A Very Non-Lean ER Experience
Thanks to a Lean Blog reader, Matt, for sending this first-hand account. I'm sorry he (and his wife) had to go through this experience. This is posted with his permission. I'll buck convention a bit and put my comments in the quote boxes. Matt's text will appear as the normal font below.
Saturday night I had to take my wife to one of the local ERs. We got there at 9:40pm. When we got there, I filled out paperwork to register her with all the basic information (name, symptoms, SSN, address, etc…….). Then we had to sit there and wait……..and wait…….and wait. This was especially frustrating since my wife was curled up in the fetal position in extreme agony and no evened seemed to care.
Mark: This is sadly reminiscent of this episode at an LA hospital, but Matt's wife survived the E.R. encounter, in this case thankfully.
The maddening part was there was no privacy (except chest pain). Everyone else in the ER had minor things (sprained ankle, minor headache, etc……..). After we checked in a mother with a baby that could not have been older than 1 came in. The baby was green! It freaked me out. It was the one person I thought should get bumped in front of us, but they didn't. They waited in the FIFO line too.
After 3+ minutes we got called into the triage room where about half the questions got asked again that were on the sheet I filled out. I found this frustrating since the data from our registration sheet was put into the computer and that is how triage got our name and called us in. Where did the rest of our data go? Why ask again? The triage nurse said this was part of registration.
Mark: This is a very common waste seen in E.R.'s — definitely the waste of overprocessing, or a defect in the process that you have to repeat yourself. There's a minimal amount of repeating that's necessary to confirm they are looking at the right patient, but I'm sure some of the information just didn't get passed along. That's something many E.R.'s that work with Lean fix, only asking for information once, instead of multiple times. It saves employee time and causes less frustration for the patients. The nurse obviously doesn't feel too empowered to “kaizen” her system… just doing her job…. what can you do about it? That's a sad attitude to see, the culture creates that mood.
Then we went back out into the waiting room and waited for another hour before they called us back. As they were taking us back they stopped me and said that I had to register to go back with my wife. I had to register at the same desk as the first registration an hour and a half earlier. So, my wife is in agony and can barely walk and I have to stay up front and to have my ID scanned and a sticker badge given to me. Then I get let in and I have to search for her room. I finally find her and we wait for a third person to come in and ask the same registration questions again. She is even wearing a badge that says “Registration” on it. My wife asks why this wasn't done in the waiting room where we have been for that last 1.5 – 2.0 hrs. The lady replies that “this is just the process.” We could've had all the registering done in the waiting room up front. This seems to be a little more batch (“batching all the paperwork up front”), but I would argue two points: 1. there isn't as much batching as one might think because we are getting all the same questions over and over with a couple of new ones, and 2. this would be more customer focused because my wife is in pain and we wouldn't be separated plus she wouldn't be getting upset about answering all the same questions over and over again. At this point, my wife looks up an me and says, “This isn't very lean is it?” I was glad to see her smile through the pain.
Mark: Matt and his wife made the point perfectly, so I won't elaborate much. Matt should have been able to register while they were waiting. Again, there's more of that “well, this is just the way it is” attitude from the staff. That's something you would have to work on during a Lean implementation, convincing people that they actually can work at improving the system, not just accepting it for what it is.
We wait for a long time and finally see a doctor who orders a CT scan, so we wait for the scanner to be setup and then we wait for the results and then we wait for the doctor, etc…………..
During all this waiting I speak with some of the nurses. At this point it is about 1 or 1:30am. The nurse tells me that this is a real slow night. Usually the halls are lined up with patients. I notice that they can't find their electronic thermometer and go borrow one from another area, the supply area is labeled but is very messy and can't tell how much is suppose to be there. The nurses can't find things and quite a few times are just sitting around talking about their lives outside of work. They spent a lot of time doing this. Not because they don't care but because they are waiting on doctors and information and whatever they need to treat the patients.
Mark: So there are 5S and organization issues… people can't find things, that leads to wasted motion and waiting time. Again, very common. The idea of people just sitting around and talking about their lives…. sure the nurses might have waiting time (waiting on others), but you can also see the opportunities to use that time for kaizen. Or, if you reduce waiting time and improve the flow of work, the nurses are going to lose some of that watercooler time. Then, will they perceive they are “working harder” or will they be happy that they can spend more time on direct patient care (the “Value adding” work)?
The most disheartening thing I heard all night was about a computer. I heard that they had test results back on the baby that was green (and I literally mean green) but nobody has been able to view them for an hour. They were having problems getting the computer to work so they called IT. There was no manual override or way to get results so the baby couldn't be treated until they got the computer working. WHAT!!!!!!!!!?????????? I couldn't believe what I was hearing. I don't know what happened to the baby and the test results but I hope everything turned out alright.
Mark: There definitely should be a backup plan or a manual process for getting that result. Worse case, they should have been able to go to another PC, unless their whole information system was down. Even then, they should have been able to make a phone call to the lab to get those results. I wonder if people didn't know the backup process or if they were too busy to take those extra steps.
At 2:30am, we finally left the ER with pain medicine in hand nearly 5 hrs after walking in the door. I figure only about an hour was value added. This house is being generous too because it includes the walk time to the CT scan and the 20 minutes we had to wait after receiving the pain meds before we could leave.
Like you have said, the doctors and nurses were great people and wanted to help. The systems just sucked!!! I was thinking about lean stuff all night and trying not to blame the people but at times I would even find myself getting upset with the people “just sitting there” and not helping. My emotions would just take over as I watched my wife in pain.
I have always believed that lean is for everyone and every place because it is the mindset. Saturday night was just one of those “hit home” experiences that brought it to light.
Matt, thanks so much for sharing that experience. That scene is repeated many times over every night. This shows how difficult it can be to NOT blame the individuals working in the system. Sitting around and chatting about home or Dancing with the Stars is just a symptom of systemic problems. It takes leadership to solve situations like that, and Lean can help. The good news is that Lean IS helping, we just need more of it, at hospitals like the one Matt and his wife went to.