From the President ... Mary Logan
March 26, 2012
What We Can All Learn From ’Grand Rounds’
I spent considerable time in March out in the field, listening to and observing what's going on out there. In my "On the Road" piece in the April issue of AAMI News, I note that this was my own form of participating in "grand rounds." We would all do well to create grand round experiences for ourselves, not unlike what MBA pundits call "management by walking around."
Healthcare technology management professionals are “heads down” at the bench; clinicians are focused on their unit, the OR, a patient, or documenting their work; medical device engineers are in the lab; the rest of us spend a lot of time at our computers or in meetings. How much of our time is spent learning by getting out in the field to listen and observe what's going on out there?
I know, rounding takes time—precious time that we don’t have. I’m convinced that getting out in the field actually saves us time, aggravation, money, and more. It makes us better at what we do.
Here are some of my favorite current examples of learning from various forms of "grand rounds."
- Alarm Safety: George Blike, chief quality and patient safety officer at Dartmouth-Hitchcock Medical Center, and a multi-disciplinary team from nursing, clinical engineering, and industry, spent several weeks following nurses around in a post-surgical unit to observe, asking questions and, most importantly, listening and learning, before attempting to design a solution to "un-witnessed" patient events and alarm safety.
- Multiple Line Infusion Study: The University of Toronto's recently released multiple-line infusion study includes nine excellent recommendations for managing multiple-line infusions (one of the clarion themes from the 2010 AAMI-FDA Infusion Systems Summit). The fundamental building blocks for these recommendations included getting out in the field, listening to, and observing what's actually going on out there.
- Clinical Usability of Health IT Solutions: If health IT designers spent more time in the field to listen and learn, they (hopefully) would have known, for example, that documenting a U.S. pediatric patient's weight in kilos instead of pounds would create a nightmare for clinicians. I listened to 2-1/2 days of safety and clinical usability nightmares such as these in the health IT learning track at the recent Human Factors and Ergonomics Society's healthcare conference.
Richard Cook, MD, a leading expert on medical accidents, spoke compellingly and controversially of these types of patient safety nightmares at our 2012 International Standards Conference earlier this month. Cook wants to see the FDA regulate health IT as a high-risk medical device, a proposal he detailed in his dissenting opinion in last year’s Institute of Medicine report on health IT and one he reiterated at our conference. Whether we agree with Richard’s opinions or not, field-based learning would help inform our opinions. Even more importantly, listening to and observing clinicians for several weeks before designing solutions would serve us all well in this health IT space.
- FDA-Required Usability Study: A medical device manufacturer recently shared with me how stunned the company was at what it learned from a usability study that the FDA required as a part of a pre-market submission. In the end, the manufacturer was grateful because it helped the company fine-tune a much better product before going to market. Ultimately, the extra time learning in the field saved time and money and resulted in a better, safer device.
It’s the end of the first quarter in a fast-paced year. Regardless of your job, make plans to get out in the field and learn by doing your own form of grand rounding. Let us know what you learn. To quote Yoda, “A little more knowledge might light our way.”
Kindest Regards,
Mary Logan, JD, CAE
AAMI President
mlogan@aami.org
+1-703-253-8265