I just returned from a weekend with my family at Cedar Point Amusement Park in Sandusky, OH (the “roller coaster capital of the world”). While we certainly had fun taking in all the coasters, I couldn’t help but think about health IT (I know, what can I say, I need a life!). What really struck me was watching how the staff attending to the rides – mostly high school or college students, I would think – unfailingly executed a checklist of steps to ensure with absolute certainty that every patron on the rides was completely safe. In all cases, though the steps may have varied, the concept was the same. And I was further struck by the fact that the staff could do this with minimal disruption to the whole patron experience and still ensure that a fun experience was had by all.
So – geek that I am – I got to wondering why it has to be so much more complex to enforce rigorous safety standards in healthcare than it is on amusement park rides. Yes, I know well the complexities and intricacies and confluences of multiple systems with different standards that permeate healthcare. And I absolutely acknowledge the validity of those challenges. But sometimes the most simple steps – even in healthcare – can be documented, enforced and have a huge impact on the quality of patient care and the reduction of medical errors. One can look no further than the Geisinger Health System, located in rural Pennsylvania, to see how some seemingly intuitive customer service concepts can be applied effectively in a complex healthcare arena. Vis a vis the roller coaster patron safety check analogy, Geisinger some time back implemented a 40-step checklist for heart bypass surgery that all physicians had to adhere to. While some physicians pushed back on this concept as “cookbook medicine”, they grew to like it as the results spoke for themselves. A seemingly very low-tech concept – a checklist – but this checklist resulted in significantly reduced complications and readmissions, as well as reductions in cost per patient measured in the thousands of dollars (varying by procedure). So in the same way we see amusement parks enforce safety checklists for “procedures” (rides) that could result in death or grievous injury, perhaps hospitals could embrace this on a larger scale? Here is a link to more detail about this business model: http://www.time.com/time/magazine/article/0,9171,1930501-2,00.html.
Geisinger also goes one step further and offers “warranties” for procedures that require readmission. If other providers were willing to put themselves on the hook for this, you could see the potential for a transformational change in how care is rendered. Medicare is certainly moving in this direction through no longer paying for “never events” and in emphasizing that there will be penalties to hospitals for readmissions.
Sometimes we can tie ourselves up in knots trying to address complex issues in complex ways. Perhaps there just may be a simpler solution to patient safety where “a little can truly buy a lot”.
Anthony Guerra says
Great post Rich — the beauty of these kinds of checklists is that they can continually be updated and refined as people begin to see which steps work, which don’t work and which are simply unnecessary.
I use checklists in many parts of my work and life. Why continually tax the brain when you can do it once, and then just tweak around the edges. It’s simply an efficient way to approach the execution of a recurring task.