Overcrowded ER killing patients


    Vancouver Sun

    The doctors are complaining publicly in Vancouver. It's a sad situation and I hate to nit pick or criticize.

    “At least once daily, during a peak in patient load, ‘the Emergency Department cannot handle the influx and has no consistent strategy to effectively handle the flow of patients,' says the hospital document.

    It adds, ‘there are areas within the department where no active treatment of patients is possible because of inadequate staffing.'”

    This reminds me of the general human nature urge to complain “we don't have enough people.” Maybe what's required is better processes and the elimination of waste and non-value added activity instead? People complain in factories and adminstrative processes, “If we only had more people.” Well, if you did, you'd have more people doing non-value-added work and getting in the way. You might get some additional value add, but I think you're better off looking for waste first. That frees up true productive capacity.

    Well a report has been written, that should solve it (sorry for the sarcasm):

    This document reveals both the health authority and the ministry are well aware of the ER problems. The ministry has asked for quarterly status reports on progress toward resolving the ER decongestion.

    The document sets out a detailed jargon-filled plan for future action, featuring a lengthy and complex list of objectives, time lines and accountability measures.

    Jargon? Unless that jargon include our favorite Japanese lean terms, I'm worried about what they are really fixing. Maybe if they say “fix it now” and put pressure on people, what will fix it? That usually doesn't work. You really need to fix your core processes and institute lean thinking.

    “Interventions and laboratory investigations are often missed or not done. Suspected cardiac patents wait for hours in chairs until their lab results come back, all the while at risk for sudden death.”

    Lab turnaround times like this (hours) are far from world class for cardiac testing. It's not just “the ER” that is the problem, as the headline says. The hospital lab is contributing to the ER delays through slow test resulting. As with many things in lean, the problems aren't always isolated to just ONE department. It's a complex system, the ER interacts with the lab, they are tied together in providing care. Most newspapers blame the ER because that's all they understand or that's all that readers will understand.

    Good luck to you if you need an ER visit in Vancouver (not that this is the only North American hospital with problems!)

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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.


    1. Given the free healthcare system, how much is efficiency really encouraged? For lean to work, you really need to have buy-in throughout the organization. How could you make that work since it seems the very precedent of the system is working against you.

      Canada’s efficiency problems within their healthcare system are prolific.

    2. Although Canadian healthcare is incredibly screwed up, I’ve found if they want to spend money on lean improvements, they can do so because it’s the “right thing to do” rather than wanting hard ROI analysis. That I consider to be a good thing.


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