VIENNA - The number one killer in the U.S. is variability in care, not heart disease or cancer, according to Dr. William Brody, president of Johns Hopkins University in Baltimore. This variability of care is pervasive throughout U.S. healthcare and is a direct contributor to the 98,000 deaths due to medical errors in the system that cost an estimated $50 billion annually.
Because the system itself is the major culprit, Brody strongly advocated a bottom-to-top culture change with the adoption of new tools and methods perfected by other industries that can successfully be adapted by healthcare to improve patient safety.
"When an error occurs, it is everyone's responsibility, not just one person," he said during his delivery of the Wilhelm Conrad Roentgen honorary lecture at the European Congress of Radiology (ECR) this weekend.
"Our current attention has been fixed on assigning blame rather than fixing the system that creates the problems," he noted. "We have to begin by admitting that hospitals cause many fatalities due to serious and preventable errors."
Brody, a radiologist who also holds a doctorate in electrical engineering, is no stranger to systems in the academic, political, or corporate world, having held leadership positions in all three venues.
Taking pages from the playbooks of two industries also highly concerned about the safety of its consumers, the automotive and aviation businesses, Brody posited that "zero defects" should be the goal of U.S. healthcare -- because it is the expectation of its patients.
To achieve this objective, he pointed to the success of Toyota Motor Sales' promotion of "kaizen", a Japanese term meaning "change for the better" or "continuous improvement." Brody studied Toyota's strategy of empowering its workers, encouraging teamwork and communication, and striving to simplify each and every procedure in the work space.
In 2002, the Johns Hopkins Center for Innovation in Quality Patient Care was created to facilitate patient-centered revamping of healthcare delivery systems at the institution. The center modeled its methodology on the Toyota philosophy of taking apart processes and systems to improve them. This task is conducted by small teams comprised of individuals who put these processes or systems into action as part of their jobs.
"We never use management consultants to build or implement quality systems," Brody stated.
The initiative for the center, Brody noted in his lecture, was in part a response to the medical-error-caused death of 18-month-old Josie King at the hospital the prior year. Her family, rather than suing the Johns Hopkins, opted to create a foundation to prevent others from dying or being harmed by medical errors.
Three areas were identified as most needing improvement at the facility: medical errors; poor communication among caregivers; and infections from in-dwelling central venous catheters, which were at a rate nearly twice the U.S. average, according to Brody.
When one of the physicians on the central venous catheter infection improvement team offered that the group's objective was to reduce infections at the facility to the national average, Brody suggested to him that "average" was an unacceptable goal for the practice of healthcare.
"The key to reducing medical errors is to set an audacious goal of zero errors," he said. "That, after all, is what the patients expect."
The central venous catheter team's efforts created a checklist that is rigorously adhered to by all healthcare professionals who perform the procedures at the facility. The result has been that these infections have been cut to almost one-quarter the U.S. average, and the Johns Hopkins is still actively seeking ways to eliminate them entirely, according to Brody.
"Improvements in safety represent, by far, the greatest opportunity to improve patient care," he said. "The result of an unfortunate death at the Hopkins Hospital has led to what I think is the next revolution in healthcare, and it is the most important one, at that."
By Jonathan S. Batchelor
AuntMinnie.com staff writer
March 11, 2007
Related Reading
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How to calculate your MRI suite safety score, February 8, 2007
Physician organizations offer principles for reform of U.S. healthcare system, January 12, 2007
SARS report says Ontario failed health workers, January 12, 2007
MRI accident data: You don't know more than you think you do, October 27, 2006
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