Quality, Safety and Healthcare Delivery Systems

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Fixing Healthcare Delivery

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University of Florida

Fixing Healthcare Delivery

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Isn’t it time to end the loss of life from preventable medical errors? Each year 100,000 patients die from preventable errors in the U.S. How can you help to change this intractable problem? Knowledge is power, and this course will provide you with a deep understanding of the problems and the solutions. You can become part of the solution.

À partir de la leçon

Introduction: Who is Caring for Mary?

100,000 patients die annually as a consequence of preventable medical errors, and over 1 million patients suffer life-changing injuries. Despite the calls to action medical errors continue at the rate of 1 out of 10 patients. How can those of us who help to deliver care and those of us that receive care help to prevent harm? There are 5 fundamental areas each of us needs to understand and use to fix healthcare delivery: 1. Apply the principles of high performing manufacturers and athletic teams to continually improve our processes. 2.We all need to learn how lead and be part of multidisciplinary teams that include patients and coordinate the care they receive. 3.The human brain continually makes errors. Certain conditions increase the likelihood of errors, and these need to be avoided. Systems can be designed that force the right behavior, and second checks can help caregivers provide the right care at the right time and in the right place. 4.We all need to become effective leaders. Most importantly we must practice adaptive leadership, that is, leadership that promotes a true change in the way things are done. 5.Finally we all can utilize the campaign methods of successful politicians and advocacy groups to change the attitudes of our fellow caregivers and patients, and thereby change the culture of our healthcare systems. During this 8-module course you will be provided with the tools to accomplish all 5 of these goals, and as an individual you can truly make a difference. Why do we need to understand about systems? How do we evaluate a system and as a patient or provider what characteristics do you think are important? How does quality relate to safety? These are important questions that we all need to have answers to as we learn how to improve how we deliver and receive healthcare. The personal consequences of distracted physicians and defective systems are illustrated in Mary's frightening hospital experience.

Who is Caring for Mary Overview3:04

Introduction7:44

Who was Caring for Mary?16:09

Quality, Safety and Healthcare Delivery Systems10:54

Systems and Quality3:58

Rencontrer les enseignants

Frederick S. Southwick, MD
Professor
College of Medicine

Based on Mary's case, I think it is very important that we discuss quality, safety,

and healthcare systems.

When it comes to defining quality,

this is a noun that has an amazing number of dimensions.

And these dimensions change depending on the product or

service you are talking about.

In the case of healthcare, cars and electronics,

reliability is a very important dimension, as is durability.

Performance is important when it comes to you car,

and also when it comes to healthcare providers and medical equipment.

Aesthetics often encourage consumers to purchase a new car.

A well designed hospital lobby, modern clinic facilities, and clean,

attractive rooms, may encourage patients to choose a specific clinic or hospital.

However patients need to understand, that just because a hospital

has a beautiful lobby, does not mean the medical care will be of high quality.

And later we will discuss the key quality measures that all patients should

investigate, before trusting their lives to a healthcare system.

When it comes to healthcare, these dimensions pale in comparison to safety.

As Mary's case exemplifies, and as the annual rate of death and

life altering injuries emphasizes, safety is a critical dimension in healthcare.

And because it is deemed the vital characteristic of quality,

safety is mentioned as a separate noun.

Hospital systems are now appointing chief quality and safety officers, and

many systems include improving quality and safety as a primary goal.

As successful manufacturers and retailers know all too well,

quality is in the eyes of the beholder.

When you rent a car, when you fly on an airline, when you eat at a restaurant,

many of you have been asked to fill out a survey designed to assess

your satisfaction.

Similarly in healthcare, many hospitals and

clinics are sending surveys to learn about your experience, and

this is certainly an important step in the right direction.

In the United States,

medicare is now using patient satisfaction as a criteria for payments.

But how do we create a truly patient centered system of care?

Simply mandating patient center care and saying these words does not make it so.

A true focus on the patient has to come from those who are directly caring for

patients.

This means the clerk who checks you in.

This means the people who clean your room.

The individual who wheels you to the x-ray department.

The nurse who answers your call bell.

And the physicians who direct your care.

In the rushed and hectic environment of modern healthcare, the patient too often

gets lost as health providers try to grapple with the continual turnover of

patients, and the large amount of data generated by every patient encounter.

But each of us who serves as a caregiver and needs to stop and think.

How will my patient react to my actions.

We need to ask our patients, what went well today?

And what could we improve.

We must look through the eyes of our patients.

Remember when patients require hospitalization they are often frightened

and worried, because they have lost one of their most precious gifts, their health.

It's our job to restore their health and at the same time restore their well being.

Too often I observe that physicians focus on the test data and

the ordering of medications, and forget to offer a gentle word of encouragement.

As well as a gentle touch, of the hand or shoulder.

These simple actions are so very important to our patient's well being.

How do systems affect the quality of care?

Let's look at Japanese manufacturing immediately following World War II.

At that time, it was estimated that it took nine Japanese workers,

to equal the output of one American worker.

Furthermore, the quality of Japanese manufactured goods was poor.

I remember as a kid avoiding toys made in Japan,

because they always fell apart quickly.

W, Edward Deming, an American who worked at Bell Laboratories,

came to Japan preaching the value of a systems approach.

He taught the Japanese how to create continually approving manufacturing

systems, and the rest is history.

But you are thinking, but systems are complicated, they are only for

MIT geniuses, I can't deal with systems.

Hold on.

In fact we all encounter systems day in and day out.

Before we discuss this issue, what are we talking about?

What is a system?

A system can be defined as an interdependent group of items,

people, or processes working together toward a common purpose.

When we turn on a light we are benefiting from our electricity generating system.

When we go out to a restaurant,

our meal comes to us thanks to a food preparation and delivery system.

Anyone who has had to wait for their food, and when it was delivered discovered was

cold, knows what a bad food delivery system looks like.

Or alternatively, I am sure you have experienced a restaurant where the waiters

were continually asking you if you needed anything, and who took your order

accurately, brought your food quickly, and the food was hot and delicious.

Systems vary in their complexity.

And the complexity of a system depends on the number of components, and

the degree that different components are interrelated.

By interrelated, we mean the components that influence each other.

As an example, if I as a physician consult a specialist,

I depend on their timely responses, and follow their advice.

A simple system has few components, and they are not interrelated.

When a physician interviews a patient and enters his or

her findings into an electronic record, this is a relatively simple system, and

the components do not significantly influence each other.

A moderately complex system has many components or steps.

But they are not interrelated.

Or a system with a few interrelated components,

is also considered moderately complex.

Our subspecially consultation system would be classified as moderately complex.

The most complex systems have many interrelated components.

As an example, the system required to transfer a patient from

the emergency room to the intensive care unit,

this process will require bed control, emergency room and

ICU teams, and many hand offs, nurse to nurse, doctor to doctor.

All of these processes depend on each other.

If the bed control person cannot identify a vacant bed, the patient can't be moved.

If the ER team incorrectly assesses the patient's severity of illness,

the ICU team would refuse the patient, because he or

she is not ill enough to warrant the ICU admission.

If the ER nurse does not accurately describe the patient's nursing challenges,

the ICU nurse will have difficulty initially managing the patient.

I hope you get the idea.

The more complex a system, the more likely there will be breakdowns and errors.

Unfortunately for us in healthcare,

the majority of our systems will be categorized as highly complex.

This means everyone who delivers and

receives healthcare must be a systems thinker.

And throughout the remainder of the course,

we will be introducing you to many system concepts.

As someone who delivers or

receives healthcare on the front lines, we encounter many microsystems.

These are discrete systems designed to achieve specific goals.

And as someone on the front lines, you can all help to improve them.

How a hospital team works together and includes you as part of the team.

How the admissions officer acquires the data for your hospital admission, and

makes the admission process efficient and user friendly.

How a clinic appointment system creates clinic visits,

that assured that you do not have to sit in the waiting room for hours.

How the nurse responds to your call bell, responding within five minutes and

arriving with a positive greeting.

Let's look at a microsystem, Mary and I encountered at the beginning of her

illness, The Peripheral Nerve Clinic, with a neurologist.

This clinic consisted of one physician, one part time nurse,

an appointment clerk and a technician who performed the nerve conduction studies.

The design of the clinics system resulted in a continual

problem that we encountered.

When the physician left town, the clinic shut down, and

the patients could no longer receive the care they needed.

As a consequence, we were forced to see an internist,

who neglected Mary's nerve injury and focused only on her thrombophlebitis.

As I described in my last video, we know how that turned out.

As exemplified by this unreliable Peripheral Nerve clinic,

every system is designed to produce the outcome it achieves.

Let's take some examples in the auto industry.

A VW Beetle slowly accelerates when you step on the gas pedal.

It is designed for good gas mileage and

shouldn't be driven over 80 miles per hour.

While a Chevrolet Corvette is designed for rapid acceleration, and

has poor gas mileage, but can easily go over 100 miles per hour.

You need to remember that errors in healthcare are usually caused

by poor systems.

To end this session, please watch Don Berwick's elegant description

of the ideal healthcare delivery system on the IHI website.

These characters can be remembered using the mnemonic STEEP.

Safe, Timely, Effective, Efficient,

Equitable, and Patient-Centered.

We can all help to achieve these important goals.

Thank you.

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