Standard Work Saves Lives

            The headline above is a bit dramatic and probably sounds like hype. But if I am correctly interpreting the latest news from the Institute for Healthcare Improvement, the headline is correct.

            In December 2004, the IHI initiated its 100,000 Lives Campaign, an effort to prevent 100,000 unnecessary hospital deaths by improving patient care. With much fanfare, the IHI recently announced that the goal has been exceeded, and hospitals enrolled in the campaign have prevented an estimated 122,300 deaths. (There were more than 3,000 hospitals enrolled, representing an estimated 75 percent of U.S. hospital beds.)

            Measuring the number of lives saved is, I’m sure, tricky at best, and an IHI news release does not say exactly what measurement methodology was used. Perhaps they compared death rates with those of previous years.

            However, for now at least, let’s give the hospitals enrolled in the campaign the benefit of the doubt, and assume the number is valid. What does this have to do with standard work?

            The Campaign was more than just people saying “let’s save lives.” It consisted of six specific steps to be taken by hospitals – techniques that were proven to improve patients’ medical results.

            Did these techniques involved the use of new drugs or advanced surgical techniques? Nope. For the most part, they involved improving the processes that support medical care by adopting best practices. The six quality improvement changes are:

• Activate a Rapid Response Team at the first sign that a patient’s condition is worsening.
  
• Prevent patients from dying of heart attacks by delivering evidence-based care, such as appropriate administration of aspirin and beta-blockers.
  
• Prevent medication errors by ensuring that accurate and continually updated lists of patients’ medications are reviewed and reconciled during their hospital stay, particularly at transition points.
  
• Prevent patients who are receiving medicines and fluids through central lines from developing infections by following five steps, including proper hand washing and cleaning the patient’s skin with a specific antiseptic.
  
• Prevent patients undergoing surgery from developing infections by following a series of steps, including timely administration of antibiotics.
  
• Prevent patients on ventilators from developing pneumonia by following four steps, including raising the head of the patient’s bed between 30 and 45 degrees.

            Proper hand washing? Raising the patient’s head? I find these recommendations startling, for several reasons.

            First, it’s remarkable that these weren’t being done already (although to anyone familiar with lean and the process problems it uncovers, that may not be so surprising).

            Second, it is similarly shocking that hospitals didn’t already know the value of such procedures. That says something about the poor state of medical computer systems and medical research, in that it has taken so many years to accumulate and analyze data clearly establishing what works.

            Third, for those of us who work outside healthcare, this campaign sheds additional light on hospitals’ dirty little secret: While most of us know, for example, that people often die of infections they acquire in hospitals, it turns out they get infections because of poor processes. That’s the real cause of death.

            However, the good news is that people in healthcare are trying to make things better, and this campaign is a good example of that. And that brings me back to my main point.

            The definition of standard work (according to our book LeanSpeak) is “an agreed upon set of work procedures that effectively combines people, materials, and machines to maintain quality, efficiency, safety and predictability.” Much of what is described in the Campaign’s practices sure sounds to me like it fits that definition.

            IHI expects to announce in December the next stage of the Campaign as well as a new aim for saving lives. And in the interim, the organization says it will “redouble its efforts” to spread the word about the six practices while also exploring new areas for hospital improvement.

            Let’s hope so.

 

            

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