Healthcare needs build a new bridge.

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 At Institute for Healthcare Improvement National Forum,  Don Berwick, MD, former CMS administrator used a 1930s engineering feat in Honduras as a metaphor for today’s healthcare system. 

The Choluteca Bridge was built by the U.S. Army Corps of Engineers with such design strength, it could withstand the worst of hurricanes that affected the area. When Hurricane Mitch came in 1998, it destroyed 150 Honduran bridges, but not the Choluteca Bridge. Instead, the storm rerouted the Choluteca River. So now, the Choluteca Bridge is useless.

More detail from Iowa Hospital Association blog:

Dr. Don Berwick declared that today’s health care organizations are like the Choluteca Bridge.  They were designed and built for a different river – the river of heavy-duty, high-volume, invasive procedures.  The river of serious illness. While the temptation is great to try and redirect the massive river to flow back under the first bridge, the work set before health care leaders is to build a new bridge – a bridge of authentic prevention. Dr. Berwick said, “Hospitals cure disease but they do not prevent it.  And they cannot prevent it, because they aren’t set up to do that today.  Prevention doesn’t have any cathedrals.  The result is a continuing misallocation of effort.  If the Martians came here to visit, they would call this insane.  We let bad things happen and then fix them.  Well, why don’t we stop them from happening?   Simply put, we just haven’t built the institutional structure for prevention.” – See more at: http://blog.iowahospital.org/2013/08/22/a-bridge-where-the-river-flows-no-more/#sthash.xSJPVPm1.dpuf

The National Academy of Engineering and Institute of Medicine of the National Academies directed attention to the issue of systems engineering and integration with their joint report in 2005, “Building a Better Delivery System: A New Engineering/Health Care Partnership.”   The collaboration between clinicians, engineers, researchers, educators, and experts from medical informatics and management will  analyze, define, design, develop, test and implement high value and comprehensive solutions to many of the challenging problems in clinical medicine.

Steve Jobs Video from 1990 on Continuous Improvement

Great post from Lean blog  if you want to read the whole transcript.

Skip to 7:54 if you don’t have time to watch the whole video.

What healthcare can learn from nuclear power industry?

Just came back from 2014 Symposium on Human Factors and Ergonomics in Health Care in Chicago. I attend a session presented by experts from AAMI, the Association for the Advancement of Medical Instrumentation  titled Safety and Risk in Health Care and Nuclear Power: Learning From Each Other .     By learning from nuclear power industry,  healthcare industry can use technology effectively and efficiently with systems engineering, human factor approaches. The re-engineered  new healthcare delivery system should integrate people, technology, process, organization and external environment. The cross industry collaboration is critical to transform the healthcare delivery.  Simulation will play more important roles on training, assessment, usability testing and process redesign.

You can read more from AAMI monograph,Risk and Reliability in Healthcare and Nuclear Power: Learning from Each Other”

“The future is already here. It’s just not evenly distributed yet.” —William Gibson

 

“In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.”

“In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.”Eric Hoffer

Short-term and Long-term Impact of the Central Line Workshop on Resident Clinical Performance During Simulated Central Line Placement.

Our paper just published at Simulation in Healthcare Journal.   The study demonstrated earlier simulation training offered greatest benefits.

INTRODUCTION:  The Central Line Workshop (CLW) was introduced at our institution to better train residents in safe placement of the central venous catheter (CVC). This study sought to determine if immediate performance improvements from the CLW are sustained 3 months after the training for residents with various levels of experience.

METHODS: Twenty-six emergency medicine residents completed the CLW, which includes online modules and experiential sessions in anatomy, ultrasound, sterile technique, and procedural task training. Demonstration of the synthesis of these skills including placement of both internal jugular and subclavian CVCs was assessed using a task trainer. Each resident was also tested approximately 3 months before and 3 months after the CLW. Residents were assessed using a validated CVC proficiency scale.

RESULTS: Residents’ CVC proficiency scores (percentage of items performed correctly during the assessment station) improved after CLW (0.6 vs. 0.93, P < 0.05). At 3 months after CLW testing, there was apparent skill decay from the CLW but overall improvement compared with baseline testing (0.6 vs. 0.8, P < 0.05). There was no significant difference in procedure time after CLW training. The postgraduate year 1 group showed the greatest improvement of CVC skill after CLW training.

CONCLUSIONS: Resident CVC placement performance improved immediately after the CLW. Although performance 3 months after the CLW revealed evidence of skill decay, it was improved when compared with initial baseline assessment. Novice learners had the greatest benefit from the CLW.

21st Century Health Care: Wedges, Homes, and the Future of Pedagogy

 

 

Happy New Year 2014

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