Ebola is scary. Though I try to allay my fears with practicality and common sense, I am – like many Americans – very concerned. The unknown is always scary. I wanted to start with that assertion to place the rest of my observations in context.
We will, I expect, ultimately pull through this latest threat to our lives better than our current fears would predict. Assuming we do, when the dust settles and the national media moves on to cover the next threat to our lives we are going to be left with some very useful case studies that we (hopefully) can use to assess how and why the healthcare industry continues to be unable to effectively embrace and utilize quality process improvement.
Of course, we will have to get past the blame game, name-calling and talking heads wanting to put the fault upon political philosophy rather than where it rightly belongs: the human beings that are involved in the promulgation of guidelines and regulations, the implementation of guidelines and regulations and the adherence to guidelines and regulations.
Already today pointed fingers are flying around Dallas like roof shingles might during a Texas size tornado. Texas Presbyterian hospital administration is accusing the media of sensationalism (go figure). A nurses union is blaming the hospital for not protecting its workers. The CDC blamed – then didn’t – the hospital for not following protocols and guidelines. How George Bush is avoiding blame down there I can’t figure.
Finger pointing in times of crisis is an innately human characteristic that only few people can avoid. Those folks that do avoid it tend to make very good leaders, and unfortunately apparently have an abhorrence for public office. But in a very real sense the finger pointing underscores how far the US healthcare delivery system has to go to change the systemic cultural aspects that impede progress toward quality improvement.
As I have shared in this space before, my colleague Nathan Ives and I wrote a white paper a while back: Aligning Healthcare Organizations: Lessons in Improved Quality and Efficiency from the Nuclear Power Industry. I believe it is informative and particularly relevant today to compare the relative safety records of both the nuclear power and airline industry safety records to healthcare. The potential wide scale impact of an epidemic raises our collective consciousness to view healthcare safety on a par with tragedies in those other industries in a way that one death at a time simply does not, however right or wrong that may be.
Though somewhat dated, there was an interesting journal article written in the December 2003 issue of Quality and Safety in the Healthcare: Applying the lessons of high risk industries to health care. In it the author notes the exemplary safety performance achieved in the oil and gas and aviation industries. And then examines why healthcare – an industry with comparable high risks – has not done nearly as well.
As the author notes, “health care has always taken medical dangers seriously, so the culture cannot be pathological. The lack of systemic risk management suggests that the culture is, at best, reactive, even though there may be the occasional proactive area.” Though we have seen the industry try and address these inherent cultural differences over the past decade since this research was conducted, we only need to look at the flying fingers in Dallas to realize not much progress has been made.
Organizational process improvement leading to the type of sustainable quality and safety that has been achieved in other industries and disciplines cannot and will not be achieved through regulatory compliance alone. It requires a paradigm shift in the thinking and attitudes of healthcare industry participants who have been effectively able to resist change for a long time. If you are looking for a silver lining in this scary period we are living through, it could be that Ebola accelerates that paradigm shift. I do believe we have more to learn than to fear.
P.S. See you at the LeadingAge Conference in Nashville! We’ll be in booth 1829.