Are standards are a waste of time?

A little while ago I was lucky enough to watch a brilliant presentation by Prof Harold Thimbleby at a conference on Sterilisation in the Healthcare Industry.

Harold gave a presentation about human behaviour in healthcare and made two very salient points 1. Getting rid of a person who made a mistake doesn’t fix a problem, the bad apple syndrome is not sound. 2. It is important to make process and failure / error visible. After reflecting, the penny dropped and an idea came to mind.

I want to concentrate on the second point for a moment. Prof Thimbleby pointed out the seemingly obvious, but perhaps not so apparent, fact that if one can’t see that an error has occurred one can’t do anything about it – one can’t go around constantly checking for errors. A fantastic example of dealing with this type of problem is wheel nut indicators used on lorries. Stay with me a second, I promise this is going somewhere. You may have noticed some lorries have bright yellow triangles attached to the wheel nuts all pointing in one direction, the point of these is that it is very easy to see when a wheel nut is coming lose, as one of the arrows will not be in align with the others. Without these indicators the only way to prevent a failure would be to check each nut periodically. It’s just not a practical solution.

After Prof Thimbleby’s presentation the floor was opened to questions. Previously on the agenda there had been a debate about whether Healthcare Standards “have gone too far”– and he was asked the same question in relation to what he had just been talking about. His answer went along the lines of “standards are a waste of time”, a member of the audience interjected that, “it wasn't the standards that are a waste of time it is their implementation and policing which can often be at fault”. Expanding on this, Harold said a better alternative to standards would be some way to make quality and safety visible to the buyer and users to prevent shoddy equipment and/or practice. Pointing to examples of the EU labelling for household goods such as fridges and washing machines, and more recently car tyres which all have labels indicating how the product performs on one, two, or three aspects allowing the buyer to make an informed decision as these aspects would otherwise be invisible leading to poor decisions.

Now, what if we take this a little further… what if standards prescribed ways in which to test and scale certain aspects of equipment, say their safety or quality? This would give the buyers in our healthcare systems the visibility they need to make risk and value judgements in relation to price. Obviously some aspects can’t be quantified but for those that can be, there should be agreed scales on which equipment can be evaluated and compared.

Let’s take cars as a good comparison to hospital washer disinfectors. They are both large items of capital equipment, and in both cases there are a number of manufactures with different offerings, but they essentially perform the same task. Every new car sold in Europe has a CO2 emissions rating on a scale, to help encourage buyers to buy in favour of better CO2 emissions. But of course this isn’t the only consideration for the buyer. I believe this would be the same for AWDs, we could have a washing efficacy scale to encourage better cleaning but sellers can still differentiate on other factors as well that may have value for the customer.

Quite a bit of research has pointed to the cleaning detergent as being one of the main factors determining the hospitals washing efficacy. So this is perhaps where this labelling should start. Some might argue that this isn’t appropriate for washing detergents as they will potentially act in different ways in different processes. But we need a way to compare them. Looking back again at the new tyre label the same problem is present. The same tyre fitted to a BMW 3 Series may perform differently when fitted to a VW Passat due to things like weight distribution, front vs. rear wheel drive, and engine power. But still a tyre rated A for braking distance in the wet will be better than one rated E on either vehicle. Stands to reason right?

This would be good for aiding purchasing decisions and would certainly push up the standards of equipment available on the market, just like the EU labels on fridges has made them universally far more efficient. But what about making operational errors visible? There are already products in use to help with this, a great example is autoclave tap. It is almost impossible to identify by looking at an instrument whether it has been sterilised or not. The autoclave tab and other chemical indicators give an obvious visual check that the instruments have at least been through a steriliser, making the error of missing the sterilisation process visible. But is it enough to be able to say something just been through a steriliser?

 

Lucina Ridgewell

 

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