Atul Gawande on…risk management
I recently heard Atul Gawande, a brilliant doctor at Brigham and Women’s Hospital in Boston and an acclaimed writer, speak about Risk Management. Well, he did not mention those two words but that was my takeaway.
Gawande has been writing about issues in Health Care for many years. At the Harvard Club discussion, he spoke about the tracking and scheduling of items in the building of a large new office tower in Boston. Unlike with the building methods of a hundred years ago, one no longer can entrust the constuction process to the mind of one person, not even the most experienced master builder.
Instead the contractors employ numerous lists and charts to track building construction. When Gawande applied the same thinking to medicine. He found a disconnect. Certainly, medicine has also become immensely more complicated in the past hundred years. Technology, science, pharmaceuticals, all have greatlly improved outcomes. But, the organizational structure of the delivery of medicine, even in the complicated setting of the operating room or the intensive care unit, has still tended to revolve around one person, the doctor. The methods of controls and systems simply have not kept up with the complexity of the job.
Gawande told us about the spectacular results that hospitals have experienced in clinical outcomes where they have adapted more systematic approaches to problem areas. For example, patients on ventilators are prone to infections that are life-threatening and patients die in great numbers from these infections. Doctors in Michigan constructed simple checklists in order to prevent the types of situations that can lead to infections for these patients: beds propped at right angle, meds delivered on time, adequate supplies of chlorohexadrine soap to keep lines clean. Within three months, the infection rate dropped by 66 %. The hospitals went from infection rates in the highest quarter of hospitals to being better than 90% of hospitals. The process prevented an estimated 43 infections and eight deaths. Tow years later, the state of Michigan decided to use the process statewide – in the first 18 months they saved an estimated 1500 lives and $175 million. The little checklists worked. And as Gawande reported, infections in the ICU is just one of many areas where critical clinical condition can be impacted by any one of dozens of small mistakes. The boring checklist is perhaps the most effective way to save lives and reduce costs in health care.
While I know too little about medicine to understand the clinical issues in these and other cases, I do recognize the process. This is classic risk management. Whether reviewing contractual provisions, inspecting sprinkler heads, or looking for trip and fall hazards, the simple work of checklists can have a meaningful impact on the overall cost of risk. And in health care, it can save lives, too.