Historically, when processes and systems are analyzed, they are
done so using tools found in the work of Edward Deming. Deming’s successes in manufacturing resulted in the development of
Lean Processing and Six-Sigma. Lean focuses on reducing waste
and Six Sigma attempts to remove defects in the process. Further
expanding on these principles are the industries of High Reliability
Organizations (HROs). These organizations are known to operate
in highly dangerous and volatile environments while maintaining
a remarkable track record for safety. HRO’s include aviation, nuclear power and the United States Navy. They follow five principles:
preoccupation with failure, reluctance to simplify, sensitivity to
operations, commitment to resilience and deference to expertise.
The first three principles anticipate medical errors and how to
prevent them, while the last two look to contain the aftermath
when an error occurs. Current efforts to improve the processes in
health care take the principles of Lean, Six Sigma and HROs, and
apply them to the very complicated, ever-changing atmosphere that
involves caring for humans.
positive impact on our environment. If we consistently make that
our mission, not only will metrics improve, but health care quality
and safety will no longer be buzzwords. They will take on a deeper
personal meaning.
Hugh Shoff, MD, MS, is the Quality and Safety Officer for the Office
of Graduate Medical Education at the University of Louisville School
of Medicine.
Now that the background has been established, how do we make
progress into the future? We must first educate ourselves on the
principles of health care quality and safety, and establish a base of
knowledge. Next, we should examine our processes for areas of improvement. We can gain significant strides by removing unnecessary
steps. We should streamline ancillary and support systems. Supply
chain, lab turnaround and radiology acquisition are some of the
areas in which assessing order-to-acquisition can be optimized. Tools
such as the Plan-Do-Study-Act (PDSA) cycle and Failure Modes and
Effects Analysis (FMEA) can be utilized to better understand the flow
as well as identify redundancies. All members of the system should
be encouraged to participate. We also cannot overlook seemingly
insignificant processes, as improvements in individual areas can
lead to large gains across the whole. Reductions in ED wait times
and hospital length of stay are possible while continuing to measure
those metrics deemed important to the evaluation of quality.
Metrics will continue to be an important aspect of our daily health
care delivery, but we cannot overlook our deeper motivation. Let’s
revisit the six aims and focus on one in particular: patient-centered
care. We cannot forget that the reason we have such an intricate
and complicated system is to take care of our patients. No person
comes to his or her job with the goal of being unsafe or providing
poor care. We strive to care for our patients, and every aspect of our
professional involvement with them endeavors to keep them safe.
Improvement in health care quality and safety is a daunting, unending task. This discussion only scratches the surface. Let’s open
a dialogue to better understand the principles and work together
to better educate and implement. The care we deliver should be of
the highest quality. Unsafe care should never happen in our health
care system, because the system should never place us in the position to provide such care. Tomorrow we should look at ourselves
and ask how we can improve patient care to therefore make a
AUGUST 2016
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