In healthcare, errors can be harmful or even deadly, therefore healthcare workers spend a lot of time and energy to minimize them. The definition of an error is a deviation from accuracy or correctness. Nurses double check each other before giving a high risk medication; pharmacists check orders multiple times before the patient receives the medication; there are bar coded wrist bands for patient identification; patients are asked their name and date of birth at the beginning of each encounter; and so on. These are all acceptable practices in healthcare today, but what about defects?
The definition of a defect is a shortcoming, imperfection, lack, or deficiency. Can you think of examples in healthcare where defects occur? Typically these happen when we pass off patients from one department to another. The defect typically occurs due to the lack of complete information being present to properly care for the patient. I recently worked with a hospital who was struggling in the OR with getting the first cases of the day to start on time. Observation and data collection of the process revealed that in more than 70 percent of the late starts, the primary cause was lack of information (i.e. no consent, history either missing or outdated, blood type and screen not completed). All of these are examples of defects that prevent proper care and result in an unpleasant experience for the patient. Yet day in and day out healthcare workers continue to pass defects on to one another at the expense of the patient.
How do we stop passing on defects in healthcare? We can learn from manufacturing and adopt simple lean principles such as visual management and andons. At Toyota, when a car fails to meet a certain specification during the manufacturing process, the line worker is expected to stop the line, gather co-workers, and solve the problem in real time. If there is no solution, they pull the car from the line. This prevents defective cars from reaching the public. Where are andons in healthcare? We have a few — the pause in the OR before the surgeon makes the incision — but by and large we don’t signal a possible defect. By creating and using andons we can ensure that all information required to care for a patient is available at the start of the procedure. If it is not, let’s stop the process.
Today’s blog was written by Dan Littlefield, director at HPP.
Dan has 30 years of healthcare experience in many clinical and leadership roles. He leads Lean and process improvement consulting engagements for HPP. His experience includes deploying Lean across numerous healthcare disciplines including imaging, laboratory, nursing, pharmacy, and physician offices. Dan began his healthcare career as a nuclear pharmacist and has also served as director of operations, responsible for 13 facilities. He has been a featured speaker at a variety of healthcare industry events.
Dan holds a Master’s Degree in Business Administration from the University of Pittsburgh, a Bachelor’s Degree in Pharmacy from Purdue University and a Specialty Certification in Nuclear Pharmacy from Butler University.