Bad "Root Causing" in the ER

    0 : Vancouver General's ER doctors warn patients

    The problem described in this article is a very common one, regarding “patient flow.” When hospitals don't have beds available for patients, this is often due to poor processes, slow room turnaround, etc.

    But, the ER suffers as patients are held in queue between the ER (they've already been treated and are waiting for admission). I'm sure it's horrible to sit or lay in a hospital corridor for hours waiting.

    Usually, the ER gets blamed, headlines say something is wrong with the ER, the ER needs fixing, etc. The ER is not the bottleneck, but they are “blocked” as we would say in the Industrial Engineering or queueing theory worlds.

    This case in Vancouver has the doctors up in arms. They are handing out pamphlets warning patients that they can “no longer guarantee “safe, timely and appropriate emergency care.”

    The “solution” they propose seems less than well thought out:

    “The doctors say the solution is to share the overcrowding in emergency with other areas of the hospitals, by moving patients who clog emergency hallways while waiting for beds to other corridors.”

    So basically they want to just shuffle patients to other hallways? Out of sight, out of mind? This is better health care?

    The head of the nurses union agrees there is a problem, but seems to have more common sense:

    “I am endorsing their frustration and their concern about providing safe patient care,” Ms. Dhillon said, “but moving patients around is just a stopgap measure.”

    So I agree with the doctors that people should write letters to administrators, but I hope they don't follow the doctors' “solution.”

    The lean approach, however, would encourage folks to look at the systemic nature of problems. Look at patient flow and the “Value Stream” across departments, not just in the ED or not just in one hallway. It probably requires a cross-functional team to get to the core of the issues there.

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


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