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One of the Problems with Lean in Healthcare - Providers Won't Report Errors!

October 6, 2011
We have the pleasure of working closely with Mike Hoseus, co-author of Toyota Culture, the Heart and Soul of the Toyota Way.  At conferences, Mike always tells the story about how he went to work at the Toyota plant in Japan and his assembly line tool slipped, damaging a car.  His Lean training told him to stop the line and make someone aware of the mistake, so they could examine the cause and prevent future errors.  His natural inclination, however, was to remain silent and avoid facing the music, so to speak.

He chose the right path.  He hit the button stopping the line.  A meeting was convened.   As they concluded the meeting, even with the language barrier, he knew that everyone coming up was congratulating him!  As an organization, they saw errors as learning experiences and his behavior was encouraged.

Now hospitals are looking to Lean as the way to reduce costs and improve the quality of care.  The problem?  Recent data shows that many in healthcare have not embraced Toyota’s view of mistakes.

Survey Reveals Reasons Doctors Avoid Online Error-Reporting Tools

According to Johns Hopkins investigators, even though 90 percent of providers witness near-misses or errors, most clinicians don't report them because they are embarrassed and don't want to cause trouble.  Getting colleagues into trouble, liability and embarrassment in front of colleagues were reported most often by physicians and residents.

Obviously, we have a long way to go. This is going to require a seismic culture shift.  Some organizations are making strides but the gains are too slow given the challenges we face.  We are in the middle of an exciting project, helping a hospital to assess its physicians.  We are looking at cultural fit, the physician’s ability to collaborate, the likelihood of disruptive behavior, willingness to constantly look at quality, and even how likely the physician will be to reveal errors when doing so will serve as a tool for improving quality.

Wouldn’t it be wonderful if sometime in the future, we have a physician speaking at a conference sharing a story very similar to the one Mike tells about his experience in Japan? Only in this case, the learning experience won’t improve the quality of production of a car, but the quality of care provided, possibly saving a life.

Bryan Warren Bryan Warren was the former Director of Healthcare Solutions at PSI. He was responsible for developing and promoting tools and services designed specifically for the unique challenges faced by healthcare organizations.