LISTEN: Systems thinking and medicine -- brilliant lecture on systemic problem-solving


#1

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#2

I concur it was a really good lecture. It amazes me that things he’s advocating are almost controversial in a medical setting. Much of industry is doing these sort of things routinely under the umbrella of Kaizen, of which mistake proofing is just one part (attach Japanese names as you see fit).

I wonder if the traditional position of doctors as lone expert wolves is what leads to a mentality lacking in humility, which is the cause of resistance to this.

My wife is a doctor in hospital, and I had a fascinating experience in which the hospital where she worked hosted a forum in which employees (nurses, doctors, phlebotomists etc) could put forward suggestions for improvement. Almost without fail, the suggestions fell into the category of system improvements, and all seemed like sound ideas - primarily around mistake proofing, or efficiency improvements - but the holes that were picked in them were all around whether they could get “buy in” from everyone else.

It strikes me that there needs to be much more training in methods of instigating effective change rather than in the changes themselves, as clearly the changes themselves are often highly situation dependent. This is really the essence of Kaizen.


#3

Knowing the simple fact that cold-water drowning victims have been revived after astonishingly long periods of time, I had no idea what an array of incredible technologies and methods make that possible. I can’t even come up with words to adequately describe this - it really is a must-listen, for the lessons as well as the outer limits of possibillty even now, still in the dark ages at the beginning of real medicine.


#4

I think it’s a factor. In previous generations a physician was the great repository of medical knowledge and skill. The responsibility level was enormous. The responsibility remains enormous today, but the body of medical knowledge is far beyond one human’s ability to manage (yes, there’s always an outlier savant --most of us are rather more mortal in our capacities).

More than the tremendous breadth of knowledge needed is the ability to coordinate care AND do that consistently well. This takes a systems approach to reducing variation and producing desirable outcomes --it isn’t enough that the top 10% of physicians get it right. Everyone needs to get it right and get it right every time.

Anecdotally speaking, the newer generations of physicians, pharmacists and nurses I’ve met seem much more in tune with systems thinking and the metrics required to drive improvement and track reliability. They “get it.” The major challenge I see looming is budgeting clinician time to support improvement work. If you cut staff to the bone, who has time to mind the store?

(And you are right about needing more training around applied improvement methodology. It’s something I’m working on getting better at myself.)


#5

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