Patient safety is the absence of preventable harm to a patient during the process of health care and the reduction of the risk of unnecessary harm associated with health care to an acceptable minimum.

Ashok Kunappareddy, CEO, Lean Healthcare Initiatives is a highly qualified and experienced professional in Lean Management. He is involved in developing and implementing state-of-the-art Lean Healthcare Processes and Lean 6 Sigma Healthcare Projects for Hospitals, Diagnostics, Pharma, Nursing, and other health care organizations.

Lean Healthcare Initiatives focuses on developing the capabilities of the front-line team (doctors, nurses, and support staff) to manage and continuously improve their work. We strive to significantly improve their patient experience and to deliver better hospital performance.

8 - 8.2% of the errors are purely medication errors

Patient safety is a global health priority, hence proved by COVID. What are your thoughts on the same? 

Ashok sheds light on the subject, "It’s really a serious problem, if you see the figures, it's really alarming in the sense that We have about 5 million deaths per annum and as per a study done in 2008, about 70 to 80% were preventable so, these medical errors consists of various things like misdiagnosis, delayed diagnosis, medication errors, errors due to equipment used. 

• About 8 - 8.2% of the errors are purely medication errors, which is very high and they happen because of look alike, sound-alike drugs, illegible writing of doctors, verbal communications.

• Then the other major thing is hospital-acquired infections (HAI), through central line infections, infections due to bad handling, and so on. 

• Then surface infections from patient to the doctors, nurses to patients, and other staff. 

• Wrong-site surgeries, there are also medical considered medical that is one side such as mistaken identities, foreign bodies, all these are medical errors. 

So people are working on this, as these quality control departments, in any health care organizations, do work on these things,” he says.

How does Lean Healthcare work to reduce medical errors?

Ashok explains, “From lean healthcare initiatives, what we do is we apply lean healthcare concepts to these things, it's a fact that most of these errors are not human-oriented, they are process-related or are systemic as the processes are broken and systems are not in place. So this is what we look at, so, this blame culture also makes more errors because it prevents the healthcare personnel to report incidences. So how will we learn to control medical errors and then improve patient safety? It is only by learning. So that's what we try to prevent. In our training programs, and activities, this is the first thing we teach them because if it's a systemic or process problem, there's no point in blaming the person unless the management corrects the system or the process. So, from the lean healthcare from all optimization, we take all these things from the process point of view. A look-alike, sound-alike, drugs mistakes, and then providing required drugs on time like PP or whatever, on time without fail through this concept of lean healthcare. And then, we have things like Kaizen which is something that helps in improving the patient safety, through taking up quality improvement projects of any area, in any area, whether it is inpatient or outpatient, they have so many problems like sometimes the patient is not saved through the equipment they use like they have dialysis, for example, the dialysis machine itself may have an infective things, all these things need to be looked into and then find out where the infection is coming from and all these things are done through lean healthcare in a systematic way and the system does the corrections and improvements in the process. So basically, it's the process 90-95% of the time, but very rarely you find people who do make mistakes, and even that is prevented through lean in lean healthcare through Standard Work where everything is fixed and set like how they should do their complete process, whether whoever does the process as different people are in each shift, another person can do and the skills are different, their knowledge is different. So even if five different people do the same process, the results are one and the same there can't be a chance for a mistake through the standard work, this is another benefit. And we have another concept called Poka-Yoke that's called mistake-proofing. So where the mistake itself is proof they know like you can't do you can't commit a mistake, you can't do things wrongly. So that is the kind of thing built into the system into the process itself. Like for example, in one simple example for people to understand like you can't insert an Anastasia inlet plug to an oxygen inlet like it's impossible that's an example for Poka-Yoke,” he says.

Health workers are part of the organization 

Ashok says, “Health workers are part of the organization and then if they are not safe, patients are not safe. The major problem for a health worker is stress, the burnout which is severe resulting in psychological problems like suicide tendencies, depression, and insomnia. So, what our lean healthcare or Lean Six Sigma through this methodology do is, we streamline all the activities, reduce their workload and reduce eliminating wasteful movements, like, if you see a nurse, she keeps walking up and down in the hospital because the process is like that, if you study and find out how much she walks in a day, it can be like 10 to 15 kilometers and that is real burnout and then added to that there is a blame culture, so all these things are avoided by setting right the process. So, once the process is set right, the movements are minimized, the waiting times are eliminated, the workload is reduced, the procedures are clear and all these things reduce the burnout and the psychological stress on the healthcare personnel, including physicians. So, what happens is this reduction in stress is a great help to keep them safe and then it improves the work-life balance. Another thing is violence which is an issue for the healthcare workers, particularly those who are attending emergencies and it's really sad to see such incidents. It's not necessarily the physician is not attending to some patient, they may be understaffed, the emergencies are not properly scheduled, no proper planning, these are the mistakes of the management they would have to attend to, and then clarify, and set them right. WHO has prescribed this particular thing as the theme topic for this year, for the patients and as well as health worker safety. These are the things that there should be national law legislation that is Zero Tolerance through providing support by the government and national programs,” he says.

Patient safety through lean healthcare and Lean Six Sigma

Ashok explains in brief, “Whatever we do is a patient-centric model. The customer is first. Whatever we do in lean healthcare is all towards the safety of the patient because safety comes first for the patient and then only comes to the cost and then his comfort and then his treatment by the hospital. I'm an examiner and a lot of hospitals are doing these patient safety improvement projects through lean and Lean Six Sigma methodologies. We use something called visual management systems so that everything is visual, you can't make a mistake. Lean healthcare particularly uses to analyze the root cause for any problem through Ishikawa diagram and then use five-way analysis and then sort it out to find out the solutions which mainly comes through brainstorming and, from the people who are doing it, and then the collaboration. So, that's where through lean healthcare, by working through collaboration and cross-functional teams, we solve all these issues in a very amicable way so that these barriers are removed. And that's how we solve these patient safety problems or any other performance problems. And then Lean Six Sigma is mainly to improve the quality through avoiding variation and minimizing the defects, it avoids any variation, up to the level of 99.99999968%. So that's 3.44 defects per million opportunities only, that you will find if you achieve Six Sigma level, through this methodology. Lean Six Sigma, still, is an upcoming subject in India, whereas it came 15 years back in the US and developed countries,” he says.

Acceptance of digital health has increased 

Ashok sheds light on the subject, “Any digital transformation will automatically support patient safety. Let me start with the digital advances that are taking place in the present and how they are affecting patient safety, if see, a lot of artificial intelligence (AI) is coming into the healthcare sector, which is already coming up for the last few years, and a lot of digital transformation is happening in the last five to 10 years, but after this COVID particularly, this is taking the rapid strides, particularly artificial intelligence. It definitely helps the precision diagnosis, which is the starting point for patient safety. So, for example, if you see, most of these radiological images, the defect is being identified by AI, and so it is an accurate way of identifying problems thereby providing safety. The next thing may be that it can give infusion pumps, IV pumps on its own without the input of the doctor. Then we have things like wearables, like ECG wearables, and biosensor wearables, and then we have fitness trackers, and so on and so forth. So all these things, self-monitor patients on a continuous basis and then transfer the mean data online in real-time to all the stakeholders. So this will automatically help the patient's safety. And new innovations are coming thanks to the COVID, there's a blessing in disguise, it surely has created a lot of damage but then it is changing the world scenario, from the point of view of technology and from the point of view of human behavior. Now even they're convinced that yes, I did not go to the hospital. I can get the teleconsultation at home. Acceptance has increased. So that will bring in further improvements in the digital transformation in healthcare,” he says.

Edited By- Rabia Mistry Mulla