When I was reading the Patient Safety and Quality Healthcare magazine, March/April 2010, I was struck by how the foundation and Lean concepts are related to patient safety. While Lean Healthcare boasts of increased efficiency, decreased costs, I have not seen the same zest or specifics about how Lean improves Quality and Patient Safety.
As a healthcare leader in patient care and safety, my experience with Lean confirms that implementation of Lean concepts will improve patient safety. The founding principles of Lean methodology are being brought forward in the literature as a venue to improve patient safety.
Continuous Improvement and Implementation of Best Practice through Standardization
Current research has proven that evidence based practice makes a difference in the quality of care. The Michigan Keystone project that focused on central line-associated blood stream infections (CLABSI) is one example. By standardizing best practice interventions, this project resulted in an estimated 1,800 lives, $281 million saved and 140,700 fewer hospital stays.
Today this program is known as CUSP, a comprehensive unit-based safety program. CUSP a collection of key changes to improve care practices related to CLABSI’s, and is implemented at the unit level. By moving the implementation to the unit level it supports the Lean theory that establishing best practice begins with the clinicians who are performing the work. Continuous improvement strategies are performed throughout the different facilities in Michigan as each facility implements this program the results are shared and evaluated.
Visual Workplace and Human Factor Engineering (HFE)
HFE is a science that studies how we interact with our environment and with each other and strives to optimize those interactions. It looks at ways to help us do the right thing. The writings of Donald A. Norman professor at the University of San Diego and Northwestern University, and Kim Vicente professor at University of Toronto state that there are two types of knowledge.
1) Head knowledge, is what we contain in our human memory and is the type of knowledge that healthcare has focused on. The depth of knowledge needed and volume of information processed daily makes relying on our memory a flaw in the assumptions about our ability to provide error free care.
2) Knowledge of the world is the knowledge that is part of our environment. This knowledge creates mental models based on our past experiences and is used as part of our decision making process.
As healthcare becomes more complex delivering safe patient care relying solely on these types of knowledge becomes impossible. One important rule of HFE is to make things visible, which is part of the visual workplace used in Lean Healthcare. The visual use of tools gives us clues on what is the right thing to do.
Color coding is one method of using visuals. Color coding can be used in many different applications; marking different types of gas cylinders and lines, storage and labeling of lookalike sound alike medications, emergency carts supply locations and job aides on how to use the equipment, matching up IV lines to the correct medication bag. To decrease interruptions for nurses when preparing medications and performing critical tasks that could lead to errors, no interruption zones have been marked on the floors, signs are placed in the physical space, and a visual “Do not Disturb” vest has been worn by nurses. Visuals can also be used as a trigger for the next step in a process. To eliminate delays, a visual in the lab signals the staff when a specimen has been delivered and is ready for processing. All of these visuals improve patient safety.
Mistake proofing or Poke Yoke is used for system designs that prevent errors. Some examples include the gas ratio protection in anesthesia machines, medical equipment devices that do not allow the user to assemble or use incorrectly with the design of the connections and computer fail safe software. Another example is Broselow Pediatric Emergency Tape System which uses a visual color code that matches up the size of a child to the correct supplies needed in an emergency. When the colors are matched, only the correct supplies are available for use.
Lean Healthcare utilizes these concepts and methods that are referenced throughout this issue of Patient Safety and Quality Healthcare. They continue to be highlighted as a practice to provide safety in our system and improve patient care quality outcomes.
© 2010 Solutions for Lean Healthcare