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Human Performance
O’Boyle E, Aguinis H. Personnel Psychology 2012;65:79-119
Human Performance
633,263 researchers, entertainers, politicians, and athletes (amateur & professional)
Performance not a normal (Gaussian) distribution
Most accomplishment - by small group of super-performers
Human Performance
O’Boyle E, Aguinis H. Personnel Psychology 2012;65:79-119
Conclusions
Most people are below average
What are those people going to do?
Be less productive
Make mistakes
Background IOM 1999 reports 44,000 to 98,000 deaths each
year due to medical errors > decade
Efforts: non-punitive error reporting, computerized order entry systems, bar coding, executive “walk rounds”, team training, simulation, specific interventions (central lines)
Societies (NQI, AHA, etc)
Non-government (TJC – National Patient Safety Goals)
Patient harm remains common, unchanged (multicenter study)
Landrigan CP et al. N Eng J Med 2010;363:2124-2134
Errors in Radiology
Faulty Data Gathering (wrong technique, wrong
patient, wrong side)
Perceptual Error (failed to see)
Faulty Information Processing (over / under
interpretation, faulty context, satisfaction of search)
Faulty Knowledge (insufficient knowledge, skill)
Communication (effective, timely, appropriate)
Taylor GA et al. Pediatr Radiol 2011;41:327-334
Pinto & Brunese. World J Radiol 2010;28:377-383
Renfrew et al. Radiology 1992:183:145-150
Tiered Huddles Clinic Huddle Clinic Huddle
Outpatient
Huddle
Inpatient/Unit
Huddle
Integrated Huddle
OR
Huddle
ED
Huddle
Materials - Quality - IT - Lab - HR - Facilities - Radiology - Pharmacy - N1 - Training - Regulatory - Registration/Scheduling -
Facilities/Security - Finance - Family Centered Care - TLC - Rehab - Respiratory - HIM/UM - Business Network Development -
Marketing/Communications - Licensing/Credentialing - Research - Construction
Critical Care
Huddle
Patient Flow Huddle
Short (10 – 15 minutes)
Standing
Occur between 7AM – 9:30AM
At site of care
Front of visual board
Metrics / Readiness Assessment / Problem list
MESA
Huddles
No scheduled meetings 7 - 10:30 am
NCH leaders attend huddles
Observe operations (Gemba) during this time
NCH Leadership Standard Work
Nemours Children’s Hospital
Opened October 22, 2012
Integration Huddle started June 2012
Data tracked February 2013
Issues
252 Complex issues (28/month)
Sept - 21, Oct - 63, Nov – 73
After opening: flow (41), supplies (17), facilities (16), & IT (15)
Mean time to resolution = 19.1 days
– (0 – 125 days)
> 10 days (n = 9): IT (5), flow (2)
Standardization – Value
Reliability of process
Executability of the process
Ability to detect abnormal states
Ability to study and improve
Understanding of those up & downstream from process
“Today’s standardization is the necessary
foundation on which tomorrow’s
improvement will be based. If you think of
“standardization” as the best you know
today, but which is to be improved
tomorrow – you get somewhere. But if
you think of standards as confining, then
progress stops.”
- Henry Ford 1926
Visibility – Visual Controls so that
Problems are not hidden
Visibility boards
Lead / solve issues in the workplace
5S (Sort, Straighten, Shine, Standardize, Sustain)
Clinical Lab - January 2009
• High turnaround times
(avg 4 to 11 hours for stat)
• Drastic variability of
turnaround times (up to 24+
hours)
• Meeting STAT turn-
around-time goal of 1 hour
less than 20% of time
• Misplaced specimens
• High volume of customer
service calls (where’s my
result?)
KPI Description: Time to Provider – time of pt arrival to time the MD/ARNP signs up for the
patient
Benchmark data suggests 30 minutes
Goal for 2012-2013 is 15 minutes
5/7/2013 KPI Owner:
How can safety be improved?
Horizontal Interventions
Culture or Environment
Vertical/Tactical Interventions
Process or Technology Adapted from © The Performance Group, 2006
Key Cultural Transformations
• Recognition: safety is an issue
• Everyone is accountable including
me
• Culture where people are
expected and encouraged to
speak up in the face of uncertainty
/ problems
Errors
Significant
events or
injuries
Adapted from Dr. James Reason, Managing the Risks of Organizational Accidents, 1997
Why Do Events Happen?
Three Types of Human Errors
Skill-Based Errors made when performing acts or tasks that require limited or
no thought attention
Rule-Based Errors made when performing acts or tasks that require
application of rules - accumulated through experience and training - to familiar situations
Knowledge-Based Errors made when performing acts related to new or unfamiliar
situations that requires problem solving and for which a rule does not exist or is not known
Standards of Behavior
Continuous Improvement
SOB #5: Be Curious Not Judgmental
“It’s about progress not perfection”
“Just Culture” – fix the system, not punish those reporting errors