Out­sider’s ques­tion helps spur a health sys­tem COO’s quest for safer pa­tient care

Some­times it takes an out­sider to point out an un­com­fort­able truth. I en­coun­tered that bit of wis­dom early in my ca­reer, running my first hos­pi­tal in cen­tral In­di­ana in the mid-1990s.

Modern Healthcare - - COMMENT - By Al Gat­mai­tan In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at modernhealth­care.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Ed­i­tor David May at dmay@modernhealth­care.com.

One of our board mem­bers, an auto engi­neer, couldn’t un­der­stand why the hos­pi­tal didn’t set a zero-tol­er­ance goal for med­i­cal er­rors. If his com­pany could de­mand 100% re­li­a­bil­ity for air bags and en­gine starters, why couldn’t hos­pi­tals do the same for trauma care and surg­eries?

The ob­ser­va­tion be­gan my 20-year quest into that most vex­ing of health­care is­sues: pa­tient harm rates that re­main un­ac­cept­ably high.

Soon after our board mem­ber posed his un­set­tling ques­tion, the In­sti­tute of Medicine re­leased its fa­mous re­port, To

Err is Hu­man. It laid out the shock­ing find­ing that med­i­cal er­rors caused up to 99,000 U.S. hos­pi­tals deaths a year. Some sub­se­quent stud­ies showed even higher lev­els of pre­ventable deaths.

My hos­pi­tal was then part of a sys­tem, and I still re­mem­ber our CEO be­ing shaken by the re­port. He said ac­cep­tance of er­ror in health­care had to change.

A year later, I found my­self de­sign­ing a new hos­pi­tal in the In­di­anapo­lis sub­urbs. Here, I thought, was a chance to change things. We would at­tack med­i­cal er­rors at their roots through in­tel­li­gent build­ing de­sign, state-of-the-art med­i­cal equip­ment, care­fully trained staff and lead­ers com­mit­ted to a cul­ture of safety.

We have been im­mensely proud of that new hos­pi­tal, even win­ning recog­ni­tions for pa­tient safety, but I found out the neme­sis of avoid­able pa­tient harm is harder to beat than I imag­ined.

The 2000s would bring new re­search that opened my eyes even more to the dizzy­ing com­plex­i­ties of pa­tient safety, mak­ing me ques­tion the ways provid- er or­ga­ni­za­tions carry out their vi­tal health­care mis­sion.

As I un­der­lined and high­lighted my way through books such as Lead­er­ship

and the New Sci­ence and Be­yond He­roes, and put some of their novel sug­ges­tions into prac­tice, I’ve been in­spired. I think we have our neme­sis on the run.

Cer­tainly we’ve had en­cour­ag­ing suc­cesses at In­di­ana Univer­sity Health. We now have met­rics and qual­ity dash­boards in place that tell us about ev­ery harm event and mea­sure the ef­fec­tive­ness of our safety ef­forts. (In­for­ma­tion most ev­ery­one lacked when my ca­reer be­gan.) And IU Health cer­tainly isn’t alone in mak­ing these ad­vances.

An­other ini­tia­tive at IU Health that’s pay­ing off is the use of Lean op­er­at­ing pro­cesses to im­prove qual­ity of care. After com­mit­ting to a trans­for­ma­tion of our op­er­at­ing sys­tem four years ago, we’ve seen in­di­vid­ual hos­pi­tal nurs­ing units cut pa­tient harm in­ci­dents to zero; am­bu­la­tory di­ag­nos­tic cen­ters re­duce pa­tient ap­point­ment wait times from months to days; and physi­cian of­fices re-ar­range their work­day so not a sin­gle pa­tient phone call, email or fax goes unan­swered.

The im­pact on pa­tient care has been heart­en­ing. In the past year alone, IU Health’s 14-hos­pi­tal sys­tem cut pa­tient harm in­ci­dents by 18%.

In my pa­tient-safety jour­ney I’ve had to come to terms with hard-toswal­low findings. My fa­ther was a small-town doc­tor and my mother was a nurse, so one find­ing was es­pe­cially tough on me: In health­care, the big­gest ob­sta­cle to avoid­ing pa­tient harm is none other than health­care work­ers them­selves.

We’re work­ing to change that as well. Re­search based in com­plex­ity the­ory shows that, no mat­ter how much train­ing and ex­pe­ri­ence doc­tors, nurses and ad­min­is­tra­tors have, or how hard they work, if they hope to have a shot at ze­ro­ing-out pa­tient harm events they need re-en­gi­neered pro­cesses and some crit­i­cal soft skills. Namely, the abil­ity to self-or­ga­nize, work well in teams and con­sis­tently re­spond with the right moves in the of­ten chaotic world of pa­tient care.

So im­part­ing these vi­tal soft skills with a “stan­dard work” ap­proach has be­come a pri­or­ity. We’re build­ing teams skilled in flaw­less “hand­offs”— mov­ing pa­tients from one care­giver to the next—and so at­tuned to their jobs they can ad­just on-the-go when things turn chaotic.

A zero-tol­er­ance goal for med­i­cal er­rors? I think I can fi­nally say to my long­time engi­neer friend: Bring it on.

Al Gat­mai­tan is ex­ec­u­tive vice pres­i­dent and chief op­er­at­ing of­fi­cer of In­di­ana Univer­sity Health in In­di­anapo­lis.

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