DailyKaizen

This article, about the Washington, DC metro (login may be required), reminds me of some of the work we have done here. It discusses specific interventions being planned to improve safety, notably having supervisors ride the system they support, and allowing individual employees to halt the system for safety reasons. This sounds a lot like going to the Gemba and implementing an Andon cord system.

At first I read the statement, “Metro’s safety officers will have increased authority to stop actions they consider unsafe…Eventually, that authority (to stop service) will extend to all employees” with some suspicion. Why eventually? Why not starting now?

I then thought about our experience and also about the death of a worker on Seattle’s under construction light rail line last week. This article said that the contractor digging the Beacon Hill tunnel “failed to establish a culture of safety on the job site last year,” according to an audit.

We put in an andon-type system for safety after we established the intent and responsibility to maintain a safe clinical information system. “Pulling the cord” is a shared decision between a concerned staff member and a physician leader. Every staff member is empowered to receive advice from a member of our physician team, who are on call 24 hours a day, without worrying about the accountability of halting the system. The goal is “door to doc” time of 45 minutes or less.

The combination of establishing intent and responsibility first, creating a formal protocol that applies the tool, and running through it several times to build confidence has made this successful for us. Implementing the tool without the culture to support it would not have worked. When I am called upon to provide consultation, I provide it and then we follow the protocol. No judgement about validity is made. When the ball starts rolling, we pull out the binder and follow the steps. It’s a huge improvement in terms of keeping the focus on the problem and the patient need when these situations arise.

I assume that the “eventuality” of Metro’s employees being able to halt service is based on their creation of a standard process that is tied to acheivement of the outcome they are looking for. Our system took a little bit of time to put in place because of this, but it was implemented quickly when we recognized the need. I would say, then, that having this as an “evenuality” makes sense in the context of creation of culture.

Incidentally, our organization has made our information system safety protocol publicly available, and I have distributed it to to health care systems in our community to use as they see fit. If there is interest, I am happy to post it here. Any knowledge that we create to support our patients’ safety should be used to support every patient in every care system.

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