Lean Transformations Group

Patients First (Part II)

Just last month in this space, Dr. Luis Haro talked about the stunning results that can be achieved when you put patients first. The idea of focusing every person involved and every part of the process on one thing seems revolutionary – and at first glance, near impossible with all the day-to-day distractions. Have you ever been in a big city emergency department on a Friday or Saturday night? It seems like complete chaos, and yet, when it's done right, it can be a beautiful dance that fulfills the primary mission of most health-care professionals that I know: saving lives and healing people.

In many places across the country, that mission is in deep trouble. While health care is full of very talented and dedicated people, they are working extremely hard in systems that are, quite frankly, completely broken. Even worse, these wildly talented people are not being effectively used to fix the problems.

So, where do you start? First, I would set the bar high for what could be. Make bold statements about what you would like to see happen for the hurting people who show up in your health-care facility, and then figure out how to get there. For example, you could say, "No one should leave an ER department without being seen." That happens a lot these days, and as you may have read in Dr. Haro's blog post last month, it can be rectified with the right organizational medicine and a commitment to the process. But, like any big fix, it begins with an honest assessment of the problems. Be honest about your issues, but set the bar high for your outcomes.

I would suggest that the assessment of your current situation be done by and with those talented people on your team who are scurrying from one crisis to another. I'd assemble a team that has people from each of the silos that affect the patient experience, and start by asking:

  • Do we agree on our purpose as a team?
  • Who is our customer?
  • Why do they come?
  • What do they expect when they get here?

Then, I would ask them to define the high level process steps in the patient journey:

  • Does it start at triage or when the patient walks through the door or when the ambulance makes contact?
  • Where and when are patients waiting?
  • When is our team waiting?

By the way, the "When is our team waiting?" question is an important and often-overlooked one. I learned a lot from an experience I had spending two days with a team just observing their emergency department. We gleaned a great deal by simply watching the process from start to finish and seeing as an outsider where the process breaks down or lags or – even worse – fails completely.

Most ER doctors and administrators believe they are too busy every day putting out fires and problem solving to do such a thing, but I can tell you that just spending some time and objectively watching the comings and goings will go a long way toward starting to solve the problems. Spend some time observing and you may find that you have fewer fires to put out going forward. That seems like a good long-term investment, doesn't it? In fact, one health-care institution took it even a step further. The department chair stayed with a patient from the time they walked through the door to the time they were discharged, and this exercise led to an epiphany that changed the institution's processes for the better.

Next, I would define the problems that need to be solved:

  • If our purpose is to treat patients, why do we have patients who leave without being seen?
  • Why, if our average patient value added time is less than 40 minutes, is our length of stay over 200 minutes?
  • Why do we need to treat patients in the hallways?
  • Why do our doctors spend more time filling out paperwork and on computers than they do with the patient?

The good news is that this transformational process is beginning to get a foothold in health-care facilities around the country and around the globe. I've been privileged to see it firsthand and I've been involved in transformations that forever changed the way health care is delivered, and the patients and health-care professionals have been the beneficiaries.

Karl Ohaus has worked with Dr. Luis Haro since 2008 and is one of the authors of Perfecting Patient Journeys.

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