I have been intrigued by numerous articles written recently on how hospital administrators are looking to other industries to learn how to adopt processes to reduce errors and improve quality of care. One recent example is that of hospitals learning from the manufacturing sector and adopting their lean manufacturing techniques to improve the efficient flow of patients through their systems and to cut down on errors. Another article, following the publication of an Oxford University study in the British medical journal Quality and Safety in Health Care, says hospitals are looking to learn new tricks from the auto racing industry to improve operations and patient safety. Then there’s Atul Gawande’s new book The Checklist Manifesto, which shows how straightforward checklists like those used by airline pilots can reduce errors in the operating room, at the bedside, and in many other situations.
As I have come across these instances of hospitals trying to learn from outside industries, I couldn’t help but be reminded of that old poem by Robert Fulghum called “All I Really Need to Know I Learned in Kindergarten.” Here is an excerpt:
All I Really Need To Know about how to live and what to do
and how to be I learned in kindergarten. These are the things I learned:
Share everything.
Play fair.
Don’t hit people.
Put things back where you found them.
Clean up your own mess.
Don’t take things that aren’t yours.
Say you’re sorry when you hurt somebody.
Wash your hands before you eat.
Flush.
Warm cookies and cold milk are good for you.
The poem ends with:
And it is still true, no matter how old you
are—when you go out into the world, it is best
to hold hands and stick together.
In thinking about this classic of 1990s pop psychology, it struck me that while high technology fields such as auto racing, airlines, and manufacturing can offer some important ideas about process management to America’s hospitals, many of the ideas for how to run a high quality hospital were first learned in kindergarten—but just didn’t stick.
For instance:
1) Share everything. If hospitals did a better job of sharing data between caregivers, departments, and families, the process of care delivery would be vastly improved. Yes, this can be done with the electronic medical records (EMR) systems that everyone is talking about, but if kindergarteners know the importance of sharing, why is it so controversial for hospitals, many of which are still noodling about whether they need to adopt technology to manage patient information? According to the 21st Annual 2010 HIMSS Leadership Survey, only 22 percent of hospitals have EMR systems fully implemented across their entire organization and another 26 percent have EMRs implemented in one facility of their hospital system. That means that more than 50 percent aren’t in a position to effectively share data about patients to maximize quality of care and eliminate redundancies and error.
2) Put things back where you found them. This is a good one for the surgical suite, where there is a terrible problem of surgical sponges and other accoutrements accidentally being left inside of patients. Estimates have varied as to whether this happens in 1 out of every 1000 surgeries or 1 out of every 18,000 surgeries, but with about 50 million surgeries occurring each year in the U.S.,
