{"id":4614,"date":"2016-03-26T12:47:02","date_gmt":"2016-03-26T11:47:02","guid":{"rendered":"http:\/\/www.saasoft.com\/blog\/?p=4614"},"modified":"2016-03-26T12:47:02","modified_gmt":"2016-03-26T11:47:02","slug":"frailsafe-design","status":"publish","type":"post","link":"https:\/\/hcse.blog\/?p=4614","title":{"rendered":"FrailSafe Design"},"content":{"rendered":"

\"frailsafe\"<\/a>Safe<\/strong> means avoiding harm, and safety is an emergent property of a well-designed system.<\/p>\n

Frail<\/strong> means infirm, poorly, wobbly and at higher risk of harm.<\/p>\n

So we want our health care system to\u00a0be a FrailSafe Design<\/em>.<\/p>\n

But is it? How would we know? And what could we do to improve it?<\/p>\n

\n

About ten years ago I was involved in a project to improve the safety design of a specific clinical stream flowing through the\u00a0hospital that I work in.<\/p>\n

The ‘at risk’ group of patients were frail elderly patients admitted as an emergency after a fall\u00a0and who had suffered a fractured\u00a0thigh bone. The neck of the femur.<\/p>\n

Historically, the outcome for these patients was poor.\u00a0 Many do not survive, and many of the survivors never returned to independent living. They become\u00a0even more frail.<\/p>\n

\n

The project was undertaken during\u00a0an organisational\u00a0transition,\u00a0the hospital was being ‘taken over’ by\u00a0a bigger\u00a0one.\u00a0 This created a window of opportunity for some disruptive innovation, and the project\u00a0was\u00a0labelled as a ‘Lean’ one because we had been inspired by similar work done at Bolton some years before and Lean was the flavour of the month.<\/p>\n

The actual change was small: it was a flow\u00a0design tweak that cost nothing to implement.<\/em><\/p>\n

First we asked two flow questions:
\nQ1: How many of these high-risk frail patients do we admit a year?<\/em>
\nA1: About one\u00a0per day\u00a0on average.
\nQ2: What is the safety critical time for these patients?<\/em>
\nA2: The first four days.\u00a0 The sooner they have hip surgery and are able to be actively mobilise the better their outcome.<\/p>\n

Second we\u00a0applied Little’s Law\u00a0which showed the average number of patients in this critical phase is four. This was the ‘work in progress’ or WIP.<\/p>\n

And we knew that\u00a0variation\u00a0is always present, and we knew that having all these patients in one place would make it much easier for the multi-disciplinary teams to provide timely care and to avoid potentially harmful delays.<\/p>\n

So we suggested\u00a0that one six-bedded bay on one of the trauma wards be designated the Fractured Neck Of Femur\u00a0bay.<\/em><\/p>\n

That was the\u00a0flow diagnosis and design done.<\/p>\n

The safety design was created by the multi-disciplinary teams who looked after these patients: the geriatricians, the\u00a0anaesthetists, the perioperative emergency care team (PECT), the trauma and orthopaedic team, the physiotherapists, and so on.<\/p>\n

They\u00a0designed checklists to ensure that all #NOF patients got what they needed when they needed it and so that nothing important was left to chance.<\/p>\n

And that was basically it.<\/p>\n

And the impact was remarkable.\u00a0The stream\u00a0flowed. And\u00a0one measured outcome was a dramatic and highly statistically significant reduction in mortality.<\/p>\n

\"Injury_2011_Results\"<\/a>
\nThe full paper\u00a0was published in Injury<\/em> 2011; 42<\/strong>: 1234-1237.<\/p>\n

We had\u00a0created a\u00a0FrailSafe Design<\/em> … which implied that what was happening before was clearly not safe for these frail patients!<\/p>\n

\n

And there was an improved outcome for the patients who survived: A far larger proportion\u00a0rehabilitated and returned to independent living, and a far smaller proportion required long-term\u00a0institutional care.<\/p>\n

By learning how to\u00a0create and implement a\u00a0FrailSafe Design<\/em> we had added both years-to-life and life-to-years.<\/p>\n

It cost nothing to achieve and the message was clear, as this quote is from the 2011 paper illustrates …<\/p>\n

\"Injury_2011_Message\"<\/a><\/p>\n

What was a bit disappointing was the gap of four years between\u00a0delivering this dramatic and highly significant patient safety and quality improvement and the sharing of the story.<\/p>\n

\n

What is more exciting is that the concept of FrailSafe<\/a> is growing, evolving\u00a0and spreading.<\/p>\n","protected":false},"excerpt":{"rendered":"

Safe means avoiding harm, and safety is an emergent property of a well-designed system. Frail means infirm, poorly, wobbly and at higher risk of harm. So we want our health care system to\u00a0be a FrailSafe Design. But is it? How would we know? And what could we do to improve it? About ten years ago … <\/p>\n

Continue reading “FrailSafe Design”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,15,17,20,21,22,31,33,38,46],"tags":[],"class_list":["post-4614","post","type-post","status-publish","format-standard","hentry","category-6m-design","category-design","category-examples","category-flow","category-governance","category-healthcare","category-papers","category-quality","category-safety","category-teach"],"_links":{"self":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4614","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4614"}],"version-history":[{"count":0,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4614\/revisions"}],"wp:attachment":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4614"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4614"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4614"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}