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by Frederick Southwick
Too often, everyone assumes the work is being done correctly and that each person knows his or her role. Many customer-supplier relationships are undefined and dysfunctional, and caregivers generally assume they are not empowered to make changes to specific processes.
In the absence of a standard model of healthcare delivery, medical errors sneak through the cracks of the disorganized care system.
By modeling the healthcare delivery system after successful business practices, we can help prevent medical errors. Let's look at Toyota, whose Toyota Production System (TPS) uses three fundamental approaches for improving automobile manufacturing.
TPS for healthcare organizations
Set protocols: Define the work that needs to be done, how it should be done, and who is responsible for its completion. Standardize this practice for all healthcare staff and all potential diagnostic situations.
When a caregiver works with multiple physicians, they are required to learn different protocols to achieve the same goal. In the absence of a single best-practice protocol for each disorder, all processes in hospitals and clinics are random and ill-defined. When there is an error or a delay, there is no single protocol that can be modified, making lasting improvements impossible.
Identify and support customer-supplier relationships: At Toyota, the assembly line worker's most important customer is the person next in the assembly line. Physicians too often regard themselves as the customers and nurses as the suppliers of respect and ego gratification.
Following this example, physicians must identify themselves as the supplier and nurses and support staff as the customers. They need to listen closely to the concerns of bedside nurses who experience the dysfunctional delivery systems all day, every day, and then supply them with clear instructions for patient care.
Use the scientific method: Caregivers should be encouraged to implement changes by using iterative cycles of planning the change (plan), trying out the change (do), measuring the effects of the change (study), and then if deemed a true improvement, implementing the change on a broader scale (act).
Often administrators discourage adaptive change for fear of breaking a regulatory rule. A command-and-control administrative structure discourages front-line leadership and any sense of autonomy.
Those with higher administrative authority must reduce formality and flatten the power gradient, because hierarchical power structures deter open communication and increase the chance of errors. When errors do occur, the individual reporting the error should be supported emotionally, and in most cases punishment should be avoided. Those with administrative authority need to understand that most errors are the consequence of bad systems, not bad people.
TPS to improve communication and prevent errors
Treat everyone with respect. Everyone has an important role to play in managing the care of our patients. Humility, friendliness and empathy go a long way in lowering the power gradient.
Become an effective team leader. Teamwork acknowledges the value of all members of the care team and encourages reciprocal communication, that is, every idea from a team member is a good idea. Teams reduce errors because you have many eyes, ears and brains focusing on the same problems. Great teams develop a team identity that gives everyone a sense of belonging and greatly increase job satisfaction.
Embrace a systems view of healthcare. Understand that in modern healthcare delivery, you as an individual will not be able to manage your patients alone. You will need to depend on fellow physicians to create shared protocols to create consistent ways of doing things.
By creating operating standards within your healthcare institution for specific diseases and problems, you will allow those working with you to be more efficient and reduce the likelihood of errors. This is not cookbook medicine, but rather the best approach for creating good habits that will free everyone to focus on events that are unexpected and which require high-level decision-making.
Frederick Southwick, M.D., is a Professor of Medicine at the University of Florida and manages New Quality and Safety Initiatives for the University of Florida and Shands Health Care System. He also is the author of Critically Ill: A 5 Point Plan to Cure Healthcare Delivery.
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