The Need for Lean E.D. in N.Z.


Code red in the nation's hospital corridors | CLOSE UP

Thanks to Michael from New Zealand for pointing this story to me. The link above has an 11 minute video on from their equivalent of a 60 Minutes type show. The first half is a pretty typical story of an overcrowded E.D. and the second half is an interview with a government health minister about their attempts to fix things.

As is common in hospitals everywhere, the problem isn't strictly the emergency department. Patients are kept in the corridors in spots labeled for beds, meaning this is normal to keep patients out in the open. The problem is a “value stream” problem across the hospital — wards are full, so ED is full because they can't get patients admitted, it's all backed up.

The interview with the health minister was interesting. There was a lot of discussion about targets and (no surprise) how they get massaged or “gamed.” Hospitals are keeping patients in the ambulance bay, as this keeps measured waiting times down. The interviewer asked a good question — does this mean the problem is worse than thought if the numbers are inaccurate.

The health minister made a good case that they need to get the whole team working together on patient flow through the whole hospital. The interviewer pretty much wondered why is this a surprise that people should work together.

The minister pointed out that they have a new target — patients should be seen within 6 hours in the E.D. Sigh, more targets.

But, at least there was a strong focus on helping front line staff — or will they just find more ways of tweaking the #'s? The interviewer pressed and asked, “Is there a danger they will fudge the figures?”, mentioning that the four hour target in England was fudged.

Flinders Hospital in Australia was mentioned as an example to model themselves after, but nothing specific was said about the great work Flinders has done with Lean (nor was this N.Z. hospital mentioned, either). One thing mentioned was that Flinders had great support from the rest of the hospital team. The host said that nobody doubts the dedication of the staff (nor do I) — so how is this going to work, he asked.

The front line staff has great ideas, so New Zealand needs to make sure that the managers are focused on getting this thing done, that they are harnessing the knowledge of the front line staff, the minister says. So maybe he's on the right track. They need more than targets — they need process improvement, value stream thinking, and employee involvement and teamwork at all levels. Their problems can be fixed.

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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

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