Improving the ER on "ER"


    YouTube – Improving the ER on ER

    I don't always watch the NBC show ER, but this portion caught my attention when my wife was watching the final episode of the season and I clumsily taped it with my digital camera. I hope this falls within “fair use” standards. The fictional ER has a new chief, played by actor Stanley Tucci. The new chief's role is to shake things up, as seen in the video below.

    If you can't watch the video, here are the highlights:

    • The chief is standing in front of a staff meeting, talking about the poor performance of the system, including a 3-hour wait to get vital signs taken and a 12-hour wait for a bed. The reactions of the MD's and RN's is priceless — a few are paying attention, some are staring at the ceiling or their shoes waiting for it to be over, and some are arms-crossed angry. One RN reacts, “Well, we push them through as fast as we can.”
    • The chief points to a case where a patient almost died and “our attempts to kill her.” He gets angry and chastises them (maybe like a traditional Shingijitsu sensei might) for not following good processes (collecting “H&P's”, the patient history). I don't prefer the yelling and screaming approach personally, but that's what we see here — the new chief was trying to shake things up, so I can see a time and a place for that approach.
    • After Dr. Pratt says the 5-hour wait “wasn't so bad,” the chief then talks about how the system (and waiting times) can be better, they WILL be better. That's an important role of leadership — setting a vision for the future of how things SHOULD be (after first recognizing how they ARE today).
    • The chief, not mentioning Lean, starts suggesting process improvements — “what if we had standing orders for labs, IV meds….” meaning that they wouldn't have to wait for an MD approval any time these basic measures were needed. That would save time. The chief isn't pushing people to work harder, nor is he attacking them personally — he's talking about the SYSTEM, reducing 4 hours of waiting time and helping patients.
    • The sullen RN says “That is a wonderful theory.Blogger: Lean Blog – Edit Post “YouTube – Improving the ER on ER”” The chief says, “Sam, you're taking this personally.” Sam says, basically, “Yeah, I do triage, I take it personally when you criticize the job I'm doing.” Notice how criticism of the system was personalized and turned into personal criticism. How often do we see that in our daily Lean work, regardless of the environment?
    • The chief then responds, “That's good…. I'd be worried about you if you didn't [take it personally].”

    Anyway, great stuff. Not just from the standpoint of healthcare, but from any change environment. Maybe the chief is erring in his approach, no matter how correct, by coming in with the answers instead of asking questions and driving the staff to see the problems themselves? Slamming tables and screaming might rally people, but it's possible you'll rally them against you.

    • Another MD butts in, “You're telling us to be more careful.” The chief responds by saying, no, he wants things done differently. He wants them “to live in mortal fear of doing the wrong thing… and to use that to get better.”
    • The chief then says later, “I'm here because I want to save the world and we're going to re-invent the way we practice medicine right here on the front…”

    That explains his passion and his frustration, and his drive to make the ER better.

    So, I think there's good and bad in that short video case study. What leadership examples do you draw on out of that clip? What advice would you have for the chief or for the employees in the ER? Is the chief starting off on the right foot or the wrong foot?

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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. Mark,
      I might not use the new chief as a role model, but I am excited by the idea of a medical drama putting focus on continuous improvement of the hospital’s systems. You have to give them dramatic license. A kindler-gentler chief making their jobs easier wouldn’t get very good ratings.
      Putting lean healthcare into the mainstream of pop culture?
      That’s exciting!


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