Well-designed systems reduce errors and save lives

Or, actually, the article I found is called How Hospital Design Saves Lives:

The report emphasized the benefit to be had from focusing not on individual people making individual mistakes, but rather on the systems themselves. Health care, the Institute of Medicine said, had to learn from industries such as aviation, nuclear power, and construction that dramatically increased safety using “systems thinking,” looking holistically at failures, rather than identifying a single weak link.

For health care, that meant replacing individual blame with collective responsibility. Improvements are already visible. In June, Dr. Donald Berwick of the Harvard School of Public Health announced that an estimated 122,300 lives had been saved in just the last 18 months, as a result of changes—ranging from improved hand-washing to establishing an organization-wide mandate for safety—recommended by the “100,000 Lives Campaign” sponsored by the Institute for Healthcare Improvement, a Cambridge (Mass.)-based nonprofit.

A few benefits from better systems:

  • Consistent work places, such as surgery rooms where the “right” is always on the right, reduce predictable errors. Perhaps surgeons could also use terms like starboard and port for the human body? Although I’d be nervous if I heard a surgeon start a procedure with “anchors a-weigh!”
  • Clean air reduces infection rate. Seems pretty obvious for a hospital, but apparently this wasn’t given appropriate priority in past systems.
  • Natural light improves mental health. I always wonder about hospitals that keep all their fluorescent lights on but the shades are drawn during the daytime. Perhaps heat-shielding or even solar-absorbing windows would cut down the negative effects of natural light while letting the positive remain
  • Reduces cost of maintenance
  • Increases likelihood of “green” practices, which further reduces harmful exposure and impact to the environment

Interesting to see tangible health and energy benefits from removing bugs in health-care systems. Of course there is some question of what it really means to be “evidence-based” since one person’s evidence might be seen by others as faith — a system of resolution is necessary.

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