Comments

Don't beat yourself up!! - you have said it now to the world Tom and that is good enough.

In any case ....Taking notice of mom's upbringing is always a good policy.

We don't kill quite so many in the UK but we kill a lot of people in hospitals over here.

When we are talking about life and death then one death is too many and cannot be 'tolerated' as a 'statistical inevitability' in large numbers.

That 'one person' who dies is 'somebody's someone' (forgive Lonestar Lyrics!)

We have to aim for zero error in healthcare - however impossible that may prove to be.

If we aim low we will always hit our target.

I posted this on my own Blog last week - a statement from Mahatma Gandhi that in my opinion should be in every hospital in the world.

Bombay Hospital Motto

A patient is the most important person in our Hospital. He is not an interruption to our work, he is the purpose of it. He is not an outsider in our Hospital, he is a part of it. We are not doing a favour by serving him, he is doing us a favour by giving us an opportunity to do so.

Mahatma Gandhi

Posted by Trevor GayTrevor Gay at June 22, 2005 11:15 AM

It seems that´s an statistic that should appear in the population growth balance:

Births:...
Deaths:...
Deaths for health care failures:...

No reason to fun. Should be a priority for politics.

Posted by felix gerena at June 22, 2005 2:47 PM

I meant for politicians.

Posted by felix gerena at June 22, 2005 2:49 PM

Felix, I agree with you 100%.The nature of the information makes this Ironic, however, increasing the visibility of hospital errors, and publishing the information is a BIG PRESURE for hospitals.

Make information available to the public,

Hospital Management, Beware, the public is informed. What a concept.

Plus, a culture change in the hospital. From: we are all human and humans make errors TO This is an error free zone, accidents are preventable, we work HARD at it.

Just like Trevor mentions in his comment. The patient in the center.

Luis

Posted by Luis at June 22, 2005 6:03 PM

Mr. P - Too bad you weren't raised Southern White Trash - We say "Sir" and "Mam" and all that...but we're real good at that rantin' stuff when you get our dander up.

Seriously, good comments above - including re the culture change. Why is it a given (requisite) that ER and staff doctors work for days without sleep? We tsk tsk about people driving heavy machinery when sleepy - and yet we expect these poor exhausted souls to never make any mistakes in high-pressure environments with equally complex problems and solutions.

Posted by Mary Schmidt at June 22, 2005 6:14 PM

The profession of a doctor is very unlike that of an engineer or a lawyer and more like that of a primary school teacher. Every patient is unique. A doctor needs the space and creativity to carry on with the work rather than looking into the rulebook everytime they need to use a surgical equipment or carry out a certain procedure. They need the confidence to carry on with the procedure without worrying about about the implications of a failed procedure - the lawsuits, insurance companies and the crappy part. When healthcare is 'tangled' with businesses and when doctors are looked as machines, the result is something like this - 98000 deaths and counting!!

Tom - Can I know what kind of 'panel' were you part of?

Posted by fullymubbed at June 22, 2005 6:31 PM

As a healthcare manager I spent 35 years working closely with hundreds - maybe thousands of hospital doctors and family doctors and in almost every case I have been enormously impressed with their dedication and motivation to do the right thing for the patient.

In reality there are very few doctors who are the stereotypical arrogant type.

No doctor wants to do a bad job - they are human and worry immensely about making mistakes. They have an awesome responsibility and with that comes the stress and pressure – look at the stats on alcoholism and stress related illness among doctors and ask yourself why?

I am very sorry to say that managers in healthcare are often asking far too much of doctors in terms of paperwork and administration which drags the doctor away from what they were trained to do which is to comfort, reassure and help people who are ill.

My view of management in healthcare (about 100 years out of date at a conservative estimate) has been written extensively elsewhere but I have the greatest admiration for most of the doctors I have ever worked with.

Sure there were a few who I may have had anxieties about … but that rule applies to any profession. There are healthcare managers I worry about much more than doctor!!!

I do need to share this light relief with you....

The queue at the gates of heaven was long and the weather was hot ... the people waiting patiently in line to get into heaven were becoming increasingly hot and frustrated with the delay.... All of a sudden a man in a white coat, carrying a black brief case and a stethoscope round his neck walked to the front of the queue and straight through the gates of heaven ignoring everyone in the line – much to their anger …... The angel on ‘gate duty’ told everyone in the queue to remain calm as she said ... “That was God - sometimes he thinks he is a doctor"

Posted by Trevor GayTrevor Gay at June 23, 2005 2:06 AM

Isn't there soemthing wrong with how we now run organisations?

We break everything up, splitting responsibility, subcontracting this, outsourcing that.

The result is that no-one owns the whole process and no-one understands the whole process.

Everyone is looking out for themselves and not for the customer (the purpose).

All these years of quality programmes, customer relationship programmes, six (sick?) sigma, and lean whatever have lined the pockets of the consultants (sorry, Tom!) and toolheads and done nothing (or less) for the customer.

Rant on!

Posted by Dave Parker at June 23, 2005 2:54 AM

Trevor,

Sure bombay hospital motto is there. But i am not sure whether mahatma gandhi made that statement verbatim... In india, his original statement relating to customer ( not patient ), is modified and printed to suit many occasions.

Posted by ujwal pradhan at June 23, 2005 7:56 AM

I certainly defer to those who work in healthcare - NOT.

Seems the decades of "healthcare" have left us at the abyss - and people aren't living longer with higher quality in most locales.

Radical rethinking of health and what it means must be a priority it seems.

Personally prizing the body like it is a $1M Maserati / Rolls Royce seems to pay incredible dividends and ROI - a bit of exercise, low bodyfat, maybe eat organic ... learn a bit about optimal seratonin / endorphin levels and how to get there ... [Amazon green tea?!] :>)

The physical IQ must be cultivated because "mainstream" media wants us fat and sassy baby - ready to consume more and more! C'est la vie ...

Posted by Sean at June 23, 2005 9:21 AM

Thanks for that Ujwal - I was given the Gandhi reference by a colleague many years ago in the UK - there may have been some changes - I will bow to your greater knowledge my friend :-)

Posted by Trevor Gay at June 23, 2005 9:59 AM

Tom - Great thought provoker. As a marketer/consultant, I'm not often in the position have the end result of my work be death.

Through spiraling insurance issues, HMOs, hospital consolidation and bktcy, the US healthcare system has been marginalized. How can we right the ship?

The beginning would be awareness. Juxtaposed against other nefarious ills such as AIDS, the accidental deaths are a tragedy as they are seemingly within control with the appropriate amount of focus. The list of deaths by hospital would ratchet up the dial on awareness. Does that list exist anywhere?

A simple two page web site could probably generate some eyeballs. Here's the hospital, here's the doc in charge - check it out before you check in...

I can't give proper reference to the comedian but the essence of the quip was that, "somewhere out there is the worst doctor in the world. Is he your doctor?"

Rant On!

Posted by Mike Wokosin at June 23, 2005 1:51 PM

Tom, you're wrong. 1 is too many. Stop being a utilitarian.

Posted by Brian Wood at June 23, 2005 2:06 PM

Yes 1 is too many - Totally agree that we need to always strive towards improving performance in Hospitals etc.

The question is how much money to spend? The Economist has run articles at various times on human perception of risk and spending. A few years ago we had a nasty rail accident in the UK - many deaths. The media screamed for an expensive new train system to be fitted. Massive pressure was brought to bear. The brutal truth - more lives would have been saved every year spending that money on road improvements. Humans are poor at understanding probability and risk. Real leadership is often about doing the right thing even in the face of conflicting pressure.

Please don't misunderstand me - I am not disagreeing with the above posters. Nor am I cold to human pain and loss of life and often it can be small inexpensive changes that make the difference. But I do believe that this type of debate and decision making needs to be multidimensional. It has to encompass the emotional, the logical and the pragmatic.

Every decision we make has an impact elswhere. Thinking about this made me think about the great debate we had on political orgs. Everytime you play the political game you create collatoral damage elsewhere with the people and projects that were shunted aside for your big thing - part of great leadership is being honest about whether your big thing is the most important.

Posted by PaulH at June 23, 2005 3:18 PM

Great comments as always Paul.

MOST (I admit not all) good quality improvement stuff in healthcare doesn't cost money - believe me IT REALLY DOESN'T!!

Here is a little story to illustrate my point.

I know an out-patient clinic here in the UK that provides after care for older people with chest problems.

The managers of the clinic did a patient survey to find out why there was a low return rate to the clinic from patients. They assumed there must be a problem with the service. The replies that came back from patients indicated extremely high levels of satisfaction and the highest possible praise for the doctors and nurses in the clinic. But despite that the patients still did not come back for ‘follow up’ appointments.

The managers decided to do more research and asked patients why did not come back for follow ups.

The answer was interesting. The clinic finished at 3.30 pm which meant that those patients who had to catch buses to go home were on the same buses as all the kids leaving schools and colleges near the hospital at 3.30 pm.

So the clinic managers brought forward the end time of the clinic to 3 pm so that the older people were able to catch an earlier ‘kid free’ bus … and hey presto … suddenly return visits to the clinic soared back up to 100%.

My point is the answer is often staring you in the face and it costs nothing in financial terms to resolve the problem.

Posted by Trevor Gay at June 24, 2005 4:51 AM

purchase cheap viagra from usa I started posting a comment yesterday but stopped to think about it some more. First: I declare an interest. My mum died of MRSA last December so this subject is a bit "close to home" for me. (By the way, the hospital wouldn't put MRSA on the death certificate saying that the root cause of death was the illness she went in with. When I queried this, I was asked if I really wanted her body put through an autopsy! I remain convinced the problem is MUCH bigger than reported.)

I agree with many of the comments above. It's about politicians putting real money and resource into the problem. It's about people observing good healthcare procedures. It's true the vast majority of doctors and nurses are at least pretty good and desperately want to do a good job.

But that isn't the real problem... the real problem is bad or lacklustre management.

You can say what you want about money, resources, headcount, training et al. They're all imporant but it fundamentally boils down to management. It matters not a jot if something is in-sourced or out-sourced. What matters is that you have a trained, motivated workforce from the cleaners on the ward down the organisational hierarchy to the boss person. People who know what is expected of them, are held accountable for it, who know who to refer something to if there's another issue, who are constantly trained up and are made to feel part of system that is designed to make people well and keep them that way.

It's a bit like 3rd world aid (hopefully without the corruption): you can pour money into it until every bank in the world is empty but it won't work unless the aid is well spent. Which means putting money into a system that works properly in the first place.

Rant on!

Posted by Mark JF at June 24, 2005 6:58 AM

Trevor - Great story! Good example of the difference between quantitative and qualitative analysis too.

I think you are right we always think that solutions have to cost bucks. Imagination should be the global currency!

Posted by PaulH at June 24, 2005 7:03 AM

Amen Paul :-)

Posted by Trevor Gay at June 24, 2005 7:10 AM

Well, even with health care we can bring back the discussion of politics. Is it ironic or just me that thinks that most health care is an oxymoron? I have worked with doctors over the past nine years trying to help them understand what is important. A doctors life is not always easy, but they like all of us have choices. We are correct, leaders not only know how to do things right, they know how to do the right thing. So is the right thing just to discuss? Do we sit on the nail and just cry until the nail hurts us or someone we love enough to move? Trevor, you were in the health care field for a long time and we all know there are great doctors, hospitals and clinics out there, how can we bring more attention to those who do the right thing? How can we help cause significant change instead of just discussing this here in this forum?

viagra price 100mg Posted by Randy Reynolds at June 24, 2005 7:16 AM

Great question Randy and a brilliant challenge.

Everyone can do something.

We can stop 'just accepting' the old view that the doctor is always right and beyond challenge.

The many good doctors I know actually like to meet what I call 'informed' patients.

I have a good friend who is a cardio vascular surgeon and he just loves patients coming to him armed with information about their condition and welcomes them with open arms. He sees them as a partner in care.

My own view is that we should all take a greater interest in our health and illnesses and then challenge the professionals to 'earn' their wages.

The 'added value' we should get from doctors and nurses - indeed any health care professional - is that which we cannot find out ourselves.

Put another way - why do we need doctors and nurses when we have Google?

To me the answer is in our own hands. If we, as individuals, are 'informed' then the professional has to prove to us they know something more than we do!!

Hope that begins to answer your question Randy - I would love to work with Tom Peters minded people on all this stuff in healthcare.

Look forward to more of the same

It is raining here in England but still very warm ...

Tim Henman is out of Wimbledon but we have a new young Brit hero called Andrew Murray - 18 years of age and in the third round - we Brits will be getting nose bleeds :-)

Posted by Trevor Gay at June 24, 2005 7:40 AM

A colleague of mine shared a story that has stuck with me and I refer to it often. It goes something like this....a new hospital administrator was walking the halls of the hospital engaging in conversation with various staff members along the way. He stopped when he came across a janitor and asked, "what is it that you do here?" The janitor replied, "I save lives" The administrator said, "no, I mean what do you do?" He said, "I save lives" The administrator said, "no, maybe you don't understand what I'm asking...what does your job entail?" The janitor said, "well, cleanliness is critical to good health. My job is to keep the hospital clean and rid of germs. I, along with doctors, save lives"

I use this story when I talk about engaging employees and getting them to "be the brand" It's this sense of higher purpose at every level that can transform any work environment. What if everyone in the healthcare industry believed their purpose was to save lives?

Posted by Darci at June 28, 2005 10:03 PM