired central line-associated bloodstream infections. Yet the culture of our healthcare system does not allow this to become a unified standard of practice.
Captain Chesley “Sully” Sullenberger gave a stern lecture at the American Hospital Association’s Leadership Summit in which he urged those leaders to adopt the safety culture of the aviation industry. He said, “They must stop thinking of accidents as inevitable and start thinking about them as unimaginable.” Sullenberger is the man acclaimed for the Jan. 15, 2009 “Miracle on the Hudson.”
His quick decisions to avoid crashing came after more than 30 years of aviation improvements and safety training. The improvements involved standardization, adherence to checklists, and required a change in the culture to one that focused on safety. He said, “This culture change in aviation is much like the change that is needed in Medicine.” Lean Healthcare implementation includes all of these attributes and is becoming a way to address these issues.
So where has healthcare gone wrong?
The healthcare culture is a major barrier to quality improvement. Although Joint Commission has Patient Safety Standards which include a culture of safety, this culture is not being embraced by the healthcare community. Research studies and the stories I have heard from patients/families confirm this. We have not been able to get into the heart of our system to make the necessary changes in the culture for the safety of our patients.
Central line-associated bloodstream infections are costly and kill 31,000 patients a year in the United States. In May 2009, Secretary Sebelius of the Department of Health and Human Services (HHS), called on hospitals across America to reduce central line infections by 75% over the next three years.
As a way to make improvements in central line infections, a checklist was introduced to hospital ICU's at John Hopkins. The use of this checklist got the central line infections down to almost 0%, and was then implemented across the entire state of Michigan. As part of the success, the hospital had to undergo a culture change. This change allowed all members of the team to intervene when there was a concern over safety or the standard was not being met. This practice is not readily accepted in hospitals today.
What is wrong with our healthcare system and our government? It should not take 3 years to improve central line infections by only 75%, when we already have a standard of best practice that will prevent these infections? It is not OK to continue to put our patients at risk within the next 3 years while we try to meet this goal. After that, there will still be 25% or 7,750 patients that will get infections and die.
I do not understand the rational for HSS not striving for 0% infections when we know how to achieve that goal. I think the use of the checklist should mandatory and implemented as best practice in all hospitals.
As we continue the pursuit to improve our system, we are still faced with barriers that I believe need to be addressed. Lean Healthcare is a way to do this, but there also needs to be additional support and understanding of these barriers to make healthcare safe in America.
We would not get on a plane if the pilots were allowed to choose if they used a checklist.
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