Is Healthcare really the same as other Businesses?

April 11, 2013
Why do we keep making the same mistakes?

I had a “routine” flight delay and “routine” miscommunication between what the posted airport flight schedule stated and the intended airline’s departure time. Flight delays are so routine that I should know better than to trust the airport departure time. But I guess I am still naive, even with years of traveling and maximizing my frequent flier miles, I still trust the information posted on the screen. I guess it’s because I still believe that someone is doing their job efficiently and striving to improve processes. But in reality it’s the 80-20 rule, they get it right 80% of the time, so why bother striving for perfection. Nobody is perfect, right?

The Lean methodology is founded on the principle of reducing waste while looking at the overall process and making tools available were they should be. Six Sigma focuses on defects and errors. I grew up with Deming and Steven Covey and I learned early on that you don’t chase process deviation spikes. However, you do monitor data and determine if any of your processes are out of norm using statistical analysis (which was early Six Sigma). So what is the proper percentage of defects? The answer of course is zero.

That is the answer that the patient wants to hear before going in for an operation. Zero defects. But some how with all our quality improvement programs we still accept a margin of error. The percent of duplicate medical records, the number of improperly coded procedures, the lack of notifications of abnormal labs, the incorrectly filled prescription, and the list goes on. We react to the incident, we chase the spike in the process which caused the problem, we report on the improved solution for that issue and we move on. We treat the symptom and not the disease.
Why do we keep making the same mistakes? Is it that nursing works separately from labs, and labs from pharmacy? Are we so compartmentalized that we can not look at the big picture? We keep saying that manufacturing is very different from healthcare. But is it really? Why do we continue to struggle to implement quality and succeed in reducing errors? Are we more like the airlines flight schedules than we care to admit?

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