DMC Officials Should Look to Auto Industry for Help Solving Problems
The Detroit Medical Center should look to the automotive industry for guidance on problem solving in the wake of issues relating to health and safety being uncovered by state and federal investigators and the Detroit News.
Problem solving techniques used in the automotive industry may not prevent the initial problem, but from my experience they are incredibly effective at preventing future problems. One such technique that hospital officials could employ is the 8D.
The 8D’s or 8 Disciplines of problem solving would help the DMC get the current situation under control, but also assist state and federal officials with preventing this situation in other hospitals. An 8D would require the organization to do the following (a few steps are missing):
- Describe the problem
- Develop an interim containment plan
- Determine and verify root causes and escape points
- Define and implement corrective actions
- Verify that the permanent corrections will resolve the problem
- Prevent system problems
Federal investigators only required that the hospital provide details on the corrective actions that would be put in place. Simply identifying corrective actions as the DMC did in their response to investigators will not guarantee that the situation has been permanently resolved. An example of a corrective action that may or may not solve a problem is:
“The operating room managers beginning October 10, 2016, will review cleaning logs on a weekly basis for four months to verify the cleaning of surgical suites is performed as outlined in policy.” — CMMS Report
Such monitoring appears good on the surface, but does it solve the root cause of the problem? I argue that it does not.
If completed properly, an 8D would significantly restore confidence in the hospital system.
Describe the Problem
Describing the problem seems like common sense, but the important part in describing the problem is knowing what problem we intend to solve as well as the scope of our solution. This element of the problem solving technique requires the hospital to specify the problem by identifying in quantifiable terms the who, what, where, when, why, how, and how many (5W2H) for the problem.
Develop an Interim Containment Plan
This is perhaps the most important step of the hospital’s immediate response. Identify the short-term plan in place to remove any doubt that the problem will continue to affect patients. The Detroit News article on October 11 states “[a]s recently as this month, doctors told The News they still encountered dirty or rusty tools in operating rooms.” Even after being confronted by these issues, the problem persisted. An interim containment plan would prevent those tools from reaching operating rooms at almost any cost.
Determine and Verify Root Causes and Escape Points
This step not only ensures the DMC is solving the correct problems, but helps other hospitals be proactive if they see evidence of the same behavior in their facilities. The DMC should identify all applicable causes that could explain why the problem has occurred. Also identify why the problem was not noticed at the time it occurred. All causes shall be verified or proved. One can use five whys or Ishikawa diagrams to map causes against the effect or problem identified.
Define and Implement Corrective Actions
Verify the Permanent Corrections Will Resolve the Problem
This is also a self explanatory step, but the DMC needs to quantitatively verify that the corrections solve the problem as described above.
Prevent System Problems
Modify the management systems, operation systems, practices, and procedures to prevent recurrence of this and all similar problems. This step of the 8D exists to again ensure the problem does not persist, but will also help other hospital systems in their evaluations of current practices.
I’m calling on the DMC leadership to go above and beyond for Detroit and her people, if that means adopting a problem solving technique from the automotive industry, then so be it. The DMC has a responsibility to deliver care of the highest quality, and I’m positive that with the proper actions, trust will be restored. Detroit deserves nothing but the best, and here in Michigan, we are all Detroit.
The Detroit Medical Center, its management and staff, are not currently villains in my eyes. I am not calling for the firing of anyone. I simply want to make sure that Detroiters who cannot seek medical care elsewhere for whatever reason, get the best care possible. Best care is in no way equivalent to mediocre care. If we accept mediocre medical care, or mediocre solutions, we lower the bar for other groups serving people in the city of Detroit. When state agencies do not take swift action or stand on the sidelines, they show that lower standards are acceptable around the state. Michigan will not be a state that accepts mediocrity. Period.