Where does your hospital rank on quality?

[Jim Wynne]

I have a hunch many of our Cove quality practitioners will empathize with the frustration the members of the Institute for Healthcare Improvement (http://www.ihi.org/ihi) experience when we meet with blank stares from healthcare practitioners as we try to discuss mistakeproofing, control plans, root cause investigation, management involvement, employee training, and evaluation of the effectiveness of the training.

Here in Illinois, State officials are trying to deliver a dope slap to one powerful "nonprofit" hospital by taking away its real estate tax exemption because it fails to deliver "charity" service to the poor patients in direct contradiction of its claim for such exemption - i.e. that it "provides free service to the poor and needy in the community."

I'm far from being knowledgeable in this area, but it sure seems to me that some sort of different approach is needed, and trying to transfer manufacturing quality principles will just keep causing the aforementioned blank stares. I think that when you walk through the front door of a hospital (or a physician's office), you're just not in Kansas anymore.

 

[Wes Bucey]

I'm far from being knowledgeable in this area, but it sure seems to me that some sort of different approach is needed, and trying to transfer manufacturing quality principles will just keep causing the aforementioned blank stares. I think that when you walk through the front door of a hospital (or a physician's office), you're just not in Kansas anymore.

Roxane writes

One of these terrible days led to the following:

• Drive to the emergency ward and park outside the doors.
• Ask nurses for help and am informed "Not our job."
• Ask for a gurney because my father could not walk due to the pain.
• "He'll have to take a chair like everyone else."
• No chairs available.
• Get him to walk in...barely...and without assistance.
• Sign him in...wait for hours despite the room being nearly deserted.
• Get an examination room...wait for hours.
• Doctor comes in and prescribes some pain killers.
• Doctor disappears. Nurses forget to administer pain kilers.
• Find doctor who reminds nurses.
• Doctor disappears. Nurses forget to adminsiter pain killers.
• Doctor reappears...confused. My father was supposed to have been admitted into the actual hospital. Administers pain killers himself.
• Administered.
• Nurse taking notes has computer die in the middle and starts to swear.
• Can't find notes from doctor.
• Can't find doctor.
• Finally get everything settled.
• Nurses won't bathe patients and will not permit my father to take a shower.
• Mom has to come in and force them to allow her to accompany him and help him clean up.
• Nurses tip over vases of flowers - breaking vases, etc. - no apologies.
• Wrong food - missed meals.
• Knocking meals on to floor and then trying to return to him saying "The floor's clean."
• Nurses unsure how to read morphine pump and start to play with it.
• Nurses screw up dosage.
• Doctor doesn't check up on the conflictions between his medications.
• Kidneys start to deteriorate.
• Goes through withdrawl as medication is removed.
• Father is now deemed 'clinically depressed' - just add it on to the physical problems.

Help me understand how the situations Roxane describes are

1. DIFFERENT (nurses don't follow prescription order)from an industrial situation where a foreman gives instructions to a worker who ignores instruction, resulting in damaged product; foreman gives second (repeat) instruction which is ignored again; finally, foreman does work himself.
2. DIFFERENT (morphine pump) from a worker put at a machine without having a competency rating to run the machine and allowed to run the machine, endangering life, health, and safety of customers.
3. DIFFERENT (medication conflict) from an operations manager who authorizes use of obsolete drawings because he didn't have an infrastructure of configuration management, resulting in products which endanger life, health, safety of end users

 

[Jim Wynne]

Roxane writes Help me understand how the situations Roxane describes are

1. DIFFERENT (nurses don't follow prescription order)from an industrial situation where a foreman gives instructions to a worker who ignores instruction, resulting in damaged product; foreman gives second (repeat) instruction which is ignored again; finally, foreman does work himself.
2. DIFFERENT (morphine pump) from a worker put at a machine without having a competency rating to run the machine and allowed to run the machine, endangering life, health, and safety of customers.
3. DIFFERENT (medication conflict) from an operations manager who authorizes use of obsolete drawings because he didn't have an infrastructure of configuration management, resulting in products which endanger life, health, safety of end users

I'm not saying that the situations are different, and I didn't suggest that the solutions in cases of defect prevention would be substantially different. I said that the approach doesn't seem to be working. That's the exasperating part of it. But if you only speak English and your target audience doesn't understand English, it doesn't matter if your English entreaties are rationally sound.

 

[Wes Bucey]

The reason the quality approach doesn't seem to be working is exacty the same reason it doesn't work in some industrial or service organizations - top management Refuses to listen, effectively putting fingers in their ears and yelling, "LA LA LA LA! I can't hear you!"

 

[Antonio Vieira]

Here we have some certified ISO 9001 parts of Hospitals. However what you told about using mistake proofing techniques in this kind of services is still not tried.
I think that the health sector should be the one where these ideas must be applied in a most efficient way – we are talking about direct human lives.
Anyway, now I’m working as an ISO 9001 trainer in an Hospital, is there any information in the Cove about applying the standard in this field?
Thanks!

António

 

[gpainter]

You better shop around. We are in a small town and there are two within about 10 miles of each other. There is a BIG difference.

 

[Wes Bucey]

Here we have some certified ISO 9001 parts of Hospitals. However what you told about using mistake proofing techniques in this kind of services is still not tried.
I think that the health sector should be the one where these ideas must be applied in a most efficient way – we are talking about direct human lives.
Anyway, now I’m working as an ISO 9001 trainer in an Hospital, is there any information in the Cove about applying the standard in this field?
Thanks!

António

I'm not aware of any substantive threads here in the Cove regarding health care and ISO Standards in the last three years.

If you are not aware of Grout's Poke Yoke page (mistake proofing) on his college's website (http://csob.berry.edu/faculty/jgrout/pokayoke.shtml), you might be interested in joining a prgram specifically for health care - see http://www.mistakeproofing.com/medical/ for further info.

Do you have this ISO Standard?

IWA 1:2005

Quality management systems -- Guidelines for process improvements in health service organizations

(available in English only)
Edition: 2 (Monolingual)
Number of pages: 84
Technical committee / subcommittee: TMB; ISO Standards
ICS: 11.020; 03.120.10
Status:

Published standard
Current stage: 60.60
Stage date: 2005-10-03
Revision information: (Show) Add to shopping basket
Size Price
IWA 1:2005 PDF version (en)
1045 KB
CHF 96,00
IWA 1:2005 paper version (en)
CHF 96,00
Abstract:
IWA 1:2005 provides additional guidance for any health service organization involved in the management, delivery, or administration of health service products or services, including training and/or research, in the life continuum process for human beings, regardless of type, size and the product or service provided.

Corrigenda, Amendments and other parts

ISO 1:2002

ISO/TTA 1:1994

 

[Aaron Lupo]

My goodness I wouldn't send a dead person to the hospital in my town. We were there a couple weeks ago and all we heard about was the contract the nurses had that was about to expire and what thier holiday plans were. Hey, here's an idea do some work. The Doctor ordered a test a 6:00 as of 8:00 it still had not been done. There were plenty of other issues but far to many to list here. If it had been me that was their for treatment I would have walked out.

 

[Antonio Vieira]

I've never heard about the standard IWA 1:2005 "Quality management systems - Guidelines for process improvements in health service organizations", I never worked in the health field.
Thanks Wes, very interesting information!

 

[Helmut Jilling]

I am working on a project I ahve mentioned previously, but the progress slowed down a bit. I am working with some Healthcare professionals to develop ISO training for the Healthcare industry using healthcare language. As discussed in this thread, a key necessity is to speak to them in language they understand.

Industry has solved many of the same quality and productivity problems that hospitals face. But we have to speak their terms.

I feel that healthcare will embrace ISO 9001 in a big way if they can see examples where it has been done correctly.