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Managing risk in a healthcare system is challenging. That is because hospital risk managers juggle many responsibilities to keep their organizations safe. Specifically, they are responsible for identifying high-risk areas that could cause harm to patients, visitors, and employees; implementing programs to avert risks; and managing a robust reporting process for adverse events that do occur.

But of all of their responsibilities, one of the most important is focusing on improving patient safety — for both the health of the patient and to minimize the financial risk an adverse event poses to the health system.

Improving patient safety improves overall patient outcomes. But there are additional incentives for avoiding adverse events. The reasons are as follows:

Declining Reimbursements. Reputation.

Because hospitals have a lot to lose — in terms of both reimbursements and reputation — accurate identification of adverse events is critical. Hospitals, and particularly risk managers, devote a lot of time and energy to determining whether an incident constitutes a reportable event. In fact, all incidents are evaluated and vetted by multiple departments to determine whether the event is indeed reportable.

Unfortunately, most hospitals do not have tools in place that enable all departments involved with the event to review the associated data in one central repository . Nor are the departments able to follow the event’s progress through the risk management workflow. For example, let’s take the case of what typically happens when there is a patient fall. A nurse charts the fall, but there is only a certain amount of data that goes into the EMR ( the fact is that a lot of risk data isn’t captured in the EMR ). The event is then triaged by multiple departments: typically quality, nursing, and risk. Each department must review the event, provide feedback, and sign off as to whether or not they believe the event should or should not be classified as reportable.

When a workflow requires multiple reviewers, risk managers face a real challenge because they likely don’t have a streamlined way to collaborate with everyone involved in the decision. They might be limited to communicating via email and meetings as a way for everyone to analyze the information, share feedback, and monitor the process. With such a time-intensive approach to reviewing each event, the evaluation process for a single event can take up to six to eight weeks and many management staff hours.

Figure 7.

Pavarotti kinesin-like protein (Pav-KLP) and Aurora B kinase fail to accumulate in the interior central spindle at late anaphase in mutant spermatocytes. (A and B) Left panels show late anaphase spermatocytes stained to reveal Pav-KLP (red), MTs (green), and DNA (blue). (A) In wild-type cells, Pav-KLP forms a distinct band at the mid-portion of the central spindle. (B) Partial formation of central spindles in the mutant resulted in some accumulation of Pav-KLP where putative plus ends of peripheral central spindle MTs interdigitate near the cell cortex. In some cells this was asymmetric (arrowhead), whereas in others it was on either side of a MT gap (arrows). (C and D) Aurora B kinase also mislocalizes in mutants. Aurora B is shown in red, MTs are stained green, and DNA blue. Similar to Pav-KLP, Aurora B assumes a tight ring-like configuration at the equator of wild-type cells (A). This distribution is less symmetrical in mutants, in which the protein could accumulate most strongly at the regions where the peripheral MTs overlapped (B, arrowhead). Bars: (B) 5 μm; (D) 10 μm.

We also investigated the distribution of Aurora B kinase, a member of the INCENP and Survivin complex that has been shown to recruit and possibly activate Pav-KLP/Zen-4 ( Severson et al., 2000 ; Mishima and Glotzer, 2003 ). As shown in Fig. 7 C, in wild-type cells, Aurora B formed an equatorial band similar to that of Pav-KLP. In contrast, in orbit mutants, Aurora B often assumed an asymmetrical localization across the central spindle ( Fig. 7 D, arrowhead) or was undetectable above background levels. Thus, in orbit mutants, the interior MTs are preferentially affected and fail to form bundles and to recruit Pav-KLP and Aurora B.

The aforementioned data indicated that a principal consequence of the orbit mutation was a failure to properly form and/or maintain interior central spindles. To further characterize how loss of this structure affected cytokinesis, we examined the distribution of other cleavage furrow-associated proteins. We began our analysis by looking at the distribution of anillin, an actin-binding protein that is recruited to a narrow band around the cell equator before the formation of the actin contractile ring ( Xandra One Shoulder Mini Dress Cushnie et Ochs Cheap Free Shipping zJieE
). In wild-type cells, anillin formed an equatorial ring as early as anaphase, where it remained as the furrow ingressed ( Womens Truey AbstractPrint Jersey Top Isabel Marant Visit Sale Online Clearance Sale Online SEpOGy92
A). Giansanti et al. (1999) found that anillin localization was unperturbed even after the central spindle was disrupted using two separate mutants, chickadee and klp3A . Therefore, we were surprised to find that anillin was only weakly recruited to the equator of orbit spermatocytes at anaphase. When anillin did form discrete structures, they tended to be aggregates concentrated along one side of the cortex in the region occupied by peripheral central spindle MTs ( Fig. 8 B, arrowhead). After anillin accumulation, the force-generating actomyosin contractile ring forms through a central spindle dependent mechanism ( Gatti et al., 2000 ). Indeed, in wild-type cells we observed clear rings of actin that were concentrated around the equator of the cell in the mid-part of the central spindle ( Fig. 8 C). As expected, whenever the interior central spindle was disorganized in orbit cells, actin rings were equally aberrant or undetectable ( Fig. 8 D, arrowheads).

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Erik Brynjolfsson is less pessimistic. An MIT economist who co-authored White Drihanna Platform Sneakers Acne Studios Buy Cheap Professional Free Shipping Official wtTfOLW
, he thinks automation won’t necessarily be so bad. The Luddites thought machines destroyed jobs, but they were only half right: They can also, eventually, create new ones. “A lot of skilled artisans did lose their jobs,” Brynjolfsson says, but several decades later demand for labor rose as new job categories emerged, like office work. “Average wages have been increasing for the past 200 years,” he notes. “The machines were creating wealth!”

The problem is that transition is rocky. In the short run, automation can destroy jobs more rapidly than it creates them—sure, things might be fine in a few decades, but that’s cold comfort to someone in, say, their 30s. Brynjolfsson thinks politicians should be adopting policies that ease the transition—much as in the past, when public education and progressive taxation and antitrust law helped prevent the 1 percent from hogging all the profits. “There’s a long list of ways we’ve tinkered with the economy to try and ensure shared prosperity,” he notes.

Will there be another Luddite uprising? Few of the historians thought that was likely. Still, they thought one could spy glimpses of Luddite-style analysis—questioning of whether the economy is fair—in the Occupy Wall Street protests, or even in the environmental movement. Others point to online activism, where hackers protest a company by hitting it with “denial of service” attacks by flooding it with so much traffic that it gets knocked off­line.

Perhaps one day, when Uber starts rolling out its robot fleet in earnest, angry out-of-work cabdrivers will go online—and try to jam up Uber’s services in the digital world.

“As work becomes more automated, I think that’s the obvious direction,” as Uglow notes. “In the West, there’s no point in trying to shut down a factory.”

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Clive Thompson is author of , and a contributing writer to the and . Photo: Tom Igoe.

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