Caregiver Becomes Patient: 3 Arguments for QI

I consider myself lucky. Until lately, I did not need any surgeries or extensive medical care. But this suddenly changed and I had my first experience as a patient. I joked that I wanted to actually see first hand how the healthcare system works…but my smile was tentative and my apprehension surpassed my curiosity. Now, after being at the receiving end of medical care, I would like to ask my healthcare colleagues: 

Are you able - and willing - to better your care for the patient?

Healthcare Worker's Search for Meaning

"The last of human freedoms- the ability to choose one's attitude in a given set of circumstances" 
Viktor Frankl

When you are a healthcare worker there is one thing you never want to hear: a fatal error leads to patient death. Sadly, today was one of those days. This terrible event is mentally and physically painful to grasp and reminds us all of our inherent and human ability to fail. The pain of the family is extremely raw and the society’s response is intensely broadcasted, and for good reason. Today though, just for once, I will talk about the pain of the provider, the one entrusted with your safety.

To Check(list) or Maybe Not?

You probably read Atul Gawande's 'The Checklist Manifesto', in which he talks about how the safe surgery checklist came to life. I enjoyed the read especially as it seemed to have come to fruition so unexpected and yet so logical. And of course, as with anything related to quality improvement, the part that was the most challenging was yet to come: implementation.

It has been now 6 years since the WHO published the first edition of the Safe Surgery Checklist Implementation manual, and so far it has been widely adopted in hospitals around the globe. Sometimes, regulations and mandates have been used to ensure compliance.

Then, in March 2014, a study in the NEJM conducted by a group of Ontario researchers concluded that the implementation of the checklist was not associated with 'significant reductions in surgical mortality and complications'. And the debate started: what are we to make of this? Although it is a checklist, the obvious fact is that not ticking the boxes is what makes the surgery safe, but performing those actions. Also, implementation of this tool is hard, in an area where tradition is strong, egos are big and change is difficult. When hospitals are under pressure to conduct audits for compliance, how truthful are those audits? Another study looking at the OR and PACU safety culture in comparison with other hospital units concludes that the OR/PACU actually score lower than other hospital units, which means the OR is an area where improvements on the understanding of safety culture is much needed. We first need to understand what a safety culture is, in order to really successfully apply tools to improve this culture.

Achieving Ultrasafe Health Care: 5 barriers

Here is a sort synopsis of an interesting and mind provoking article by Amalberti, Berwick, Auray and Barach. It brings back the discussion about how do we compare with ultra safe industries, and how many steps do we have to take to bring us to that much needed point of safety.

Becoming ultrasafe may require health care to abandon traditions and autonomy that some professionals erroneously believe are necessary to make their work effective, profitable, and pleasant.
Reliable measurement of health care and patient safety outcomes is the first challenge for health care benchmarking

The 5 barriers to achieve ultra safe health care are:

The EQ of OR

The term ‘non-technical skills’ came from the European aviation regulator in the 1990s and the concept is now used to underpin training and workplace-based assessment in a number of safety-critical occupations, including healthcare.

In this article Rhona Flin gives a brief overview of three non-technical skills frameworks developed for training and evaluating the performance of clinical practitioners. These are: ANTS for anaesthetists; NOTSS for surgeons; and SPLINTS for scrub practitioners. These acronyms should be more used in the OR. Technical skills are not all that it takes to make the OR safer.

Read the full report here