What Healthcare Can Learn From Mining About Reducing Harm

The preventable harm that occurs in our nation's hospitals each year is shameful. We as an industry have known this for years, and yet, the needle has barely moved when it comes to drastic industry-wide reductions in preventable harm. Certain individual hospitals and systems have considerably reduced harm in their organizations; some have even been able to reduce the number of certain hospital-acquired infections, falls or medication errors to zero, and have sustained that performance for years.  

Yet, as a nation, more than 200,000 patients die each year due to preventable harm, and millions are injured.

All hospital executives and medical leaders want to reduce preventable harm in their organizations, but there are several confounding factors making this more challenging than it seems on the surface. The first is that many processes are so engrained in organizations that they take significant time and effort to change, especially if they change how physicians or staff go about their work. Secondly, there seems to be a culture in many organizations that some medical error is inevitable.

This acceptance of medical error is a major hindrance to reducing error. No hospital leader accepts that idea that 200,000 patient deaths are inevitable, but the mindset that any patient death is inevitable will impede improvement efforts.

I spoke with Cedars-Sinai CEO Thomas Priselac yesterday about the Los Angeles-based system's efforts to reduce medical error. He explained much of the organization's success came after shifting from a mindset of reducing medical error to eliminating it.

"For a long time, our efforts with regard to [hospital-acquired infection rates] were around being in the 90th percentile plus," said Mr. Priselac, explaining that from school, we're used to a 90th percentile equating to high performance. But, Mr. Priselac and other leaders at Cedars-Sinai realized that the theoretical best performance was "0" infections, and that should instead be the goal for the organization, not a 5 or 10 percent reduction in the infection rate.

Explained Cedars-Sinai CMO Dr. Michael Langberg, "We don't hold ourselves [accountable] for rates of infection, such as CLABSI rate, we hold ourselves accountable for each and every infection we have."

This mindset of zero tolerance has proven effective in an other industry plagued with preventable harm: mining.

In a recent article for Harvard Business Review, Cynthia Carroll, the CEO of mining company Anglo American details her quest to reduce deaths within her firm during her first few years leading the company.

"When I became the CEO of Anglo American in 2007, the company had suffered nearly 200 fatalities over the previous five years. Some company veterans insisted that deaths were inevitable at such a large mining company, because mining is simply a dangerous business. I fundamentally rejected that assumption."

As she met with leaders throughout the organization about safety improvement efforts, she was greeted with a familiar response: "Safety was improving, they assured me, but it would never be perfect," she wrote.

After the first death occurred on her watch, she took what was seen as drastic response: She shut down the entire mine where the fatality occurred.

"That was it. I refused to accept that fatalities were an inevitable by-product of mining. There was only one way to send that message throughout the company. We would shut down the world's largest platinum mine, at Rustenburg. And we would do so immediately."

Anglo American leaders began a top-to-bottom examination of processes at the mine, and retrained more than 30,000 workers to instill a culture of safety. Nearly every manager at the mine was replaced, which showed the company's deep commitment to developing a safety culture.

The efforts paid off. In 2011, Anglo American experienced 17 fatalities, down 62 percent from the 44 in 2006 before Carroll took the helm. While 17 still represents room for significant improvement, the drastic reduction shows the potential benefits of taking safety seriously — so seriously that you would shut down your entire operation until the safety culture was improved.

Would any hospital leader you know be so courageous?

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