New York Times highlights Seattle Children’s efficiency program
The New York Times today describes how Seattle Children’s Hospital has adopted the industrial quality improvement program developed by Toyota to reduce costs and improve the quality of care.
In the article reporter Julie Weed writes:
The main goals of the approach, known as kaizen, are to reduce waste and to increase value for customers through continuous small improvements.
Manufacturers, particularly in the auto and aerospace industries, have been using these methods for many years. And while a sick child isn’t a Camry, Seattle Children’s Hospital has found that checklists, standardization and nonstop brainstorming with front-line staff and customers can pay off.
“It turns out the highest-quality care also is the most cost-effective because we make fewer mistakes and create better outcomes,” says Patrick Hagan, the hospital’s president.
To learn more:
- Read Weed’s article: Factory Efficiency Comes to the Hospital
Category: News, Seattle Children's
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I worked at Children’s in the early 1980s, so I’m delighted to hear that it’s pioneering in this much needed area. At that time and from my limited perspective, correcting errors seemed to be hit-and-miss proposition. Correction seemed to be little more that some committee eventually meeting and responding to incident reports from nurses. Perhaps worst of all, something had to go badly wrong to generate an incident report. Problems that through good fortune didn’t result in harm to patients didn’t usually generate an incident report. Mistakes kept being repeated until one led to a disaster.
I can remember a situation where I’d personally seen two IV lines separate at a connector in a couple of days and I’d heard about a third incident. Nurses seem to be blaming themselves, but that didn’t seem right to me. I knew of no formal procedure for getting quick action, so I resorted to the only thing I could think of–injecting “something is wrong with these IV lines” into every conversation I could, no matter how silly that made me look. I’m not sure I was the cause, but a day later, a recent shipment of IV lines was yanked from inventory as defective.
I also hope Children’s Hospital is not neglecting what Atul Gawande describes about paper checklists in The Checklist Manifesto and that they’re also integrating ‘smart’ monitoring of care by computers to prevent medication errors and ensure timely lab work. One night, I saw a small child almost die because an overworked MD made a power-of-ten error in his order for a morphine infusion. For far too long, medicine has assumed that hospital staff, particularly physicians, have incredible memories covering thousand of topics, perhaps because that’s how medicine is taught in medical school. That’s expecting too much of tired and harried medical staff. It’s no disgrace to let computers do the sorts of mechanical drudgery they do well and let humans do what they do best, make judgments and apply human values.
And finally, we shouldn’t forget that grassroots-up change like this tends to work much better than top-down dictates from remote “experts” who lack hands-on experience. We see that in the Gulf oil disaster. Because the North Sea has so many deep-water oil wells, countries such as the Netherlands have the best expertise and equipment to handle the blown oil well in the Gulf of Mexico And yet our federal government, for reasons that defy understanding, turned down their offers of help. The same is true of local knowledge in Louisiana about how to protect fragile wetlands by erecting mud barriers. State efforts were blocked by a faraway federal bureaucracy.
Medicine is much the same. The very sort of top-down policies some in Washington want to impose on us may not only be disastrous, but create a system that is hard to correct. If you follow the news about medicine in the UK, after many decades of top-down dictate, the National Health Service has just conceded that medical decision making needs to the placed in the hands of doctors rather than distant administrators and bureaucrats.