Like most processes, there are also some very good emergency rooms as well as some very bad ones.

About a year ago, I had the experience of taking my mother-in-law to the emergency room at St. John Health Systems in Detroit when she was experiencing trouble breathing and chest pains. When we got there, they took her directly into a treatment room and started treatment, even though it was not what I would call critical. I kept waiting for all the paperwork, but I was told that since she was already in their computer from some tests she had earlier (elsewhere in their system), it was not necessary to go through all the paperwork again. I don’t believe they even asked for the social security number, much less her insurance coverage.

The hospitals in Detroit are seemingly competitive in their emergency room care. Detroit Medical Center has a guarantee that you will see an ER doctor in 29 minute or less – I don’t know what happens if you don’t.

By the way, I noticed that St. John Health systems is looking for an administrative director of their emergency room services if any blog readers are interested and feel qualified to apply.

Like or Dislike: 0  0

Like or Dislike: 0  0

Seems like a “Chicken or the Egg” situation. Without good leaders, change is nearly impossible. However, without people willing to stand up, change is nearly impossible.

Have I always had good leaders as someone who truly believes in Lean for US company success? No. I’ve often been “at odds” with those above and around me. I could have given up on Lean as a concept years ago. I could have been like everyone else and decided to simply talk about last night’s football game, rather than look at ways to improve my situation (anyone know who won last night?). From that perspective, I (even as a ‘lowly’ employee) have made a decision not to be a victim.

Now, in the Chicken/Egg theme…has management made it extremely difficult to institute change? Absolutely. Every day I deal with people who only want to complain about how they had ideas in the past and management squished them like bugs. How many times can a person’s ego handle being beaten down. The system has corrupted so many that the few who remain untainted have an uphill battle. The system needs to change.

For certain, one of Mike’s statements is right on track, INFORMAL leadership is as important (IF NOT MORE IMPORTANT) than formal leadership. Both are needed to succeed – certainly in a Union environment, where I am today.

Like or Dislike: 0  0

We could go through a “5 Why’s” exercise. Why are they sitting and just flapping their gums instead of improving the system?

That would all be speculation, but it’s probably not from a root cause of “not caring.”

I’m not making excuses for people, but be realistic… in your workplace, why don’t people drive improvements?

1) They’re tired or mentally exhausted (bad system design)

2) They’ve tried before, with bad results or bad response from management (bad leadership)

Like or Dislike: 0  0

From skilling up ENP’s to assume more senior roles, to implementing short stay wards, and the development of standard protocols for a huge number of conditions that can be printed by junior MD’s and others to ensure that the treatment that each patient receives is consistent patient to patient.

Like or Dislike: 0  0

Otherwise, you have the dynamic of:

1) Employee says “I have an idea, we could…”
2) Manager says “No that’s a dumb idea, get back to work…”
3) Employee says “OK, I’ll talk about Greys Anatomy instead of trying to help.”

It’s not that people are VICTIMS, but one isolated “worker” usually has a very uphill battle to “just fix things” unless they are a pretty amazing individual. Leadership has to lead and help set the tone for improvement to happen.

So I guess you think Deming was full of crap, then? Based on what? Care to name a time YOU got up on your hind legs and miraculously fixed a bad system you were a “victim” of Mike? Please, let us learn from your superhero like ability to fix a bad system.

Like or Dislike: 0  0

Like or Dislike: 0  0

This is now being taken a lot further. Upon registration in the ER you will be either “Meeted and Greeted away” to a more suitable provider such as your primary care physician or a PCP who works in the ER. Alternatively if you stay in the ER you will go down one of two paths; the first is see and treat which is run by Emergency Nurse Practioners who can deal with minor injuries such as upper and lower limb issues, stitches and other minor ailments and during this visit you will not be seen by any MD, the second pathway is majors where you would be triaged and seen by a MD and then referred on to a specialist.

The target in the UK is that 98.5% of attendees in the ER are discharged or admitted within 4 hours and virtually all trusts in the UK comply and whilst their are occasional breaches which comtribute to the 1.5% failure these are incredibly difficult / impossible to mitigate without having enormous numbers of staff sitting idle simply to cope with unanticipated surges which occur less than 1.5% of the time.

The next development of this is currentlt being implemented in a number of trusts and it is called a Urgent Care Centre where the minors, primary care issues and non-major attendences are being kept completely out of Hospital and are being dealt with by the ENP’s and MD’s in a seperate organisation.

In parallel those that are attending the ER appropriately are being assessed and if they are deemed to be short stay (less than 72 hours) medical or surgical patients these are being put in to specialist short stay wards managed by the ER department with attending surgeons and clinicians and they never get in to the general hospital population. These prevents them from staying longer than necessary and maintains separate flows based on length of stay. The short stay patients becoming effectively runners, whilst the longer stay in the main hospital are the repeaters and strangers.

This has been so successful that we (the NHS) are assisting one of the US teaching hospitals to put in place the same system.

Like or Dislike: 0  0

What do you think about solutions like this?

This sounds like setting up two separate “value streams” right? Push the non-emergencies to a different value stream so they can focus on true emergencies? Is this “Lean?” Many hospitals are doing this, it seems.

Like or Dislike: 0  0