ok, can of worms...
no quarrel with any of the ideas in this publication
BIG concern with decision to formulate the consensus statement as a "bundle" rather than committee opinion, a KEY difference that risks compromising rather than bolstering improvement efforts --> THREAD
no quarrel with any of the ideas in this publication
BIG concern with decision to formulate the consensus statement as a "bundle" rather than committee opinion, a KEY difference that risks compromising rather than bolstering improvement efforts --> THREAD
1/ among American hospitals working to improve care, it's common to see good ideas get embedded into bad tools
2/ improvement tools are never neutral, they either help or hurt
how do they hurt?
Beyond unintended consequences is the very real problem of crowd out. Hospitals have limited bandwidth to take on quality (or equity) improvement projects.
how do they hurt?
Beyond unintended consequences is the very real problem of crowd out. Hospitals have limited bandwidth to take on quality (or equity) improvement projects.
3/ cautionary tale: several yrs ago my profession went on a checklist spree, checklisting care that shouldn't be checklisted, forgetting what checklists are actually for...this HURT efforts to make patients safer
acog.org/Clinical-Guida…
acog.org/Clinical-Guida…
4/ push to use poorly designed checklists created disillusionment and slowed adoption of the checklists (and other tools) that actually save lives
5/ why? checklists should not push back against clinical decision-making or literally itemize all options--the opposite.
they should improve reliability by reinforcing care we already think we're providing (but are at risk of overlooking), & simplify the options into categories
they should improve reliability by reinforcing care we already think we're providing (but are at risk of overlooking), & simplify the options into categories
6/ there's actually a checklist for making checklists
here's what happens without a well-considered design process: good ideas, unhelpful tool acog.org/Clinical-Guida…
here's what happens without a well-considered design process: good ideas, unhelpful tool acog.org/Clinical-Guida…
7/ now let's talk about bundles. they should NOT be an extensive grouping of ideas that experts have agreed upon
they should be adoption-ready, 'minimally viable products,' containing process changes that are ALL necessary as well as ALL sufficient
ihi.org/resources/Page…
they should be adoption-ready, 'minimally viable products,' containing process changes that are ALL necessary as well as ALL sufficient
ihi.org/resources/Page…
8/ as I travel country I'm seeing same adverse effects of bundling spree as we experienced with checklists not too long ago
public health departments create initiatives to promote them, adoption is uneven in content and implementation, impact is absent, bandwidth is exhausted
public health departments create initiatives to promote them, adoption is uneven in content and implementation, impact is absent, bandwidth is exhausted
9/ achieving greater equity in childbirth is very possible, but need thoughtful approaches to translate ideas into right tools for right problem, to take time to design them for real people working in real contexts
