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International Physician Update
Sharing Best "Safety" Practices, Globally
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| Richard Davis, left, and Peter Pronovost, leading initiatives under the Hopkins Center for Innovation in Quality Patient Care. |
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How is it, asks Hopkins outpatient administrator Richard Davis, that a Federal Express employee wearing a miniature computer on his belt can accurately track an overnight package anywhere in the world, yet a physician might have a hard time locating a patient or getting a clear answer on why the patient’s medication hasn’t arrived on the floor? The answer, in part, Davis says, is that health care, while innovative, is a change-averse industry. In other words, it learns a lot—even better ways to track patients and meds—but it has a difficult time putting that knowledge into practice. Why? Health care focuses more on people and paper than operational systems.
But on the heels of an Institute of Medicine report that 7 percent of patients suffer a medication error in American hospitals each year, Hopkins has been reaching outside of health care to private industry for insights on how to make its system not only safer, but more efficient, too.
“We’re trying to take the best of both worlds,” says Davis, “by incorporating some of the innovation and creativity in health care into change frameworks from industry that allow people to be successful.”
To launch that initiative, Davis and anesthesiologist Peter Pronovost have formed the Hopkins Center for Innovation in Quality Patient Care, with the blessing and financial support of Hopkins Medicine leadership. The center’s eye is on systems, with the aim of not blaming staff for errors—but on making them all fundamentally responsible for the system they work in.
“Who is responsible? For many doctors and nurses, the answer is often the hospital or the performance improvement department,” Pronovost says. “We need to engage people to take ownership and say, Quality is what I do, I’m responsible for that.”
The first step is to observe the system, see what’s broken. Borrowing from the Toyota idea of “change coaches” trained to look for safety problems, inefficiencies and waste, the Center is creating like-minded teams of physicians, nurses and administrators within units. Like the Toyota coaches, Pronovost says, “When they see a problem, they stop in real time and people actually work together to fix it.”
Fixing it means applying rapid-cycle change tools from private industry, and then using metrics to measure the results. Pronovost cites one Center pilot that used an aviation industry survey tool to weed out any system breakdowns that might be contributing to hospital infections and medication errors.
“We improved our safety culture about 30 percent on each question using the survey,” Pronovost says. “More importantly, our results are higher now than anything reported in aviation.”
Currently, the center is conducting about a dozen initiatives, most focusing on infections and medication errors, others on creating system efficiencies. The center also is doing something else—sharing the best practices they’re developing with other health systems, including those outside the United States.
“Through technical assistance engagements and educational sessions within and beyond Hopkins, our experts are helping leaders in other institutions combat these safety problems,” Pronovost says.
“The challenge is to take this learning and spread it throughout health care globally, to create a structure for true knowledge management.” n
(For information about the Tools and Solutions Seminar to be offered by Johns Hopkins International and the Hopkins Center for Innovation in Quality Patient Care in October, email us at jhis@jhmi.edu or click here to see a pdf file of the program and registration information.
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Safety in the ICU
In one safety initiative by the Center for Innovation in Quality Patient Care, a team looking at catheter-related infections in an intensive care unit quickly discovered that physicians had to go to eight different places to get everything they needed to insert a central line. The solution? A central line cart.
And in another ICU initiative aimed at avoiding miscommunication--the cause of 8.5 percent of all medical errors--staff in the unit followed a "daily goals form." The result? Length of stay in that ICU decreased from 2.2 days to 1.1 days.
Says anesthesiologist Peter Pronovost, "These forms clearly improve communication among all caregivers and clarify the work needed to get the patient to the next level of care."
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