Spotlight

New Delhi, 10 February 2024

Nation’s Healthcare

ENGINEERING CAN BE A CURE

By Rajiv Gupta 

In the recent interim budget, the Finance Minister announced a marginal increase of Rs 3000-odd crore allocation for the health sector, along with plans to set up new medical colleges, a new pharmaceutical programme to promote research and innovation, etc. However, the field of healthcare is going through several challenges and the issues need to be clearly understood if the desired end result is an improvement in the availability and quality of healthcare to all Indians. 

It is evident that the price of healthcare has gone up significantly up, while the trust of people in healthcare has gone down due to a variety of reasons. Some of the reasons may be medical negligence, the corporate model of healthcare which puts profit above the needs of the patients, as well as poorly planned systems which lead to unnecessary waste and costs in the system. So, while there may be a perceived shortage of qualified doctors, unless we view healthcare as a system with the patient as the primary customer, we are likely to fall short of the goal of affordable, quality healthcare. 

It is ironic that hospitals, and healthcare facilities, which are expected to cure people of whatever ails them, themselves are in need of help from the malady of negligence, medical errors, and healthcare acquired infections. A study conducted in the US and reported by the Institute of Medicine publication “To Err Is Human,” estimated that at least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors. 

There have been other publications including one by the British Medical Journal claiming a much higher figure of deaths due to medical errors. Although some people have disputed the findings of the BMJ study due to lacunae in the research methodology, it is commonly accepted by medical professionals that medical errors, and the avoidable tragic consequences thereof, need serious consideration and some sustainable solutions found. 

A recent Op Ed in a leading English daily mentioned that one of the clauses in the new Bharat Nyay Samhita (BNS), the penalty for death due to medical negligence is limited to a maximum of two years and a fine, while the maximum penalty for death due to any other act of negligence is five years and a fine. This merits some discussion, not so much on the penalty for negligence, but on the act of negligence itself. 

Quality in healthcare is an emerging field with medical professionals striving to gain competence in systems and technologies to improve the journey undertaken by patients as they go through a healthcare facility. In the context of healthcare, quality would include the consideration of medical errors, inefficiencies in procedures, wasteful activities, and a lack of sensitivity to patient needs and concerns. The tools and techniques that can be used come from very diverse areas such as flying airplanes to the Toyota Production System, and the teachings of Dr. W. E. Deming. While it is not possible to provide an extensive coverage of all the tools that can be used to improve healthcare productivity and quality, a few techniques will be discussed in this article. 

First, a very simple and effective approach used by aircraft pilots will be discussed. Before a pilot starts to taxi and take off, he/she conducts several checks on various systems on the aircraft to ensure that there is no malfunction. This reduces the possibility of problems once the aircraft is airborne. Dr. Atul Gawande, a well-known surgeon and author, has written a book “The Checklist Manifesto” where he discusses the application of similar checklists in healthcare, especially before starting a medical procedure or surgery. 

Such checklists are being implemented in several hospitals in India where the chief surgeon goes through a list of people, tasks, medications, and supplies before starting the procedure or surgery. This is done with the entire medical team in the operating theater and if anyone feels that something is missing, they are encouraged to speak up so that a costly error or problem may be averted once the procedure is started. 

Dr. Gawande likens the role of a surgeon to that of an airline pilot because both have the lives of people dependent on them. Pilots deal with many complicated procedures and technology and each aircraft may have different systems. Similarly, surgeons have to deal with complicated procedures and also the individual patients have different characteristics which may necessitate different approaches. Both the pilots and surgeons cannot rely solely on their memory. Therefore, the checklists are very useful in both cases. 

Another very simple and effective way to reduce errors in healthcare is 5S. 5S is part of the Toyota Production System. It refers to 5 practices, each starting with the letter S (Sort, Set in order, Shine, Standardise, and Sustain), which can help in improving systems from car manufacturing, to healthcare. Although 5S does not involve any complicated or expensive technology, it does require discipline to sustain the benefits that come from the process. The first element of 5S (the first S) suggests that an organisation do an assessment of all materials and equipment that are present in the workplace. If there is anything that is in the system, but should not be there, we should remove it from the system. 

A common complaint of organisations is the lack of sufficient space. However, what they do not realise is that useful space is being occupied by things that should be removed. If we eliminate unnecessary items from the workplace, not only is additional space created, but the workplace is less cluttered, allowing workers to find things more easily. Once we have eliminated unnecessary items, the necessary items should be organised so that they are easy to identify and access. This reduces time to accomplish tasks as well as reduces the possibility of errors. 

An example of the application of 5S in healthcare is the storage of medications which look alike, and also have similar names. It is easy for individuals to make a mistake in such cases, possibly resulting in serious harm to the patients. In such situations, 5S suggests that the medications should be color coded, and also they should be stored in different locations to minimise the possibility of a mix-up. There was a case in 2006 involving the mistake of administering a wrong drug to a cancer patient which resulted in her death. The probability of making such mistakes could be significantly reduced by the application of 5S. 

A third technique comes from the area of Industrial Engineering. When industrial engineers design a facility, they ensure that unnecessary waste in the form of walking or other actions of the workers be eliminated. A similar approach can be taken in the design of a healthcare facility. It has been estimated that nurses in hospitals spend about 30 per cent of available time in providing care to patients. The rest of the time is spent in walking or performing other tasks such as searching for items. An application of industrial engineering design principles can reduce walk times and unnecessary tasks, freeing up more time for patient care. Also, if healthcare facilities are designed to reduce walking and movement, it will also reduce unnecessary movement of patients, which can be a major relief to them. 

These are some of the approaches that can help in improving the productivity of healthcare professionals, reduce the instances of errors, and should lead to an overall improvement in the patient experience. As Deming and other gurus of quality have always suggested, the customer is the reason why an organisation exists. If an organisation can improve the customer experience, the customer as well as the organisation will benefit. Patients are the principal customers of healthcare. It is therefore important to ensure that healthcare facilities focus on what is important for the patients.---INFA 

(Copyright, India News & Feature Alliance)