How hospitals can learn from the manufacturing industry to curb medical errors

Hospitals are learning patient safety improvement from two unlikely models —manufacturing and behavioral science, The Economist reports.

Five insights from the article:

1. After a patient was mistakenly injected with a lethal antiseptic in 2004, Seattle-based Virginia Mason Medical Center committed itself to improving safety — and used the Toyota Production System's "lean" manufacturing techniques to help.

The model helped to analyze and standardize almost every part of the hospital, from radiology to recruitment. Hospital staff received training to raise safety concerns, and Virginia Mason now takes pride in its safety record, selling its experience with Toyota's model to hospitals worldwide.

2. Virginia Mason isn't the only hospital looking beyond medicine to improve patient safety. Several hospitals in rich countries have borrowed from manufacturing and aviation to improve care, The Economist reports. "Lean" is one industrial-management theories hospitals have learned from manufacturing. The theory suggests hospitals study a patient's "flow" through the facility, just as factory workers monitor a car throughout the production line.

3. Using the lean theory, hospital staff can identify and address bottlenecks and inefficiencies. Virginia Mason utilizes a "stop the line" policy, encouraging staff members to stop a procedure deemed unsafe. The hospital also uses the Toyota production principle of genchi genbutsu, or "go and see for yourself," as a standard for executives to talk with staff about safety risks in various hospital wards.

4. Although Virginia Mason says it has become more profitable as it has decreased liability claims since 2001, not much evidence shows manufacturing-based management in other hospitals has had a significant effect on patient outcomes.

A 2016 literature review found only 19 of 207 articles on the effects of "lean" methodologies were peer-reviewed and had quantifiable results, The Economist reports. No link has been found between lean methods and health outcomes.

5. Approaches that do not add more work for physicians may be more promising. For example, behavioral scientists recently have begun trying to nudge physicians to make better decisions by studying and acting on their inherent biases.

The Penn Medicine Nudge Unit at the University of Pennsylvania in Philadelphia is the first behavioral science unit to be set up within a health system. The unit, developed in 2016, demonstrates how courses of action can be safer when physicians have to opt out of typically better practices rather than opt in.

For example, only 15 percent of patients with heart attacks were being referred to cardiac rehabilitation when physicians were required to opt in to referring them and complete a lengthy form. By making referral to rehab the hospital's default setting and giving physicians forms that were already completed, the referral rates jumped to 85 percent.

More articles on clinical leadership and infection control: 
5 hospitals in the spotlight for medical errors — and how they're fixing them
University Hospitals denies liability for loss of 4,000 eggs, embryos
Hospital-acquired condition penalty has little effect on reimbursement, study finds

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