The Fog of War in Patient-Care Delivery and What's Being Done to Lift It Here's how we clear the confusion found in patient-care delivery and its dangerous consequences.
By Jeff Terry •
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The term "fog of war" is used to describe uncertainty during situations in military operations. It happens because battlefields are highly complex and fast-paced with many moving parts that must come together to complete the mission. In an environment where so much is going on, confusion or errors can easily occur. We see this same kind of uncertainty in daily patient care.
The mid-range length of stay in hospitals is four to seven days, during which time teams work together to progress and deliver care. Like in a war zone, situations change every hour, minute and second. It's important to recognize that being "always on" in a war zone or in daily patient care is different than it is in most professions. Every matter is somehow connected to life and death.
The rhythms and routines in patient care are complex, fluid and dynamic
In a single day, there are endless handoffs of information between caregivers. Enter a fog of war.
The physician may not know what the nurse knows. The case manager might not know that the situation has changed. The consulting physician may not be able to help until tomorrow morning. There are lab draws and results, imaging tests, medicines and procedures. In this fast-moving environment, it's easy for inefficiency to develop. And the stakes are high for every patient.
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Errors lead to delays, misdiagnoses and more
A study found that medical errors may cause 251,000 deaths out of over 35 million hospitalized patients. With a death rate of less than 1%, the vast majority of people who enter hospitals receive excellent care. This is due to the professionals who fight through the "fog of work" every day. However, serious consequences of this fog do occur.
In my own experience in the military, I once saw a soldier get shot and killed by "friendly fire." Weeks later, I happened to see the "shooter," and he was completely devasted. It was an accident. He didn't want to hurt anyone. The root cause was the fog of war — there were different interpretations of "turn left after the minefield" at speed, and we were in small spaces with live ammunition. There was no bad actor.
This was a classic case of fog and confusion leading to tragedy. The same can happen with care teams. Many things happen in just moments. Directions can be misunderstood. Key information can be missed. Everyone is busy managing their own duties. What's remarkable is how all key players — physicians, nurses, case managers, charge nurses and so on — work together so well for each patient. When we make that teamwork routine, the potential for mistakes decreases.
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How do we fight the fog?
To prevent this fog of work in patient care and its outcomes, hospitals first need to invest in their culture — whether that's lean culture or patient-safe culture. Culture brings teams together across disciplines for a shared commitment to excellence, accountability, transparency and teamwork. This is a precondition for high performance.
After this culture has been established, software can help even further because of its ability to bring structure, process data and save clinicians time. Technology can pull thousands of potential pieces of information, extract the few most effective items and present them to the right caregiver at the right moment so the caregiver doesn't have to find time to do that digging herself.
There are two main types of software that can help: real-time optimization software and unified communication tools. Optimization software can listen to all the activity within subsystems and connect the dots to give caregivers an integrated, holistic picture of what's going on. For instance, if patients aren't leaving the Emergency Department, someone can be quick to conclude there are no beds available. However, with information tools, they may find there actually are enough beds, but another issue is present.
Most people are familiar with using mobile phones and text messages in their day-to-day life. Unified communication tools bring these everyday devices to healthcare and replace outdated technology like pagers. Caregivers can't use their personal phones to communicate because they deal with sensitive data, and patient information needs to be handled safely. Real-time messaging from unified communication companies allows caregivers to share data with each other, ask questions and stay updated. These tools bring the same ease and convenience as our everyday tools while also handling all the nuances of healthcare data.
Conversely, complex technology can also contribute to the fog. Simplicity must be the goal. Medical professionals should demand this simplicity from software providers.
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There are no bad actors
Although statistics show that many patients suffer medical errors, there are rarely bad actors in these situations. Mistakes happen. The inherent complexity of patient care makes mistakes likely while its inherent risks can make small mistakes big. That's why it's crucial to routinize systems, processes and information tools so caregivers are confident to do their work.
We can do this by building the right culture and using technology the right way. This is how we lift the fog of work in patient care.
