Thursday, March 24, 2011

I've always done it that way.

“Curmudge, today’s title looks as if it might be a sequel to last week’s We’ve always done it that way.”

“Very perceptive, Jaded Julie. Let me give you a ‘heads up.’ Today’s lesson is that standard work is more efficient, less costly, and usually easier than when everyone does things as they have always done them in his or her own way. Most importantly, standard work enhances patient safety.”

“That sounds intuitive, Curmudge, but I’ll bet that you have some evidence to back it up.”

“You recall my mentioning my senior citizen friends that I see every Independence Day. Although it’s depressing, we often talk about health issues. It is discouraging to learn that among that group and my other friends and acquaintances, many people have incurred surgical site infections. Of course these people were the fortunate ones, because they lived to tell about their experience. My circle of close friends is small (and its diameter is being reduced by the Grim Reaper); but even without hard data, the frequency of these presumably preventable infections is shocking.”

“So much for anecdotal evidence. There must be some information out there that supports your thesis that standard work makes patients safer.”

“Have patience, Julie, we’ll get to it. It’s my understanding that individual surgeons favor specific instruments, sutures, prosthetic devices, and other replacement parts for a given procedure. This is called their ‘preference list.’ So surgeon A would have his/her preference list for procedure X, while surgeon B might have a different list for the same procedure.”

“That doesn’t sound like standard work to me. But it’s not surprising, because surgeons A and B might have learned the procedure from attending surgeons in institutions hundreds of miles apart. In each case, the surgeon might say about his technique and preference list, ‘I’ve always done it that way.’ That must be pretty common, Curmudge, but how does it relate to surgical site infections?”

“In his leanblog.com posting on March 7, 2011, Mark Graban cited a study of a procedure that historically yielded from 2 to 5% frequency of surgical site infections. At the start, the study group members used 14 different pre-printed order sets for the same procedure. After weeks of deliberations, the surgeons and anesthesiologists reached consensus on standard order sets.”

“Wow! Those meetings must have required a talented facilitator. What was the outcome of their having adopted standard infection control procedures?”

“The study group went 11 months without a single occurrence of the target infection. And when a single infection ended their record, the group was able to investigate its root cause without blaming an individual. Overall, their surgical site infection rate dropped 63%. Furthermore, the team agreed that they would make changes that are best for the patient rather than the provider.”

“That’s really impressive. It’s critical to realize that the changes were made by the physicians themselves. They most likely would not have been adopted if they had been imposed on the physicians by someone else. By the way, Curmudge, do you have a standard procedure for writing this blog?”

“Sometimes I ruminate on a topic for weeks; sometimes for only a few minutes. Then I just sit at the computer and write. I’ve always done it that way.”

Affinity’s Kaizen Curmudgeon

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