The book is a Tour de France in the healthcare industry. “This book should be required reading for anyone willing to face the facts about what it will take for health care to be as safe as it truly can be."( Donald M. Berwick, MD, MPP).
The book is much further than just a great story. Through book medium John Nance has challenged the healthcare industry with an intensely emergent appeal to action. The bottom line is to break free of the destructive cultural foundations of the past, and a comprehensive education about the realities and incorporating it into curriculum of what it will take to make America ’s hospitals the safest and highest reliability organizations …show more content…
In other words, the universal constant is that human infallibility is impossible. Since human infallibility is impossible, the only chance to keep human errors from hurting patients is by creating collegial interactive teams. Achieve ‘Barrierrless Communication System’.
The book compares the traditional hospital design to “farmers’ markets,” with the landlord having little or no control over those who work under his roof. The three basic ways humans fail and thus the three basic tendencies a safety system has to address, our failures in perception, consumption, and communication.
The basic “Time-out” procedure is another essential element of patient safety and must be imposed as a non-negotiable no-variance procedure prior to all surgeries. Non-standardized surgical practice is an “absurd” way to do business in so far as providing reasonable levels of assurance that healthcare professionals have learned from past major mistakes and won’t repeat the same tragedies, which is what standardization is all about. There is a need to change non-collaborative attitudes of surgeons. The patients don’t visit hospital for gambling, but they come for services trusting their doctors. Hospitals should develop a safety net by: adequate training of the providers, bringing cultural change, build a shock absorbing system to overcome outpatient impact and thoroughly