I Pledge Allegiance to Science and Evidence

At the 2006 Institute for Healthcare Improvement (IHI), Don Berwick announced the IHI's new campaign to dramatically improve healthcare quality. It's called the 5 Million Lives Campaign.

In 2004, the IHI initiated the 100,000 lives campaign to eliminate 100,000 of the estimated deaths caused by medical errors in hospitals each year. By 2006 they estimated that they had used science and evidence to eliminate 122,000 unnecessary deaths. Studies using science and evidence had found ways to prevent many unnecessary deaths when treating heart attacks (AMI), heart failure, pneumonia, surgical infections, and pregnancy. The campaign mobilized caregivers in over 3,000 hospitals to take these processes to heart and measure compliance.

The Cost of Medical Harm
The new campaign focuses on injuries or "harm" caused by medical errors. An estimated 40-50 patients out of every 100 will suffer some sort of "harm" during their stay. Some of these are minor, but many cause temporary or lasting disability or even death.

From a Six Sigma perspective, this process is worse than 1-Sigma (300,000 PPM).

With an estimated 37 million hospital admissions a year (and perhaps three times that many emergency room visits that aren't admitted), medical harm affects 17 million patients and their families each year.

The Goal
The goal is to reduce this number by 5 million over two years or 2.5 million per year. Because it takes time to ramp up these efforts, perhaps 1 million lives can be affected in 2007 and 4 million in 2008.

The campaign will focus on the top five categories of medical harm
(leaving out the minor categories A-D)

E. Temporary injury from care (an estimated 60% of the overall total)
F. Temporary injury that requires hospitalization
G. Permanent injury
H. Injury requiring intervention within one hour to save the patient's life
I. Death

Campaign Focus
There are six "planks" in this campaign:

  1. Prevent pressure ulcers
  2. Prevent MRSA (antibiotic resistent staph infections - $2.5 Billion per year)
  3. Prevent high alert medication errors
  4. Prevent surgical complications (about 3 out of 30 million complications per year)
  5. Prevent congestive heart failure complications ($29 billion per year)
  6. Get hospital boards on board with the changes required.

There's already plenty of science and evidence that points the way toward solutions that will prevent these types of errors, harm and injuries. Over 3,000 hospitals have committed to implementing these proven methods. Now comes the hard part...implementing the change.

This campaign focuses on hospitals. It doesn't even touch clinics, rural healthcare, doctor's offices, mental health facilities or most of the other care that occurs in this country. Instead of waiting on the IHI to launch an intitiative, I hope that these groups will craft their own campaigns and get started.

Find out more at IHI.org.

If you want to know why healthcare is so expensive, the answer may well be that there are too many preventable mistakes.

Design Your Own Campaign
One thing I've learned from watching the 100,000 lives campaign is that a lot of progress can be made quickly across huge geographic and demographic boundaries by setting clear targeted goals that focus around a shared purpose.

Ask any doctor, nurse or clinician, they all want to serve the patient, even if it means strapping on what Berwick calls the "handcuffs and straightjackets" of rigorous procedures that ensure every patient gets proven therapies (e.g., aspirin at arrival for heart attacks).

What's the overriding purpose in your business? What does everyone agree on? How can you craft a campaign to reduce the "harm" (i.e., delay, defects and deviation) your business processes inflict on your customers? How can you craft the campaign so that it will ignite the passion and creativity of your employees and get them to pledge allegiance to science and evidence?

How much progress could you make in the next 24 months?

Jay's latest book Lean Six Sigma Demystified is now available on Amazon

© 2008 Jay Arthur, the KnowWare® Man, works with managers who want to plug the leaks in their cash flow.

Rights to reprint this article in company periodicals is freely given with the inclusion of the following tag line: "© 2008 Jay Arthur, the KnowWare® Man, (888) 468-1537, support@qimacros.com."

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