Suboptimizing an Australian ER
Sub-optimizing decisions are a fairly universal human behavior, regardless of the industry (or continent). Lean teaches us to look at “value streams” that go across departments and to view operations from a “systems” standpoint, looking at the complexity and the interconnections the best we can.
In the article I’ve linked to, an Australian hospital has a pretty common problem — the ER is full because they’re having trouble getting patients into rooms, the so-called “boarding” problem where patients are kept in the ER longer than they have to. It’s a systemic patient flow problem that goes across departments. It might be an overall hospital capacity issue, it’s sometimes a process issue where the discharge process is inefficient and inpatients are kept in rooms longer than necessary, thus backing up the ER.
When the ER is full, the hospital can’t accept more ambulances. It sounds like, in this case, the patients are kept waiting in the ambulances, which is bad for the patient and it ties up the ambulance resources.
“A specialist in emergency medicine says hospitals in south-east Queensland should stop elective surgery for up to a month to clear a backlog of emergency cases.”
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Think about that for a minute. To solve the ER problem, you’re going to STOP doing elective surgeries? That seems like a “solution” that a specialist would come up with — concerned only with their own department, the ER, apparently.
What are they going to do to solve the elective surgery queue that would grow by one month??
We need systemic solutions to problems like these. Easier said than done, but Lean methods are having a huge impact with hospitals around the world.
Here’s a longer article on the same story. Here, it claims the doctor is asking for a “two day” stoppage on elective procedures. That’s better than a full month, but still isn’t getting to the root cause of the patient flow problems.
Dr Knox said although stopping elective surgery was not a long-term fix, the situation needed a circuit-breaker.
“If you stopped elective surgery for two or three days, you could then clear emergency departments and let them recover,” he said. “I think that’s the only immediate solution.”
At least he realizes it isn’t a long-term fix. The queue would eventually re-form if the flow isnt’ balanced.