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Vol. LXVI, No. 22
October 24, 2014
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Production Line Philosophy Can Reduce Medical Errors, Says Southwick

Anywhere from 200,000 to 400,000 people die each year each from preventable medical errors, according to recent estimates.

That makes preventable medical errors the third leading cause of death in the United States, said Dr. Frederick Southwick at a Contemporary Clinical Medicine Great Teachers Grand Rounds held in Lipsett Amphitheater recently.

“For every death, there are 10 serious, life altering injuries,” said Southwick, professor of medicine at the University of Florida College of Medicine and quality projects manager for the senior vice president for health affairs, University of Florida Health. “There’s somewhere between 1 million to 4 million life altering injuries per year. The human toll is incalculable. The monetary cost is somewhere near $29 billion.”

Southwick knows firsthand the emotional and physical trauma of preventable medical error. In 1995, he had surgery on his left Achilles tendon. During the procedure, his surgeon placed a tourniquet above his knee to block the flow of blood. The tourniquet was left on for too long and injured his arteries. Over time, the damaged arteries scarred and calcified, hindering blood flow to the leg. As a result, Southwick’s leg had to be amputated.

Dr. Frederick Southwick of the University of Florida put an athletic department spin on car-building principles to improve patient safety at his school.

Dr. Frederick Southwick of the University of Florida put an athletic department spin on car-building principles to improve patient safety at his school.

Photos: Bill Branson

“The total cost of this error was $194,915 and I lost 6 months of work. The emotional and physical trauma for me and my family is inestimable,” he said.

Before his injury, Southwick had been studying how to prevent medical errors. Then he learned about the Toyota Production System, a management practice focused on producing vehicles as rapidly, safely and efficiently as possible.

He believed he could apply the philosophy to patient care.

Southwick said that the Toyota Production System is based on three rules: First, every worker must know his or her role within the system. This is called a protocol. Southwick noted that there must be no ambiguity regarding a worker’s role. Next, the supply line between two workers must be as simple and direct as possible. Finally, every employee must offer suggestions to increase quality and efficiency.

If these principles are implemented in health care on a large scale, Southwick estimated that costs could be reduced by 30 to 40 percent without impairing quality.

Southwick tried to apply the Toyota principles to multidisciplinary inpatient work rounds at the University of Florida College of Medicine. He met resistance. Many physicians noted that patients weren’t cars.

“So I took Toyota Production System principles and turned them into athletic principles,” Southwick said.

Southwick called it “Gatorounds,” because the University of Florida’s mascot is an alligator.

“The primary goals of Gatorounds are to have timely, efficient, error-free patient-centered care with nurse involvement and to maximize teaching opportunities,” said Southwick.

Just as each player on a football team has responsibilities for specific plays, each medical provider participating in rounds has responsibilities for managing complex cases.

In a typical Gatorounds, the team forms a huddle around the patient.

“When everyone is in a circle, everyone hears the same thing at the same time. It creates a shared mental model, it flattens the hierarchy and allows everyone to share information,” said Southwick.

He also noted that when an unexpected problem arises, the team works together to understand and solve that problem.

After every Gatorounds, Southwick reviews the team’s performance and suggests strategies for improvement and for preventing mistakes in the future.

Southwick surveyed those who participated in Gatorounds. Attendants, residents, medical students and nurses all thought the system was much more efficient. He also found the length of hospital stays decreased by 18 percent and readmission to the hospital decreased by 30 percent.

He cautioned that change isn’t easy. He recommends that those who wish to adopt changes in health care move slowly and listen to those resistant to change.

“Without change, preventable patient deaths and injuries will continue,” Southwick concluded. “We must change. Our patients are counting on us.”

Muniyappa Wins 2014 Distinguished Clinical Teacher Award

Just before Dr. Frederick Southwick’s Great Teachers Grand Rounds got under way, future greatness was predicted by presentation of the annual Distinguished Clinical Teacher Award. Dr. Ranganath Muniyappa received the 2014 DCTA, given by the NIH clinical fellows committee. Muniyappa is a staff clinician in the clinical endocrinology section of NIDDK’s Diabetes, Endocrinology and Obesity Branch.

Established in 1985, the DCTA recognizes excellence in mentoring health care professionals, teaching about issues related to patient care and outstanding contributions to clinical research.

“The Distinguished Clinical Teacher Award is the highest honor bestowed on an NIH investigator, staff clinician or tenure-track investigator. By my standards, it’s really one of the most special awards someone can receive here,” said CC director Dr. John Gallin, who presented the honor.

On hand at the presentation of the 2014 Distinguished Clinical Teacher Award are (from l) CC director Dr. John Gallin, 2014 DCTA recipient Dr. Ranganath Muniyappa, and co-chairs of the DCTA Dr. Syed Abbas Ali of NCI and Dr. Ricardo R. Correa of NICHD.

On hand at the presentation of the 2014 Distinguished Clinical Teacher Award are (from l) CC director Dr. John Gallin, 2014 DCTA recipient Dr. Ranganath Muniyappa, and co-chairs of the DCTA Dr. Syed Abbas Ali of NCI and Dr. Ricardo R. Correa of NICHD.

 


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