Streamline Training & Documentation: Hospitals Scout for Best Practices

Sunday, November 19, 2006

Hospitals Scout for Best Practices

In the space of two weeks, the New York Times and the Wall Street Journal have published articles on the efforts a number of hospitals are making to improve patient care by tapping ideas from outside the health care industry.

The NYT article, published on October 31, describes how airline practices for maintaining passenger safety have translated to the hospital emergency room and operating room settings. As Kate Murphy, the article's author, notes:

It is well established that, like airplane crashes, the majority of adverse events in health care are the result of human error, particularly failures in communication, leadership and decision-making.

To reinforce the proposition that there are strong parallels between what needs to happen aboard an aircraft and what needs to happen in an OR, Murphy quotes Dr. Stephen B. Smith, chief medical officer at the Nebraska Medical Center in Omaha:

The culture of the operating room has always been the surgeon as the captain at the controls with a crew of anesthesiologists, nurses and techs hinting at problems and hoping they will be addressed. We need to change the culture so communication is more organized, regimented and collaborative, like what you find now in the cockpit of an airplane.

The training pilots receive teaches them:

... to recognize human limitations and the impact of fatigue, to identify and effectively communicate problems, to support and listen to team members, resolve conflicts, develop contingency plans and use all available resources to make decisions.

Other borrowed techniques recommended for hospital training include "pre- and post-operative briefings, simulator training, checklists, annual competency reviews and incident reporting systems."

The WSJ article, published on November 14, looks at what useful practices auto racing pit crews can offer hospital teams, who have a comparable need to move fast while avoiding dangerous mistakes.

Great Ormond Street Hospital for Children in London has borrowed techniques from the Italian Formula One Ferrari racing team. Specifically, the hospital has introduced safeguards, based on Ferrari pit crew techniques, to minimize errors that occur when a patient is handed off from one team of caregivers to another (e.g., from the ER team to the recovery room team, or from one shift of doctors and nurses to the next).

Gautam Naik, the author of the WSJ article, reports what happened when a Great Ormond Street Hospital delegation visited Ferrari headquarters in Maranello, Italy:

In that meeting, Mr. Stepney [the Ferrari team's technical director] described how each member of the Ferrari crew is required to do a specific job, in a specific sequence, and usually in silence. By contrast, he noted, the hospital handover was often chaotic. Several conversations between nurses and doctors went on at once. Meanwhile, different members of the team disconnected or reconnected equipment to a patient, but in no particular order.

A key piece of learning from the pit crew was the importance of paying conscious attention to small errors that, if overlooked, can cumulatively lead to a seriously compromised outcome for the patient.

The hospital team returned to London and drew up a detailed protocol for handoffs, based both on what they had learned from Ferrari and from talking to two jumbo-jet pilots. After two years, the hospital's data showed that the average number of technical errors per handoff had fallen 42%, and "information handover omissions" had fallen 49%.

In these two best-practice examples, we have the converse of the caution concerning "casual benchmarking" discussed in an earlier post. If practices working well in another industry appear to be genuinely relevant to your own organization, it is worth your while to investigate in some depth whether adopting them is likely to significantly improve your organization's performance.

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Labels: Collaboration, Quality

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