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We Must Do Something …

Your business makes boxes. Business is good and demand is increasing. In response, you increase production. All is well until demand increases again, and again, and again. You are now at maximum production but it is not enough. What next? You decide to increase the number of employees and purchase more equipment. But, you can’t find any new employees to hire. You have the additional equipment but it remains unused because the employees you do have are already at maximum productivity. You decide to add the additional equipment into the current employee pool and manage to squeeze out a few more boxes, but quality takes a hit. You have sufficient revenue to expand your infrastructure, but you are yet to hire enough employees to fill the area that is already in existence. Now what?

This is the conundrum healthcare finds itself in everyday. There is a national shortage of nurses and there is a looming physician shortage. Yet, there is increasing demand for healthcare as a product. Wether it is primary care, urgent care, or emergency care, all areas are struggling with increasing demand. Adding to this already difficult scenario is the increasing focus on patient satisfaction and government oversight. More and more focus is being placed on the patient perspective, which is generally a good thing.  However in the setting of increasing demand and no significant improvement in nurse or physician availability, improving the healthcare product (making better boxes) seems an almost impossible task. What are we to do?

Efficiency remains the only area that can be improved upon in such a crisis. Make more boxes with what you have, without sacrificing quality. Unfortunately, many organizations go about this process in the wrong manner. Here are a few examples:

  • Other people’s success: Successful strategies employed at other facilities are often copied and then mandated. You could easily make the assumption that we are all in healthcare (making the same kind of boxes), so why wouldn’t someone else’s process  work for you?  Success stories are born out of a common approach. The investigation of a current process (employee workflow), the identification of it’s room for improvement (waste) and the implementation of a very specific solution (improved workflow). Though the approach is common, the specific solution is not necessarily generalizable because of the differences in work environment. There are different staff type mixtures (nurses, techs, etc), as well as differing technology products in use (EMR, pharmacy systems, scanners, tube systems, etc). All these variables can prevent a solution at one facility from working at another.
  • Technology: We increasingly rely on technology to find solutions to everyday workflow problems. This is a good thing. Automation of mundane steps that do not require a human mind allows employees to focus on the more critical decisions. However, as we’ve seen before( Yes, We Count Clicks ! , How to destroy an ED physician’s productivity… ) , software engineers very rarely have a good understanding of your employee’s work environment. Products are built to get most of the job done but still require the employee to perform mundane tasks like data entry. In this kind of scenario, we simply replace one task with another, or worse, we add a process that has even more tasks built in. Now we find ourselves tied to machinery, performing data entry, or translating information from one program to another due to lack of integration. All we’ve accomplished is taking away time from the patient.
  • Anecdotes: There is great power in the story. Wether it is a patient encounter, a family member’s perspective, or even a manager observing something in passing, anecdotal stories make tremendous impressions and often find their way to senior leadership. However, extracting truth is difficult unless you dedicate the time to investigate and thoroughly understand workflows. Decisions are made based on anecdotal observations (yes, even in 2017) and, though well intended, cause more disruption in an already overburdened environment.

Solutions comes through laborious examination. The process of improving efficiency is VERY time consuming. Leaders must enter the world of employees and breakdown day to day, minute to minute tasks in order to extract those processes that result in poor workflow. Once that is done, there is an even greater investment in process improvement. Each process is scrutinized and rebuilt for maximum efficiency. It seems almost impossible in a large complex system like a hospital. Perhaps it is a little less daunting in a smaller office practice but typically there are fewer resources available. However, we see organizations with the greatest improvements do so by investing in process improvement. There are costs, new systems to be built, new methods to be established, and sometimes assistance is required from those who have succeeded previously. But the gains are significant and there is no other method of success. Dictating processes, adding tasks, mandating use of inefficient systems designed without the end user in mind, are all great ways to drive your organization into the ground.

So, the next time you are faced with someone stating “we have to do something !” , your answer should be “yes… it will not be easy or quick but it is the only solution we have.”

One thought on “We Must Do Something …

  1. Sam,
    I am enjoying reading your articles….all stuff ED users can relate to!
    Possible articles for the future:
    Organizational flow/ED flow;
    The kind of leadership needed to improve organizational flow;
    Positive patient centered culture draws nurses and physicians to organizations.
    I need to subscribe as you might have already hit on these topics.
    I will stay in touch and linkedin!
    All my best, Kim

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