Medical Error Rate and Reducing the Medical Error Rate

Did you know that there is more than 4,000 surgical errors (in the study 4044) in a year in the U.S?
(see: http://www.medicalnewstoday.com/articles/254426.php)

What do you think about this number?

High?

Low?

How about when I say that there is about 50 million surgeries a year in the United States (http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm).

4000/50000000=0.00008=.008%

The error rate in a mechanized factory is so called 6 sigma (0.00034% error rate).
So the US surgeon has about 5.5 sigma rate, which is pretty awesome for a human done service.

 80 errors per million.

Would I want to be the 80? No.

But, what do we expect?

How much error do you make in your work?  And are we going to unreasonable to expect that from a surgeon?

Well, it will be better if the error rate reduces.

Less problems, death, and crisis.
It will be a type of crisis management I would say.

Can it become better?

Sure!

By the way:

"They estimate that at least 39 times a week a surgeon leaves foreign objects inside their patients, which includes stuff like towels or sponges. In addition surgeons performing the wrong surgery or operating on the wrong body part occurs around 20 times a week (http://www.medicalnewstoday.com/ articles/254426.php)."

So, 4044/52weeks= about 78 errors a week.  Out of the 78; 39+20=59 errors apparently are preventable.  Which if we do prevent this, 78-59= only 19 errors a week!

Which will reduce the yearly error rate to 988; an amazing 0.002% error rate.

Still higher than the six sigma standard, but hey, John Hopkins says you can prevent these why won't we?  And it is my hallucination that preventing leaving towels and sponges in the body, operating wrong surgery or on wrong body parts cannot be that hard to prevent right?

Hmmmmmm but why does it happen?

These are probably experienced, at least highly intelligent, kind hearted people!

And becoming a medical doctor means, you weren't allowed to make mistakes and was told to be "perfect" verbally or nonverbally.

So, it is not the intention of any doctors to leave objects or operate a wrong surgery.

Then, the question becomes outside of that doctor.

Ohhhhh I know you wanted to BLAME the doctors but YOU CAN'T.

We always need to look at the bigger picture.

Doctor's work are very stressful.  It is very time sensitive and they are responsible for another person's life!

However, how about if the information they were given were wrong?

They haven't had a sleep for the past 36 hours because of their work?

Or the resources they needed was just not given to them? (time, correct tools, etc.)


The bottom line of today's post is that for everyone to remember that:

1) Don't react to the big number posted, it may be not as bad to comparison of a global standard
2) The person taking the action (surgeon) may not be the cause of the problem
3) No joke but don't get sick or get in an accident at night or during holidays (see: http://www.theatlantic.com/magazine/archive/2013/07/the-worst-time-to-have-surgery/309393/)

Support to and Let's Seriously Think of Solution to: Employee Strikes Highlight America's Mental Health Crisis

Support to and Let's Seriously Think of Solution to: Employee Strikes Highlight America's Mental Health Crisis

In California mental health workers of Kaiser Permanente, major health insurance and health care provider, strikes for not enough employees for quality care.

I'm sure this sounds familiar for many mental health practitioners employed by a cooperation. Lack of staffing seemed to be an issue in where I used to work, in the substance abuse treatment center.

The issue is the following:

• The affordable care act has increased the number of patients into the mental health field.
• In response to such demands there should be an increase in number of service providers.
• However, actually there is a decrease in number of service provider.

As a result, service cannot be provided to the patients, and as a result there are people who committed suicide and possibly homicide.

This currently is named the "Mental Health Crisis" as adequate care is not available in relation to the demands. As a type of crisis, this issue it is a maturation crisis (crisis built over time) where the number of mental health problem is increasing in the nation and when it comes to a certain point it will have a tipping point "crisis."

Let me analyze the situation to see where the cause is and the possible solution to this problem.

1) Is it affordable care act or other reasons too?

Increase in number of mental health issues has been discussed a lot around 2013, now the focus seems to be on increase in mental health issue in Children.  Either way, the discussion of "increased mental health issue" has been around.

The affordable care act just made it easy for individuals who originally did not have insurance to come see a professional for there challenges to see the professionals, or they thought they can see the professionals.  These individuals were always around suffering from mental health issues and we as a nation did not do anything about it.

So it is not necessary the affordable care act but the underlining issue of increase in mental health must be taken care of.

2) Should there be an increase in number of service providers?

It is a simple way of resolving the issue, yet from a business perspective this cannot easily be accepted as "people" are one of the most costly expense to a business. So if they do, another problem will naturally happen, decrease in the already reduced salary of mental health professionals.

Then what should the business and employees do?

LEVERAGE! the time and human interaction.

The number of clients/patients seen in an hour must increase. Of course, that is the reason why psychiatric medications became popular (you need to see the patients one a month or so).  However, we know the kick back of that problem, actual problem not resolved, increase in substance abuse, etc. etc.  Moreover, there seems to be a decrease in number of psychiatrist in this nation anyways (according to the news).

Quick question when do you think mental health practitioner makes money?

When they give the service to the clients?

YEEEE (incorrect)

When we complete the paperwork for the INSURANCE COMPANY.

We just can't prove YOU (patient) that we did a great job, we need to prove the insurance company.  And do they pay? HAHAHA, you tell me.

1) So cutting down on the paper work time will be essential by implementing efficient system or...

When I used to practice, I wanted to provide as much service as possible in the working hour for my client.  Ended up doing multiple after hour works, up to 5 hours, doing paper work.  Yes, I did provide great service, but burning out was the correct word. And majority of the paper work did not benefit any bit to my client.

There are multiple services, computer programs to make the writing paperwork more efficient as possible, does the company implement such system? and have they trained the employees in it?

By the way the reason why we like private pay client is that they pay upfront (not after like the insurance company) and no unnecessary paper works.

2) Cutting down treatment time by having ways for the clients/patient to know, like, and trust the practitioner before hands.

There has been a lot to be said about treatment time reduction.  Strategies such as "brief therapy" discusses a lot about it. Legendary therapist/doctor like Dr. Milton Erickson will be able to resolve a problem in one session.  Yes, there is extraordinary skills that Dr. Erickson had but what it really boils down to is TRUST.

If the clients trust us then the treatment goes exponentially fast.

But in order to gain trust, they need to like us, and before that know us.

The key of Dr. Erickson was in his later years, people heard about him, friend referred him, or seen on some paper and came.  Clients already knew about him, likely to like him, and possibly trusted him before the treatment started.

This cuts down on how fast we can finish the treatment.

Think about this.  You opened a door, and there is a total stranger.  How long would it take for you to TRUST that person?  Even if you knew they are professionals, it's not like fixing your car, it's about your life and you need to collaborate in order to make the necessary change (not like a surgery where you are knocked out and the surgeon just operates).

Social psychology would say at least three interaction to have a concrete perspective about another person.  Okay... that is three sessions already!

Thus, interesting enough therapists' public relation effort will reduce the treatment time.  Why do you think I write blogs?

Thus solutions are:

1) Have an introductory video of the therapist on a website or places clients can see.
2) Have podcast for the company and have your therapist as a guest.
3) Each therapist should have a blog, twitter, or some sort of way to send out messages to the world.

And of course, the therapist must keep training, improving their skills, knowledge, experience, and on themselves.

3) Decreasing service provider. The cause of it.

Is there decrease in service provider? Ahh, yes and no.  Yes, seems to have less psychiatrist, less people coming into our field, and no there is a lot of licensed psychologist, and alternative individuals such as healers and coaches.

General: Low pay for what we do. Salaries are originally based on the need to obtain the skills, knowledge, ability, and effort to maintain attitude and awareness of the required job.  Now a days it is based on the end result we provide and who we provide to (difference between treating depression of a millionaire and depression of a homeless).  The nature of the targeted population tends to be the lower income population.  Yes, there is rich people who have mental illness that needs treatment but that's not many compared to the poor.  Usually these rich people come to get treatment when they become broke.  It is difficult to maintain wealth with mental health issues, thus natural targeted population does not bring money to this industry.

If you treat many or provide value to many, it can compensate for the low income low paying population.  However, the nature of the service tends to be one-on-one or at max one-on-twelve (group therapy) and limits the income.

Rare cases are substance abuse because it requires some level of cash flow in order to sustain the habit. Many times, the family members are wealthy "enough" to pay for the treatment.

Moreover, the level of mental stress and psychological contamination risk (getting mentally ill yourself) are high.


Psychiatrist: pay is high but risk is higher.  1/3 of all sued cases for medical doctors are apparently against psychiatrists. Federal funding also was shifted from specialties to primary physician, resulting in natural drop in numbers.

Psychologist: pay is high but likelihood of being hired is slim.  All the knowledge, experience, skills, and abilities seemed to be undermined and seen equal to a master level therapist.  Plus you only need one to manage many below.  You can find many psychologist who will provide treatment and I am sure they will provide values to you but many are like me and take private payment, or only specific insurance.

Coaches and Healers: Their pay and expense to gain the certification or skills matches for these individuals. Plus many times they deal with higher functioning individuals which means higher economic status, higher pay.

Conclusion:

Strike itself, I will support it because it shines a light on the crisis we are facing now which will become worse if it is left untouched.
1) We must reduce the number of clients to begin with by providing prevention to the community, and hopefully the insurance company pays for such prevention seminars/training.
2) Always have better efficient way to reduce the unnecessary time wasted on paper work.
3) Find and implement ways to increase visibility of the therapist so they are known, liked and trusted before the session to reduce number of sessions (overall therapist will be able to see more people in a year).

Lastly, the strike also has to do with not only the lack of therapist in Kaiser but also has to do with team development, where the business and employee do not have the same mission.  Simply, they are not working as a team. If the mission was the same then people will work overtime, and be creative.  The inability to create a company were mission comes first, then the team, and individuals last are the cause of the problem, which probably my mentor, a rich dad adviser, Blair Singer would say.

see: https://news.vice.com/article/employee-strikes-highlight-americas-mental-health-crisis

My thought to: Opinion Journal: What Caused the Financial Crisis?

My thought to: Opinion Journal: 

What Caused the Financial Crisis?

In this short 5 minutes video an expert brings on the topic of what caused financial crisis. The response was primarily to the government having loans with low down payment.

If you categorize financial crisis based on "crisis theory" it will be categorized under maturational crisis, which means a crisis that developed in the normal increase of stress, and it is predictable.

Maturational Crisis is caused by a role change or inability to change the role.

So who's role did not change in response to what?

Just like Robert Kiyosaki says, August 15, 1971 is probably the date we need to go back to the reason for our role change.

This is the date, president Nixon took money off the gold standard and money became debt based "currency." (see more on http://www.historycommons.org/context.jsp?item=financial_crisis_1).

This means the role of "money" changed and we as people needed to adapt to this new rule and change our role.  It is like a baseball changing to a tennis ball, or a kitchen knife changing to a paper cutter. Although it seemed similar, it was a drastic change.

As a result people continued to work and use money as if it was "money", something that would not change in its value.  However, inflation shows that the value has been changing, which for those who did not adapt to the new rule, relied on "dept" to survive.

Dept in this scenario is stress. Increase in dept of individuals, families, communities, counties, states, and the country has led to a point of crisis to release the stress somehow.  And this is financial crisis.

Interestingly, as I mentioned above maturational crisis are predictable.  And indeed, the U.S.' financial crisis is also some what predictable.  Just like every dept based country has gone bankrupt the results are determined.  You don't need a genius to imagine what happens when you keep on borrowing money which does not create any income/asset.

So, Taka! When is it going to happen?

Good question.  If you have any literacy on reading charts for stock, then those investors and traders have been aware of what is going on. (see: http://www.forbes.com/sites/chriswright/ 2015/01/13/sell-sell-why-the-sp-500-will-halve-in-2016/)

Although, it is out of topic, let me do a quick analysis of the candle stick chart pattern for S&P 500.  The resistance (the highest value attained) is 2088.50 on December 29, 2014. Next is 2062.00, on January 8, 2015 (based on investing.com).  Okay, if there is an upward trend usually chronologically we should be seeing a higher number than 12/29/2014.  Now the next point is 1984.25 on January 5, 2015.  If we ever penetrate lower than this number we need to be aware for the big down fall.

Make sure you change your "role" of your retirement fund and investment (i.e., change to sell from hold). That is at least what we can do for prevention of financial crisis.  

If the market goes above 2088.50 then we have little more time to breath.

So, what is my opinion as a psychologist about the cause?  It is lack of prefrontal cortex use among the mass, meaning the lack of flexibility to shift thinking patterns and decision making knowing that the rule have changed.  Or lack of awareness to the fact the rule has changed (which is also a prefrontal cortex weakness).

Strategies will be to set alerts on Yahoo! Finance if you do have an Yahoo account or have Google alerts to send you information about S&P 500. Also, news related to such economical crisis is a good alert to have as it is predictable.

Oh, for those who want to take advantage of it, when stock market begins moving down, buy the stock in about 2 years when "usually" it is at the lowest possible.  Thus, saving money for investment from now may not be a bad idea.  That is how John Templeton became a millionaire after the Word War I (see: http://www. templeton.org/sir-john-templeton/life-story).

Can you turn this crisis to an opportunity?

See video at: http://www.wsj.com/video/opinion-journal-what-caused-the-financial-crisis/4395C507-D179-436F-B286-6C66A1B9524C.html

Saving My Aunt who had a Stroke and Meningitis through Coma and Brain Recovery

In end of last month (December 2014), my maternal aunt had a meningitis and a stroke.

She went into a coma, where my family was told that she had 50/50 chance to survive. I personally did not know what I can do, especially when I was in the U.S. and my aunt was in Japan.

So, just as a good psychologist will do, I researched about coma, stroke, meningitis to add to what I already know and give the information to my family. Especially, to my grandmother who was extremely worried.

Interestingly, I found a case study where they helped a person to be awake from coma using hypnosis and continued using hypnosis for recovery in 1987 (see: http://www.tandfonline.com/doi/abs/ 10.1080/00029157.1987.10402705).

To give a hypnosis, I recorded a hypnotic session of 8 minutes (which can be repeated) hoping that the Ericksonian hypnosis will have an affect on my Aunt's recovery.

And interestingly enough, she opened her eyes in two days from coma, right after listening to my recording where I state the suggestion of "open your eyes!"

I am sure she was receiving the correct treatment for her medical condition, and it is still interesting where such thing happens.

I created more recordings to support her brain recovery through hypnosis and also did couple of neuropsychological test to see her progress and have statistical expectation on her recovery.

Interestingly enough medical treatments in Japan do not do such things.

Neuropsychological assessment, treatment planning, and hypnotic treatment are some thing I believe Japanese treatment can do more of.