Friday, 14 August 2009

Fear of failure? Never Events need a target of zero

So how would you feel if you were the patient of a surgical team whose improvement target for the "Never" event of wrong site surgery was - to reduce by 20%? A "Never" event is something that, by definition, should never happen. The NHS in England have a list of 8 that are so well evidenced they should be adopted for implementation with no further discussion.

Why then are we seeing targets for Never Events that are not zero? My recent experiences suggest the following dynamics at play:
  • zero is too difficult a target to achieve in healthcare (try telling that to the patient who has just had their wrong kidney removed or the suicide that happened when on 1-1 watch and using non-collapsible rails). Admittedly in some healthcare processes zero may be a tough tartget, however, Never Events mean never.
  • we may not meet the target (fear the failure and the knock on consequences for individuals, teams and project work); when I encounter this I realise I am working with an individual or group who fear the failure of improvement greater than they feal the failure of harming a patient.
  • it's not worth all the changes for zero (the costs of the change outweight the cost of full redeuction of a never event); this is, of course, a judgement call and my hope is it is made with full data analysis and consultation of those involved. Some never events happen so seldom it may be difficult to justify the changes required.
  • we don't believe the research is good enough; the NHS in England (National Patient Safety Agency) have streamlines a varietyof Never Event lists to determine a core 8 which are well proven in all aspects. More research I suggest is not required.
  • we will take a while to get to zero; that's ok, then let's see a desired outcome of zero and some leeway to reduce over time. The trick is perhaps not to design for a 20% reduction in year 1 but rather to design for zero in year 3 and monitor progress over time.
Never events need targets of Zero - 0. They should never happen.

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