Healthcare SafetyAn Aviation Perspective

Michael Appel, M.D.30th International System Safety ConferenceAugust 7, 2012 Atlanta, GA

primumnon

nocere

Patient Safety It’s a DECISION we make

Patient Safety It’s a DECISION we make

“Safety” can best be defined as:

a) Eliminating harmb) Eliminating blamec) Being very carefuld) Investigating all errorse) Managing risk

CURRENT FINANCIAL INCENTIVES

DEFECTS

Toyota absorbs the cost of defects Healthcare MARKS UP and SELLS the defects

to the consumer In the future, the healthcare industry will have to absorb the costs of defects

SAFETY DECISIONS

WHO does the work? HOW we do the work? WHAT level of risk is acceptable?

1

Risk=Safety

Risk =

(available mitigating resources)

(likelihood of failure)x (magnitude of harm)x (acceptable harm rate)

1

Risk=Safety

RESOURCES ODDSx CONSEQUENCESx INVISIBILITY

=Safety

RESOURCES ODDSx CONSEQUENCES INVISIBILITY

=Safety

x

x VISIBILITY

Barriers to “RESOURCES”

Shrinking margins / financial distress Impending “reform” Short-term ROI Industry-wide lack of SYSTEMS approach

Barriers to “VISIBILITY” Brilliant physician Looming lawyers NO safety expertise Good outcome = “safety” Industry-wide lack of SYSTEMS approach

michael.appel@nghs.com(678) 521-2418 cell