What construction can learn from healthcare about preventing errors

A focus on cure rather than prevention is a common shortfall across both traditional healthcare systems and the construction industry, participants at GIRI’s latest online forum agreed in a discussion about what lessons the construction industry might learn from the medical profession. However, redirecting the focus towards preventing errors – or health problems – requires a change of mindset and culture, not just the imposition of more processes.

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Traditional healthcare models apply rigorous procedures of diagnosis and treatment, but things can still go wrong that are outside the control of medical professionals. On the other hand, several major studies have shown that the single biggest influence on an individual’s long-term health and wellbeing is not the healthcare system but the individual themselves.

Led by Nick Francis, the GIRI discussion forum explored the pros and cons of traditional and modern approaches to healthcare, comparing process-driven systems with behaviour-based, patient-centred models, and asked delegates about the analogies that can be drawn between the two industries in terms of managing error.

Treating the symptoms not the cause

“We spend more time figuring out how to fix something once it goes wrong than thinking about how to prevent it going wrong in the first place,” observed one participant. Or, as another put it, both industries are focused on treating symptoms rather than causes. “People focus on putting it right afterwards rather than concentrating on a healthy lifestyle to prevent it happening.”

The discussion covered issues such as supervision, governance, and competence in relation to the occurrence and repetition of error, and how both industries need to get better at learning from their mistakes.

But to a large extent it comes down to culture and buy-in from teams to a culture of quality. “You can have as many procedures and rules as you want, but you still need to influence people to do the right thing,” said a participant. “People on the ground need to understand and recognise and want to do the right thing.”

Another observed that culture is difficult to ‘teach’. “It needs to be demonstrated behaviours – a drip feed over time.”

The benefits of good communication

Nick then introduced the concept of patient-centred care. In this scenario, instead of telling the patient what they need to do, as in the traditional model, the focus is on understanding their hopes, fears, and expectations, and tailoring the healthcare approach to their context and priorities. “Rather than simply telling someone they need to do something, this approach encourages or rewards them when they do something beneficial.”

How does this relate to construction? Does the industry direct and constrain or take a more outward approach? One participant noted that the need for consistency across projects tends to result in the standardisation and imposition of processes, which can stifle the aspirations of a particular project as to how it achieves its goals. However, the alternative means unknown risks and outcomes. It was felt that risk management needs to be a priority.

“Do we need both in construction?” asked Nick. “On the one hand, freedom and flexibility are great, but because we also need consistency, standardisation and processes are important, and procedures help to minimise risk.”

Others made the point that the definition of a ‘good outcome’ differs between the two industries, and even within them. On the one hand, construction has a more defined deliverable – the design. But what an individual may consider a good outcome in health terms can differ widely from one person to the other based on their situation and priorities.

“The only way to understand an individual patient’s beneficial outcome is through good communication and that is something construction can learn from,” said one attendee. “If we have good relationship with clients, we can understand their drivers and focus our efforts on the things they really care about.” He pointed out that framework type relationships, which see clients impose KPIs, mean their priorities and sensitives are better understood by contractors. This means it is easier to deliver what the client really wants as opposed to the ‘bid for work, win work, deliver it and move on’ model.

Parallels were also drawn with the supply chain, where an outward approach means a collaborative supply chain where everyone is working together to find the best approach. However, participants acknowledged the realities of commercial pressures. “When people are under stress, the approach tends to become more directive and controlling,” one observed.

How to achieve the biggest gains

Back to medicine, and Nick discussed the concept of patient activation levels. Level one is someone who finds managing their own health too overwhelming; at the other end of the scale at level four, you have someone who not only actively manages their health but also looks for ways to improve it. However, research has shown that the biggest health gains can be made not by moving someone from level three to level four, but from level one to level two.

Nick asked participants to think about whether this concept relates to construction and the different people working on a site, particularly in light of the skills shortage and high churn of day labourers. Delegates agreed that the biggest gains can be achieved through the ability to demonstrate ‘what good looks like’ and rapidly train people to get them from level one to level two. “However, breaking that down task by task and at appropriate levels is quite challenging.”

Health activation levels could be compared to the DuPont Bradley curve, used to assess the maturity of health and safety culture on site, said one delegate. “If you substitute defects and errors for injury rates and plot where you are on the curve and how you can move from left to right, this is a good match for the idea of activation levels in the medical world.”

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