Just been reading "Better" by Atul Gawande, recommended by a speaker at the recent IFM Healthcare study day. Gawande is a surgeon and is known for writing about quality and improvement. In this book, he focuses on what he calls "three core requirements for success in medicine":
- diligence - essentially about identifying and embedding best practice and avoiding errors. He talks through the attempts in various organisations to reduce hospital-acquired infections, including campaigns to promote handwashing. It seems the most successful attempts stemmed from wide-ranging campaigns which involved all staff submitting their ideas, implementation of some of these ideas and a comprehensive comms programme keeping everyone informed of progress. Another example is how more American troops are saved than ever before because the whole system of treating them was reviewed - this resulted in Forward Surgical Teams who are there to provide immediate care - their focus is damage control rather than repair. The next level of care is a Combat Support Hospital designed to care for patients for up to 3 days - any longer and they are transferred home - "the average time from battlefield to arrival in the US is now less than four days".
- doing right - refers to ethics, dignity and respect. Gawande explores ethical dilemmas around examinations and considers the lack of evidence on issues such as the use of chaperones. "How each interaction is negotiated can determine whether a doctor is trusted, whether a patient is heard, whether the right diagnosis is made, the right treatment given". He also considers the malpractice system and litigation in the US which he points out, doesn't really address the fundamental issues of errors and negligence in a fair way and doesn't encourage dialogue.
- ingenuity - reflection and innovation. Gawande considers how we measure performance and how we recognise and learn from excellence, using treatment centres for children with cystic fibrosis as an example, showing that some centres achieve an average life expectancy of 46 whereas others only 30.