The discussion then turns to the flowsheet – a paper form to document the time points of our treatment. Without the flowsheet, not all the time points are captured, so we cannot prove we completed the treatments on time. The staff are so focused on treating the patient, they neglect to record the success of their efforts. For that reason, this case becomes a fallout.
The ensuing discussion of this case then becomes an exercise in how to make sure a flowsheet is started in every case of suspected sepsis. It is a mind-numbing detail but crucial to our success. Through this systematic review and monitoring of progress, Bellevue has done its part to promote the international sepsis guidelines in hopes of saving lives.
And the effort has paid off. Bellevue’s mortality rate for severe sepsis in the 2018 report of New York State was an astounding 14%, way below the state average of 25%.3 Of the 87 hospitals who treated more than 200 severe sepsis cases, Bellevue’s rate was the absolute lowest. In view of the 450 severe sepsis cases we treat, we are saving about 50 extra lives per year compared to the performance of the average hospital in our state.
Note that the key to this performance is repeatedly to confront our gaps, week by week. The stories I share about adverse outcomes, then, must be matched against the many lives saved through careful attention to performance improvement. In fact, I will argue that our systematic response to adverse outcomes is exactly the key to saving those lives.
From The Ailing Nation, Chapter Five: Treatment
One of the most difficult tasks in any leadership role is to move the needle, to get from point A to point B. It is one thing to identify a problem and compose a solution, but it is quite another to actually get there, to successfully carry out the plan and achieve the target state. I have always found the getting there to be the greatest challenge because it is so easy to get mired in the mind-numbing details of any project, and to succumb to the many obstacles against forward movement. To help us get to goal, my hospital adopted Lean, an efficiency-promoting performance improvement process that originated in the Japanese automotive industry and then swept through the American service sector. We used Lean across many hospital departments to great effect, but nowhere more so than in improving mortality from sepsis. Over several years, in New York State’s sepsis treatment campaign, we slogged our way to the head of the class.