“So, Curmudge, what more are we going to learn from Hôpital Nord 92?”
“Jaded Julie, I hope we’ll learn more about safety and efficiency in nursing.”
“By the way, Curmudge, how does one say 92 in French?”
“Quatre-vingt-douze. It means four twenties twelve. Why do you ask?”
“Well, their math is okay, but it’s sure not a very efficient way to say ninety-two. Can the French really teach us anything about efficiency?”
“You’re in luck, Julie. Ballé and Régnier cite an American author, Steven Spear. Dr. Spear contends that ambiguity and workarounds contribute to medical errors*. They are also undeniable sources of inefficiency. Think of what must be known for any process to occur: who (patient as well as caregiver)? what? when? where? why? how? Ambiguity in answering any of these questions leads to inefficiency and time wasting. If root causes of problems in a process or procedure are not resolved, workarounds must be developed each time it is performed.”
“I can certainly see that ambiguity can lead to inefficiency, but in what ways might it compromise patient safety?”
“Answering the ‘how?’ question is one of the most critical. Here’s what people tend to do when they are uncertain about how to do something (from a seminar at SEH by Lucia Berte):
· They ask someone.
· They look it up (if the document is easy to interpret and not too long).
· They make it up.
· They might not do it. (In Nord 92, the nurses sometimes skipped steps in procedures.)”
“Wow, Curmudge, the last two options are kind of scary. I can understand how they might lead to errors. So how did the nurses at Nord 92 respond to Dr. Spear’s teachings, especially his urging that patient care practices be highly specified, i.e., standardized?”
“Because checklists had been developed in order to achieve the basic stability that we discussed last week, the nurses were familiar with the concept. They were, as might be expected, protective of their autonomy and reluctant to use checklists on themselves. So the effort started on a small scale with a checklist on basic patient care. Early checklists likely avoided topics that might be considered efforts to standardize nursing judgment. Later, however, the program grew to standardize more technical aspects of patient care.”
“It sounds as if the folks at Nord 92 jumped headlong into the Toyota Production System.”
“They did, Julie. And they used some other Lean techniques that we’ll cover in later discussions. Remember that they accomplished all of this using teams of nurses guided by their managers. If these changes had been dictated by management, they would have been accepted about as fast as if they had been written in German (or maybe in English).”
“The French have taught us a valuable lesson. After basic stability is achieved, standard work can be applied to patient care. Say, Curmudge, do you have any other examples of French efficiency?”
“Sure. Est-ce que at the beginning of a sentence means that the sentence will be a question. You don’t have to wait for the question mark at the end.”
“Well, that’s not as efficient as the inverted question mark (¿) in Spanish.”
“Good observation, but did you ever hear anyone speak an inverted question mark?”
“Hey! That’s pretty quick for an old guy. See you after your trip, Curmudge?”
“Of course, Julie.”
Affinity’s Kaizen Curmudgeon
*http://www.annals.org/cgi/reprint/142/8/627.pdf
P.S.—“Check this out, Julie. It’s a timely blog posting that provides strong support for standardized processes in patient care.” http://www.dailykaizen.org/archives/564
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