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A medical school professor once told me that if power plant engineers were to evaluate health care systems, they would be appalled. I was reminded of this during the Hospitalist Medicine 2014 conference in Las Vegas, not by one of the classes, but by "Ka."
I have seen this Cirque du Soleil show several times, and it is breathtaking. This time, I had the opportunity to go with several of my hospitalist group partners and take a backstage tour; it was as impressive as the show itself. With 15 stories of cables, springs, walkways, and pulleys, and with seven moving stages, it looked more like a city than a theatre. Our guide, also a performer, told us that during the show this circus city is a blur of complicated activity with hundreds of staff ensuring the safety of dozens of performers doing jaw-dropping stunts. There are backup plans to the backup plans. There is real-time communication with the performers regarding equipment malfunctions, delays, etc., allowing the artists to adjust and change the performance if something has become unsafe. As we left the tour, our quality improvement guru uttered simply: "Why can’t we obtain this kind of quality in health care?"
Cirque du Soleil has been pushing the limits of acrobatics for 30 years with only one accident resulting in death. Compare that with medicine, where data extrapolated from the seminal Institute of Medicine report in 1999 suggested that hospital-based medical errors were the eighth-leading cause of death in the United States.
That being said, health care has come a long way in the last decade, but it has likely been the result of looking to other safety-oriented industries. The most well-known is the aviation industry’s influence of checklists in the operating room (see the 2009 book "The Checklist Manifesto: How to Get Things Right"), though this has now become a theme in medial ICUs too, where we see checklists, protocols, performance audits, and bundles. Though order sets have tried to protocolize some floor-based treatment plans, checklists and bundles have yet to truly become part of our culture.
Just like that human element that only the artists of Ka can provide, the thought process of the physician will always be needed in medicine. But change is coming, and like the surgeons and intensivists before us, I think it will be in the form of checklists, protocols, and bundles. While some of us may resist, hopefully it will ultimately make our own circus just a little bit safer.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013 and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
A medical school professor once told me that if power plant engineers were to evaluate health care systems, they would be appalled. I was reminded of this during the Hospitalist Medicine 2014 conference in Las Vegas, not by one of the classes, but by "Ka."
I have seen this Cirque du Soleil show several times, and it is breathtaking. This time, I had the opportunity to go with several of my hospitalist group partners and take a backstage tour; it was as impressive as the show itself. With 15 stories of cables, springs, walkways, and pulleys, and with seven moving stages, it looked more like a city than a theatre. Our guide, also a performer, told us that during the show this circus city is a blur of complicated activity with hundreds of staff ensuring the safety of dozens of performers doing jaw-dropping stunts. There are backup plans to the backup plans. There is real-time communication with the performers regarding equipment malfunctions, delays, etc., allowing the artists to adjust and change the performance if something has become unsafe. As we left the tour, our quality improvement guru uttered simply: "Why can’t we obtain this kind of quality in health care?"
Cirque du Soleil has been pushing the limits of acrobatics for 30 years with only one accident resulting in death. Compare that with medicine, where data extrapolated from the seminal Institute of Medicine report in 1999 suggested that hospital-based medical errors were the eighth-leading cause of death in the United States.
That being said, health care has come a long way in the last decade, but it has likely been the result of looking to other safety-oriented industries. The most well-known is the aviation industry’s influence of checklists in the operating room (see the 2009 book "The Checklist Manifesto: How to Get Things Right"), though this has now become a theme in medial ICUs too, where we see checklists, protocols, performance audits, and bundles. Though order sets have tried to protocolize some floor-based treatment plans, checklists and bundles have yet to truly become part of our culture.
Just like that human element that only the artists of Ka can provide, the thought process of the physician will always be needed in medicine. But change is coming, and like the surgeons and intensivists before us, I think it will be in the form of checklists, protocols, and bundles. While some of us may resist, hopefully it will ultimately make our own circus just a little bit safer.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013 and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
A medical school professor once told me that if power plant engineers were to evaluate health care systems, they would be appalled. I was reminded of this during the Hospitalist Medicine 2014 conference in Las Vegas, not by one of the classes, but by "Ka."
I have seen this Cirque du Soleil show several times, and it is breathtaking. This time, I had the opportunity to go with several of my hospitalist group partners and take a backstage tour; it was as impressive as the show itself. With 15 stories of cables, springs, walkways, and pulleys, and with seven moving stages, it looked more like a city than a theatre. Our guide, also a performer, told us that during the show this circus city is a blur of complicated activity with hundreds of staff ensuring the safety of dozens of performers doing jaw-dropping stunts. There are backup plans to the backup plans. There is real-time communication with the performers regarding equipment malfunctions, delays, etc., allowing the artists to adjust and change the performance if something has become unsafe. As we left the tour, our quality improvement guru uttered simply: "Why can’t we obtain this kind of quality in health care?"
Cirque du Soleil has been pushing the limits of acrobatics for 30 years with only one accident resulting in death. Compare that with medicine, where data extrapolated from the seminal Institute of Medicine report in 1999 suggested that hospital-based medical errors were the eighth-leading cause of death in the United States.
That being said, health care has come a long way in the last decade, but it has likely been the result of looking to other safety-oriented industries. The most well-known is the aviation industry’s influence of checklists in the operating room (see the 2009 book "The Checklist Manifesto: How to Get Things Right"), though this has now become a theme in medial ICUs too, where we see checklists, protocols, performance audits, and bundles. Though order sets have tried to protocolize some floor-based treatment plans, checklists and bundles have yet to truly become part of our culture.
Just like that human element that only the artists of Ka can provide, the thought process of the physician will always be needed in medicine. But change is coming, and like the surgeons and intensivists before us, I think it will be in the form of checklists, protocols, and bundles. While some of us may resist, hopefully it will ultimately make our own circus just a little bit safer.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013 and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
