If another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the Root Cause Analysts might mount their horses, the Six Sigma Black Belts will sky dive and the Safety Champions will tunnel their way clandestinely to rendezvous at the sentinel place.
What might be their unique insights? What will be their prescriptions?
One never knows what pearls one will encounter from ‘after-the-fact’ risk managers. I can imagine Caesar consulting a Sybil as he was being stabbed by Brutus. “Obviously Jules you should have shared Cleo with Brutus.” Thanks Sybil. Perhaps you should have told him that last night.
Nevertheless, permit me to conjecture.
First, they might say that the hospital ‘lacks a culture of safety which resonates with the values and aspirations of the American people.’
That’s always a safe analysis when the Ebola virus has just been mistaken for a coronavirus. It’s sufficiently nebulous to never be wrong. The premise supports the conclusion. How do we know the hospital lacks culture of safety? ‘Cos, they is missing Ebola, innit,’ as Ali G might not have said.
They would be careful in blaming the electronic health record (EHR), because it represents one of the citadels of Toyotafication of Healthcare. But they would remind us of the obvious ‘EHRs don’t go to medical school, doctors do.’ A truism which shares the phenotype with the favorite of the pro-gun lobby ‘guns don’t kill, people kill.’
European health care systems are already awash in “big data.” The United States is rushing to catch up, although clumsily thanks to the need to corral a century’s worth of heterogeneity. To avoid confounding the chaos further, the United States is postponing the adoption of the ICD-10 classification system. Hence, it will be some time before American “big data” can be put to the task of defining accuracy, costs and effectiveness of individual tests and treatments with the exquisite analytics that are already being employed in Europe. From my perspective as a clinician and clinical educator, of all the many failings of the American “health care” system, the ability to massage “big data” in this fashion is least pressing. I am no Luddite – but I am cautious if not skeptical when “big data” intrudes into the patient-doctor relationship.
The driver for all this is the notion that “health care” can be brought to heel with a “systems approach.”
This was first advocated by Lucien Leape in the context of patient safety and reiterated in “To Err is Human,” the influential document published by the National Academies Press in 2000. This is an approach that borrows heavily from the work of W. Edwards Deming and later Bill Smith. Deming (1900-1993) was an engineer who earned a PhD in physics at Yale. The aftermath of World War II found him on General Douglas MacArthur’s staff offering lessons in statistical process control to Japanese business leaders. He continued to do so as a consultant for much of his later life and is considered the genius behind the Japanese industrial resurgence. The principal underlying Deming’s approach is that focusing on quality increases productivity and thereby reduces cost; focusing on cost does the opposite. Bill Smith was also an engineer who honed this approach for Motorola Corporation with a methodology he introduced in 1987. The principal of Smith’s “six sigma” approach is that all aspects of production, even output, could be reduced to quantifiable data allowing the manufacturer to have complete control of the process. Such control allows for collective effort and teamwork to achieve the quality goals. These landmark achievements in industrial engineering have been widely adopted in industry having been championed by giants such as Jack Welch of GE. No doubt they can result in improvement in the quality and profitability of myriad products from jet engines to cell phones. Every product is the same, every product well designed and built, and every product profitable.