Lean: Stopping the Line, Empowering the Individual to Affect Quality in Medicine
Reddit is amazed by the New Yorker article The Checklist that explains how a simple checklist in hospital intensive care units (ICUs) helped save many lives and lower infection rates in patients from 11% to practically 0. The checklist is given far too much credit in this story though, the important information is that nurses were empowered to stop the line if the checklist was not followed. The nurses were now empowered to uphold the quality of patient care and were able to speak with authority to doctors not following procedure. There are three important lean principles you should recognize in this article:
Eliminate Waste
Line infections occur in eighty thousand people a year in the United States, and are fatal between five and twenty-eight per cent of the time, depending on how sick one is at the start. 1
Stop the Line: The nurses were empowered to stop the line to maintain the quality of patient care.
Nurses have always had their ways of nudging a doctor into doing the right thing, ranging from the gentle reminder (“Um, did you forget to put on your mask, doctor?”) to more forceful methods (I’ve had a nurse bodycheck me when she thought I hadn’t put enough drapes on a patient). But many nurses aren’t sure whether this is their place, or whether a given step is worth a confrontation. (Does it really matter whether a patient’s legs are draped for a line going into the chest?) The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene. 2
Focus on continual improvement
The researchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half. 3
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[…] wrote Checklist-Driven Programming about the New Yorker, Atul Gawande article that I previously compared to lean. He asks how this portion of the article maps to […]