ABSTRACT
The lockdown strategy used to prevent the spread of COVID-19 (coronavirus disease 2019) has disrupted the global economy. Some countries have started reopening their economies under the threat of a second wave because studies show that only 4% of the population is infected so far and more waves will be needed to achieve herd immunity. Lockdowns have been used with a primary purpose of regulating the demand for healthcare while ignoring the economic consequences. Contrary to the lockdown strategy, some countries such as Brazil have given priority to their economy leading to very high infection and mortality rates. After a first wave of the pandemic, we now know something critically important-those who are likely to become seriously ill and potentially die if SARS-CoV-2 infection is not prevented. That information cannot be ignored in our strategy and is used to control the pandemic. The paper proposes to focus on managing the risk of the virus being transmitted to the vulnerable rather than focusing on controlling all who can potentially transmit it. It argues that only 4% of the global population is at high risk of severe COVID-19 and would require hospital admission if infected. We propose to target this 4% of the population for preventive efforts. Protecting the vulnerable via lockdowns and other measures will be more effective and efficient than locking down the entire population and destroying their economies that are equally critical to life. We hypothesize that such "targeted prevention" strategies are more likely to help achieve our goals: 1) reduce mortality by preventing the infection reaching its potential victims, 2) spend the resources efficiently by knowing the "target" of our preventive efforts, and 3) achieve effective and efficient control of the pandemic without causing disruption to the socio-economic activities until an effective vaccine is available.
ABSTRACT
Background: The functional role of Comprehensive Unit-based Safety Program (CUSP) teams was extended to empower them and make them a part of the organizational management. Purpose: These improvements in the functional roles of CUSP were made with the objective of solving two structural issues, namely, departmentalization and compartmentalization present in health care organizations. Methods: The following were three improved functional roles: 1) instead of just being a reactive mechanism to implement improvements based on real safety issues, they also carried out risk analysis and implemented preventive actions proactively; 2) instead of focusing only on safety, they controlled all results such as safety, quality, treatment effectiveness and timeliness of their respective process units, using a series of Key Performance Indicators; and 3) instead of being a supplementary multidisciplinary team parallel to the organization´s departmentalized management structure, they were made to participate in the decision-making structure, representing their respective process units. These teams represented different process units and were named as Comprehensive Unit-based Process (CUP) teams. Results: The CUP structural design changed the dynamics of the organization: 1) it integrated members of different disciplines, especially physicians and nurses, and integrated them into a team with a shared goal, making internal communication and teamwork a "systemic" requirement; 2) it disabled the middle-level managers to represent the interests of specific knowledge-based groups such as physician departments or nursing areas while making decisions; and 3) it reassigned middle-level managers the task of representing different CUPs, making each manager responsible for a process unit, thus ensuring control over the results of multidisciplinary activities. Conclusion: The new organizational structure put burden on the system, not on its people, as it made multidisciplinary communication and teamwork to be the rule of the game, allowing patient-centered health care.
ABSTRACT
Objetivos: A raíz de una incidencia de sobredosis detectada en el servicio de radioterapia, se puso en marcha un proyecto de análisis y eliminación de riesgos para aumentar la seguridad de los pacientes.Material y método: Se aplicó el análisis modal de fallos y efectos (AMFE), un instrumento analítico aplicado en varios hospitales de Estados Unidos. Como exige la metodología, se cuantificaron los riesgos de cada modo de fallo en una escala de 1:1.000 utilizando el índice NPR (número de priorización del riesgo). En una primera fase de mejora, se definió el nivel de actuación como NPR > 100. Se detectaron varios riesgos en los protocolos actuales y se eliminaron todos ellos mediante redefinición de circuitos, controles y verificaciones adicionales, listas de comprobación y auditorias internas, entre otros. Posteriormente, se introdujo un sistema de gestión de la calidad según ISO9001, se definió una serie de indicadores y la dirección se implicó realizando revisiones mensuales de los resultados. Resultados: Se implantaron 100 acciones de mejora. El índice de riesgo calculado después de haber tomado las acciones bajó significativamente y aumentó la seguridad. Las mejoras realizadas aseguran el mantenimiento del grado de seguridad logrado. Conclusiones: La experiencia muestra que se puede identificar objetivamente los riesgos de cada paso que damos y destinar los escasos recursos de que disponemos a los procesos o actividades donde el riesgo es mayor, mediante mejoras metodológicas de nuestros protocolos de trabajo
Objectives: As a result of an adverse event detected at the Radiotherapy Treatment Unit, a safety improvement project was undertaken to analyze and eliminate risks and thus increase patient safety. Material and method: Failure Mode and Effects Analysis (FMEA), ananalytical tool used in many US hospitals, was applied. As required by FMEA, risks of potential failure modes were quantified on a scale of 1 to 1000, using the Risk Priority Number (RPN). In the first improvement phase, an RPN value greater than 100 was consideredto be the limit above which corrective actions should be taken. Several potential failure modes were detected in existing treatment protocols and all the causes of potential failure modes were eliminatedthrough corrective actions that included redefinition of treatment protocols, the creation of new records for existing controls and the addition of new controls, checklists, and internal audits, amongother measures. Subsequently, a quality management system based on ISO9001 was introduced. Process indicators were defined to measure treatment quality, and the results were analyzed on a monthly basis with top management participation.Results: A total of 100 improvement actions were taken. The RPN values calculated after the implementation of the actions were significantly lower, increasing patient safety. The actions taken ensure the maintenance of the achieved safety levels. Conclusions: The experience shows that the risks present in all steps taken can be objectively identified. Through improved procedures, the limited resources available can be allocated to those processes or activities that pose maximum risk
