Learn from the aviation industry to manage – the ultimate flight program for medical quality and patient safety

Over the past decade, there has been a stark paradox in improving patient safety: far too many people die from medical errors, despite all the efforts we know and do to prevent medical injuries.

The American Institute of Medicine report clearly points out: it's not the human problem, it's the system that's too bad.

As a result, major hospitals have made great efforts to "fix" the system, including identity confirmation, preoperative pause, hand hygiene, flow charts, etc. However, progress in improving patient safety has been slow and efforts have been ineffective.

The medical industry is far from creating an impressive "safety culture" like industries such as commercial aviation, nuclear energy, and chemical manufacturing.

Hao Hongshu, author of "Learning Management from the Aviation Industry" and a professor at the Institute of Hospital Management of Tsinghua University, said bluntly: "Cultural change is not an easy thing. ”

But "they" have shown us that change is not impossible.

Borrowing from the airline's model, they have created a miracle of three years of no alarm incidents, no patient safety incidents, high patient and medical staff satisfaction ratings, and low mortality rates.

Let's walk inside St. Michael's Hospital and see what makes it special!

First stop: the emergency room

Doctors are the weaker party in care

It would be better for patients to get better information sooner rather than after a misdiagnosis and then get more reference information.

As the eyes and ears of medical care, nurses can help doctors get first-hand information about a patient's condition. In the emergency room, when the doctor has to make a decision before continuing to work, the nurse will participate in the discussion and make reasonable diagnosis or treatment recommendations, creating a "delicate" atmosphere of "the doctor must obtain permission from the nurse or ambulance staff before treatment".

The culture of blame is stifled here

A doctor gave a patient a prescription for morphine for pain before resting, and when he returned, he found that dihydromorphone hydrochloride had been replaced. What will the doctor do? Change it without saying a word? Or harshly reprimanding the nurse?

However, the doctor walked to the nurse's station before reacting, flipped through the medical records, read them carefully, and apologized to the nurse for finding out that this patient of his was allergic to morphine.

Every drug order can be fatal mistakes, but here, the nurse does not have to worry about being scolded, and the doctor does not care about his "face" in the team, not only admitting his mistake in public, but also holding a meeting in time to analyze every "accident".

Second stop: Intensive care unit

Patients should be part of an interdisciplinary team

In front of patients, the medical staff at St. Michael's Hospital will never address patients in the third person.

During ward rounds, the medical team greets patients like old friends. The nurse in charge briefly introduces the basic situation of the patient, and the pharmacist and critical care physician solve the questions in the treatment, and give suggestions on the medication plan and possible complications. The case manager then asks the patient for their opinion and works together to make a final treatment plan.

We do not shy away from the "take-it-or-leave-it" strategy

Many of the hospital's "amazing" processes were not invented, and if there was anything they could do to better help their patients, they would adopt an "take-it-or-leave-it" strategy.

For example, the ward round team mentioned above is a plan proposed by a nurse. The hospital listened to the nurses' advice, leveled the playing field, and formed interdisciplinary teams to work together, and ultimately succeeded.

They also learned from the Swedish hospital model that a very good way to reduce the main enemy of the intensive care unit – especially the pneumonia associated with ventilators – is to build so-called 'combinations', or process combinations.

Third stop: Surgical Theatre

"Recipe-based" surgical procedures

In any surgical procedure, there are a large number of procedures that can and should be performed in the same way every time.

St. Michael's Hospital has confirmed that the standardized management of these procedures does not interfere with the normal technical operation of the doctors, but allows them to concentrate on the procedure without the need for a lot of energy on daily tasks, reducing the worry of the whole team.

This "recipe therapy" may cause discomfort to the doctor and needs to be guided by the hospital so that the doctor can implement it convincingly.

Video recording of the whole operation from 6 different angles

Hospitals have rules about when and how to use the video, and there are also very specific requirements for how the video can be used, and no doctor will be disciplined or penalized for the video, all centered on improving training and systems.

Once I started using the video, the results were almost immediate, which solved some of the process and communication issues that many caregivers might never have noticed, made caregivers more honest, and even made all surgeons successfully change the way they communicated.

Fourth stop: Nurse's Station

Write a "medical record" instead of a "chronicle"

Nurses keep track of what's changed, what's wrong, what's needed attention, not just inconsequential things like the sun still rises in the east every morning and the patient is still breathing. They identify problems and plan what they should do.

Everyone at the nurses' station and the doctor will read these medical records because they can pick up the key points and get important information. The medical record is no longer a perfunctory checklist, nor is it a chronicle that no one reads.

Designing "wards" instead of "five-star hotels"

After being discharged from the hospital, you can always visit a five-star hotel, and here, they do their best to restore the patient's health while also making him comfortable during his hospital stay.

St. Michael's Hospital has designed three types of five-bed suites with variable number of windows. The individual beds spread outward from the central point, which is the nurse's workstation. Each room can be separated from the others, and the curtains can be drawn to protect the patient's privacy. But most of the time, nurses can see five beds at the same time and can hear the patients.

There is no need to call the lights here and there is no need to worry about the nurse's reaction time, as the nurse is always with the patient.

St. Michael's Hospital is so much more appealing than that......

Swiss cheese pattern

Seesaw philosophy

A backup warning system that is not completely anonymous

……

Although St. Michael's Hospital is imaginary, what it represents is an achievable paradigm. If we can't imagine a truly safe and cooperative hospital, we can't build it.