Toyota tactics. Some hospitals have transformed themselves by borrowing safety practices from other industries. A decade ago, Virginia Mason Medical Center in Seattle re-engineered its approaches to patient care using Toyota's policy of encouraging everyone on the shop floor to stop the assembly line and nip small problems before they have a chance to become big ones. Virginia Mason invites everyone, including the patient's family, to interrupt the action and declare a patient-safety alert when anything raises an eyebrow, from a staffer's failure to wash his hands to a nurse's administration of an unexpected medication.
In one instance, when a new lung cancer patient was given a pink wristband for "Do Not Resuscitate," a nurse who thought it odd the patient would merit such a drastic instruction checked with the patient and sounded the alarm. It turned out that the nurse on a previous shift who had picked out the wristband was colorblind, and what the patient really needed was an orange wristband signifying drug allergies. Now, in addition to being color-coded, the wristbands spell out their meaning in words. About 500 patient-safety alerts are reported every month. Each one is thoroughly evaluated, preventive steps are taken, and the most serious are reported to the board of trustees, says the hospital's CEO, Gary Kaplan.
Medicine is also looking to lessons learned in aviation, which have made commercial air travel so much safer. One of the patient-safety movement's newest spokesmen is former US Airways Capt. Chesley B. "Sully" Sullenberger III, famous for landing Flight 1549 in New York's Hudson River in 2009 without loss of life. Sullenberger worked for decades to reduce fatalities in commercial aviation and is highly critical of medicine's failure to broadly apply safeguards to protect patients; he joined other activists in calling for change in the March issue of the Journal of Patient Safety. "We have islands of excellence in a sea of system failure," he says.
Sullenberger and others are calling for a medical version of the National Transportation Safety Board, the agency that probes air crashes. The new agency would investigate a sampling of major incidents each year, report what went wrong, and recommend fixes that would be distributed to hospitals nationwide. They'd like to see a version of the Federal Aviation Administration's Aviation Safety Action Program, too; it encourages pilots and other industry workers to confidentially report lapses that might cost lives.
Few hospitals can count on the sort of top-to-bottom buy-in they'd need to model themselves after Toyota. But certain key values should be universal in medicine, says Brent James, chief quality officer at Intermountain Healthcare in Salt Lake City. Among these, he includes basing decisions on the best medical evidence and relentlessly monitoring what works and what doesn't. James's team has taken the monitoring to a whole new level by partnering with the Mayo Clinic, Dartmouth-Hitchcock Health, and Denver Health to examine whether one hospital's procedures can serve as a model for the others.
The group tackled total knee replacement first. "Wouldn't you know it, we found big variations" in the length of the operations and complication rates, James says, noting that Intermountain relies on "tightly controlled" operating room teams led by a surgeon who routinely works with the same group of nurses and technicians and specializes in one procedure. The team sticks closely to an evidence-based approach designed to get the best results with the fewest complications. "Our complication rates and time in surgery were 30 percent below what the others were doing," James says. Such an exchange of information on a range of medical practices will ideally improve all of the hospitals' patient care.
The patient's part. Following some simple rules themselves can help patients head off mistakes. Bashfulness won't help. It's important to speak up on your own or a family member's behalf and insist that doctors and nurses fully explain procedures they plan to perform and medications they intend to prescribe. Ask questions, watch what's done, and don't be afraid to put on the brakes if you're concerned about what you see. When it's a loved one who's in the hospital, "stay at the bedside," says Berwick. "Don't leave."