Applying Lean Principles to Mitigate the “July Effect”: Addressing Challenges Associated with Cohort Turnover in Teaching Hospitals

Abstract

<p>The healthcare system in the United States is comparatively superior to healthcare systems of other countries in terms of advanced and modern technology, drugs used, services offered, and required care. However, hospital management has to face the challenges in the managing of care and addressing safety issues for its patients due to the multiple stakeholders involved such as medical doctors, residents, nurses, diagnostic tool providers, as well as patients. Every year many people lose their lives due to medical errors caused by new employees in hospitals, errors that can be prevented by “mistake-proofing.” Similarly, teaching hospitals face an increase in medical errors in the month of July due to cohort turnover, which occurs when trained residents graduate and new ones begin their residency, resulting in increased fatalities and mishaps; this phenomenon is called the “July effect.” This sudden changeover of workforce puts the quality of healthcare in teaching hospitals at stake. In this paper, we discuss various reasons behind the July effect and several tools of quality that can be implemented to improve healthcare and increase patients’ safety.</p>