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Written by: Darlene D'Altorio-Jones (1959-2015) on Sunday, September 9, 2012 Posted in: Inpatient Rehab

Do no harm. Not only is this part of a physician’s Hippocratic Oath; every healthcare professional should be compelled to own that same mantra. However, specific actions known to cause harm are still practiced or ignored by those of us that provide licensed forms of care. Is it because we don’t care? I don’t believe so, most blame time as the leading cause for not doing what we inherently believe is best practice.

Imagine you’re the patient. Whose time matters? It’s a simple exercise of placing yourself, or a loved one, in thought as the recipient of everything we do as clinicians. Time becomes just a little more important and less constrictive. We constantly look at the cost of materials, software and machinery, but rarely do we look at the expense of work we do that has little value because we are not acting on fact and knowledge of a particular status. Wasteful process is costly to clinicians who need fact and measures to guide work in real-time.

When you are ”Lean trained,” you learn about “Muda,” the Japanese word for waste. In healthcare, we are surrounded by processes that were built on previous workflow, even when new or changing information is provided. We are resistant to change and hold on to wasteful yet familiar practice. Rarely do we challenge the fact that if we are wasting time, then we are fueling excuses to add cost and harm to patients. It is time to examine the cost of working without facts so that we can model care to continuous changes in conditions, based on information available through documentation of care process and those outcomes. If you are still abstracting information manually, and only at a limited percent, you can never be close to 100 percent effective. Being effective supports “do no harm.” Being effective requires you to know the current status and eliminate work processes without value.

Examine the value of clinical intelligence. Learn to examine process and to adopt information as the leader in true healthcare reform. When Toyota executive, Taiichi Ohno, defined seven causes of waste (Muda), he called them “The Seven Deadly Types of Waste.” Mind you, he meant deadly in a business sense, but in healthcare we can relate to those words more inherently. The cost and time associated with how and why we do things needs to be challenged. When we don’t do the right things because there is not enough time, it’s time to reconsider why healthcare needs reform in the first place. Reform that begins internally with mindset and has nothing to do with regulatory mandates. Why do we do everything that we do and what is the value of the information in the process of effective, efficient care?

Going through wasteful processes so they can be eliminated and replaced with useful efficient practices is vital. From the bottom up and the top down we must question workflow and process to meet expectations and to provide time to do the right things; treat, teach, train and educate the patient to manage the impairment they have acquired. Know just how much has been done and how successful (within charting), so that every clinician interacting with the patient can spend their time meaningfully by building on past accomplishments and not starting over.

By adopting these concepts we can reduce waste, do no harm and manage toward expected outcomes. It’s all about continuous quality improvement; not working harder, but more effectively in the time we have to do more good and less harm

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