SaferPatients

Crew Resource Management, or team training, is not a new topic in health care. Health care has even adopted its own name for a CRM-based patient safety project - TeamSTEPPS. Whatever you call it, it’s the idea that health care as an industry can learn a lot from the aviation industry - specifically that many of the concepts used in creating a culture of safety in the U.S. commercial airline industry can be used in health care to improve patient outcomes.

The question is often asked “Where is the data that proves this approach?” A study that provides the data to back up this notion is reported in  American Medical News.

The research, published in the  Archives of Surgery, followed caregivers who had taken a course titled “Lessons from the Cockpit,” which attempts to relate errors in aviation with medical errors and teach how to avoid them. After studying 857 participants of the six-hour course since 2003, researchers concluded that teaching health care workers the principles of crew resource management has a positive effect not only on patient care, but on workers’ perception of the culture of safety and self-empowerment.

Some of the most striking results include the use of preoperative checklists (75 % of participants were using them in 2003, and by 2007 100% of participants were using them). Self-initiated incident reports rose from 709 in the first quarter of 2002 to 1,481 in the first quarter of 2008.

You can read more by checking out the American Medical News article.

The Patient Safety and Quality Health Care journal reports that 90% of hospitals include patient safety as an integral part of their strategic plan and, even in this difficult economic climate, 53% plan to spend more money on patient safety initiatives than they did last year.

I wonder, given the data that verifies the CRM approach, how many will invest in training their staff with the teamwork and communication skills used by all high-performance teams?

Here is an interesting blog post from Seth Godin, author of Linchpin and Poke the Box (two of my favorite books). Seth says…

“Thousands of doctors have signed up for a service that, among other things, they can use to try to prohibit patients from posting reviews. You can read a bit about it here.

In Iowa, in a surprisingly similar move, the state government is moving ahead with a law that will make it a crime to take or possess videotapes of factory farming that might harm the commercial interests of the farmer.

In both cases, an organization is trying to maintain power by hiding information from the public. Can you imagine being arrested for possession of a photo of a pig?

It’s easy to argue that from the public’s point of view, laws like this are a bad idea. The public certainly benefits from the outing of bad doctors and from the improved hygiene of factory farms. In that sense, it’s unethical for doctors and legislators to subvert their responsibilities by ordering the un-empowered to shut up.

I think it’s interesting to think about from the doc’s point of view (and the chicken farmer), as well. The temptation is for those in charge to defend the status quo by fighting transparency. This ignores a simple truth:

When book reviews are posted, book sales go up.

Yes, the argument of fairness matters.

(Yet) it turns out that transparency increases profitability.

Here’s the thing: when consumers get used to transparency, they’re also more interested in the quality of what you sell, and are more likely to willingly pay extra. They’ll certainly cross the street to buy from an ethical provider. And once people start moving in that direction, the cost of being an unethical provider gets so high that you either change your ways or fade away.

Inundate us with images of cleanliness and quality instead of blacking us out. Don’t race to the bottom (you might win). Instead, force your competition to race you to the top instead.

[Aside: the same objection happened when we started regulating hygeine in restaurant kitchens. Yes, it got more expensive to clean the pots and kill the rodents, but it was okay, because post-Duncan Hines, demand for quality went up enough to more than pay for it.]

The same argument holds true for doctors. Once information about good doctors becomes widespread, patients will be more willing to seek out those doctors, rewarding the ones who consistently take better care of their patients. The entire profession doesn’t suffer (we’ll still go to a doctor) merely the careless doctors will.

One more: A leading politician in India is arguing that bribery (in certain transactions) ought to be legalized. Why? Because if the briber feels free to rat out the bureaucrat, bribery goes down.

In all three cases, sunlight is an antiseptic and the marketplace rewards those that behave–and the entire market grows when the standards increase.

Consumers and those that want their admiration ought to reward those in favor of transparency.“

Measurement. How to measure, what to measure, when to measure, who should measure, where to measure. Despite the “culture of measurement” that exists in most hospitals today, I continue to get these type of questions after almost every presentation I give about implementing aviation-based teamwork and safety tools in healthcare. Read more »