Code Software to be Robust and Easy to Update Quickly

Comment on: Correction vs Prevention in Software Development

I think both prevention and designing the software and management system so that rapid correction is possible are important. While rare events may be difficult to prevent when looking at each instance there are styles of coding that make more "edge case" failures more likely. Coding so that the system is as robust as possible is wise but you should also realize those efforts will likely not be perfect and so designing in visible notifications of failure and coding so rapid correction is possible is necessary.

In addition to the need to update quickly for bugs, software should be easy to update due to changing requirements and to aid in continual improvement efforts.

Related: Improving Software Development with Automated Tests - Software Supporting Processes Not the Other Way Around - Building a System to Reduce Interruptions for Software Developers
- Use Urls: Don’t Use Click x, Then Click y, Then Click z Instructions

Data on Medical Errors

How Many Die From Medical Mistakes in U.S. Hospitals?

In 1999, the Institute of Medicine published the famous “To Err Is Human” report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.

In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.

That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.

I wish these reports would provide some detail on what these really mean. Is it 250,000 people that were completely healthy coming in for a physical and they die when they would have been healthy if the medical system didn't exist? I doubt it. Is it 2,000 completely healthy people and 248,000 people that were under intensive medical care for years keeping them alive and now we slipped up and they died? Probably not, again, but my guess is it is closer to the second.

Preventing errors is obviously important. And in health care it is very important, of course. But just because you use data doesn't mean it isn't misleading. Medical errors leading to death is just too big an operational definition to be very meaningful in my opinion. For these numbers to provide much insight I really think they need to be segmented more:

• perfectly health person that was going to be perfectly healthy for decades but were killed by medical error.
• person that needed life saving care of they were going to die that month and we routinely should be able to provide the very easy care to make them perfectly healthy again but they were killed.
• etc…
• person that was extremely sick with many problems for years and was saved with medical care over and over again. Complex care was needed and much of it was done well but in the very challenging situation there was a mistake and that mistake is the proximate cause of death.

We should be working on making everything better and eliminating medical errors that cause damage and death. But there are huge differences between a medical error conditions that caused death and to me those differences are so huge lumping them together is hardly useful.

My understanding is we do use risk based assessment to compare things like survival rates or operations at different hospitals. A figure of survival rates comparing two hospitals when one was the hospital where all the most difficult case for the Western USA were sent to a local hospital that dealt with the easy operations for that health issue would not be very useful. So they try to adjust for the severity of the problem (as I understand it). It would seem to me a similar thing would be much more useful for medical error death rates. Was the person in such a risky state that the tiniest misstep (error or whatever else) would kill them or was it someone who is perfectly health and dies immediately due to an error.

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Response to comment on my comment

Right, l think the thing I am getting at is there is a big difference between making a mistake while you are in a complex situation where any of 30 bad decisions in a pressure situation could result in death (and where doing nothing results in death) versus a situation where there is no risk of death until you do an absolutely idiotic thing that turns my visit to get a physical into death.

Everything should be constantly improved and made safer with mistake-proofing thinking... And healthcare needs this more than most everything due to the dangers and consequences involved.

When there are headlines like 100,000 deaths due to medical error every year that reads to me like John was walking along the street and boom a medical-error/piano dropped on his head and killed him. But I don't believe that is true. I bet it is true that are lots of deaths due to just unforgivable errors - someone is given a drug which was indicated in numerous sensible ways would kill them due an allergy but they were given it anyway and died.

But I don't trust how much of the deaths attributed to error are really 20% error, 19% cancer, 18% diabetes, 17% cardio-vascular disease, 16% long term high level use of powerful drugs ravaging the body, 10% car accident (which also someone else might say is 5% error, 30% cancer, 25%...). The error is still bad, and the system needs to be improved to reduce the frequency and consequences of errors. But I just don't know how to take the error to death data without much more explanation.

In reading more details on the studies they comprehend this issue with the data but I haven't found where they provide more meaningful data. What I read just talks about the contributing nature of "blame" on medical error etc..

Mistake Proofing and Mistake Making Less Easy

For my own thinking I think of "mistake proofing" as best and different from "mistake making less easy" (visual indications of a problem for example, but no physical block to making the mistake). And I don't think of "mistake proofing" as different for person v. a machine.

But in communicating with others I have to be much more verbose as the understanding of what poka-yoke means doesn't fit the understanding I have in my head. Making it harder to make mistakes and making mistakes that are made more visible is good. Preventing them is even better.

Reaction to: Yet Another Post About Poka-Yoke

I discuss these ideas in my book: Management Matters: Building Enterprise Capability

Quick Mistake Proofing Ideas for Preventing Date Entry Error

I found a new failure mode for online bill pay. I had an electric bill due April 24. I mistakenly entered May 23 as the pay date 

So, by April 30, I had a late payment termination notice from the electric company. Kudos to them for the fast cycle time on getting those out. I paid the bill via credit card on their website. 

I’m not sure how to error proof “wrong date.” You?

It is easy to put in a filter that checks and then puts a big flash message:

  “The date you entered is after the due date. Are you sure you don’t want to put in a date prior to that...”

You can also make the data entry bias toward a on-time payment: require an extra step to go beyond the due date, default the value to be the due date... How you implement this would depend on the entry method.

It is really easy to do well if you are using calendar point and click – grey out all the post due date entries, if click on a greyed out entry, pop-up a message that says “that date is after the due date are you sure...” It gets less effective/cool if it is just text entry...

Even with text entry thought you can popup the message on submit of the form if the date is too late (so they enter the wrong date but you catch it before the action is completed).

You can also follow up with (using this method alone is better than nothing but it is pretty lame so I wouldn’t suggest it as the only method unless nothing else can be done reasonably) email saying “you entered a date after the due date in your last bill payment, if you don’t pay before that late fee…

Anyone what to hire me for a few minutes at a time to think of ways to make it harder to make an error just let me know. I don’t like processes that allow errors so have become fairly good and thinking up ways to make it harder pretty quickly :-)

Related: Mistake Proofing Deployment of Software Code - Improving Software Development with Automated Tests - Poka-Yoke Assembly