Michael Apkon is using techniques from manufacturing to improve the efficiency and safety of medication delivery at Yale-New Haven Hospital, and he’s finding some solutions can be very simple.
More than 1.5 million people are harmed by medication errors, creating $3.5 billion in treatment costs in the Unites States every year, according to a National Academies report. More dramatic than the numbers is talking to a mother whose child has experienced one of those errors, says Michael Apkon, vice president and executive director of Yale-New Haven Children’s Hospital.
Apkon describes one incident that made a deep impression on him. A child coming out of surgery was given pain medication. The normal thing to do, but the patient’s reaction wasn’t normal. After some terrifying moments, the medical team realized that a hurried caregiver had picked up the wrong concentration of the right drug. The error was caught and corrected. Apkon met with the child’s mother afterward. “Her child was fine. She wanted to know how the next child would be protected,” he says. Apkon was then in charge of performance management for Yale-New Haven Health System, and had been working to create safer systems in the Children’s Hospital for several years. “Having her sit there and talk it through created a sense of urgency.”
Apkon is proud of the care delivered at YNHH, where he has served, in various capacities, since beginning his residency in 1989, but he is also proud of the efforts the hospital has made to improve. “We can focus on the metric of drug errors,” he says. “But what’s an appropriate number? What’s an acceptable failure rate?” Yale-New Haven Hospital has 944 beds and dispenses 1.4 million doses of medicine a year. “No system can ever do it perfectly 100% of the time. But if you look at what could have happened to that child, that creates a tremendous amount of motivation to close that gap, regardless of whether it’s one failure in ten or if it was the one failure out of a billion.”
Apkon is working to “create a culture of a high reliability organization” at the children’s hospital using the tools of the management profession. “The language that I like to use actually comes from other industries,” he says.
These process improvement efforts draw on Six Sigma and Toyota Lean management processes.
