Oct 9, 2009

Check a Box. Save a Life.

Check a Box. Save a Life.
The 1st Global Student Sprint to Improve Healthcare.

Drs. Atul Gawande and Don Berwick will be addressing students on October 22nd at 12pm EST and encouraging them to engage in global efforts to improve the quality of patient care.

In effort to spread the incredible energy and enthusiasm of student involvement, we have gathered from all over the world at the IHI in Boston to get it underway...and we couldn't be more excited to be a part of the effort!

Oct 8, 2009

On Humans and Handles - Addendum

First, not recognizing that my last post would be viewed by so many important IHIers, thank you all for your kind and generous praise! This has been an incredible week.

I wanted to expand on my previous point regarding the solitary design flaw in the office - the front exit door handle.

We've all seen the far side cartoon depicting the Midvale School for the Gifted (a classic!). I believe this cartoon derives its humor from two sources 1) Making the viewer feel superior, a theme of most jokes, and part of the funniest joke in the world (NB: As determined by scientists; British ones, to boot - sorry Andy), and 2) Reminding the viewer of a mistake that feels universal to the human condition.

How many times have you walked up to a door, attempted to pull it open, only to find that this was a "push" door? In my case, more times than I can count. Does this replay of the Midvale scene mean I’m, ahem, less than "gifted?"

In fact, no. The door handle problem represents a conflict between our automatic mental processes - the fast, decisive parts of our brains that allow us to catch a falling cell phone, or supply an effortless "you're welcome" when needed - and the slower, rational processes that think their way to an answer.

To the automatic brain, a vertical bar means “pull,” while the rational brain wonders, “don’t most exit doors push outward? Except in houses. Hmm. . . “ But by then, the mistake has been made.

An observer might laugh, but why? Isn’t it better to be frugal with one’s brainpower, committing it to loftier challenges than those presented by a handle? Even though I committed the mistake, it's not me who is wrong – it's the door.

To me, the push-pull problem is a favorite example of the predictability of human error. As with even the gravest medical mistakes, pulling the door is bound to make sense to someone on occasion. How do we prevent the embarrassment and wasted time resulting from door misuse?

We could put a sign up: "Note, push the door; thank you for your cooperation." We could penalize those who attempt to pull the door, and promote those who push it. We could host an annual seminar to remind everyone to always push the door (slogan: "be pushy about going home from work!"). We could even station an assistant (IHI Egress Coordinator) near the door to make sure we exited properly.

Or, we can admit that as long as humans are the ones grasping the handles, some will pull them, and try to fix all the world’s doors.

-Dan H.

Oct 5, 2009

People who work in glass offices. . .

Write all over the walls.

At least is the case at the Institute for Healthcare Improvement.

To set foot inside the IHI offices is to perceive, no doubt with dumbfounded expression in my case, what it means to truly practice what you preach. More on this in a moment (for those who absolutely can't wait - they have a virtual tour, of course. First, some background:

This week, I'm working with six friends - until yesterday, I might have written "other students interested in health care improvement," but a day of work and an evening on the town quickly cemented the upgrade - on a broad roll-out of the WHO Surgical Checklist to medical students worldwide.

To those new to the Checklist, it is a 19-item set of basic and essential safety questions which, when answered together by all members of a surgical team, ensures dramatic reductions in preventable harm. To be sure, the checklist succeeds, in part, like the pilot's checklists that inspired it's use. It guarantees that all required steps are taken to get patients (or passengers) through safely. I believe that the checklist is so effective because it also helps turn a group of coworkers into a true "team." That is, it makes clear the identities and roles of everyone in the operating room, raising the level of situational awareness. The gentleman resting peacefully on the table is not just the next patient to a scrub technician or medical student in the room, but rather, Mr. Jones, who is having his gallblader removed, and will probably do well throughout surgery but does have an allergy to Keflex. By investing every team member in the shared goal of safety, the Checklist produces lifesaving results. Impressive, considering it costs pennies to use.

Getting this piece of paper into the hands of every student who is or will one day be in an operating room - PA, RN, NP, MD, and PharmD, is our goal, and what brought me to the glass-lined, offices above the posh Charles Hotel, which house the idea factory known as the IHI.

The IHI offices are remarkable in many ways - the free diet coke certainly had one team member floored - mainly, because walking within them, you become absolutely sure that every element of their design has been both 1) planned, and 2) made better than a previous version at some point. There was one notable exception which bears mention, a design flaw on the front door handles, which I observed being - predictably - pulled rather than pushed by another of my teammates. A classic example in the science of human factors, perhaps the vertical door push is retained for its teaching value.

OK, back to the office. Amazing. Walking in, I Immediately noticed the IHI's mission and core values inscribed on the walls. "No needless deaths." A poignant motivator for everyone who passes by. High on the walls, one finds quotes from history's leaders in innovators: "Sometimes it's fun to do the impossible," or the more curt, "Hope is not a plan." Down the central corridor, the six aims of the IOM report, Crossing the Quality Chasm (report here, aims here) line the hallway's load-bearing posts - they are literally the pillars of the IHI!!

Another inspiring translation of mission into structure is visible in the offices - or, more correctly, invisible: The walls are all glass. Remember transparency, "going naked?" Well, the IHI is a place where you can see what everyone is doing at all times. There are no secret meetings here. Often, employees are walking into the otherwise unremarkable office shared by the CEO and COO and three others to grab a piece of candy. Nearly always, at least in my observation, they're smiling.

In its constant efforts to improve everything, its flat corporate culture, its and its conspicuous openness and transparency, the IHI is the epitome of the attitudes it seeks to impart to the health care professions. Visiting the IHI has been a revelation. This place is filled with an incredible energy and enthusiasm. This must be what it was like to be at Bell Labs in the 60s, or Google at the millenium. They even have a fun committee.

Practice what you preach, and please, preach often.

-Dan H.