What Hospitals Can Learn from Airlines About Buying Equipment

For critically ill patients on breathing machines, a simple step drastically improves their survival chances by almost 10% — from 60% to 70%. It involves programming the machine to deliver enough life-sustaining breaths, but not so much that it damages their lungs by overinflating them. Given that this intervention could prevent more suffering than many wonder drugs, one would expect that there would be zero market for a breathing machine that didn’t make lung-preventive ventilation as easy as possible. But in health care, few things work as expected. Fewer than half of patients, and in some hospitals fewer than 20%, receive this life-saving intervention.

One big reason why is that hospitals purchase technologies without requiring that they communicate with each other. The optimal air flow is based on a straightforward calculation using the height of the patient. Height data, however, resides in the electronic medical record, which typically does not communicate with the ventilator. As a result, physicians must retrieve this information from the medical record, perform the calculation (sometimes on paper), and enter the order. A respiratory therapist then takes the order and types it into the ventilator, often relying on memory.

If the ventilator and medical record communicated with each another, calculating the ideal air flow would be automated and clinicians would only need to verify the correct settings. Instead, they waste time on nonproductive work, filling the gap between these two systems. Because similar gaps exist between dozens of other hospital technologies, and clinicians are asked to perform hundreds of steps each day to deliver evidence-based care, unnecessary errors occur, and providers’ productivity has fallen, even while spending on technology has ballooned...