The Sixm Control Model: Application Of The 6M Control Plan
APPLICATION OF THE 6M CONTROL PLAN:
Any process, even if well planned and controlled, can lose its stability at some point. As has been explained in Chapter 6, the correction and improvement of a process will consist of an analysis of its root cause. When an error occurs, we must analyze the cause and look for the culprit M of our 6Ms. The culprit could be any of the 6Ms, not necessarily the Manpower M. However, when there is an error people tend to blame the Manpower M, as has happened in the case of baby Ryan.
When errors do occur, I would like to encourage my readers to apply the Ishikawa model (my modified version detailed in Chapter 6) to identify the culprit M. For this type of analysis, the participation of the people who know and …show more content…
In this case, the nurse was blamed for the error that caused baby Ryan’s death. This is an apparent truth but it is not necessarily the case. The more organized a company is, the more capacity it has to enhance its causal analysis and identify the true failure. Without such a learning process, there is no way to prevent the same problem from occurring with other patients. As has been reiterated in Chapter 4, the weakest M of the 6M is the M of Manpower, which is why we need to apply POKE-YOKE to avoid involuntary errors. An involuntary error, which can happen to any staff member, is not the true cause of an error. An involuntary error is not the "disease" but the "symptom" of a deeper illness which is caused by "organizational disorder" ¬– something that we deal with throughout this …show more content…
If a treatment is omitted or if an alarm or call could not be attended due to a shortage of staff, the cause may be due to a lack of resources. If there is a person with legally required training and a process error occurs through them, there is a tendency to blame it on a lack of guidance and training or a lack of POKE-YOKE.
8. Of course, I don’t want to start a debate on whether there were missing resources, if nurses needed further specialization training or whether the policy of public healthcare privatization in Madrid is a good thing or not. However, as noted in chapters 1 and 7 of this book, if we do not enforce order in the management of public health, through professional, efficient and effective management and ensuring the safety and effectiveness of treatment, then patients could lose confidence in the healthcare
Any process, even if well planned and controlled, can lose its stability at some point. As has been explained in Chapter 6, the correction and improvement of a process will consist of an analysis of its root cause. When an error occurs, we must analyze the cause and look for the culprit M of our 6Ms. The culprit could be any of the 6Ms, not necessarily the Manpower M. However, when there is an error people tend to blame the Manpower M, as has happened in the case of baby Ryan.
When errors do occur, I would like to encourage my readers to apply the Ishikawa model (my modified version detailed in Chapter 6) to identify the culprit M. For this type of analysis, the participation of the people who know and …show more content…
In this case, the nurse was blamed for the error that caused baby Ryan’s death. This is an apparent truth but it is not necessarily the case. The more organized a company is, the more capacity it has to enhance its causal analysis and identify the true failure. Without such a learning process, there is no way to prevent the same problem from occurring with other patients. As has been reiterated in Chapter 4, the weakest M of the 6M is the M of Manpower, which is why we need to apply POKE-YOKE to avoid involuntary errors. An involuntary error, which can happen to any staff member, is not the true cause of an error. An involuntary error is not the "disease" but the "symptom" of a deeper illness which is caused by "organizational disorder" ¬– something that we deal with throughout this …show more content…
If a treatment is omitted or if an alarm or call could not be attended due to a shortage of staff, the cause may be due to a lack of resources. If there is a person with legally required training and a process error occurs through them, there is a tendency to blame it on a lack of guidance and training or a lack of POKE-YOKE.
8. Of course, I don’t want to start a debate on whether there were missing resources, if nurses needed further specialization training or whether the policy of public healthcare privatization in Madrid is a good thing or not. However, as noted in chapters 1 and 7 of this book, if we do not enforce order in the management of public health, through professional, efficient and effective management and ensuring the safety and effectiveness of treatment, then patients could lose confidence in the healthcare