Tag: Mistake-Proofing
Fire Fighting vs. Root Cause Problem Solving
Below is some of the text from edition #3 of the newsletter from my upcoming book Lean Hospitals: Improving Quality, Patient Safety, and Employee...
Martin Hinckley on Mistake Proofing (Poka-Yoke) [Podcast]
This is LeanBlog Podcast episode #42 with Dr.C. Martin Hinckley, of the firm Assured Quality. He is the author of the book Make No...
Error Proofing Vs. “Be Careful” – Which is More Effective?
Why do you need a "be careful" warning message when you've already error proofed something? For liability's sake?
I am going to be flying back...
Dennis Quaid on 60 Minutes
Dennis Quaid Recounts Twins' Drug Ordeal, Actor Tells 60 Minutes' Steve Kroft Medical Errors Kill Thousands - CBS News
Did you see the actor Dennis...
Another Pathology Mishap
L.I. Hospital Scrutinized After Deaths of Patients - New York Times
It wasn't the same laboratory this time, but it's more than likely a similar...
An Example of Vehicle Error Proofing
Urban Legends Reference Pages: Cruise Control on Wet Roads HazardThis is sort of an old urban legend that has been making the rounds again,...
Quaid Case Update: Whose Responsibility is Standardized Work?
If you're a regular reader, you might recall the Cedar-Sinai medical error that harmed Dennis Quad's twins (and others).
Quaid and his wife are now...
Follow Ups to BIDMC
If you've been following any of the posts about healthcare, here are a few interesting follow ups.Following up on this post about Boston's Beth...
My At-Home Medical Mistake: Taking the Wrong Version of Day /...
I'm a bit mad at myself for inflicting some preventable human error on myself last night. It's OK, I didn't harm myself, but let...
Adverse Drug Events and Harm in Hospitals – Follow Up on...
Here are some follow-up articles, quotes, and data following up on the news from the other day that Dennis Quaid's twins were impacted by...
Updated: How Often Must the Same Mistake Be Repeated?
Dennis Quaid's newborns reportedly harmed by medical mix-up - Los Angeles Times
(Updated 4:57 PM, again at 9:51 PM, see bottom of post)
If this story...
"Heightened Vigilance" is Not Enough
The Sun Chronicle Online - OpinionA medical error was in the news this week, a teacher was mistakenly given an insulin shot instead of...