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From newborns switched in the nursery to medication mix-ups and hospital-acquired infections, we are all familiar with the horror stories about hospital safety, and unfortunately, the statistics say we aren’t exaggerating. The safety issue in U.S. hospitals has become so profound and embedded, that we cannot hope to fix it without a paradigm shift in our approach. After defining and demonstrating the true depth of this dangerous concern, Safer Hospital Care: Strategies for Continuous Innovation elaborates on the steps required to make that paradigm shift a reality. A respected and sought out expert on hospital safety, author Dev Raheja draws on his 25 years of experience as a risk management and quality assurance consultant to provide hospital stakeholders with a systematic way to learn the science of safe care. Supported by case studies as well as input from such paradigm pioneers as Johns Hopkins and Seattle Children’s, he explains how to: Adapt evidence-based safety theories and tools taken from the aerospace, nuclear, and chemical industries Identify the combination of root causes that result in an adverse event Apply analytical tools that can effectively measure hospital efficiency Establish evidence between Lean strategies and patient satisfaction Make use of various types of innovation including accidental, incremental, strategic, and radical, and establish a culture conducive to innovation This practical guide shows how to find solutions that are simple and comprehensive, and can produce a high ROI. To reform hospitals, we must recognize that they are highly dynamic systems that must be fixed systemically. Instead of thinking in terms of continuous improvement, we need to think in terms of continuous innovation. Safe hospital care is not just about doing things right; it is also about breaking old habits, finding new tools and doing the right things.
A critical and often overlooked aspect of preventing medical device recalls is the ability to implement systems thinking. Although systems thinking won’t prevent every mistake, it remains one of the most effective tools for evaluating hidden risks and discovering robust solutions for eliminating those risks. Based on the author’s extensive experience in the medical device, aerospace, and manufacturing engineering industries, Preventing Medical Device Recalls presents a detailed structure for systems thinking that can help to prevent costly device recalls. Based on Dr. W. Edwards Deming’s System of Profound Knowledge, this structure can help medical device designers and manufacturers exceed their customers’ expectations for quality and safety. This book is among the first to demonstrate how to control safety risks—from specifications all the way through to safely retiring products without harm to the environment. Supplying an accessible overview of medical device requirements and the science of safety, it explains why risk analysis must start with product specification and continue throughout the product life cycle. Covering paradigms for proactive thinking and doing, the text details methods that readers can implement during the specification writing, product design, and product development phases to prevent recalls. It also includes numerous examples from the author’s experience in the medical device, consumer, and aerospace industries. Even in healthcare, where compliance with standards is at its highest level, more patients die from medical mistakes each week than would be involved in a jumbo jet crash. With coverage that includes risk assessment and risk management, this book provides you with an understanding of how mishaps happen so you can account for unexpected events and design devices that are free of costly recalls.
A one-stop reference guide to design for safety principles and applications Design for Safety (DfSa) provides design engineers and engineering managers with a range of tools and techniques for incorporating safety into the design process for complex systems. It explains how to design for maximum safe conditions and minimum risk of accidents. The book covers safety design practices, which will result in improved safety, fewer accidents, and substantial savings in life cycle costs for producers and users. Readers who apply DfSa principles can expect to have a dramatic improvement in the ability to compete in global markets. They will also find a wealth of design practices not covered in typical engineering books—allowing them to think outside the box when developing safety requirements. Design Safety is already a high demand field due to its importance to system design and will be even more vital for engineers in multiple design disciplines as more systems become increasingly complex and liabilities increase. Therefore, risk mitigation methods to design systems with safety features are becoming more important. Designing systems for safety has been a high priority for many safety-critical systems—especially in the aerospace and military industries. However, with the expansion of technological innovations into other market places, industries that had not previously considered safety design requirements are now using the technology in applications. Design for Safety: Covers trending topics and the latest technologies Provides ten paradigms for managing and designing systems for safety and uses them as guiding themes throughout the book Logically defines the parameters and concepts, sets the safety program and requirements, covers basic methodologies, investigates lessons from history, and addresses specialty topics within the topic of Design for Safety (DfSa) Supplements other books in the series on Quality and Reliability Engineering Design for Safety is an ideal book for new and experienced engineers and managers who are involved with design, testing, and maintenance of safety critical applications. It is also helpful for advanced undergraduate and postgraduate students in engineering. Design for Safety is the second in a series of “Design for” books. Design for Reliability was the first in the series with more planned for the future.
As developed economies enter a period of slower growth, emerging economies such as India have become prime examples of how more can be achieved with less. Bringing together experience and expertise from across the healthcare industry, this book examines innovations that can bring about real advances in the healthcare industry. Innovations in Healthcare Management: Cost-Effective and Sustainable Solutions explores recent innovations in healthcare from a global and Indian perspective. Emphasizing the importance of Lean healthcare and innovation, it presents low-cost, high-volume solutions that improve access to care. Providing concrete examples of the five levels of innovation present in healthcare, the book presents new concepts, methods, and tools for advancing processes and operational flow. It includes case studies of actual results in healthcare innovation from three continents that highlight emerging global trends in healthcare system innovation. The book describes how to organize resources and flows so that given targets, such as cost, clinical quality, and patient experience, can be achieved with available resources. It also covers nontraditional ecosystems of innovation that move outside of expected technological innovations, such as innovations in social persuasion, rural health delivery, and the planning and design of hospitals. The book maintains a focus on key issues across the healthcare industry—such as access to care, demand creation, patient experiences, and data—to help readers implement new ideas and new models of delivery of affordable care in healthcare systems around the world.
America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009--roughly $750 billion--was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.
Each year, hospital-acquired infections, prescribing and treatment errors, lost documents and test reports, communication failures, and other problems have caused thousands of deaths in the United States, added millions of days to patients' hospital stays, and cost Americans tens of billions of dollars. Despite (and sometimes because of) new medical information technology and numerous well-intentioned initiatives to address these problems, threats to patient safety remain, and in some areas are on the rise. In First, Do Less Harm, twelve health care professionals and researchers plus two former patients look at patient safety from a variety of perspectives, finding many of the proposed solutions to be inadequate or impractical. Several contributors to this book attribute the failure to confront patient safety concerns to the influence of the "market model" on medicine and emphasize the need for hospital-wide teamwork and greater involvement from frontline workers (from janitors and aides to nurses and physicians) in planning, implementing, and evaluating effective safety initiatives. Several chapters in First, Do Less Harm focus on the critical role of interprofessional and occupational practice in patient safety. Rather than focusing on the usual suspects-physicians, safety champions, or high level management-these chapters expand the list of "stakeholders" and patient safety advocates to include nurses, patient care assistants, and other staff, as well as the health care unions that may represent them. First, Do Less Harm also highlights workplace issues that negatively affect safety: including sleeplessness, excessive workloads, outsourcing of hospital cleaning, and lack of teamwork between physicians and other health care staff. In two chapters, experts explain why the promise of health care information technology to fix safety problems remains unrealized, with examples that are at once humorous and frightening. A book that will be required reading for physicians, nurses, hospital administrators, public health officers, quality and risk managers, healthcare educators, economists, and policymakers, First, Do Less Harm concludes with a list of twenty-seven paradoxes and challenges facing everyone interested in making care safe for both patients and those who care for them.
How work gets done in complex health care systems is ethically important. When health care professionals and other staff are pressured to improvise, fix structural problems, or comply with competing policies, the uncertainty and distress they experience have potential consequences for patients, families, colleagues, and the system itself. This book presents a new theory of health care ethics that is grounded in the nature of health care work and how it is shaped by the ever-changing conditions of complex systems, in particular, problems of safety and harm. By exploring workarounds and other improvised practices in complex health care systems that are difficult for professionals to talk about openly, yet have unclear effects, including their value or risk to patients, this book offers a realistic look at our changing health care system and how we can improve the way we manage moral problems arising in the care of the sick. Berlinger argues that health care ethics in complex and changing health care systems should reflect the moral complexity of health care work, analyze common ethical challenges with reference to behaviors and pressures driven by the system itself, and support opportunities for health care professionals and staff at all levels to reflect on the problems they face and to take part in social change. The book's chapters include frameworks for looking at ethical challenges in health care as problems of safety and harm with consequences for patients. Are Workarounds Ethical? is designed to support clinician education in medicine, nursing, and interdisciplinary contexts and recommend methods for integrating ethics, safety, and justice in practice.

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