Press "1" If You’re Hurting in English…

er atm Press "1" If Youre Hurting in English... leanParkland Hospital Deploys Galvanon’s MediKiosk(TM) in the ER to Decrease Patient Wait Times

It’s been discussed here before, how hospitals are just as susceptible as manufacturers are to the “Siren Song” of technology. This time, it appears Parkland Hospital (here in Dallas) is presenting with such symptoms…

You might know Parkland as the historic hospital JFK was taken to  after being shot in Dealey Plaza. It’s still open as the large county hospital for Dallas County. I presume they have long waits for ER treatment, as is common in hospitals. Many hospitals are taking the “Lean” approach to reducing waiting times in the ER. Strategies I’ve heard recently about include:

  • Changing the “triage” process so patients are seen immediately by an MD — providing more accurate assessment than an RN could with the added benefit of reducing the need for a patient to repeat the same story to multiple people.
  • Separating the ER into two separate “value streams” or “patient pathways” — patients who will be treated and sent home versus those patients who are likely to be admitted. A hospital in Australia implemented such a process and started seeing patients in each stream in a “FIFO” (first-in-first-out) process that cleared up delays immediately.

The Lean hospitals are fundamentally rethinking the process, not just automating parts of the process. Parkland went the technology route:

Parkland Health & Hospital System, based in Dallas, recently launched self-service check-in kiosks in the emergency room to speed the delivery of care and streamline registration processes. The technology, called MediKiosk, is provided by Galvanon, a subsidiary of NCR Corporation (NYSE:NCR).

So, basically, you have the “option” of pushing buttons on a glorified ATM machine? This is considered an advancement in healthcare? I’d think not, it certainly doesn’t seem very “Lean” at first glance. This article claims Parkland is the first to implement this system. Do we want to see others? Here is the MediKiosk website with their PDF brochure (with pictures)

Three self-service check-in stations in the Parkland emergency room triage area offer patients the option of interacting in either English or Spanish. Instead of waiting in line to explain their symptoms, patients can identify themselves at one of the kiosks by entering their name, along with an additional identifier, such as a birth date. Patients then use the kiosks touch screen to identify their symptoms by pointing to areas on a body diagram where they feel pain and answering brief questions about the nature of their visit.

What amazes me is that this “innovation” is referred to as “more comfortable” and “less stressful” for patients.

I’ll go out on a limb and say what we need are real patient flow improvements, using Lean methods, instead of throwing technology at one part the problem.

I’d be curious to get involved and ask “why” patients are waiting to be seen at the ER. Is triage really the bottleneck? Is a computer system cost effective compared to adding more people? Is it more humane? Is the ATM more effective?

Rather than throwing resources (ATMs or people) at it, can we streamline the process so triage can be done more effectives? Better yet, let’s question if triage is really necessary… the goal isn’t efficient triage, it’s improved care, improved patient outcomes, and reduced waiting times. I’ll be curious to see if there is a press release bragging about the actual results of this new technology…


mark graban lean blog Press "1" If Youre Hurting in English... leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus.

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6 Comments on "Press "1" If You’re Hurting in English…"

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  1. Anonymous says:

    I recently visited a hospital that had a qmatic (I think that is how it is spelled) system installed. Before the hospital was unorganized and I didn’t think the service was good. This time I went in and I felt like they actually cared about me not waiting a long time. It may not be the human touch, but lets face it. Times have changed. There are more people in the country than ever before and there is no sign of that stopping. The technology is out there. Why not use it?

  2. Mark Graban says:

    Thanks for your comment.

    “The technology is out there. Why not use it?”

    That’s not the “lean thinking” approach. Toyota is not afraid of technology, but they don’t jump in to use it just because it’s there. If the system was put in place because “waiting times are too long,” the Lean approach would push you to ask “why” the waiting times are so long. Maybe there are some “root causes” that can be fixed to avoid the need for the technology AND reduce waiting times.

    There is cost to installing and maintaining technology.

    But, it also concerns me that a kiosk can’t make any medical assessment of a patient’s condition. This is different than checking in at a bank or something.

    I’m curious to hear more about your experiences with the system and how it was perceived as “caring.”

  3. Anonymous says:

    I show this as caring, not in the sense of them being able to determine my illness, but in the fact that they know they have a problem, only that they don’t know where to find it. I did some research before responding. Q-MATIC Corporation is the provider of the solution I discussed earlier. They have been in business of queuing since the 1980’s.

    The solution is more than “take-a-number”. It provides reports showing wait times, customer, or patient, counts, and can even prioritize a customer based on a service that is being rendered. You can state all day long that there is a problem and no one will argue with you. You can’t fix a problem until you know where it is.

    I think the hospital’s approach by adding this technology is a step in the right direction. They see there is a problem. They want to fix it. Now, with this technology, they can start to applying fixes to the astronomical wait times.

  4. Mark Graban says:

    I still don’t buy it, that technology is the solution to emergency room queues. I hear too many stories of ER’s *eliminating* the wait through process and flow improvement. Making significant process changes to how triage is done can eliminate the need for technology such as this.

    To your point about “we have to understand the problem,” the problem is long waiting time. Prioritizing queues or tracking queues might prevent long outlier times, but it doesn’t get to the root causes of WHY the patients have to wait.

    I’m sorry, but being in the “business of queueing” is just like someone being in the business of warehouse automation in the manufacturing world. Automating a problem is not a true solution to me. It’s what non-creative people do, they throw money at technology that will solve their problem. Even if it works, it’s an expensive approach.

  5. Mark Graban
    Twitter:
    says:

    It looks like this company might be out of business now? Or did they get acquired?

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