Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Wellness Model
PATIENT CENTERED
ING
FUR NISH ING S
LIGHT
TIMELY
EFFICIENT
MA ARO
QUALITY
EQUITABLE EFFECTIVE
QUALITY
MAT ERIA
LS
SAFE
ART
Assuming a system is 99.9% safe, what does that mean in the real world ?
! 84 unsafe landings /day ! 1 major plane crash every 3 days ! 16,000 mail items lost/hr ! 37,000 bank transaction errors/hr
Fatal Iatrogenic adverse events Cardiac Surgery Patient ASA!3-5 Microlight flights helicopters Medical risk (total)
Himalaya mountaineering
Railways (France)
Nuclear Industry
Very unsafe
10-2
10-3
10-4
10-5
10-6
Risk
Ultra safe
Minor Adverse Events and Patient Satisfaction After Anaesthesia:A Prospective Interview Study
Michael Lehmann, Kai Monte, Paul Barach, Christoph Kindler, MD JCA, 2010
!!12, 347 cases; 29% minor adverse event that cause much unhappiness and dissatisfaction, yet are not long lasting or permanent. !!These minor events, however, cause much delay in healing and are an added expense to the cost of healthcare.
operations performed on Fridays were associated with a higher 30-day mortality rate than those performed on Mondays through Wednesdays: 2.94% vs. 2.18%;
Odds ratio, 1.36; 95% CI, 1.241.49)
10
Mental Models
"!Our personal image of the world
! None are perfectly accurate ! Differences in mental models explain how two people can understand the same event differently ! Are generally invisible to us until we look for them
11
Risk Model
If an error is possible, someone will make it. The designer must assume that all possible errors will occur and design so as to minimize the chance of the error in the first place, or its effects once it gets made Norman, The Design of Everyday Things, 2001
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Individual Factors
HH: hand hygiene. OT: operating theatre. NSG: non-sterile gloves. SG: sterile gloves
Annelot C Krediet, et al. Hygiene Practices in the Operating Theatre: An Observational Study., BJA, 2011
60% 50%
total increase
Handwashing rate
Open bay
Error Rate
250 lux
480 lux
1100 lux
1550 lux
Hybrid Operating Room Defined Procedure room designed for: #! open and/or closed surgical procedures #! configured for surgical sterile control precautions, including the establishment of a surgical red-line of demarcation #! use of anesthesia #! advanced image-guidance
#! Future flexibility #! Turf battles / decision-making #! Available space, infrastructure, capital #! Integration of clinical devices #! Design for Surgery vs. Interventional Procedures
Image, courtesy of Stantec
Technology Based
Surgery Interventional Imaging Cardiac Catheterization Endoscopy (natural orifice access)
Systems Based
Brain Head and Neck Lung Heart Vasculature Breast Bone Intestine Kidney and Bladder
Service
Registration Family Waiting Pre-Op/PACU Anesthesia Pathology Central Supply
Savings
Scheduling Clear Wayfinding Reduce positions Colocation of staff
Flexibility Strategies
Communications Strategy I
Consensus Building
Vision (from the top) Alignment of Surgery/ Medicine Alignment of Surgery/ Radiology Cardiac Catheterization buy in Playing by Surgical Rules Code/Operational Issues Culture Shock
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Communications Strategy II
Scales of Consensus
The Big Idea (guiding principles) Change management as normative (big idea) Establishing a new hierarchy Understanding group and individual loss Leveling an unlevel playing field Establishing small group alliances
Program (numbers and narrative) Adjacency and Flow Diagrams Plans and Reflected Ceiling Plans Elevations and Equipment Placement 3D Modeling and Scale Models Full Scale Models and Simulation Mock-ups with Equipment and Finishes
! 72% response rate ! Significant differences (p<0.001) between both institutions regarding communication at all levels ! 45% felt that outcomes were not safe ! 33% felt that errors of the same kind keep on recurring ! 47% felt that administration was not sensitive to patient safety issues
Team Orientatio n
Back-Up Behavior
Adaptabilit y
2009 Perkins+Will
Slide: 51
Source: Healthcare Leadership white Paper: Ulrich, Zimring, Zhu, DuBose, Seo, Choi, Quan, Joseph (2008) http: //www.healthdesign.org/hcleader/HCLeader 5 LitReviewWP.pdf
High-Priority Research Directions for Seeking to Built Safer and Sustainable Facilities
#!
Design of Cardiovascular Operating Rooms for Tomorrows Technology and Clinical Practice Part One;
B. Rostenberg, P. Barach; Progress in Pediatric Cardiology; 32 (2011) 121-128
#!
#!
Design of Cardiovascular Operating Rooms for Tomorrows Technology and Clinical Practice Part Two;
B. Rostenberg, P. Barach; Progress in Pediatric Cardiology; 33 (2012) 57-65
#!