2.08.2008

Saving Lives by Making Hospitals Lean

How many lives can be saved by using a lean approach to improve hospitals?

That’s hard to quantify, of course, but the Philadelphia Inquirer has come up with some interesting possible answers.

The newspaper notes that the Pennsylvania Department of Public Welfare, following the lead of Medicaid, will stop paying for the costs of care resulting from serious, avoidable medical mistakes.

To enforce that policy, the state will be scrutinizing 419 billing codes used in cases of the most catastrophic problems. That will identify serious problems, and then a review of full medical records will to determine whether the problems resulted from medical errors.

The Inquirer came up with an interesting approach to determine what state officials might find. The newspaper looked at billing codes for more than 700,000 hospital admissions in the Philadelphia metropolitan area in 2006.

According to the article, written by Josh Goldstein, the research revealed nearly 1,500 deaths. These included 11 patients who died after receiving transfusions of the wrong blood type; 40 who died after medication errors, and four more who were accidentally burned.

Probably a minority of the deaths can clearly be attributed to medical errors.

"I would be surprised that we have more than 100 cases in any given year that we would actually reduce the funding," said David K. Kelley, chief medical officer for the state's Medicaid program.

The article also includes data from the Pennsylvania Patient Safety Authority, an independent state agency that already collects and analyzes information about events that harm or could have harmed hospital patients.

The safety authority got data indicating 1,214 reports of hospital errors statewide that correspond roughly to the "never events" targeted by Rendell's initiative - preventable medical mistakes that cause serious injury or death - from July 2004, when the information was first collected, through December 2007.


In 2006, the authority got reports about 13 patients who died or were hurt by medication errors in hospitals. An additional 42 people had sponges, instruments or other medical equipment accidentally left in their bodies. And 42 others had operations performed on the wrong part of their bodies, according to the agency.

" 'Never events' make up a small portion of all of the different reports that we see," said Mike Doering, executive director of the patient safety authority.
"Still, when we look at something like a wrong-site surgery, clearly we can say something is not working here."


I’ve said before that the spread of these new reimbursement policies is a good thing because it removes a disincentive for hospitals to improve their processes. This new information drives home that point.

Also, we have a couple of new books that drive home what process improvement can accomplish in healthcare:


The Pittsburgh Way to Efficient Healthcare: Improving Patient Care Using Toyota Based Methods, by Naida Grunden

Paradox and Imperatives in Health Care: How Efficiency, Effectiveness, and E-Transformation Can Conquer Waste and Optimize Quality, by Dr. Jeffrey C. Bauer and Mark Hagland

1 comments:

Dean Bliss said...

As a member of the healthcare community, I can tell you that the pending changes to reimbursement have indeed spurred efforts to improve, which is a good thing. But the proposed overall reduction of Medicare reimbursement has created some major concern. In the hospital business, where 5% margins are considered outstanding, a reduction in the largest portion of our revenue while costs (if only a modest pay increase) continue to rise is creating an unsustainable situation. We are using our Lean philosophy and tools to improve, but can we improve fast enough? For the sake of the communities we serve, we hope so.