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rhonda wyskiel

Re-engineering health care for safety and cost savings

Long-time intensive care nurse Rhonda Wyskiel (left) and engineer Alan Ravitz represent just a couple of the 18 professional disciplines involved with Project Emerge.

Despite 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 than measured.

Other industries rely much less on heroism by individuals and more on designing safe systems and using technology to support work. Today a pilot’s cockpit is much simpler than 30 years ago; it is far more error-proof, and built-in defenses enhance safety. By comparison, hospital intensive care units, which contain anywhere from 50 to 100 pieces of separate electronic equipment, appear unchanged.

Changing this will require unprecedented collaboration between health care’s many stakeholders. That’s one reason why this fall the Armstrong Institute and the World Health Organization convened health care leaders, consumers, providers, regulators and private-industry partners to discuss such topics as how to design safer systems at the Forum on Emerging Topics in Patient Safety held in Baltimore.

One effort to design safer systems at Johns Hopkins is Project Emerge. Supported by a $9.4 million grant from the Gordon and Betty Moore Foundation, Emerge is tapping into the wisdom of a diverse team of engineers, nurses, doctors, bioethicists, and patients and family members — 18 disciplines in all from across Johns Hopkins University— to design safer care in ICUs.

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Giving patients the big picture

"I have a complicated medical situation that involves neurologists, surgeons, obstetricians, specialized ophthalmologists and others. I was at Johns Hopkins and very lucky to be because I had some of the best doctors in the country. What really struck me, though, was that each specialist was really very narrowly focused and really ne'er the twain did meet. I felt like it was up to me to put the pieces together into some kind of sensible picture in order to move forward to greater health. I will note that, for the most part, they had great bedside manner.”

Rhonda Wyskiel, an ICU nurse and staff member with the Armstrong Institute, was one of the guests on The Kojo Nnamdi Show last week when the radio host read these words from an e-mail, penned by a woman named Anne. Rhonda, one of three guests who appeared on the NPR-affiliated program to discuss the challenges of providing patient-centered care, acknowledged that this writer’s experience was common, and she empathized with Anne. As Rhonda pointed out, there are efforts at the hospital and national level to better coordinate care so that patients can have a central contact for when they have questions. For instance, in some ICUs, there is an intensivist who coordinates a patient’s care in that environment.

But Anne points out a problem that eats away at the quality of care that hospitals provide and leaves patients feeling confused: Too often, care is organized around providers rather than patients.

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