National data suggest that up to 70 percent of sentinel events—the most serious errors in hospitals—stem at least in part from miscommunications. Communication problems are especially apt to occur during hospital shift changes, when a patient’s care is transferred to incoming doctors and nurses—known in health care as the “handoff.”
More than a year ago, a team led by Amy Starmer, MD, MPH, of the Division of General Pediatrics at Boston Children’s Hospital, developed and began testing a bundle of interventions to ensure that the hospital’s residents were thoroughly and accurately briefed on each patient’s medical history, status and treatment plan in a standardized way.
Through measures such as communications training, a mnemonic to help residents remember key information to pass on and a computerized handoff tool that integrated with the patient’s electronic medical record, they managed to move the needle: Medical errors fell by 40 percent—from 32 percent of admissions at baseline to 19 percent of admissions three months after the program started.
Innovation is one of the most talked-about subjects in business and now health care. It is also one of the most misunderstood subjects. People confuse innovation with creativity, brainstorming and invention.
Simply put: Innovation is a process for testing and developing new ideas. Innovation in health care organizations does not happen by chance, and in fact follows a predictable course.
Several years ago I developed the idea of an innovation “lifecycle,” comprised of six predictable stages with a gap in the middle (more on that gap below). It’s a powerful paradigm for understanding and organizing innovation in a health care organization (or any organization, for that matter).
Stage 1: Initiate
An innovation’s lifecycle begins with the identification of a problem or opportunity. Full story »
IDEO's Rodrigo Martinez believes we all have the power to improve people's lives by gleaning small insights from everyday interactions
“What is the purpose of healthcare?”To a room full of doctors, nurses and other healthcare experts at Boston Children’s Hospital, it was a startling question—justifying why they save lives was not part of their everyday experience.
“It may seem like a crazy question but it’s important to ask why we do what we do,” said Rodrigo Martinez, life sciences chief strategist from the international design firm IDEO, during a monthly Innovator’s Forum at the hospital. “Is it to care? Is it for us to feel better? Is it for us to have less emotional trauma in our lives?”
One audience member admitted that a lot of his time in the Emergency Department is spent reporting what he does. “During an eight hour shift, I may spend a significant amount of time recording all the things I’ve done to help a patient, but that’s time I’m not with the patient.” Martinez nodded. Full story »
Margaret Coughlin is a Senior Vice President and the Chief Marketing and Communications Officer at Boston Children’s Hospital.
Here at the TEDMED conference, it’s all about horizontal or lateral thinking – coming at problems from new directions, without regard to conventional boundaries. I like the thoughts of Edward DeBono (not a TEDMED speaker), who coined the term “lateral thinking” in 1967:
Some people are unhappy about lateral thinking because they feel it threatens the validity of vertical thinking. This is not so at all. The two processes are complementary, not antagonistic. Lateral thinking enhances the effectiveness of vertical thinking by offering it more to select from. Vertical thinking multiplies the effectiveness of lateral thinking by making good use of the ideas generated.
Lateral thinking is, in a way, an antidote to the way we’re all taught—vertically and specifically. Our education systems seem to be getting more vertical – more concerned with meeting prescribed benchmarks, and, in so doing, discarding the creativity and imagination of learning that is critical to real innovation and real forward movement. As for medical education, radiation oncologist and TEDMED speaker Jacob Scott said it has replaced creativity in the brain with a warehouse. Full story »
When children return home from the hospital after surgery, parents can be overwhelmed by the written information and instructions for follow-up. At the MIT Media Lab’s Health and Wellness Hackathon earlier this year, the focus was on empowering patients to take an active role in their health. As my colleague Brian Rosman described, our team from Boston Children’s Hospital attended and spent two weeks developing “Ralph,” a mobile application for managing post-operative care that incorporates an avatar and features of gaming to engage and motivate children to follow their regimen. I was one of the primary programmers for our group.
We won third place, working alongside five other talented teams. Here are some snapshots of what they were up to — helping patients manage asthma, diabetes, pain, cardiac rehab and more. Full story »
Debra Weiner speaks with Emergency Department Fellow Joel Hudgins who holds one of the iPhones piloting BEAPPER
For Debra Weiner, MD, PhD, working in the Emergency Medicine Department is a numbers game. During a 12-hour shift she works with more than 50 other providers, sees up to 25 patients and analyzes multiple lab results. Every day she’s also meeting new staff members in addition to new patients.
“People don’t know each other,” Weiner said at a recent Innovators’ Forum, a monthly internal lecture series intended to showcase and encourage new developments at Children’s Hospital Boston. “We have over 100 nurses and physicians and over 200 trainees that filter in [every two to four weeks]… it’s hard to remember who everyone is and what they do.”
Coupled with the frenetic pace of Children’s Emergency Department (ED), remembering names and managing the flow of patients becomes a constant challenge. Full story »
When I entered the MIT Health and Wellness Innovation “hackathon,” it wasn’t with high hopes. I felt our team from Children’s Hospital Boston had a solid idea to develop, but I’d taken part in similar collaborations that fell victim to personal disputes, group member apathy and overzealous leadership. This time I was wrong.
Here’s a snapshot of the 10-day event/competition, sponsored by MIT Media Lab, and the digital health projects that came out of it. The idea for our project — a mobile telecommunication robot that could monitor children in their homes after surgery — originated with Bob Nguyen, a urologist at Children’s Hospital Boston.
Our mobile robot, the VGo, has the potential to be a great tool, but when we’re not using it to make remote visits, it just takes up space in the patient’s house.
Dr. Nguyen felt the robot could be enhanced if the family could interact with it to ask questions, through some type of artificial intelligence, while the child played with some kind of game or character that would help them stay on their post-operative regimen. Full story »
I spent my Valentine’s Day with the people I love — the wonderful, creative, hardworking innovators at Children’s Hospital Boston. Excitement, curiosity and, yes, love were in the air as guests came to hear about emerging clinical innovation projects at Children’s first annual Innovation Day.
It was a chance to recognize and celebrate 17 quiet heroes. Innovators often feel isolated, and for some last week, it was the first time they and their ideas had been acknowledged publicly. Some were meeting each other for the first time.
Children’s has a long and rich history of innovation, born of the need to care for our small patients. From Mary Ellen Avery‘s discovery of the lack of lung surfactant in premature babies to Judah Folkman’s path-breaking work on angiogenesis, history shows that innovation, then as now, requires perseverance.
While being an innovator may seem glamorous, and while we idolize celebrity innovators like Steve Jobs and Mark Zuckerberg, the truth is that innovation is really hard work. Full story »
Even a small idea, given a small boost, can have a high impact. (Rick Kimpel/Flickr)
When I tell people I work at the Technology and Innovation Development Office at Children’s (TIDO), they usually think I work to commercialize patented blockbuster drug candidates. But many of the most satisfying projects I help promote are innovations that don’t involve as much risk, time and investment, yet make a big difference for patients. Commercializing these innovations can help the greater good, and is part of what propels me to work at a licensing office at a pediatric hospital.
And sometimes it doesn’t take much to help them along.
The Sonnewheel Body Mass Index Calculator and the Vidatak communications board for patients unable to speak or write are some products supported by TIDO without income being the primary goal. Another great example, which we blogged about recently, is helping make routine blood draws less stressful for kids with learning differences and their parents.
Valentine's Day is Innovation Day (image: Richard Giles/Flickr)
In a series of 17 short TED-style talks next Tuesday, February 14, clinicians and scientists from Children’s will present new products, processes and technologies to make health care safer, better and less expensive. The event, from 1-5 p.m. Eastern, is sponsored by the Innovation Acceleration Program. It’s now running a wait list, but you can also watch the live stream or track the proceedings on Twitter (#iDay) or via @science4care. Here’s a small sampling of next week’s presenters; for details, read the press release or view the full agenda.
Diagnosing lazy eye when it’s most treatable: in preschoolers
If lazy eye, or amblyopia, is caught early – ideally, before age 5 – it’s easily treated by patching the “good” eye, forcing the child to use and strengthen the weaker eye. But if it goes unnoticed, the weak, unused eye can slowly go blind, Full story »
