No 26 - Unexpected outcomes drive improvement in healthcare

This will be a short article. I promise.

During the Afghan War the British Defence Medical Services developed a system where every single patient brought to the hospital in camp bastion was rated. Each patient was scored and then in the notes the team wrote down their decision. Was this patient expected to survive this illness or injury, or not?

These scores were then reviewed on a regular basis and across the 13 year conflict the number of “Unexpected Survivors” went up and the number of “expected and Unexpected deaths” went down!

The healthcare teams made good notes, used good systems, gave the best care they good and they kept score. This score keeping, and auditing of their performance against their predictions made it easier to track improvement.

Measuring performance is difficult in medicine as I have said before. The only true hard outcome that we have is life and death. And yet, in the NHS we don’t even use this outcome for the majority of our patients.

There is nothing new under the sun.

So, I propose, the NHS adopts the system from the military.

Every single patient who attend hospital for any reason should have a box in their paperwork that needs to be ticked by the first junior and senior clinician to see the patient. That box should say, “do you expect this patient to survive this hospital visit?”

And then, every few weeks or months we compare the junior and senior predictions with the outcomes.

Any Unexpected Deaths get investigated as to why and any Unexpected Survivors get reviewed to learn from good practice.

You could eventually compare clinicians, teams, departments and even hospitals on how many Unexpected Survivors or deaths they have.

This system would be a very rough a dirty way to start building a system that assesses real medical performance in almost real time.

Would it work?

I don’t know. Do I think it’s worth a try? You bet.

What do you think? Let me know in the comments below.