Here’s another great post by another great person I met online, Maryanne Colter, of MMColter Ltd.   She’s on Twitter @mmcolter.  What I love about this post is her emphasis on hitting a target worth hitting.  Aim for the moon on quality or defects and you may hit it.  Perfect ought not be a stretch goal, as a target it should be de rigeur.  Thanks Maryanne–the rest is hers.

Treating people like shoes…

On January 19^th Senator Grassley issued an open letter to medical software vendors and hospitals, chastising them for slamming in EMR software, giving higher regard to being on time and on budget than making sure the software was performing flawlessly.  After all, we are dealing with people’s lives. I got the impression from the Senator’s letter that the passive “mistakes were made” is not going to be an acceptable answer; 100% accuracy should be the only acceptable answer.

And yet it happens. A few weeks ago I spoke to a charge nurse at an Academic Medical Center  (one that was cited in a 2006 study as being exemplary in high quality care) who told me they had around 100 fixes to their system in the first few weeks after go-live.  He also recounted an incident where they lost an entire day of a patient’s nursing documentation somewhere in the transfer between the PACU and the patient’s room.

Strange as this may sound, the solution may be to treat people like shoes.   I once consulted at a company that’s known for its shoes.  Not a tiny company, but one where probably half the world owns a pair of their shoes.  A team of highly trained employees and consultants streamlined processes and put in the technology that increased the overall efficiency of the supply chain by 34%.

Imagine if we had done a shoddy job with their data and said 98% accuracy was ‘good enough’?   We would have transferred data from design to manufacturing, but maybe the shoelaces were a little short, but that hit the 98% mark and would have been ‘good enough’.  When we started manufacturing the shoes, who would have cared if the sole were a little cockeyed?  It still would have been within our 98% mark.  Two percent of the customer orders for the faulty shoes would have contained 2% wrong products or the wrong sizes. Two percent of all orders would have been shipped to the wrong stores. Invoices that were 98% accurate would have been ‘good enough’.  And all of those mistakes would have been done 34% faster.

How about if we treat the delivery of medicine with the same regard as a carton of shoes? We supplied shoes to a major retailer who demanded 100% accuracy of carton labels.  If any one of the hundreds of characters on the carton label were misplaced, the carton would be automatically rerouted, photographed, and emailed back to the supplier with the message of “get this 100% accurate, or else…”.  Think of all the places in medicine where a “get it 100% accurate, or else” rejection message might save a life.

There is no single analogous situation from business to medicine and there are certainly enormous differences, not the least of which is we are dealing with biological systems and the things that can go wrong increase by a thousand-fold.  But instead of looking at what works and adapting it to healthcare, most of healthcare patently rejects ‘outsiders’ with ‘outside ideas’ and throws the baby out with the bathwater.

Whenever using analogies it is imperative to do a thorough analysis of the differences, but the answer to the question “what is different?” is not “everything”! Data is either accurate or not.  Software testing results are either thorough or not. The only answer to the question, “Did you get enough training to flawlessly perform you job?” should be yes, or else more training is needed. Period. These are not unique notions. The healthcare industry has the worst case of ‘not invented here’ refusal to adapt quality improvement measures from ‘outside sources’ since JIT had to be renamed Lean because the US could not get over its WWII bigotry of anything remotely Japanese.

“Outsiders” are not viewed as people who would take accuracy even more seriously when dealing with human beings. Instead, we are viewed with the assumption that because we have only dealt with shoes and cardboard boxes that our concern for accuracy and quality must somehow be cavalier.

The healthcare industry needs perfectionists and they can come from anywhere.  It needs people who when they hear “perfect is the enemy of the good” answer with “tell that to the patient whose medicine is one decimal point away from killing them.” Sometimes, perfect is the only option.

I have a dear friend who has a brain tumor.  Thankfully it is benign, but eventually he will need radiation or surgery.   When that day comes, one of the most brilliant, wise, and compassionate minds in the world will be one decimal point away from destruction or cure.  He is the only reason I keep pounding my head against the wall of “ideas from outsiders are not good enough here.”

One of my heroes once said about accidents, “I am of the opinion that zero is the right number…You cannot plan to kill three people a year because you killed four people last year and you want to get a little better…So the goal is zero…Zero injuries. Zero reportable incidents.”  That man was Paul O’Neill when he was the CEO of Alcoa.  Heaven forbid we should learn a lesson from people who make pop cans.