Karen Remley: Reflections on Monday

August 12, 2009

Hospitals have remarkable similarities the world over - dedicated clinicians with little to work with are seeing patients in an organized system. But here in Kenya I had an overwhelming sense of a quiet pensiveness in staff and patients, particularly acute in the nursery where row after row of newborn babies lay very quietly. In fact, only one screamed, a vocal reminder that these babies should all be on various schedules of eating, crying, and sleeping. One wonders if being at a mother’s bedside might better promote breast feeding and temperature control.

More importantly, it reminds me that as we work on quality and patient safety issues in the U.S. we should be aggressively exporting the LEAN and Plan-Do-Study-Act approaches to health, thus allowing developing medical systems to learn from our mistakes and leap frog over our many failures. If this is done, they may be able to more rapidly develop a "highly reliable" organization. It is my understanding that the Institute for Healthcare Improvement has begun this work in South Africa.

Karen Remley, MD, MBA, FAAP. Virginia Commissioner of Health