Becker's Hospital Review

51 Executive Briefing: Organizational Improvement Sponsored by: Do Checklists Work in Healthcare? Patient Safety, Behaviors and Organizational Culture Introduction The task can seem monumental: Improve patient outcomes. Im- prove patient safety. Improve the patient experience. Accomplish all of this while reducing costs. Re-design a delivery system that evolved around the traditional practice of medicine, a hospital structure designed decades ago and payment methodologies built on volume, rather than quality and efficiency. Sometimes the response feels like a shotgun approach of every solution we can think of: new technology, new data systems, new organizational structures, new delivery models and processes. Not surprisingly, this approach doesn't always work. Hospitals learned this when they tried to mandate the use of surgical check- lists without understanding why these tools were successful in other industries. Companies over-emphasize process tools, ignoring half the equation Mike Hoseus, co-author of the best-selling book, "Toyota Culture: Heart and Soul of the Toyota Way," recently spoke at the Rice Uni- versity Jones Graduate School of Business on this topic. He noted that many organizations, especially hospitals, miss an entire half of the lean equation: the value that Toyota places on employees and their behaviors. With his permission, we'll borrow liberally from Hoseus' Rice Uni- versity presentation. Most lean (and other continuous quality im- provement) consultants and their clients focus almost exclusively on lean process tools. Hoseus may be one of the only speakers who consistently points out a flaw in the approach. The ability to identify and solve problems depends on three equally important components: 1. Vision and goals — Clearly defining organizational purpose, your "true north;" 2. Process — Workplace management through standardiza- tion and visualization, including relentless elimination of waste; and 3. People — Engaging, challenging and coaching employees. Developing teamwork and putting people before products. The third component is no less important but consistently ne- glected. Leaders, focused on the potential cost savings of lean, shouldn't ignore a core principle of the Toyota Production System: Organization and employee goals must complement each other to ensure long-term mutual prosperity. An organization has goals re- lating to profit and financial performance, long-term success, qual- ity and contribution to the community. Employees want a secure paycheck, personal and company growth, a safe workplace and meaningful work. Both organizational prosperity and employee satisfaction are built around, and achieved through, the continu- ous improvement process. The goals on both sides of the relation- ship depend upon, and contribute to, long-term mutual prosperity. An example: Do operating room checklists improve patient safety? Hospitals have been investing time and money into improving pa- tient safety for over a decade. Lean and other continuous quality approaches are ideally suited to improve patient care processes and safety but we find, time and again, that "process" alone does not suffice. The results have been inconsistent. The other speaker at the Rice event was Michael Rose, MD, vice president of surgi- cal services for McLeod Health in Florence, S.C., and chairman of the South Carolina Safe Surgery 2015 leadership team. Dr. Rose was recently named as one of the top 50 Experts Leading the Field of Patient Safety by Becker's Hospital Review. He spoke about his experience implementing surgical checklists and, with his permission, we borrow from his presentation: The Joint Commission Universal Surgical Protocol is a checklist endorsed by 50 national groups and mandated for use in every hospital since 2004. The goal was to use checklists to ensure stan- dardized processes and eliminate errors in the operating room. It was identified as an innovation that would change medicine. Man- dating this change made perfect sense, and you'd expect near immediate performance improvements. During the initial two year period after adoption of the protocol, however, many hospitals actually saw an increase in reportable events. Merely mandating that surgical teams implement the protocol clearly didn't work. Many hospitals have re-grouped and "re-implemented" surgical checklists with much better success. What is different this time around? A different approach to the process, itself, to team work and team relationships, and to the staff care experience. 1. process. It's not just a checklist. It's the thoughtful implementa- tion of a deliberate process. This includes a three step process: brief, time-out and debrief. Team members complete pre-proce- dure safety briefs. Then, everyone, including the surgeon, verbally

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