Tag: Emergency Dept
Patients waiting too long for the E.D. is a problem around the world. Many U.S. hospitals put up billboards that claim to shed light on how long you'll have to wait. But are the signs and numbers more confusing than helpful? Does it matter?
This story was sent to me by somebody I know with a Lean manufacturing career. It’s shocking, but it could happen anywhere, I suppose. I’m not going to name names… the author of this has allowed me to share it, without mentioning him or the health system.
As I said then:
Now, there’s a story written by an emergency medicine physician, Dr. Brad Cotton, that appears in a publication called “Emergency Medicine News” — FIRST PERSON: ‘We Fired Our Hospital’...
Mark’s Note: Today’s guest post comes via my friends at the ThedaCare Center for Healthcare Value, who suggested this case study from Salem Health. You might remember my post from 2012 where I shared a video of some of their senior leaders talking about going to Japan. At the bottom of this post is an 18-minute long video that was shared by the Center.
There’s been a back and forth of views about the state of pediatric emergency medicine recently in the Wall St Journal.
Let me start first, actually, with the more recent statement, a rebuttal from Michael Gerardi M.D., FACEP, President of the American College of Emergency Physicians, in the form of a letter to the editor.
Last Wednesday and Thursday, I collaborated with Joe Swartz and a countless number of his colleagues to host 24 visitors from different health systems (and an Indiana state government organization) to learn about the “Kaizen” approach to continuous improvement first hand at Joe’s health system – Franciscan St. Francis Health in Indianapolis.
Hospital billboards and health system advertising can be a curious thing. One ad that I see driving between San Antonio and Austin is one that promises:
“Serious E.R. Care”
Or something like that. I don’t have a picture of it because taking photos while driving might lead to an visit to the emergency department (safety first!).
I’ve partnered up with the Ohio-based non-profit consulting group, TechSolve, over the past few years in some of their Lean healthcare promotions efforts, recently teaching some classes with them on Lean and Kaizen in healthcare.
Stuff I’m Reading – June 14, 2013: Sleepy Banker, Concerned Workers, Cost Diversity, Conference Diversity
It’s again time to close some browser tabs and clear out the backlog of articles I’ve wanted to share but maybe don’t merit an entire blog post…
It’s time again for “Stuff I’m Reading”… Click on any header for the article I’m referencing.
A banker fell asleep on his keyboard, in particular the “2” key, entering a transfer of 222,222,222.22 euros. A colleague was fired for not double-checking or confirming the error. That’s why it’s called “human error” – many types of human error involved in this case.
“Approximately 8 to 10% of the individuals who walk through our doors are being hurt by us,” says David Musyj, CEO of Windsor Regional Hospital. That’s one of the first things you hear in this CBC program “Rate My Hospital,” which aired earlier this month in Canada. See also this page on the investigative report.
The patient safety challenges are pretty universal across modern Western countries. This isn’t just a Canada problem. You see similar estimates of patient harm in Canada, the U.S., England, Germany, the Netherlands, etc.
I’ve cited his book before (including this post with an example from The Office)… Brian Joiner wrote, in his outstanding book Fourth Generation Management: The New Business Consciousness, that there are three things that can happen when you have a quota or a target imposed upon people:
- Distort the system
- Distort the numbers
- Improve the system
Sadly, it’s often easier to do the first two than the latter. The news recently brought us sad examples of distorting the numbers (in other words, cheating) in education and healthcare.
MP3 File (run time 29:48)
My guest for podcast #160 is Joseph S. Guarisco, M.D., FAAEM, FACEP. Dr. Guarisco is currently Chairman of the Department of Emergency Medicine and System Chief of Emergency Services for the Ochsner Health System. Dr. Guarisco is a keynote speaker at the upcoming Society for Health Systems conference (which I’ll be attending) and we are both part of the American Academy of Emergency Physicians annual scientific assembly in February (where I’ll be co-presenting with my Healthcare Kaizen co-author Joe Swartz on E.D. process improvement strategies). Here is a Q&A, hosted by SHS, with Dr. Guarisco.
In this episode, we talk about Dr. Guarisco’s process improvement efforts at Oschner and how that was made necessary by Hurricane Katrina and the aftermath, where demand TRIPLED in their E.D. We also chat about standardized work and variation reduction fit in with the practice of medicine and improving E.D patient flow.
For a link to this episode, refer people to www.leanblog.org/160.
MP3 File (run time 25:56)
My guest for episode #149 is Gregory Jacobson, MD, the co-founder and CEO at KaiNexus. We’ll be talking about his early work with Kaizen in emergency medicine settings – how did he get introduced to Kaizen principles and how did train others, especially physicians, in getting started with this methodology? In a future episode, we’ll talk more about KaiNexus and use of software, but today’s focus is on the application of core Kaizen principles (as discussed in my book Healthcare Kaizen).
For a link to this episode, refer people to www.leanblog.org/149/.
Conflict of interest disclosure: I have been on the management team at KaiNexus since 2011 an
Ken Congdon at Healthcare Technology Online recently interviewed me for this story that’s now online: Kaizen: The Key To Lean Healthcare?.
Mark Graban, lean expert and co-author of an upcoming book titled Healthcare Kaizen, often compares Kaizen to the suggestion box methodology. “Traditionally, suggestion boxes have employees submit anonymous ideas,” says Graban. “Those ideas are then reviewed by a committee on a monthly or quarterly basis and are either or dismissed. The individual who submitted the idea rarely gets any feedback on their idea. Kaizen, on the other hand, is a local process that moves much faster than the suggestion box approach. Someone in a work group will talk to their supervisor about a change they feel should be implemented. These ideas are either collected on a bulletin board or entered into a web-tracking system. Rather than running these ideas up to a committee, the employee that made the suggestion and their supervisor are empowered to implement these changes on their own. The idea of Kaizen is that a lot of little ideas evaluated and implemented at a local level can have a huge impact on an organization and can generally be implemented much more quickly and easily than a single million-dollar idea handed down from corporate.”
Back in the manufacturing world, the distinction between “push” and “pull” is often much more obvious than it is in healthcare. Push production occurs when products are built based on the forecast were something other than actual customer needs. In the Lean approach, pull systems are the ideal to prevent overproduction, to reduce inventory costs, and to make sure the customer gets what they need when they need.
In healthcare, pull systems can be very effective for the replenishment of supplies and medications. But the conversation often gets muddled when we are talking about patients. It “pull” or “push” better for patient flow? Is that even the right question?
I was at the ThedaCare Center for Healthcare Value office a few months ago when Dr. John Toussaint reported that he had gotten a call from Dr. Don Berwick, the head of Medicare and Medicaid. Dr. Berwick wanted a collection of results from healthcare organizations that are improving quality and reducing costs, through approaches like Lean management.
We scurried and collected results from a number of Healthcare Value Network member organizations and sent the data to D.C. Toussaint posted that collection of data on his website and I’m happy to share highlights here.
On June 30, the PBS NewsHour program did a 7-minute story on healthcare improvement (featuring Lean and Toyota methods) at Denver Health.
You can also see the video or read the transcript on the NewsHour site: “Denver Hospital Sets the Bar for Patient Safety.”