Take a ‘systems’ approach to Ebola
Primum non nocere – “First, do no harm” – comes from the Hippocratic Oath, a principal tenet of medical practice. But the amazing advancements of science and technology often overshadow safety. Even as we do our best to improve peoples’ lives, our current health care delivery system can expose patients and health care workers to a disturbing level of risk, a fact magnified by the current Ebola outbreak.
It’s time to take a closer look at health care systems — doctors, nurses, patients, emergency responders, medical devices, medical records, safety gear and procedures, disposal processes and more. What are the risks? What works well? What can work better? How can they all work collectively? This approach — a holistic look at each component — is also known as “systems engineering.”
Systems engineering focuses on ensuring that within any industry, the pieces work together to achieve desired outcomes. In large part, health care professionals already understand its importance for such tasks as integrating medical records. Yet as extreme situations like Ebola prove, not enough is being done.
To tackle this challenge, every detail matters. Every strategy and action taken should be the most effective option possible; any steps that do not add value should be eliminated. The battle must be deliberate and effective at every level.
One example of how we could optimize human performance and avoid medical errors would be to overhaul the communications systems of health care workers. For instance, medical professionals generally do not have standard terminology for critical communication that ensures everyone understands what’s going on. How many times have we heard “STAT” in a medical setting or on a TV show? It sounds cool, but what does it really mean? Has “STAT” perhaps been so overused that it’s now meaningless?
Systems engineering recognizes the importance of crisp, concise phrases in intense industries such as health care. When lives are at stake, specific safety behaviors such as “S.T.A.R.” (Stop, Think, Act, Review), or safety-oriented phrases such as “Doctor, I have a concern,” can make the difference between life and death.
If a significant Ebola outbreak should happen in the U.S., we need to be ready. Even a handful of simultaneous Ebola cases at any one hospital would overwhelm the current system and result in a crash. A plan in a drawer does not mean we’re ready. A successful national response to Ebola would be complex and multifaceted and require all elements to work perfectly under worst-case conditions.
For example, a hospital deemed “Tier 2” by the Centers for Disease Control and Prevention is required only to be prepared to isolate and test suspected patients, and to transfer proven Ebola cases to a “Tier 1” facility for treatment. However, in a real outbreak, when it inevitably becomes too overwhelming to transfer patients from one facility to another, a Tier 2 Ebola center instantly becomes an involuntary Tier 1 center. Is Tier 2 ready for this? The systems in a Tier 2 hospital need to be organized and prepared to care for patients with Ebola through the whole treatment process.
Recently, there has been a national call to action. Taking a systems approach to health care overall was recommended to President Barack Obama in May in the report, “Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering,” by the President’s Council of Advisors on Science and Technology.
Recommendations included: Rework the payment system; improve health data gathering; provide technical tools for systems approaches; involve the community; share best practices, and train health professionals on systems engineering approaches. The presidential report noted that systems engineering is extensively used in manufacturing and aviation. Though there are successful examples in health care, these practices should be more widespread.
It’s also important to note that Ebola is not simply a biomedical problem; it is social, political and economic. Thus, the solution is not the sole responsibility of the health care industry.
Michael Appel, an area anesthesiologist, is president of the North American Safety Education Group LLC. David Long is president of INCOSE, the International Council on Systems Engineering, and the president and founder of Vitech Corp., a global systems engineering solutions company.
