All Entries Tagged With: "process management"
Fat COWs ‘grazing’ in hall lead to BCMA workarounds
I had an interview with Ross Koppel, PhD, professor of sociology at the University of Pennsylvania last week about human factors engineering and its relation to patient safety. Koppel is also the principal investigator on the study of the hospital as a workplace and medication errors at the Center for Clinical Epidemiology and Biostatistics, School of Medicine at UPenn. We specifically talked about a study he was involved in that was published in the Journal of the American Medical Informatics Association in 2008 about workarounds used in conjunction with barcoded mediation administration systems (BCMA) and how they may affect patient safety.
He was a pleasure to talk to and explained the results of the study very clearly. He and his team found that clinicians used workarounds with BCMAs for 4.2% of patients, accounting for 10.3 % of medications administered. The reasons are numerous and all legitimate. But there is one reason that stuck out in my mind, simply because of the picture it left in my mind:
Fat COWs grazing in the hallway.
Of course COWs are not the kind that go ‘moo’ but are Computers on Wheels, COWs for short. One of the problems that Koppel and his team found was that some medication errors occurred because the COWs were too large to enter the patient’s room or is “tethered” to an electrical outlet, and therefore the nurse responsible for scanning the medication to administer to the right patient did so outside of the patient’s room. When the alarm went off notifying the nurse that the scanned patient ID was incorrect, he or she was already in the room administering the medications to the patient.
“That’s the reality and solving that problem is probably a $12 fix of getting a thinner COW, but only if you do the kind of observational work that I and my colleagues did are you going to figure that out,” said Koppel.
This was just one of the many examples of workarounds that Koppel and his team found, but it illustrates the need to apply human factors engineering to new patient safety projects, especially those that have to do with HIT. In the coming years this will be of the utmost importance. EMR implementation has the potential to really help hospitals unravel many communication issues. It also has the potential to make those issues even more complicated. By taking human factors engineering into account, vendors and clinicians can hopefully accomplish the former.
Mistake-proofing and its relation to process management
One of my colleagues at HealthLeaders Media, Cheryl Clark, wrote this columnyesterday about making things fail-proof–anything really. She starts out by giving the example of how her fancy refrigerator beeps when the doors have been open for too long, reminding owners to shut the doors. She used that analogy to draw some comparisons to many of the mistake-proofing devices in healthcare, and how we are now really are coming into the age of really predicting how an error might occur and designing systems better to prevent those errors.
I’ve been reading up a lot lately on process management and even when speaking with people in the healthcare industry, there seems to be a lot of momentum behind the Lean and Six Sigma, the notion of ridding our systems of waste if we truly want them to succeed–and be the easiest and most logical way of doing things. Designing processes so that they are “mistake-proof” certainly ties in.
I suggest reading her column, it’s a good one. Do you see a larger waste reduction and process improvement effort taking place at your facility?
IHI launches online component of Improvement Map
Earlier this week, the Institute for Healthcare Improvement (IHI) launched the online tool component of its Improvement Map, which was announced at IHI’s December 2008 National Forum (and I’m sure many of you have waiting in anticipation since then). The Improvement Map is a collection of processes that ultimately determine how a healthcare organization functions. The processes are broken down by domain (type of processes) and by aim (corresponding with the Institute of Medicine’s six aims for improvement). Users also have the option of customizing the Improvement Map so only the processes in which they are most interested appear when they log on.
This comprehensive resource looks to be an asset to the field. Many of you reading may be involved with one or many of the IHI’s existing initiatives and I’m sure you’ll find this new online component of real value. Not only does the Improvement Map offer guidance on many specific topics, it also provides resources, information, and points users in the direction even more information outside of its confines if you so desire.
Joint Commission launches Center for Transforming Healthcare
The Joint Commission announced a new effort to address the nation’s biggest issues in terms of quality care and patient safety yesterday when it launched the Center for Transforming Healthcare. At the crux of the Center’s approach to improving patient safety is using Lean and Six Sigma to improve processes and address some of the challenges facing caregivers and patients. It hopes to offer specific guidance on how to solve issues like preventing healthcare-acquired infection, ensuring medication safety, coordinating safe patient handoffs, and focusing on surgical safety.
This not-for-profit has coordinated with some of the nation’s leading health systems to work on some of the above mentioned issues. You can find the full list by clicking here.
I did find it useful to know that starting midway through 2010, hospitals that are Joint Commission-accredited will be able to utilize an application on the site that will work with each facility individually to develop custom solutions.
Improving efficiency, reducing waste are keys to safe, quality patient care
For years the healthcare industry has maintained that it is unlike others simply because caring for people is more complex than creating cars, shipping goods, or generating energy. However, hospitals are being forced to examine their processes this year as the healthcare reform debate continues. Healthcare has been exposed as being extremely wasteful and has not embraced simple technology that other industries adopted years ago to improve their workflows and products. In two separate stories, The Boston Globe and Business Week examine instances in which hospitals adopted new, more efficient practices and have seen positive outcomes.
The Boston Globe articletakes the case of Cincinnati Children’s Hospital (CCH). The facility reached out to well known flow and efficiency expert Eugene Litvak, a professor at Boston University and Harvard University, as well as a patient flow advisor to the Institute for Healthcare Improvement. He was asked by CCH to help them streamline the flow of patients from the emergency department waiting room to the recovery area for patients post-surgery. Over the past six years, the facility has seen both quality and economic improvements.
The Business Week articleexamines how administrators at the Moffitt Cancer & Research Institute in Tampa, FL, used a consulting group within General Electric to help them learn how to better manage and run the facility. The facility analyzed how time in the operating rooms was being used, then scheduled surgeries in a more efficient manner. Although this disruption required some new ways of thinking, ultimately it has led to improved performance and better outcomes.
Has your hospital or healthcare facility taken the first steps into better managing its processes to produce better outcomes via more efficient care? Have you experienced any major changes to how you do your work, and if so, have they been for the better?
