Yesterday we looked at CLI’s (Central Line Infections), a type of infection that results from the use of a Central line, the needle and flexible tube used to insert an intravenous drip bag. CLI’s are extremely dangerous and expensive, infecting 100,000 Americans and resulting in 30,000 fatalities annually. We went through a few steps and estimated that CLI’s probably increase medical costs by at least a billion dollars a year. Yet these costs in human terms and in dollars largely result from a simple failure by medical workers to ensure that their hands and the insertion site for the central line’s needle is clean and sterile. Today, we’re going to see what we can learn from this case study and how we can apply what we’ve learned to your operations.

In looking at the issues we discussed yesterday, didn’t you think that by the 21st century basic sanitary issues were under control in most medical facility? If you’re the chief administrator of a hospital, you probably thought that these issues were resolved long ago. You are shocked that your staff has failed to take preventive actions that would save the lives of your patients. Then why is this happening? Well, the management of the hospital may not know how to convert the recommendations from these studies into an action plan. They would need to ask questions, such as “Do you know which disinfectant should be used when inserting a central line: soap and water, 70% alcohol solution, Chlorhexidine, Iodine, or something else?” And, “How much time should you wait for each type of disinfectant to kill contamination, before you insert the needle?” Questions like these are needed to develop the SPECIFIC, reliable, repeatable training needed to eliminate CLI’s, and save thousands of lives. Most nurses wouldn’t be surprised by these findings. An experienced nurse could probably identify a dozen other issues (and solutions) that could improve patient health and lower cost.

If any hospital administrators are reading this, and CLI’s occur in your facility, you need to ask yourself if your organization has agreed to best practices, if they follow the practices they agreed to, and if you have a system to verify that best practices are followed (metrics + relevant reporting + a governance system to follow up on issues). If you are not a hospital administrator, the stakes may not be quite as high, but the opportunities to identify and resolve problems are probably just as numerous. Would you like to make some improvements in your organization? Then, without developing any new best practices, collect information on the best practices that you believe your organization follows:

1. Choose just a few of the most important best practices that you (or your managers) agree they are following. Practices that are supposed to deliver work on time, reduce errors, manage costs, etc.
2. Identify the outcome your best practices are supposed to bring about. Taking a simple example, if your group produces written reports for customers (word processing, research reports, financial report summaries, etc.) every document should be fully spell checked. Is this a best practice for your workers? If so, good… let’s go to the next step.
3. Is this best practice in writing? If so, where are these documents and who reads them? Are wrokers responsible for locating and reading the document (how do you verify that it was read and understood), or do you provide a class or online training? Have you ever personally reviewed the materials or attended training?
4. Is everyone 100% compliant with this best practice? Who is everyone? Do you have a list of who has been trained, by position, and how long ago training took place?
5. How do you track that the best practice is followed? Have you identified metrics for tracking? Which reports use this metric? Who reads the report… the individuals that are responsible for following the best practice?
6. Finally, if you have a best practice to bring about (or eliminate) a specific outcome, have you achieved this goal?

In our example we wanted every document spell checked. If you have reporting on this in place, are documents still going to your users without being spell checked (easy to verify in Microsoft Word)? Are you testing the work as it is performed by your document creators, or are you only checking the work as it is recieved by the client? If you don’t check the creators’s work, you don’t know if tehy are contributing effors and relying on layers of proof readers and quality checkers to fix the document. When the original “creator” performs the spell checking it is ALWAYS more cost effective and improves the user experience for your clients. (The reasons why will be discussed in another Blog in a few days.)

What have we learned? I think we’re learned that organization as large, as sophisticated and as regulated as a hospital, organizations that are filled with incredibly educated individuals, can still still miss basic best practices. We’ve also learned that failure to follow these best practices can be incredibly expensive and dangerous. Given this, it’s pretty likely that your organization has at least a few gaps in its list of best practices, or in the way those best practices are communicated, or in how they are reported. Check some of the steps above with your staff and see what you find. You may identify opportunities to raise service levels and resolve long standing problems by taking very simple steps. And that’s my Niccolls worth for today!