June 7th, 2011

Success and Failure: An Experience with Healthcare Ergonomics

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In the process of assisting my aging parents with a series of recent health concerns and medical emergencies, I’ve had ample opportunity to observe the USA medical system in action, from first emergency responders, through the surgical, hospital and home recovery experiences, and into the swamp of Medicare and supplemental insurance. I’ve been awed and amazed at times; shocked and dismayed at others. Ergonomics has made a huge impact in some care settings and processes, and others remain in dire need of the benefits that human-centered design will bring.

Process is a key word here. As with any organization, most of the people we’ve dealt with, on an individual basis, have been good people. But poor process design or implementation, or no process design, can make even the best people go bad, whether it be the caregiver or the patient. And sometimes, even with a well crafted process in place, lack of effective equipment and training, or poorly designed equipment and training, will detract from the human experience.

Awareness of patient handling, the poster child for ergonomics in care facilities these days, has been noticeable among the caregiving staff at the two hospitals I’ve frequented. I’ve repeatedly observed caregivers at both facilities seek assistance and coordinate teams when repositioning or transfers were needed, but I also noticed the staff at one hospital was far better, to themselves and to the patient, than the other, and the primary difference appeared to be rooted in training and organizational culture. In fact, if I could pinpoint the underlying difference between the two hospitals, it would be organizational culture. Both hospitals had comparable equipment, facilities and technologies, but only one had effective processes. That is to say, only one had effective leadership.

Hospital A had easily recognizable processes for nearly every aspect of care and patient interaction. Hospital B had a variety of processes, or so it appeared, but little consistency and poor adherence, which I would attribute to inadequate training, and likely, inadequate recognition and carry-through by management. The most important demonstration of this difference was in the control of medical errors.

Hospital A had clearly recognizable and regularly and cheerfully adhered to procedures to reduce the likelihood of medication errors, while Hospital B had what looked to be a similar procedure in place, yet I observed haphazard adherence among the caregivers, as well as a lack of clear understanding of the importance of compliance. Hospital A employees deployed the safeguards with pride and diligence; hospital B employees did so with a lack of conviction and an air of displeasure and distraction, which I can only assume translates into less overall compliance and success, and are therefore more likely to commit life-threatening errors.

This ongoing experience brings the importance of what I’ve come to call an ergonomically designed processes to the forefront. Hospital A obviously has an ongoing commitment to creating value for both the patient and the caregiver — essentially all of the people that interface with the process. This is known as macroergonomics, which vastly increases the likelihood of a successful, effective, sustainable business model. Hospital B has a commitment to short term cost reduction, even if it comes at the expense of the patient or caregiver. That business model will ultimately fail if left to its own devices. The difference is a human-centered systems approach vs. an accounting centered, myopic, non-systems approach.

And here’s the funny part: Hospital A will ultimately be much more profitable than Hospital B, even though their primary focus is not merely on finances. The management of Hospital A understands there is complex relationship between people, processes and profits, and they know they can’t maintain profits without an integrated approach to optimizing people and processes. Hospital B just doesn’t get it.

In an article I wrote for Ergonomics In Design, I shared what I have come to understand as the basic ingredients for an effective, sustainable organization:

1.    management leadership;
2.    defining and effectively communicating strategic plans;
3.    respect for people (employees, customers, suppliers, stakeholders, communities);
4.    a scientific approach to continuous improvement (e.g., plan-do-check-act, standardized methods);
5.    a holistic system and process focus that reduces wasteful activities and costs at their root;
6.    cross-functional cooperation and teamwork;
7.    training, knowledge and skill development; and
8.    responsibility and accountability throughout the organization.

In my experience, few organizations recognize, and even fewer embrace, the Respect for People principle. Those that do are typically very successful. Those that don’t will either fail in the long run, or will resort to brute force as a means to prevail.

As Henry Ford once said, Profit is the inevitable conclusion of work well done. Hospital A understands that.



Comments

  1. Donald Morelli says:

    Peter, your experiences reflect what is the case in too many healthcare facilities. I had the opportunity to talk with the in-house pharmacy staff of a local hospital several years ago in an attempt to determine the potential scope and severity of medication errors. The Pharmacists all had examples of mis-medication or mis-dosage events, clearly indicating a process out of control. The management of the pharmacy, as well as the managers of the managers, did not believe there was any problem. Even after discussing what a closed-loop system should look like, and where there might be discontinuities in the control loop, they were unmoved. To their defense, the management was preoccupied with plans for new construction at the hospital, to include a new pharmacy. My fear was that they were going to simply copy their process from the current to the new pharmacy, so the risk exposures would endure. I only hope that they brought in a new vendor for electronic medical records and meds dispensing who could help them improve their process – because I was unsuccessful in doing so.

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