By October 23, 2008 7 Comments Read More →

Emergency Docs Flaunt Standardized Work

Moonlighting county docs raise questions :: CHICAGO SUN-TIMES :: The Watchdogs

OK, this isn’t strictly a Lean issue, but this caught my eye in the paper near where I’m working. Regarding county doctors who work in the E.R. (think the show “ER):

County doctors are required to “swipe in” to prove they showed up for work — but they don’t have to swipe out.

[Dr.] Wakim has gone weeks without swiping in, according to records obtained by the Chicago Sun-Times.

“No one complies with swiping,” Wakim said in an interview. “We doctors are here all the time. And, if we’re not here, we are available all the time. A doctor is different than a secretary. A secretary should swipe in and out.”

“Required” ?? Except it’s not required, apparently.

These doctors are accountable to nobody? Or they are not being held accountable? Nobody is managing them? I’m not at all trying to trash all physicians. But attitudes like that in the Sun Times article would be pretty bad for any team setting. Could you imagine trying to start anything “Lean” with attitudes like Dr. Wakim’s?

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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7 Comments on "Emergency Docs Flaunt Standardized Work"

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  1. Anonymous says:

    Exactly what value is added to an ER if the doctor swipes in?

    Maybe the fact there is none is precisly the reson it is not done?

    Perhaps, unless proven otherwise, the doctor, and most anyone working there can be given the respect of expecting them to arrive to work when they are supposed to and to work as long as they are supposed to?

    – Ryan

  2. Mark Graban says:

    There is no “value add” but its required waste. The taxpayers need to make sure they’re getting what they pay for, so swiping proves that. I think the rules should apply to all – if swiping in is waste and we can trust people, then also trust the secretaries or other salaried staff and change the policy.

  3. Anonymous says:

    Swiping does not prove a patient is recieving quality care.
    If a work envirnment does not have staff that can be trusted, it is a management issue.
    The policy should be reviewed.
    – Ryan

  4. Anonymous says:

    ED docs have to provide round the clock coverage. If one of them shows up late it usually means someone else doesn’t get to go home when they planned (unless it happens to be a staggered shift with no relief). The ED docs I work with really pride themselves on prompt arrivals.

    On the other hand, a hospitalist group I work with recently put together their standard work and the first issue they addressed was prompt shift start times as they usually weren’t relieving someone.

    And I know an intensivist group where a doc may only stay two or three hours during a paid shift depending on the workload and gentleman’s agreement with the other physician on duty knowing that there will be some times when they have to stay a couple of hours late for patient care or meetings/education.

    Time clock swiping is not value added and is only necessary in organizations operating at a lower order.

  5. Mr B. says:

    I have been building the Lean Healthcare Academy in the UK for the last few years and have met many doctors with Dr. Wakin’s problem of lack of respect for colleages(and many many more who do not I might add). Where is the value in swipe cards? In the UK they provide logged security access to most key areas and usually provide PC access with a slot in the keyboard (to avoid repeated entry of passwords). In the plastics factory where I worked for many years it provided an automated wages feed for the hourly paid staff- helpfull. However it’s primary job was to provide an “live” rollcall of who was on-site in the event of a (statistically highly likely) fire. This meant that a member of the fire brigade wouldn’t have to enter a burning building risking their life for some who “should” have been there. Only those swiped in would be on the roll-call and therefor searched for- compliance was 100%. I wonder what irony the good Dr’s thoughts would be trapped inside a burning hospital with no-one comming to look for him because swipeing in like the “proles” was beneath him?
    As for further value of the swipe cards, the data can be analysed against demand trends to decide whether further staff are required, to look at imbalance in activity within teams (also dis-respectful). It can help with job planning and OD stratagies.
    Yes you can spy on people and people can feel personally agreaved but only those with something to hide- like a poor attendence record.
    Generally ED docs are not on call forever, they have rostered working time and on call time and get paid accordingly for it.
    I have enormous respect for ED Docs (I’m married to one) and understand their quite a lot about their work. In other specialities in the UK attendence abuse is more of an issue with poor start on time rates, delayed operations and in very rare occasions downright fraud (getting a junior to do your Op while you do a couple of private patients in the hospital down the road).
    Swipe cards have value and capitulating to those employees who have a medical degree is not helpful nor in the spirit of teamwork.
    Rant over- feel free to detect some underlying issue…….

  6. Anonymous says:

    I doubt the numerous value added points you listed are implemented at this particular hospital in Chicago and therefore have no bearing on that particular work environment, other then showing the potential value in swiping the hospital is probably not taking advantage of. All cool ideas, but all could be debated as to how much real value they really bring to the work environment.

    As for attendance abuse, that is a management issue and requires no extra money, time, or complexity in work to address it.
    It should be noted the article posted says nothing about anyone not showing up on time, or leaving early.

    So far, Dr. Watkins point is valid in this hospital as there is no added value in requiring the swiping of an ID card in that work environment.
    – Ryan

  7. Mark Graban says:

    Ryan – I agree there’s no “value” to the patients (which is how we define value in the Lean world). But, if there are rules, they should be followed — even if those rules benefit the owners (the taxpayers). If the rules are not needed or unjust, then change the rules. Don’t create a culture of double standards.

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