"Stop the Line" in a Hospital

Today it’s Toyota, tomorrow the NHS; Hospital looks to adopt safety
initiative

The concept of any worker being able to stop the line in a Toyota
plant is a key part of the quality strategy.

In traditional manufacturing settings, management will pressure
workers to keep the line running at all costs — quantity over
quality. If defects are being made, keep the line running and
you’ll sort them out at the end of the line (through inspection and
repair). It’s a failed quality strategy because it ultimately costs
more and potentially leads to more customer dissatisfaction than if
you had just stopped the line to immediately fix the problem and
prevent more defects from being made.

In a Toyota plant, this is called an “andon cord”, a line that the
worker can grab to notify the team leader (supervisor) that there
is a problem. This could be a quality defect or any problem (such
as dropping a bolt). If the supervisor can’t help resolve the
problem in the job cycle, the line stops (often, pulling the cord
does not really lead to a line stoppage because the problem is
fixed immediately).

It’s great to see that hospitals are starting to adopt this quality
philosophy — empowering healthcare workers to “stop the line” or
stop the process to make sure an error is not going to occur. For
example, if a tech in the operating room suspects that the wrong
patient has been brought in, they can call a time out and raise the
issue.

In the article linked to at the top of the post, some hospitals in
the UK are using this “stop the line” strategy:

Although planning is in the very early stages, it is thought a
check-list for procedures would be highlighted and an employee who
believed routine was not being adhered to could page a senior
member of staff to call for
immediate assistance.

Gateshead Queen Elizabeth hospital’s medical director and
surgeon, Bill Cunliffe said: “We want to empower all members of staff and we
place a strong emphasis on patient safety.

“Junior members of staff can
lack confidence in approaching senior members if they see or
feel a medical procedure is not being done right.

“‘Stop the Line’ would empower all staff to take action and
literally stop a procedure in its
tracks in order to prevent a mistake being made.”

This isn’t just similar thinking, it is inspired directly by a
visit to Toyota in Japan:

The idea for the process came when health officials sent a delegation to Japan last year to
discover ways of increasing efficiency in the health service.

The group, made up of senior doctors and chief executives,
visited Toyota to see the management systems that have made it the
world’s biggest carmaker.

The picture below shows a similar document from a U.S. hospital.
This was in an employee newsletter, so I’m assuming it’s not
public. The hospital deserves credit — I’m not blacking out names
to protect the guilty, by any means. Click on the photo for a
larger view and this hospital’s use of the approach.

Staff members are taught to stop and ask, “I need some clarity…”
Stop and ask immediately. I’d be curious to see what action
hospital administrators would take if someone tries this and isn’t
listened to. What’s the immediate escalation process if a surgeon
refuses to stop or acknowledge the stop the line request? The
article says the leaders are fully committed…. I hope so.

This is far superior to another hospital I visited in late 2007
that had an “andon” type process. The thing I didn’t like about
that process was that it wasn’t real time. Employees could send an
email or call a voice mail line AFTER the procedure. That’s too
late. That’s not stopping the line. I like the approach shown in
the picture that teaches people to stop NOW and ask questions NOW.
Even if you’re wrong in the question (thinking there was an error
when there was no error), that slight delay in the name of safety
has got to be better than being quiet when you think something is
going wrong.

What’s your organization doing in this regard?