I once read an article that one of my colleagues left on my desk entitled “2017 Healthcare in Crisis, Needs a Revolution” by Dr. Bill Bysinger, PhD. The opening sentence of this articles states “Having been involved in healthcare since 1980, I continue to be frustrated by the lack of real change or improvement in the industry”. In addition, we are confronted every day with news about what our political leaders are contemplating doing in regards to repeal and replacement of the Affordable Care Act (Obamacare). For those of us who spend most of our waking hours involved in the process of healthcare, this is truly a confusing time. Which way will our federal government go? How will it affect our healthcare concerns? Hopefully, the decisions that are made will be in the best interest of the American people and our healthcare.
Yet, under the radar of all of this confusing information, there is very important work being done in a series of cooperative ventures between our military hospitals, our veterans’ hospitals, and major not-for-profit world-recognized healthcare systems that are exploring innovative delivery models which will make healthcare delivery safer, with better results, utilizing less resources.
It is a well known fact that some of the most significant advances in saving lives have been devised and perfected by our military in theaters of war. Many of the surgical procedures we consider routine today resulted from physicians and nurses in field hospitals making extraordinary life or death decisions that resulted in many of our troops returning home to their families, rather than becoming battlefield casualties.
Once again, our military, along with the VA, are replicating their creativity on the battlefields in joint projects with the not-for-profit healthcare world that are resulting in dramatic breakthroughs in quality of care and efficiency. A study emerging from Wright-Patterson Air Force Base Medical Center in Ohio is leading the way in inventing and implementing a new model of care to improve safety and efficiency for patients. The new model, called the Military Acuity Model (MAM), was inspired by now retired Lt. Col. Jared Mort, a Wright-Patterson Clinical Nurse Specialist who had served in numerous active-duty theaters of war.
“Reducing task saturation improves the process of care, as it ensures better completion of care-related tasks and thereby increasing safe patient outcomes”, noted (then Major) Mort. “This is crucial with preventing future problems in getting patients well sooner.” This model focuses on planning ahead to ensure each healthcare professional is not mentally overloaded, or task saturated, which would otherwise lead to errors. In the study, the researchers focused on standards of safety that have been applied to the aviation and the nuclear industry to reduce the risk of serious errors. Think about the standards that have been implemented over the years in the airline industry that have resulted in a remarkable record of safety. As the leaders of the airline industry learned, the best way to avoid human error with air traffic controllers, maintenance, engineers, and pilots, was to implement a set of processes and procedures that maximized decision-making that would lead to the best possible outcome in a critical situation. The movie SULLY is a study in remarkable decision-making by Capt. Sullenberger when both of his plane’s engines were hit by birds. Sullenberger’s response to the FAA review of his accident is the best case study in contextualization of appropriate decision-making based upon the circumstances and the time parameters necessary to make the appropriate decision.
In healthcare, we have begun to recognize the very significant impact of “decision fatigue” on outcomes in critical healthcare situations. A study was done a few years ago on practicing physicians ordering diagnostic tests to assist them in the diagnosis process. In that study, it was revealed that the more rested the physician was the more likely he/she would use a good history and physical as the primary diagnostic tool. Once the physician felt a sense of fatigue, the doctor would prescribe additional testing as an assist in allowing the physician to reach the proper diagnostic conclusion. Certainly, physicians do not order tests frivolously but the data from this earlier study and from the MAM study indicates our doctors are human after all, despite many of their superhuman efforts on our behalf.
Because all of our healthcare providers are indeed human, developing these protocols in healthcare, similar to the protocols that have been instituted in the airline industry, can lead to “Approaching a Zero – Defect Culture in Healthcare”. Our military and VA institutions, along with a group of renowned not-for-profit healthcare systems, are leading the way.
Too little attention has been paid by most of us to these unique contributions to American healthcare emerging from our military hospitals and the VA in conjunction with these not-for- profit enterprises, including the High Reliability Organization Council (HROC).
As the battle heats up to determine the fate of the Affordable Care Act, whichever way it resolves itself, we are all the beneficiaries of remarkable work being done in healthcare research by our military and veterans’ hospitals, which will result in improved quality of care for all of us as these procedures begin to be implemented across all aspects of healthcare.
