Ebola at THBH – Is the Absence of Standards an Anomaly, or the Norm? Part 2

By Pascal Dennis

Last week’s Ebola blog triggered much fine discussion – thanks, folks.

When will we know how many people were infected at THBH? Ebola’s incubation period is 21 days, so let’s circle October 21.

The Ebola crisis conveys many lessons, not the least of which is the importance of Lean fundamentals.

Standardized work, visual management, quality in the process and other basics are not just nice ideas.

In a factory, standardized work for, say, die changeover, or work at altitude, is a life and death matter – for the worker.

In a hospital, standardized work is all that stands between the community, and a pandemic.

Here’s an Emergency Department doctor’s take on it.

I’m worried too, and am reminded of the Jeff Goldblum character in the movie Jurassic Park, who, as you may recall, was a scientist specializing in chaos theory.

“These are inherently chaotic systems,” he warned. “You can’t control them.”

In the absence of Lean fundamentals, I think he’s right.

Best,

Pascal

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Ebola at Texas Health Presbyterian Hospital - Is the Absence of Standards an Anomaly, or the Norm?

By Pascal Dennis

No jokes today, folks. Serious situation at Texas Health Presbyterian Hospital (THPH).

A man has died, and at least two health care workers have been affected.

Especially distressing is THPH’s seeming absence of basic standards, and weak adherence to those that exist. This despite numerous heads-up calls from the Centre for Disease Control (CDC).

Is THPH the anomaly – or the norm? When it comes to deadly, highly infectious diseases, one would expect clear, simple standards for:

• Patient accommodation
o Rooms – location, content & equipment, ventilation, surfaces
• Treatment protocol – in particular, how to eliminate exposure to toxic bodily fluids?
• Access - who has access, entry & exit process
• Personal protective equipment – use and disposal
• Housekeeping & disposal of hazardous waste – what, who, when & how
• Decontamination

Each standard should comprise:

• Content, sequence, timing & expected outcome, or
• Key point checklist

As for adherence to standards, is it too much expect visual tools, leader standard work and Kamishibai?

Instead, THBH issues a statement that’s pure ‘happy talk’:

"We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting. Our nursing staff is committed to providing quality, compassionate care, as we have always known, and as the world has seen firsthand in recent days. We will continue to review and respond to any concerns raised by our nurses and all employees."

Mama mia…

Don’t want to be misunderstood. I have no doubt that THBH team members are highly capable, committed and compassionate. (Some are likely heroic.)

But are they working a good management system?

Best regards,

Pascal

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