FEATURE PATIENT SAFETY


Until we have clearer statistics on patient safety in the Middle East, let’s look at the highest healthcare spending country in the world (14% of GDP). In the US, adverse drug events and patient falls cost hospitals $4.5 billion annually. As many as 780,000 surgical site infections occur each year, up to 60% of them preventable. Ventilator-associated pneumonia (VAP) accounts for up to 18% of all hospital-acquired infections, affecting some 250,000 patients per year and causing 1.75 million excess hospital days.


CHALLENGES AND OPPORTUNITIES Through the use of advanced event reporting and analyzing systems, every incident (challenge) can be recorded and investigated to understand their root-cause and come up with ways to prevent future ones (opportunity). Frustrations arising from patients as victims of medical errors are also shared by healthcare providers. Patients put their trust in the healthcare systems starting from “doctors know best” to leaving almost all decisions down to their treating clinicians. Healthcare providers also get frustrated when they put all that effort, dedication and commitment into their jobs, only to find out that errors could have been avoided or a better system would have ensured more quality, better reliability and transparent accountability.


NEW ERA IN PATIENT SAFETY As healthcare systems are being redesigned to focus on measurable outcomes, the delivery system itself is also becoming an increasingly important factor in the provision of safe quality care. Health planners now recognize that healthcare is a function of organization design and not individual effort. We no longer weave our healthcare organizations around surgeons and physicians as the axis of delivery, rather, we are truly moving toward a patient- centric healthcare continuum. However, as a note for caution, methods and tools are not outcomes by themselves; evidence based performance is the ultimate outcome. That’s why GE Healthcare Performance Solutions partners with healthcare organizations to implement transformational change that suits the target organization culture using systems thinking combined with assistive technologies to deliver accessible, high quality safe care for patients.


For example, in the United States,


Kent Hospital – along with a number of hospitals in Rhode Island – experienced several serious patient safety events. To improve safety and address these events, Kent implemented GE Healthcare’s Medical Event Reporting System (MERS) to track and analyze safety events and address the root causes of error. The reporting tool empowered the staff to report not only when events occurred, but also when errors might have occurred. Recognizing that true change was only possible if accepted by the hospital’s staff, Kent also implemented cultural change strategies to ease transition to software reporting and cultivate executive communication. In just seven months, Kent recorded 1,993 reports – up from 1,356 for the total Fiscal Year 2010. In addition, within 30 to 45 days after the system went live, Kent received enough reports to identify two processes


«Methods and tools are not outcomes by themselves; evidence based performance is the ultimate outcome»


of the hospital where near-miss events were an issue: the laboratory specimens and radiology orders. Measures are now being taken to correct processes and reduce the potential of future errors.


SIMPLE CHANGE, BIG GAIN In 2006, I wrote about “back to basics” in the British Medical Journal to emphasize that by applying management concepts, healthcare performance can be enhanced and outcomes improved. All healthcare processes start and end with the patient, and using techniques such as value stream mapping provides the ability to employ system-wide thinking to reorganize the way we deliver healthcare. From appointment booking, through


patient hand-offs and all the way to discharge and beyond, if we start/continue looking at the process through patients’ eyes, not only will we identify opportunities for improving quality and avoiding errors, but we will save time and effort and allow more space to have embedded checks and balances to ensure sustainability in the


newly adopted quality measures. Quick- fixes and short-term “bandages” should be avoided; we are aiming at longer term system-wide approach.


LEANING HEALTHCARE: PROCESS SAPIENS GE helps its clients through the use of lean methods to remove non-value added steps from any given process. The aim is to simplify, streamline and standardize processes to be able to do the right things the right way first and every time. The success of lean thinking is strongly supported by academic research; however there is still a hurdle to be overcome. Maria Rieders, an adjunct professor of operations and information management at Wharton, has observed various lean healthcare initiatives. Over the last few years, she says, hospitals have systematically decreased the number of infections by standardizing their procedures. Healthcare professionals are dedicated and well-educated people who focus on doing the best at all times. However, the challenge they face is that whilst they are very good at coming up with a quick solution when faced with a problem, they are not trained to be “systems thinkers.” GE Healthcare is committed to helping


professionals deliver safer patient care and has set in motion a revolution in how to tackle this issue. GE Healthcare Performance Solutions has established a Patient Safety Organization (PSO) as both a think-tank and a delivery arm to put together concepts and implementable solutions to minimize medical errors. While technology is definitely helpful, like Medical Event Reporting System (MERS), the Performance Solutions team is also adapting methods and tools used in other process- intensive industries (like aviation, energy and retail) to apply best practices and quality systems (like Lean, Six Sigma) into the healthcare sector. Through the unique adoption and use of IT, analytics helps provide new insights uncovering new ways to prevent and address any areas within healthcare processes that are error-prone. Medicine is both an art and a science; so


is lean. True change in patient safety will only come when we think beyond data, methods and techniques, and focus on acceptance, culture and behavior of all those involved in delivering the change initiative focused on safe quality care to the patient. ■


AH Arab Health Issue 4 2011 43


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