Chasing the Rabbit: Official Blog by Author Steven Spear

I’ll be presenting at an MIT Engineering Systems Division seminar (Lean Advancement Initiative) on Dec 3 at 4:15 in Building 33 Room 206.

Paul Levy and his colleagues at Beth Israel Deaconess Medical Center were profiled in the Boston Globe.  They are on exactly the right track in calling out errors, and they are setting an example that should be emulated energetically at other hospitals.  Delivering care requires coordinating harmoniously an extraordinary number of individual disciplines.  This means anticipating myriad interactions of patient, provider, place, and circumstance, and anticipating perfectly all circumstances is impossible.  However, by responding when things go wrong, those working in and responsible for care delivery processes can see their vulnerabilities, identify their causes, and rectify weaknesses, leading to ever improving efficacy, efficiency, and responsiveness.  This is not a hypothetical assertion: Order of magnitude improvements in care have been recorded in Pittsburgh hospitals, at Ascension Healthcare and Virginia Mason Medical Center, and elsewhere.   Those hospitals not pursuing the same degree of openness are not any less dangerous.  They are simply not admitting the reality to themselves, their staff, and their patients.

Errors test openness at Beth Israel Deaconess (Boston Globe: October 27, 2008)
 

Hospital aims to eliminate mistakes (Boston Globe: January 18, 2008)

Paul Levy BIDMC blog

With the extraordinary advances in medical science and the tremendous effort made by care providers towards achieving professional excellence, we should expect extraordinary medical care. Yet, for all the time and money spent in the United States, what we actually get is awful: Too little care to too few people, tremendous cost for those who get care, and risks of harm and injury that are extraordinary–akin to parachuting off of bridges.  Don Berwick and I explore how the the gap between the actual and the potential can be closed.  

Berwick-Spear Op-ed

Boston University is slated to construct and manage a biohazard research facility for the US government.  How do you ensure that the bad bugs don’t escape causing havoc.  One response is to screen potential employees, filtering out ‘bad apples.’  While important, this misses the larger issue of how to manage very complex systems for excellent outcomes.  See my letter to the editor for more details, applying lessons from Chasing the Rabbit to this challenge. 

Link to Boston Globe letter to the editor

I will be discussing the concepts in Chasing the Rabbit and signing copies at the MIT Coop at Kendall Square on November 10 at 5:00pm. Be sure to stop by!

Date: November 10, 2008
Time: 5:00 - 6:00pm
Location:
MIT Coop at Kendall Square
3 Cambridge Center
Cambridge, MA 02142
617.499.3200