Safer Hospital Care: Strategies for Continuous Innovation, 1st Edition (Paperback) book cover

Safer Hospital Care

Strategies for Continuous Innovation, 1st Edition

By Dev Raheja

Productivity Press

200 pages | 23 B/W Illus.

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From newborns switched in the nursery to medication mix-ups and hospital-acquired infections, we are all familiar with the horror stories about hospital safety, and unfortunately, the statistics say we aren’t exaggerating. The safety issue in U.S. hospitals has become so profound and embedded, that we cannot hope to fix it without a paradigm shift in our approach. After defining and demonstrating the true depth of this dangerous concern, Safer Hospital Care: Strategies for Continuous Innovation elaborates on the steps required to make that paradigm shift a reality.

A respected and sought out expert on hospital safety, author Dev Raheja draws on his 25 years of experience as a risk management and quality assurance consultant to provide hospital stakeholders with a systematic way to learn the science of safe care. Supported by case studies as well as input from such paradigm pioneers as Johns Hopkins and Seattle Children’s, he explains how to:

  • Adapt evidence-based safety theories and tools taken from the aerospace, nuclear, and chemical industries
  • Identify the combination of root causes that result in an adverse event
  • Apply analytical tools that can effectively measure hospital efficiency
  • Establish evidence between Lean strategies and patient satisfaction
  • Make use of various types of innovation including accidental, incremental, strategic, and radical, and establish a culture conducive to innovation

This practical guide shows how to find solutions that are simple and comprehensive, and can produce a high ROI. To reform hospitals, we must recognize that they are highly dynamic systems that must be fixed systemically. Instead of thinking in terms of continuous improvement, we need to think in terms of continuous innovation. Safe hospital care is not just about doing things right; it is also about breaking old habits, finding new tools and doing the right things.


Not only is this an excellent work and a valuable addition to the field, it is also very timely in light of revelations about woefully inadequate or absent procedures in the present crisis. We have always needed a 'systems' approach, and this book should be required reading for all decision makers.

—Richard Fellows, MD

Table of Contents

The Etiologies of Unsafe Healthcare

Failure Is Not an Option

An Unconventional Way to Manage Risks

Defining Unsafe Work

How Unsafe Work Propagates Unknowingly

How Does Unsafe Work Originate?

So, Why Do We Unknowingly Sustain Unsafe Work?

Using Best Practices Is Insufficient

There Is Hope

The Lessons Learned

Sufficient Understanding Is a Prerequisite to Safe Care

Insufficient Understanding of System Vulnerability

Insufficient Understanding of What Is Preventable

Insufficient Understanding from Myopia

Insufficient Understanding of Oversights and Omissions

Insufficient Understanding of Variation

Some Remedies

Preventing "Indifferencity" to Enhance Patient Safety

Performance without Passion

Not Learning from Mistakes

Inattention to the Voice of the Patient

Making Premature Judgments without Critical Thinking

Lack of Teamwork

Lack of Feedback and Follow-Up

Performance without Due Concern

Lack of Accountability

Encouraging Substandard Work

Reacting to Unsafe Incidences Instead of Proactively Seeking Them

Inattention to Clinical Systems

Difference in Mindset between Management and Employees

Poor Risk Management

Performance Diligently Done in a Substandard Manner

Continuing to Do Substandard Work, Knowing It Is


Ignoring Bad Behavior

Inattention to Quality

Continuous Innovation Is Better Than Continuous Improvement

Why Continuous Innovation?

Types of Innovations

Marginal Innovation

Incremental Innovation

Radical Innovation

Disruptive Innovation

Accidental Innovation

Strategic Innovation

Diffusion Innovation

Translocation Innovation

The Foundation for the Innovation Culture

Choice of Innovation

Encouraging Creativity

Structure for Sustaining Innovation

Innovations Should Start with Incidence Reports

The Purpose and Scope of Incidence Reports

What to Do with Incidence Reports?

A Sample Incidence Reporting Procedure

A Sample Incidence Report Form

Ideas for Innovative Solutions

Doing More with Less Is Innovation

Be Lean, Don’t Be Mean

Eliminate Waste, Don’t Eliminate Value

Do It Right the First Time—Excellence Does Matter

Add More Right Work to Save Time and Money

Attack Complacency

Create a Sense of Urgency

Establish Evidence between Lean Strategies and Patient Satisfaction

Ideas for Lean Innovation

Reinvent Quality Management

A Recipe for Success

Redefine Quality

Conduct Negative Requirements Analysis

Develop Strategic Plan Based on SWOT Analysis

Consciously Manage Quality at All the Levels of an Organization

Quality at Conformance Level

Quality at Process Level

Quality of Kind at Organization Level

Architect a Patient-Centric Quality System

Validate Interactions and Dependencies Frequently

Incorporate Feedback Loops

Reinvent Risk Management

Identify Risks

Failure Mode and Effects Analysis (FMEA)

Fault Tree Analysis (FTA)

Operations and Support Hazard Analysis

More Safety Analysis Techniques

Mitigate Risks

Orchestrate Risks

Create a Sound Structure

Integrate the Support Staff

Conduct Risk Management Rehearsals

Aim at High Return on Investment without Compromising Safety

Human Errors May Be Unpreventable; Preventing Harm Is an Innovation

Principles of Human Factors Engineering

Principles of Human Factors Engineering (HFE)

Harm Prevention Methodologies

Crew Resource Management (CRM)

Management Oversight and Risk Tree (MORT)

Change Analysis

Swiss Cheese Model for Error Trapping

Mistake Proofing

Managing Safety: Lessons from Aerospace

Where Does US Healthcare Stand on System Safety?

System Safety Theory of Accidents

System Safety in Emergency Medicine

Aerospace Hazard Analysis Techniques

The Paradigm Pioneers

Johns Hopkins Hospital

Allegheny General Hospital

Geisinger Health System

VA Hospitals

Seattle Children’s Hospital

Ideas for Future Paradigm Pioneers

Protect Patients from Dangers in Medical Devices

The Nature of Dangers

Hazard Mitigation for Existing Devices

Potential Dangers in New Devices and Technologies

Hazard Mitigation for New Devices and Technologies

Can We Use This Knowledge in Bedside Intelligence?

Heuristics for Continuous Innovation

Heuristics for Medicine

Other Heuristics for Medicine

Heuristics for Frontline Processes

Stop Working on Wrong Things, and You Will Automatically

Work on Right Things

Learn to Say "No" to Yes Men

"No Action" Is an Action

No Control Is the Best Control

Heuristics for Management

If You Don’t Know Where You Are Going, Any Road Will Get You There

Convert Bad News into Good News

As Quality Goes up, the Costs Go Down

That Which Gets Measured, Is What Gets Done

% of Causes Are Responsible For % of Effects

Aequanimitas—The Best-Known Strategy for Safe Care

Aequanimitas Explained

Why Aequanimitas Is the Best-Known Strategy for Safe Care?

The Practice of Aequanimitas

Modern Variations of Aequanimitas

Emotional Intelligence (EI)

The Beginner’s Mind

Ray Brown’s Senses

Appendix A: Swiss Cheese Model for Error Trapping


Each chapter includes an Introduction, Summary, & References

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Manufacturing Industries
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration
MEDICAL / Health Care Delivery