Establishing a Patient Safety Culture, Part Three

Process transformation using quality by design

Editor’s note: This is the third of a three-part series on quality in healthcare. Part one described the Juran Model for Patient Safety, and part two identified elements of a patient safety officer program.

With between 44,000 to 98,000 patients dying each year in hospitals as a result of medical errors, patient safety has moved to the forefront as one of the most significant challenges facing the U.S. healthcare system today. In 2001, the Institute of Medicine released a report, “Crossing the Quality Chasm: A New Healthcare System for the 21st Century,” which describes a fragmented and inefficient system of care that results in medical errors, unnecessary treatments, and wasted resources.

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The IOM report from 1999 needs some updating. Because of better record keeping we now know that:

  • 99,000 patients die each year because of hosital-acquired infections
  • 150,000 die due to medication errors
  • 150,000 die due to preventable surgical complications
  • One patient in six will suffer some complication due to their treatment, not their disease

Good news!

Dr. Peter Pronovost's check list for central lines has reduced CLBSI from 240,000/year to 40,000/year (about 1/4th of these patients still die each year).

The World Health Organization's surgical checklist cuts preventable mortality by almost half.

But healthcare is still the fourth leading cause of preventable death in the U.S.

Waste and rework in healthcare is estimated to be a Trillion Dollars out of the $2.5 Trillion we spend.

Lean Six Sigma could quickly cut these costs and boost quality of healthcare, but hospitals and other medical facilities are hesitant to embrace it because of the perceived time and cost involved. Of course, healthcare doesn't need to know everything in the Green Belt or Black Belt body of knowledge. The Magnificent Seven tools of Lean Six Sigma will solve most problems facing healthcare, but like their patients, doctors, nurses and administrators have to want to "change their lifestyle" and aggressively pursue improvements in speed, quality and cost across the board.

Improvement projects can be done in days, not months, using the right set of tools.

The shift from pay per procedure to pay per outcome will demand rapid analysis and improvement. Question is, are we in the Lean Six Sigma community willing to bend our know-everything-to-be-able-to-solve-anything approach to training and implementation? Or are we willing to teach only the key tools needed to solve most problems? Probably  not, because we resist change just like clinicians and their patients.

Are we going to listen to the voice of our healthcare customer and help them accelerate patient safety and healthcare quality, or we going to continue preaching the gospel of "know everything before you can do anything"?

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