Do you remember the rather bizarre statement made by Donald Rumsfeld about the Iraq War? He said something along the lines of "There are known knowns, there are known unknowns and there are unknown unknowns." He was paraphrasing an interesting and useful concept that I have chosen to form the basis of this blog and it goes like this........

I promised to update the blog after we had undertaken the experimental exercise to apply Lean Healthcare to a reduction in Medication Risk as opposed to simply Service Redesign and although it was a fraught and stressful journey, with the support of the nursing and medical staff as well as the National Patient Safety Agency we have managed to apply Lean Healthcare (and particularly VSAs) to the reduction in Risk.