High Tech Creates Patient Inconvenience

A few weeks ago I had the misfortune of walking on a sidewalk and having a car jump the curb and hit me from behind. Fortunately, it was in a parking lot and the car was not traveling very fast and it was a knock down rather than a flight!

My wife drove me to a 24 hour free standing emergency room (affiliated with a local hospital – important later), the cost of the ambulance was vey high and I was not hurt that badly. The experience there was fine, seen timely, X-rays, staff handled paperwork and my personal needs very well. I am critical of these types of things, as you will see in other posts. Nothing broken so discharged home to rest.

Experience in an Emergency Department and Hospital Admission

The next series of posts will relate to recent experiences I have had while being a patient or involving personal experiences with family members as patients. The goal is to share ideas from the VOC – voice of the customer – perspective and encourage all to consider these as well as your own experiences. This is a “research” project on understanding the customer experience.

Recently, the EMS team was called to my home to take a family member to the Emergency Department of the closest hospital to our home. We had a very nice experience in the ED, staff worked well, kept us informed as to what was going on and what would happen while there. It was determined that an inpatient admission was in order. We were told that a “hospitalist” would see us either in the ED or shortly after arriving on the floor.

Practical and Gemba

Let’s get practical. Applications of some of the tools we have talked about have produced some interesting results.

• A three doctor practice in the Houston area looked at their patient cycle time, improved their scheduling process, shifted tasks between staff members and were able to increase patient visits by four per day.
• Tools used: flow chart, run chart (we will see one later), brainstorming.
• A large practice in the mid west was reviewing their cash flow. The CEO simply used the “5 why” technique and found out that there was an automatic hold of 14 days on the AR. The reason given finally was that there was a problem with the billing system several years ago and that became the policy.
• Key tools used was the 5 why which came in a brainstorming session.
• A large oncology group decided to track compliance with care plans, which were developed and agreed upon. They monitored the results and determined that peer pressure and consequences were the best way to see improvement. Compliance increased from 35% to greater than 50% within three months and as of now compliance continues to improve.
• Key tools used was cause and effect diagram (we will see one later), flow chart, brainstorming, session with EMR vendor.

There are many more. One of the keys here is the involvement of the staff through brainstorming. It is not possible for one person to fix or solve all your problems. Utilizing staff knowledge and encouraging them to be involved is essential to the success of an efficiency program.

Another key term and concept in Lean is “Gemba” which literally means “the real place”. We think of it as the place where the work is done. It is essential that those involved go to the Gemba to see how, what, why, and/or when things are done.

Manage for Perfection

The final principle is to manage toward perfection. Here we can integrate both the prior four principles addressed as well as the concept of Six Sigma. Six Sigma refers to defects. A defect in your practice could be a medication error, the wrong size of gloves in the exam room, or something like that that is not correct.

To strive for perfection is to smooth out the flow and eliminate any defects that you may have.

As mentioned in the previous blog, you will have many days that are not efficient and you may get frustrated. You may want to stop reading this blog since it seems ideal and is not realistic. I hope you will stick with it. Your goal has been to improve patient care in any way possible. These tools discussed and more tools to follow will help. In addition, we will shift to more practical applications, experiences that the author has had as well as those from others who are willing to share with you what works.