Over a decade ago, I consulted on a project for the U.S. Air Force involving very large-scale simulations. These "war games" involved more than 1,500 participants around the world — some in simulators and some using real equipment in training mode. In a warehouse-sized building, a wall of gigantic screens captured the mock battle, as a(...)
Designing Safer Systems
How We Can Engineer a Less Costly Health Care System
Posted by | Designing Safer Systems, Patient-Centered Care, Preventing Patient HarmIf we want to rein in the costs of the U.S. health-care system — now equal to nearly 18 percent of the nation's gross domestic product — we cannot ignore the fragmented technologies used to help heal and save lives. At first glance, the devices, monitors, electronic health records and machines found in today's hospitals(...)
Reinventing the Physical Exam
Posted by | Designing Safer Systems, Patient-Centered CareIn the technology-thick landscape of modern health care, the physical exam remains in a backwoods. Sure, there have been advances — blood-pressure cuffs, for example, now inflate themselves — but on the whole the exam has barely changed in the past century. Patients still open up and say "ah," take deep breaths and gaze at(...)
How the Flint Water Crisis Is a Cautionary Tale for Health Care
Posted by | Designing Safer Systems, Organizational and Cultural Change, Preventing Patient HarmThere has been no shortage of blame for the poisoning of Flint, Michigan's water supply. In March, a governor-appointed task force issued a report that rebuked local, state and federal authorities for their actions — and inactions — that created the public health crisis. Then, in late April, state prosecutors announced the first charges in the(...)
Seeking the Right Stuff for Teams: In the Hospital or Distant Space
Posted by | Designing Safer Systems, Measurement of Safety and Quality, Organizational and Cultural ChangeWanted: Talented, highly driven individuals to take on multiyear work assignment with potential for benefiting humankind. Requires the highest levels of technical skill, teamwork and adaptability. Must be able to tolerate social isolation, mental and physical fatigue, demanding and uneven work schedules, days and nights away from home. Risk of depression and burnout. Must be(...)
Patient Safety at 15: How Much Have We Grown?
Posted by | Designing Safer Systems, Measurement of Safety and Quality, Organizational and Cultural Change, Preventing Patient HarmFifteen-year anniversaries often come and go without fuss, overlooked in favor of those we can mark in full decades. Yet recently, at Johns Hopkins and nationally, we've crossed that mark for a couple of events in patient safety that merit both celebration and reflection. In January 2001, a series of lapses at Johns Hopkins led(...)
Five Steps to Innovative Solutions for Health Care Improvement
Posted by | Designing Safer SystemsIn my role as the patient safety innovation coordinator for the Armstrong Institute, I spend a lot of time helping clinicians improve processes in health care delivery. Oftentimes I've found that when faced with a challenge we all have a tendency to go right to solutions we're comfortable with. Especially in health care, we’re used(...)
Patient Safety Perils at 36,000 Feet
Posted by | Designing Safer Systems, Preventing Patient HarmThere are more than 50 in-flight medical emergencies a day on commercial airlines — or one for every 604 flights, according to a study published in 2013. What are the odds that two emergencies would occur on the exact same flight, above the Atlantic Ocean and hours from the nearest airport? My colleague Mark, a critical(...)
New Ebola Training Modules Will Help Safeguard Patients, Providers, and the Public
Posted by | Designing Safer Systems, Preventing Patient HarmYour body is covered from head to toe in protective equipment, and it’s 115 degrees Fahrenheit inside your outfit. Your hands sweat under two pairs of gloves. An ill-fitting hood creeps down your forehead and nearly covers your eyes, but you cannot touch your head to shift it back up. To top it off, the(...)
Re-engineering health care for safety and cost savings
Posted by | Designing Safer Systems, Preventing Patient HarmDespite spending $800 billion on technology last year, health care productivity is flat and preventable patient harm remains the third leading cause of death in the U.S. One reason is that health care is grossly under-engineered: medical devices don't talk to each other, treatments are not specified and ensured, and outcomes are largely assumed rather(...)
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