Patient Safety and Healthcare Policy

  • The Agile Safety Case: This one is so super-niche that probably no one I know will ever read it, but I'm glad I did. It is an examination of the formal regulations for proving railway equipment safety in the EU, together with the authors' guidance on making the process more agile. Hard-core ISO types will be aghast at the agility here, and all the agile folks I know will look at the pages of required paperwork and extra meetings and pronounce it completely non-agile. But keeping people alive is serious business, and this was a good reminder that "safety" is much more advanced in some fields of endeavor than others. I don't see anything wrong with combining ideas from the safety and agile domains, if it helps keep people from being run over by trains. (Review by Mike Gunderloy)
  • Beyond Heroes: A Lean Management System for Healthcare: Kim Barnas worked her way up to SVP at ThedaCare, a Wisconsin-based healthcare system, during the time (starting in the mid-nineties) described in this 2016 book. The book itself is an outline of how the system applied lean principles (kaizen, gemba, huddles, standard work, and many more) to the system to improve quality. From the sound of it, this worked well there, and ensured both better outcomes for patients and more satisfaction for providers. Though written from the perspective of moving away from firefighting and into sustainable improvement in the healthcare industry, it explains the tools and ideas clearly enough to be employed much more wisely. I'd be interested to know how the ongoing work is proceeding and whether ThedaCare has pulled back from any of these ideas, but this is a solid contribution to the quality & safety literature. (Reviewed by Mike Gunderloy)
  • Blood, Sweat, & Tears: This one recounts an individual surgeon's journey as his career matures. It also shares a good deal of advice for other (mostly younger) surgeons, with an emphasis on the benefits of empathy and concrete measures that help lead to better outcomes for patients. I was interested to see the thinking about patient safety & healthcare quality from the inside of the system. Lots to think about in this one, especially about how making human connections helps, and big systems sometimes don't. One of the key insights is that simple checklists can help, but the attitude of the entire team towards the checklist has a big impact on whether they do help. (Reviewed by Mike Gunderloy)
  • High Reliability Organizations: A Healthcare Handbook for Patient Safety & Quality: An excellent book on HROs, from the point of view of the frontline nursing staff (the publisher is the honor society of nursing, Sigma Theta Tau). Being a collection of chapters from a diverse set of authors, the quality and focus is somewhat uneven; topics range from a broad overview of patient safety and HROs down to individual case studies of applying HRO principles to CAUTI reduction or proper skin graft care in the OR. Overall, this collection does a great job of explaining the basics without a lot of fluff, and it's accessible to anyone in nursing who wants to be a part of the HRO changes that are slowly percolating through healthcare. (Reviewed by Mike Gunderloy)
  • Hospitals and Health Systems: What They Are and How They Work: A solid overview of how modern health care is put together, including their history, the ins and outs of funding, and the way that systems are built and managed, along with the organization of care teams. Two caveats keep me from giving this one five stars: 1. It's completely US-centric, which is clear from the marketing and cover copy, but the title might lead some readers to believe they're getting a worldwide overview, which decidedly this is not. 2. The whole book is descriptive right until the last chapter on unions, which is so anti-union that it made my teeth hurt. (Reviewed by Mike Gunderloy)
  • HQ Solutions: Resource for the Healthcare Quality Professional: Mainly a study guide for the CPHQ exam, but also a broad overview of what healthcare quality professionals should know (at least, according to the National Association for Healthcare Quality). Some of it suffers from writing-by-committee ("change models are important, here are eight you should know" instead of recommending one and perhaps upsetting someone), and some of it is rather superficial (the coverage of data analytics was very light, at least from my point of view as an engineer and software developer). But it's also a great reference on leadership in complex organizations, the major tools and trends in patient safety, performance monitoring and improvement, and the like. If you're involved with leading improvement teams in healthcare, or just want to pass the exam, it's a must-have. (Reviewed by Mike Gunderloy)
  • Leading Healthcare Improvement: A Personal & Organizational Journey: An excellent (and short, about 150 pages) framework for helping an organization and its leaders along the road to better performance and outcomes. The authors combine work from a wide variety of thinkers, notably Deming & Wilber, together with their own years of learning to come up with a view that starts with the individual and then moves out to the organization. Though this is specifically aimed at healthcare professionals, a large proportion applies to any organization trying to improve its reliability. (Reviewed by Mike Gunderloy)
  • Management Lessons from Mayo Clinic: Inside One of the World's Most Admired Service Organizations: I picked this one up because it lies at the intersection of my interests in management theory in general and healthcare quality in particular, and I was not disappointed. Mayo Clinic is one of the most respected brands around, and it's been one for a long time - and the authors here make the case that this is no accident. There are plenty of smart doctors working at other hospitals, there are plenty of other organizations doing good work - but Mayo has managed to put all the pieces together to create long-lasting excellence. It shouldn't be any huge surprise that this is the result of culture, maybe even more than it is of clinical superiority. With everyone dedicated to the patient first, with a guideline set early on that profit took the back seat, with deliberate training programs for leaders, this organization does most everything right. (Reviewed by Mike Gunderloy)
  • The Patient Survival Handbook: Increasingly the hospital system sees patients as partners in their own quality of care - but very few people know that before they enter the hospital. This book is a clear guide to some of the things that you can do as a patient, or perhaps even more important as an advocate for a patient, to get the best possible care. They range from simply reminding people to wash their hands, to the difficult subject of avoiding care from a physician who is impaired by drugs. It's an overwhelming amount of information, and not every piece will apply to every hospital stay, but it's worth reading before you get hospitalized so you get a sense of what levels you can pull to have a better chance of a good outcome. Loaded with resources for further research and help as well. (Full disclosure: one of the authors is on the board of my current employer). (Reviewed by Mike Gunderloy)
  • Rethinking Patient Safety: Woodward has been a long-time patient safety advocate in the UK's National Health Service. In this book, she reflects on why, even when we know there's a problem and have many tactics for improving patient safety in particular situations, long-term change and improvement remain elusive. There's no cookbook recipe for fixing everything, but an underlying theme of talking and listening in a "just culture" way to help move everyone along to a better place. Reminds me a bit of the "No silver bullet" thinking in software development; there's no substitute for doing the work, and no flashy technique that will make actually communicating with people unnecessary. (Reviewed by Mike Gunderloy)
  • Safety Cases and Safety Reports: A book for professionals in the safety industry, ie, those who think about how to make things safer in general, rather than on the level of a particular company or industrial sector. It's written mainly for those who have to work within various regulatory frameworks, and offers good advice on things like figuring out what level of risk is acceptable in a particular operation, or the difference between auditing and assessing reports. (Reviewed by Mike Gunderloy)
  • Still Not Safe: This book is at the intersection of two of my areas of interest: science and technology studies (which was my grad school major), and patient safety (the field of my current job). The co-authors apply the tools of history and sociology to investigate what's happened in the field of patient safety in the US in the past twenty years, since the publication of To Err Is Human. Their conclusion is fairly damning: that the entire patient safety movement has been gradually co-opted by a class of professional medical bureaucrats, more concerned with protecting their own positions and the structure they're embedded in than in seriously addressing the issues. I expect to see this debated in patient safety circles, but it does at the very least provide an explanation of why things have really not gotten much better in the past two decades. Yes, there are areas of healthcare that are safer, and some types of patient harms that have been reduced. But overall, it seems as many people as ever are hurt by hospitals (though it's tough to be sure, since the measurement is so tricky). Wears and Sutcliffe argue strongly that the tools of epedemiology and Taylorism are inadequate to even understand the problem, let alone get a handle on it, and provide evidence that the findings of non-medical safety science researchers have been de-emphasized even as the safety talk within the healthcare system has ramped up. If you don't find this convincing, then you need some other explanation for our lack of progress. I'm not impelled to stop trying to make a difference; however, I am less sure than ever after reading this book that one more app, one more bit of technology, or one more training or conference will make a difference to the lives of actual patients. and in the end, that's what matters. (Reviewed by Mike Gunderloy)
  • To Err is Human: A year after I started working in the patient safety field, I finally got around to reading one of the books that launched it. This Institute of Medicine lays out the basic issues (too many people harmed by avoidable error) and some ideas for moving forward. They've been implemented in piecemeal fashion in the 20 years since the report, and we've still got quite a ways to go. Definitely this should be complemented with some of the more recent work in the field, because "fixing the problem" is not as simple as perhaps it once seemed to be. (Reviewed by Mike Gunderloy)
  • Understanding Health Policy: A Clinical Approach: A college-level text that takes a broad survey of quite a few important topics in healthcare. Given the rapidly-increasing costs in the sector, the first four chapters focus on the financial aspects of payment and access, and money continues to be an important subtopic throughout. But the book also covers quality and preventative health issues, the mechanics of long-term care, health care reform and medical ethics. Though it's mostly focused on the US system, there is a valuable chapter comparing the way things are organized in four other nations (Germany, Canada, the UK, and Japan). It concludes with a look at some of the current conflict and perhaps forthcoming changes. This seventh edition dates to 2015, so parts are already a bit obsolete, but it's a valuable overview with plenty of references and a selection of discussion topics. (Reviewed by Mike Gunderloy)
  • Understanding Patient Safety: A basic text on all things patient safety from Robert Wachter, an academic physician who has been heavily involved in defining the direction of the movement. This is a wide-ranging survey work, reviewing basic classes of patient safety issues and then walking through a variety of more-or-less mature solutions. There are no silver bullets here, but there is plenty of evidence as to what goes wrong, what works, and what doesn't. (Reviewed by Mike Gunderloy)
  • Why Hospitals Should Fly: The story of a fictional hospital that the author concocted to demonstrate his ideas on how to improve healthcare quality & safety. Some of these (such as checklists and timeouts in the OR, or creating an atmosphere of safety for everyone to speak up) are relatively mainstream. Others (such as empowering nurses and putting patients into shared 5-bed suites) are somewhat less so. It's an interesting way to explore these ideas, but of course in fiction you can make whatever you like work well. An introduction to the field but not I think a substitute for more academic work. (reviewed by Mike Gunderloy)

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