Recently, my family and I spent a week in Orlando, staying at a Disney resort. Once we checked in, we received a "Disney band" – a rubber bracelet that we were supposed to wear continuously. It had all of our information on it, allowed us to pay for things (using a PIN linked to our credit card), and was our room key and admission ticket. I was amazed at how much information could be contained on this flexible, lightweight band that was also disposable and could be ordered in a variety of colors.
During our requisite visit to a Disney theme park, we took a safari. Part of the safari had us walking into animal enclosures or traversing an Indiana-Jones style bridge over a crocodile pit. Not surprisingly, the safety precautions were comprehensive and closely adhered to. We wore a vest and harness and would be attached to a tether at different spots to prevent us from falling. When we first got suited up, we were checked and double checked. They used a visual cue on our vest that indicated to any of the staff whether we received our official double check. This vest was rechecked every time it was used for our safety.
Both of these experiences made me ponder what we could be doing better in medicine. Wouldn't it be neat if you were issued a band upon entrance to the hospital or clinic that had all of your important information on it? Scanning the band could assure that medications were not duplicated or help prevent a medication being given to someone with an allergy. Important information could be embedded in the band that would quickly indicate things like code status. The technology is there, although I imagine quite expensive. We all recognize the need for improved monitoring and safety in healthcare. How do we make the leap?
For our safety harness, I was impressed by the diligence of doing the same thing every time – even it was just checked 10 minutes before. The combination of a process and visual management enhanced the reliability of the safety checks. No one assumed it was "probably okay" because it worked the last time. No one assumed that someone else did the check. Walking over a crocodile pit is risky, but probably about as risky as going into the hospital for a surgery or receiving chemotherapy. A lot could go wrong.
There's something about the culture of medicine that inherently eschews Disney-esque solutions to problems of monitoring and safety. Somehow, I think we assume that because we are there to help people, because we work in places of healing, because we are smart and caring, we don't need the same type of processes and workflows that exist in other industries. However, we know that's wrong. We make mistakes – easily avoidable mistakes – and harm patients every day. That is unacceptable, as has frequently been pointed out by the IOM and others. Physicians must collectively swallow our pride and look to other examples of how this is done efficiently and reliably for the sake of our patients and ourselves.